Category 1: Liver transplantation,

surgery, acute liver failure

49

not contributive. The results also favor the hypothesis of a direct viral cytotoxicity in the context of immunosuppression. References [l] Hepatology 1995, 21: 730.

and histologic improvement in all cases. The remaining 6 patients, who did not receive specific treatment, lost their grafts. Conclusion: De novo AIH may occur at any time after LT and it can cause severe graft dysfunction. Although additional immnosupression with steroids and azathioprine seems to be effective, further studies are required.

1488

lMMUNOHlSTOCHEMlCAL (IHC) DEMONSTRATION OF HCV RECURRENCE AFTER LIVER TRANSPLANTATION

I 1536

A. Rullier, P. Trimoulet, PH. Bernard, M. Neau, G. Ballardini, P. Bioulac-Sage, B. Le Bail. Service dAnatomie Pathologique et Unite
de Transplantation, CHU Bordeaux, France; Hepatology Unit, Bologna, Italy

MOLECULAR ADSORBANT RECIRCULATING SYSTEM (MARS) IN PATIENTS WITH LIVER FAILURE

P. Alfred Lamesch, U. Jost, I. Geissler, J. Fangmann, J. Hauss.

Department of Surgery, University of Leipzig, Germany

The timing of recurrence of hepatitis C and the intrahepatic distribution of the virus are not well characterized. 41 patients with liver transplantation for HCV cirrhosis have had 1 to 3 post transplantation frozen biopsies with immunostaining, using a polyclonal antibody of human origin raised against the different HCV proteins (1). IHC recurrence was proven in 50/84 (60%) of biopsies from 25/41 (61%) patients. During the first month, 21/44 (48%) biopsies and 12/28 patients (46%) were positive, as early as day 5. Lobular hepatitis was associated with a strong staining; histology was often non diagnostic. During the first month, 23/28 (82%) of biopsies and 82% of patients were positive; rejection, unexplained cholestasis, lobular hepatitis were present alone or in association. During the first year thepositivity values were 50% and 55% respectively; histology showed chronic active hepatitis. The strongest stainings were obtained dumg the first month. In patients with more than 1 biopsy, positivation of IHC in the first month was linked to rejection episode. Amongst 7/l 1 patients with strong staining (>50% positive hepatocytes) at any time had suffisiant follow up and all developped a severe fibrosing/cholestatic form of recurrence. Using IHC, viral recurrence in the graft appears frequent, early, sometimes massive, although histology is not always diagnostic, especially during the first month. Strong staining of the graft correlates with lobular hepatitis and may indicate severe evolution. This immunohistochemical technic seems helpful in the management of these patients. References [l] Hepatology, 1995, 21: 730.

Introduction: MARS@ (Molecular Adsorbant Recirculating System) is a new detoxification method for protein bound substances in pat. with acute liver failure. In the following a single center experience using MARS in pat. with acute liver failure are presented. Patients and Methods: Between 07/1999 and 06/2000 13 pat. with acute liver failure were admitted to our intensive care unit. Two patients were treated because of a severe graft dysfunction following trans-plantation, in 1 pat. liver failure occurred after a left hepatectomy, in 1 pat. posttraumatic liver dysfunc-tion with bilirubine levels > 600 pmol/l. 4 pat. were admitted with the diagnosis of an acute on chronic liver failure in whom a transplantation could not be performed because of the pat. rapid deterioration. 4 pat. were successfully bridged prior to transplantation. 4.5 (2-9) treatments/pat., mean duration of each treatment 18 hours. Results: 4 pat. with a history of esophageal bleeding died from further deterioration and sepsis. The beneficial effects in patients with severe graft dysfunction after transplantation (n = 2) needs to be eva-luated and compared to the results of an early retransplantation. One pat. treated because of liver failure after resection was extubated after 2 treatments, the pat. subsequently died from other non related corn-plications. 4 pat. with a spontaneous prognosis of less than 3 months were bridged prior to a successful transplantation. Conclusion: Treatment with the MARS system revealed to be save, easy to handle without any side effects. In all patients a dramatic initial improvement was noted after l-2 treatments. These preliminary single center results are encouraging, further studies are needed to specify worthwhile indications for this treatment.

I 1501

DE NOVO AUTOIMMUNE HEPATITIS (AIH) AFTER LIVER TRANSPLANTATION (LT)

I 1559

BILIARY COMPLICATIONS AFTER ORTHOTOPIC LIVER TRANSPLANTATION (OLT): THE ROLE OF ENDOSCOPIC MANAGEMENT

M. Salcedo, J.A. Pons, J.M. Sousa, A. Rimola, F. Suarez, R. Bainues, G. Clemente. AIH Spanish Group; M.G. U. Gregorio Maraiion, C/Dr
Esquerdo, 46, Madrid, Spain

J. $pic& M. Ryska, F. Belina, P. Trunecka, J. Peregrin, H. Filipova, P. Stirand, I. Skala, S. Vitko, K. Filip. Dept. of Hepatogastroenterology,
Institute of Clinical and Experimental Medicine, Czech Republic Objective: Biliary complications remain a common problem after OLT. The aim of this study was to assess their incidence, type and the role of endoscopic management in our series of patients. Methods: 195 consecutive patients were enrolled from the start of the programme in April 1995 to October 2000. Results: ERCP was performed in 68, and biliary complications were diagnosed in 57 patients. 36 patients had anastomotic strictures, 7 anastomotic leak, 6 choledocholithiasis, 4 junctional stenoses due to lymphoproliferative mass and 1 papillary dysfunction. Cannulation of the bile duct was unsuccessful only in 1 patient. In 43 patients we performed biliary stent insertion. In 14 patients we had to combine ERCP with transhepatic intervention, in 10 hepatico-jejuno-anastomosis was neccessary. Endoscopic treatment was fully successful in 15 of the 36 anastomotic strictures, in 4 of the 7 leaks, in 4 of the 6 common bile duct stones and one papillary dysfunction. In 14, biliary stenting is still under way. 3 patients with lymphoproliferation died and all patients with biliary peritonitis underwent surgery.

De novo AIH is uncommon after LT and its natural history of AIH is not well established. We report 31 AIH in adult LT recipients (graft dysfunction, serum auto-antibody titer > 160 and histologic hepatitis, in patients grafted by non-autoimmune diseases) treated with cyclosporine-based immunosuppressive regimes. Diagnosis of AIH was made a mean of 31 months after LT (range: 7-97). At this time, 5 and 14 patients still were on steroid and azathioprine immunosuppression, respectively. Antinuclear, anti-smooth muscle and atypical autoantibodies were present in 22, 15 and 19 cases. Monoclonal gammapathy, anti-DNA native, serum immunocomplexes and uveitis were present in 8,4, 1 and 1 patients. In 15 patients AIH was severe (ALT > 400 III/L,, bilirubin z 10 mg/dL and/or marked histological necrosis). No differences were found between patients with severe and non-severe AIH in relation to any factor analyzed, although there was a trend towards a more prolonged treatment with steroids and azathioprine in non-severe AIH cases. Therapy with increased dose of steroids, alone (14 patients) or with azathioprine (11 patients), was administered in 25 patients, with significant biochemical