Surgical resection of hepatocellular carcinoma in cirrhotic patients: Prognostic value of preoperative portal pressure

HEPATOLOGY Vol. 22, N o . 4, P t . 2, 1 9 9 5

1161

AASLD

ABSTRACTS

LONG TERM TREATMENT OF CHRONIC HEPATITIS D WITH LYMPHOBLASTOID INTERFERON: 10 MU vs 5 MU. AN INTERIM REPORT OF A RANDOMIZED C o N ' r R O I J ~ D T R I A L ~ i o E, Roena F. *Di Marco V, .'Man~a A~ "A~co81iE, °VandeUi C, °Venmra E, "Mazze.]la(3, 'Niro MG. *Cre~ A snd Rizzetto M. Deparmm~ of Gastrcenterology, Molinette Hospital, Torino; *Ins~tu~ of ImemM Medicine,CcrvelloHospital,Palermo; 'Divisionof Crastroentm~log%Casa Sollicvoddla Soffe~'enza,San Gio'~xoniRoteralo;"Divisionof Gastroenterology, San Orsols Hospkal, Bolos,a; °Departmemof lnlernal Medicine IL Modetm;italy

1162

Treah'nemof darothc hepatitis D requtres prolonged ~kninisu'ation (t2 months) of high L-WNdoses (9-10 MU TIW), a schedule frequently hurdled by severe side effects. gesportse to IFN may require more than 12 months therapy; but the opttmum tream~erit re~-non has notyetbeenestablished.Aim: to verifywhether a 5 M V dailyI~q dosecan maintain the responserate wi*,htmprovedtolerability and whether t 2 momhs corrtmuously effective ~ ~-e~lment is required to m:tprovethe long term responserate. Methods: pts with histologicallyeon~'med c3rvnie hepatitis D, without concormta~ ',arm infectious or history of drug addiction were randomly s.ssigned to ur.annen~, whh tyTnphobta~qoid IFN CO/ellferon,Wellcome, Italy) 10 MU TI'W or 5 M'U daily. Both groups of pts were scheduled to be t r ~ l up to ALT normalization (phase I) plus 12 monlhs (phase U). Non responders ~ 12 months did no1 enter phase [[. A [2 months follow up was provided for pts who had completedthe treatment Ixmo~ Resu/ts: Fourteen pts (M/F 11/3, mes.n abe 40.1 yrs, range 19-55; mean .,LLT 140 FU,1, r~nSe 82-257) have beenenrolled in the stud)'.Liver histoloE¢showed CPH m l p~tietrL CAH th 7 and aetive cirrhosis in 6; 8 ptstmve beanaasigned to 10M'UT'D.V , 6to 5 ~ dmly Five pts (10MqJ" 3 pts, 5MU: 2 pts) ~.-estill on phuse I (mean 3 me. range 1-6 too)..Another p a U ~ a 55 year old rmm,treated with 10 M-C TIW for .i too, did oot complete pease I for the onset after 660 . ~ of LFN of severe depresmon leading !o ~aicide 2 weeks aRer stopping IFN Eight pts (10 MU: 4 pts; 5 MU: 4 pu) corr~ie~ed phuse I. Responsewas ob'afinedin 6/8 ~s (75%) (SMU: 4 Ins; 10MU: 2 pts) a / ~ a..l me of trestm~ (rang~ t-ll me). Thmet6 p~ who entered phase H, completed this study' period:2 pts(bothon 5M'U) ~ noreml ALT levds, 1 (10MU) reded in the other3 pts(SMU: 2 pts,t0M'U: l pt)IFN had to be stoppedforseveredepression 4-14 rnoafterst.&rtmgtreatmemand a totalIFN doseof 740-1915 XCt.J.These 3 ptswere s~ll responders ~tthe time OfWN stopp/ag. IBM ami-HD persisted posiuve in MI the 7 tested pts. To da~ no patiem has completed the follow-up period. Conclusion:Tresm~ent~ h high IYN doses~ its e~cacy in inducing b~och~-nac~ remissionin a high ra~e of HDV dmmic carriers.The absenceof adequme follow-up does not ~Jow any conclusionon the influenceof prolongedeffectiveth~-'apy c~.long term rCaUSmor~Therapy with 5MU/day is comparable to 10 MU TIa.V in mduong response, but doesnot prevem severt psychian'ic sidc effects. HDV patientst~eatedwi~ high[ ~ d~es requirea strict corfa'oltoprc~'empossiblylffc.-khreatUmin 8 complicsfiom

1163

REDUCED FILTRATION FRACTION AND GLOMERULAR PERFU ~ SION IN DECONPENSATED LIVER CIRRHOSIS: A REEVALUATION USING INULIN/PAH-CLEARANCE WITH CONSTANT P L A S M A LEVELS AND ASCITES ADJUSTED TEST-DOSES. K A Brensinu. J Perz. J Ferber. P Raab. p S c h ~ d e r maier. HU Klehr. T Sauerbruch. D e p a r t m e n t of G e n e r a l I n t e r n a l M e d i c i n e , U n i v e r s i t y of Bonn, Germany. It is c o n t r o v e r s i a l w h e t h e r pts w i t h liver c i r r h o s i s and a s c i t e s have r e d u c e d G F R and f i l t r a t i o n f r a c t i o n (FF) b e s i d e an i m p a i r e d s o d i u m e x c r e t i o n (1,2). In p a r t this c o n t r o v e r s y m a y be a t t r i b u t e d to m e t h o d o l o g i c a l p r o b l e m s (steady state) in a s c i tic pts. M e t h o d s : T h e r e f o r e we t e s t e d I N / P A H - t e s t doses b a s e d on s u r f a c e and u l t r a s o u n d - e s t i m a t e d a s c i t e s v o l u m e in 16 c i r r h o t i c s (51±11Yrs; 10M; Child 7A/B,gC) w i t h m o d e r a t e (6x) and s e v e r e (9x) a s c i t e s and c r e a t i n i n e ~2 mg/dl. A f t e r I V - b o l u s and c o n s t a n t I N / P A H i n f u s i o n (2h) we e s t i m a t e d I N / P A H Cl for t h r e e 2 0 - M i n - i n t e r v a l s b a s e d on s e r u m + u r i n e (S/U) or o n l y on a s i n g l e s e r u m level (1). R e s u l t s : M e a n c r e a t i n i n e was 1.3±0.4 mg/dl. We a c h i e v e d g o o d s t e a d y s t a t e I N / P A H s e r u m l e v e l s (Mean-VC: 9% a n d 8%, r e s p e c t i v e l y ) . On a v e r a g e the S / U - I N - C L w a s 42±18 m l / m i n and the S / U - P A H - C L was 2 8 7 ± 1 3 9 m l / m i n . Age a d a p t e d S / U - G F R (-57± 21%), S / U - R P F (-45±22%) and f i l t r a t i o n f r a c t i o n (FF: 15.9±4%) w e r e m a r k e d l y reduced. G F R and FF c a l c u l a t e d w i t h s i n g l e s e r u m level C L m e t h o d (1), s h o w e d a l m o s t n o r m a l G F R and FF results. Conclusions: Tested IN/PAH-doses including ascitesvolume estimation showed reliable s t e a d y state IN /PAH s e r u m levels. In c o n t r a s t to s i n g l e s e r u m level b a s e d CL we saw m a r k e d FF and GFR r e d u c t i o n w i t h our s t e a d y state m e t h o d i n d i c a t i n g a h i g h vas a f f e r e n s t o n u s in t h e s e a s c i t i c pts. (i) G a s t r o e n t e r o l o g y 1992,102:1309; (2) G a s t r o e n t e r o l o g y 1993,105:229.

397A

R E D U C T I O N OF L I V E R I R O N C O N T E N T F O L L O W I N G TREATMENT OF CHRONIC HEPATITIS C E Boucher. A Boudenne, B Turlin, R Moirand, P Bfissot and Y Deugnier. Cliniqne des Maladies du Foie and INSERM U 4 9 , CHRU Pontchaillou, 35033 Rennes, France. In a previous study we observed thatin patientswith chrorfichepatitis C, the addition of ursodcoxycholic acid ( U D C A ) to interferon (IFN) therapy significantly extends the duration o f normal serum transaminasc levels afmr cessation o f IFN. A s iron stores have b c e n claimed to modulate response to interferon, we hypothesized that the beneficial effect o f U D C A could be related t o iron depiction. Then we compared the evolution o f biochemical iron [Liver iron concentration (LIC, N < 36gmol/g)] and histological liver iron content [total iron score (TIS) = hcpatocytic (HIS) + mesenchymal iron scores (MIS)] before and after treatmeat in 55 patients treated by either IFN (group I, n = 28) or IFN plus U D C A (group H, n = 27). R e s u l t s showed (table) in both groups a sindlar decremse in LIC, TIS a n d MIS but not in the HIS. Otherwise, there w a s a significant correlation b e t w e e n disease activity and m e s e n c h y m a l iron score w h i c h decreased significantly in sustained responders only. IFN group IFN + UDCA group MOMcarctsd M12Mean.~d MOMearctsd M12Mea~-~ Lie 33 ± 15 26 ± 111 48 + 30 35 :[: 214 [TIS 1.8 + 2.8 0.8 ± 1.52 3.9 _+ 4.2* 1.9 ± 2.25 [MIS 1.3 + 2 0.5 ~-, 1.23 , 2.5 + 2.7 1.4 + 1.76 * Significant diffarance betwem the two groups for TIS at M0: p= 0.003. Significant difference between M0 and M12: I p = 0.03, 2 p = 0.05; 3 p = 0.04; 4 p = 0.0l, 5 p = 0.007, 6 p ffi0.02. I n conclusion: W e did not pointed out a specific effect of U D C A on fiver iron metabolism as patients neared by either IFN and UDCA, or IFN alone, exhibited a significant and similar decrease of b i o c h e m i c a l a n d histologicalliveriron content.This reduction of iron contentwas mainly due to the diminution in mesanchymal iron deposits.The iron depletion was inmrpmtatcd as both a consequence of the anti-inflamraatotyeffect of therapy and a factorof improvement in liverhistology.

1164

SURGICAL RESECTION OF HEPATOCELLULAR CARCINOMA (HCC) IN CIRRHOTICS. PROGNOSTIC VALUE OF pREOPERATIVE PORTAL PRESSURE. J Breix. A Castells. J Bosch. F Fen. J Fuster. C BnL JC GaroiaPagfin, J Rod6s. Liver Unit. Hospital Clinic i Provincial. University of Barcelona. The present study was aimed -to establish the incidence of postoperative liver decompensetion (PLD) in a series of 69 cirrhotic patients (pts) (age 61+_.7 yr, 44 male, all but 3 being Child-Pugh's A) with HCC (60 being solitary < 5 Gin) submitted to resection between January'87 and June'94, -to determine the impact of PLD on survival, and -to define the parameters with predictive value for assessing the risk of PLD, thus providing a tool for a proper selection of surgical candidates. 46 pts presented FLD which was unresolved after 3 months follow-up in 30, all of them presenting ascites associated or not to jaundice or recurrent eucephalnpethy. After a median follow-up of 22 months, the 1-2-3 year survival probability was 79%,74% and 54%, there being a significant difference between pts with unresolved PLD (nffi30) and compensated pts (n=39) (56%,43%,25% vs 97%,97%,76%, p