studies

594A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Disclosures:
Simona Bota - Speaking and Teaching: Janssen Pharmaceutica, Bristol-Myers
Squibb
Mattias Mandorfer - Consulting: Janssen; Speaking and Teaching: AbbVie, Gilead,
Janssen, Boehringer Ingelheim, Bristol-Myers Squibb, Roche
Michael Trauner - Advisory Committees or Review Panels: MSD, Janssen, Gilead,
Abbvie; Consulting: Phenex; Grant/Research Support: Intercept, Falk Pharma,
Albireo; Patent Held/Filed: Med Uni Graz (norUDCA); Speaking and Teaching:
Falk Foundation, Roche, Gilead
Markus Peck-Radosavljevic - Advisory Committees or Review Panels: Bayer, Gilead,
Janssen, BMS, AbbVie; Consulting: Bayer, Boehringer-Ingelheim, Jennerex,
Eli Lilly, AbbVie; Grant/Research Support: Bayer, Roche, Gilead, MSD, AbbVie;
Speaking and Teaching: Bayer, Roche, Gilead, MSD, Eli Lilly, AbbVie, Bayer
Thomas Reiberger - Consulting: Xtuit; Grant/Research Support: Roche, Gilead,
MSD, Phenex; Speaking and Teaching: Roche, Gilead, MSD
The following authors have nothing to disclose: Philipp Schwabl, Theresa Bucsics,
Remy Schwarzer, Arnulf Ferlitsch
772
Does Haemodynamic or Clinical Rebound Exist in
patients with Cirrhosis after Abrupt Interruption of
Beta-blockers?
Audrey Payance 2 , Julien Bissonette 2 , Olivier Roux 2 , Laure Elkrief 2 ,
claire francoz 2 , Ouardia Nekachtali 1 , Dominique C. Valla 1 , Didier
Lebrec 1 , Francois Durand 2 , Pierre-Emmanuel Rautou 1 ; 1 Paris VII
University and INSERM, BEAUJON HOSPITAL, Clichy, France;
2 HEPATOLOGY, BEAUJON HOSPITAL, Clichy, France
Background and Aims: Beta-blockers (BBs) may be interrupted
in patients with portal hypertension. The concept of rebound
after abrupt interruption of BBs is based on animal studies
showing a transient β-adrenergic hypersensitivity state following
propranolol withdrawal and on few case reports of
variceal bleeding following abrupt interruption of this drug.
However, no human study addressed this issue yet. Our aim
was thus to determine if a rebound after abrupt interruption of
BBs exists in patients with cirrhosis both on a hemodynamic
and a clinical point of view. Patients and Methods: This prospective
observational study included all patients with cirrhosis
undergoing right heart and hepatic vein catheterization in our
hemodynamic laboratory. Four groups of patients were a priori
defined: “no BBs” defined as patients not receiving BBs;
“≥ 1day” defined as patients having received BBs within 1
day before catheterization; “2-3 days”, defined as patients
having interrupted BBs 2 or 3 days before catheterization;
and “≥4days” defined as patients having interrupted BBs 4
days or more before catheterization. Results are presented as
median (interquartile range). Results: A total of 150 patients
were included (men, 76%; median age, 57 yrs; alcoholic cirrhosis,
75%; large varices, 73%). Indications for right heart
and hepatic vein catheterization included evaluation prior to
liver transplantation (n=90) or liver surgery (n=8) and assessment
of cirrhosis severity (n=52). There were 81, 44, 11, 14
patients in the “no BBs”, “≥1day”, “2-3 days” and “≥4days”
groups, respectively. MELD and Child-Pugh scores were not
different among the groups. Hepatic venous pressure gradient
was not different between patients in groups “≥ 1day” (18.5
mm Hg, 15-23), “2-3 days” (17 mm Hg, 13-23) and “≥4days”
(19.5 mm Hg, 17-26). Cardiac index remained low up to 3
days after BBs interruption. Patients in the “≥4days” group
had higher cardiac index than those in the “≥1day” group
[4.6 (3.5-5.1) vs 3.4 (2.6-4.0); p=0.001)] or in the “2-3 days”
group [4.6 (3.5-5.1) vs 3.1 (2.7-3.7); p=0.007], but only borderline
significantly higher than patients not receiving BBs [4.6
(3.5-5.1) vs 3.7 (3.0-4.5); p=0.052]. Among the 25 patients
in the groups “2-3 days” and “≥4days”, median duration of
BBs interruption was 4 (3-6) days. No gastrointestinal bleeding
occurred during that period. Conclusions: Abrupt interruption
of BBs may slightly increase cardiac index without rebound
in hepatic venous pressure gradient and with no apparent
increase in the risk of variceal bleeding. Thus, interruption
of BBs in cirrhotic patients with portal hypertension does not
require particular dosing or surveillance.
Disclosures:
Francois Durand - Advisory Committees or Review Panels: Astellas, Novartis,
BMS; Speaking and Teaching: Gilead
Pierre-Emmanuel Rautou - Speaking and Teaching: Gilead
The following authors have nothing to disclose: Audrey Payance, Julien Bissonette,
Olivier Roux, Laure Elkrief, claire francoz, Ouardia Nekachtali, Dominique
C. Valla, Didier Lebrec
773
High risk of misclassifying liver stiffness using 2D shearwave
and transient elastography during a moderate or
high calorie meal
Maria Kjærgaard 1 , Maja Thiele 1 , Bjørn S. Madsen 1 , Christian
Jansen 2 , Jonel Trebicka 2 , Aleksander Krag 1 ; 1 Odense University
Hospital, Odense, Denmark; 2 University of Bonn, Bonn, Germany
Introduction: Transient Elastography (TE) (FibroScan) and
real time 2D shear wave elastography (2D-SWE) (Aixplorer)
are widely used in the grading and staging of liver fibrosis.
In patients with chronic viral hepatitis a meal of 600 kcal
increases liver stiffness (LS) measured by TE. Thus, food intake
may hamper interpretation of results and clinical decision-making.
This study aimed to investigate the impact of a meal on
LS measured by both TE and 2D-SWE in patients with alcoholic
fibrosis, the role of the meal size and the time it takes
to return to baseline. Methods: Patients with a liver biopsy
or known cirrhosis participated in a two-day protocol with a
250ml/625 kcal liquid meal (49% carbohydrates, 36% fat,
15% protein) and 500ml/1250 kcal meal on day 1 and 2
respectively. TE and 2D-SWE were measured at 0, 20, 40, 60,
120 and 180 minutes. DLS are the highest increase in LS from
baseline. Results: 51 patients participated: 71% male, median
age 61years, 88% with alcoholic etiology, 8% HCV and 4%
NASH. 14 patients showed none or minimal fibrosis (METAVIR
F0-1), 9 patients moderate or severe fibrosis (F2-3) and 28
patients cirrhosis (F4). On day 1 and 2, post-meal LS increased
significantly in all fibrosis groups (see table). The highest DLS
was measured after a median of 60 minutes (range 20-180)
and the largest DLS were observed in patients with cirrhosis
(43% increase). In these patients, LS increased similarly on day
1 and 2, despite twice the volume and calories (P= 0.93). In
patients with F0-F3 fibrosis there was a trend towards a higher
DTE on day 2; F0-1 (P= 0.08) and F2-3 (P=0.07). In patients
with baseline TE