Abstract Journal Transplantation Surgery

Journal Transplantation Surgery TN001P PREDICTION OF OUTCOME OF DONATION AFTER CIRCULATORY DEATH LIVER TRANSPLANTATION – THE CONCEPT OF HYPOTENSION EXPOSURE MICHAEL FINK, GEORGINA RIDDIOUGH, GRAHAM STARKEY, MARCOS PERINI, BAO-ZHONG WANG, CHRISTOPHER CHRISTOPHI, MEHRDAD NIKFARJAM, VIJAYARAGAVAN MURALIDHARAN AND ROBERT JONES University of Melbourne, VIC Introduction: Current definitions of warm ischaemia in DCD transplantation do not account for the total exposure to hypotension, which is a function of both blood pressure and time, during the agonal period after withdrawal of cardiorespiratory support (WCRS). The aim of this study is to identify risk factors for primary non-function (PNF) after DCD liver transplantation, with particular attention to hypotension exposure. Methods: Cases performed in Victoria during the period from 1/10/07 to 30/9/17 were analysed. Hypotension exposure was defined as the ideal blood pressure (100 mmHg for systolic, 80 mmHg for mean and 60 mmHg for diastolic) multiplied by the time in minutes between WCRS and perfusion minus the area under curve (AUC) of the blood pressure versus time that was observed between WCRS and asystole. Results: Forty DCD liver transplants were performed during the study period. PNF occurred in three of 40 (7.5%) cases. Cases of PNF in comparison to those with no PNF had higher systolic hypotension exposure (4,227 +/-1,572 vs 2,807+/-708 mmHg.min, respectively, OR 1.002, 95% CI 1.000-1.0040, AUC = 0.865, P = 0.035), mean hypotension exposure (3,829 +/-1,509 vs 2,539+/-600 mmHg.min, respectively, OR 1.003, 95% CI 1.000-1.006, AUC = 0.873, P = 0.032) and diastolic hypotension exposure (3,357+/-1,405 vs 2,166+/-537 mmHg.min, respectively, OR 1.004, 95% CI 1.000-1.008, AUC = 0.853, P = 0.045). Conclusion: Hypotension exposure is predictive of PNF following DCD liver transplantation and could be used to aid in the decision of whether to transplant DCD livers. TN002P OVERHYDRATION AFFECTS CROSS-SECTIONAL SKELETAL MUSCLE AREA MEASUREMENTS OF SARCOPENIA IN PATIENTS WITH CIRRHOSIS CAMERON WELLS, JOHN MCCALL AND LINDSAY PLANK The University of Auckland, Auckland, New Zealand Purpose: Sarcopenia as defined by reduced skeletal muscle area (SMA) on cross-sectional abdominal imaging has been proposed as an objective measure of malnutrition, and is associated with both waitlist mortality and post-transplant complications in patients with cirrhosis. However, SMA has not been validated against gold-standard measurement of total body protein (TBP) by in vivo neutron activation analysis (IVNAA). Furthermore, overhydration is common in cirrhosis and its effect on muscle area measurement remains unknown. Methodology: Cirrhotic patients who had undergone IVNAA and crosssectional imaging (CT or MRI) within a 30-day period were retrospectively identified. Patients with significant clinical events between measurements were excluded. Psoas muscle area (PMA) and SMA at the level of the L3 vertebrae were determined. Total body water was estimated from a multicompartment model and expressed as a fraction of fat-free mass, as determined by dual-energy X-ray absorptiometry, to provide an index of hydration status. Results: A total of 107 patients underwent 109 cross-sectional imaging studies (87 CT, 22 MRI) within 30 days of IVNAA. Median time between measurements was 1 d (IQR -1 to 3 d). TBP was strongly correlated with SMA (r=0.78, P<0.0001) and weakly correlated with PMA (r=0.49, P<0.0001). Multiple linear regression showed that SMA was significantly and positively associated with fat-free mass hydration (P<0.001) independently of TBP. Conclusion: Over-hydration significantly affects the measurement of cross-sectional muscle area from CT or MRI imaging and future studies investigating sarcopenia in cirrhosis may need to account for this. TN003P BACTEC SCREENING OF TRANSPORT PERFUSATE FOR MICROBIAL GROWTH REDUCES RECIPIENT WOUND INFECTIONS IN KIDNEY AND SIMULTANEOUS PANCREASKIDNEY (SPK) TRANSPLANTS SARA SHAHRESTANI, KERRY HITOS, SHARON CHEN, NAMRAJ GOIRE, PAUL ROBINSON, KATHY KABLE, VINCENT LAM, LAWRENCE YUEN, BRENDAN RYAN, RONALD DE ROO, HENRY PLEASS AND WAYNE HAWTHORNE Westmead Hospital, NSW Purpose: Many major transplant centres screen for microbial growth in organ donor perfusate fluid the organ is transported to the recipient hospital in, but the clinical utility of this practice is unclear. We examined whether utilising BACTEC culture of this perfusate could be used to identify and reduce recipient wound complications. Methodology: We performed a retrospective review of potential bacterial contamination of organ perfusion fluid (OPF) from all kidney and pancreas transplants at Westmead Hospital, between January 2012 and June 2016. Sterile samples of 25mls of OPF were transferred to either standard culture pots or BACTEC blood culture tubes. Microbial results were correlated with recipient wound infections in the month following transplantation. Results: We reviewed the OPF results from 95 BACTEC and 191 standard cultures performed on our kidney and SPK transplant recipients. BACTEC culture significantly increased the odds of detecting a donor organism by more than 13 times (OR: 13.2; 95% CI: 6.11-28.50; P<0.0001) compared to the non-BACTEC. The risk of recipient infection decreased by 76% (OR: 0.24; 95% CI: 0.07-0.86; P=0.029) when BACTEC was utilised to guide anti-microbial therapy. However, when standard culture was used donor infection significantly raised the risk of recipient infection by 4.0 times (OR: 4.02; 95% CI: 1.09-14.84; P=0.037). Conclusions: Using BACTEC culture of OPF to guide antimicrobial prophylaxis reduced recipient wound infections. We, therefore, recommend all transplant centres utilise the improved sensitivity of BACTEC culture over standard culture for the screening of OPF, to reduce wound complications in transplant patients. TN004P BILIARY COMPLICATIONS IN DONATION AFTER CIRCULATORY DEATH LIVER TRANSPLANTS: THE AUSTRALIAN NATIONAL LIVER TRANSPLANTATION UNIT’S RECENT EXPERIENCE MARK LY, MICHAEL CRAWFORD, CARLO PULITANO, CHARBEL SANDROUSSI, JEROME LAURENCE AND DEBORAH VERRAN The Australian National Liver Transplantation Unit, NSW Background: Donation after Circulatory Death (DCD) liver transplantation is associated with higher rates of post-transplant Biliary Complications (BCs). The aim of this study is to explore the nature and risks of posttransplant BCs in adult recipients of DCD liver allografts in one unit. Methods: A retrospective analysis was performed on the Australian National Liver Transplantation Unit’s adult database from 2007-2015. Data collected included donor data, recipient data, and post-transplant outcome data including biliary and vascular complications. BCs were defined as bile leaks, Anastomotic strictures (AS) and Non-anastomotic strictures (NAS). Risk factors for the presence of BCs were explored. Results: A total of 37/496 (7.5%) recipients received DCD allografts, 5 of whom (17%) have died and 2 were retransplanted, 1 for NAS and 1 for rejection. The 1 and 3 year patient survival was 92%. BCs occurred in 32% (n=12), with NAS and AS occurring in 22% (n=8) and 22% (n=8) respectively, 4 cases had both. All BC’s were initially managed via endoscopic means, but 2 cases (17%) required surgery. An elevated Donor Risk Index was associated with BCs (p=0.012) and NAS (p=0.003). The presence of Portal Vein Complications (PVC) was associated with BCs (p=0.045), but Editorial material and organization © 2018 Royal Australasian College of Surgeons. Copyright of individual abstracts remains with the authors. ANZ J. Surg. 2018; 88 (S1) 206–209