(10% in Group 2).
Nine (90%) children in Group 1 achieved complete clinical and biochemi- 807
cal remission at 12 months compared to 36 (86%) patients in Group 2 (NS). Two children
in Group 1 discontinued therapy (one at 6 months and the other after 24 months), and
none relapsed at the end of the study (at 25 month- and 50 month- visits, respectively).
Two (5%) patients in Group 2 underwent liver transplant at 1 and 17 months. The mortality
rate was 5% in Group 2 (one died at 10 months after transplant, the other died of meningococ-
cal meningitis) and 0% in Group 1. Conclusions: Children with MIAIH frequently had
more symptoms of arthralgia, displayed serological markers of type 1 AIH only, and had
excellent treatment outcomes. Durable immunosuppression withdrawal was possible in
MIAIH patients.
Table 1. Clinical, biochemical, autoimmune, and histology features
*p<0.05
806
Etiology of Cirrhosis in the Young
Ananta Gurung, Pramod K. Mistry, Sanjay Kakar, Matthew M. Yeh, Tsung-Teh Wu,
Michael Torbenson, Dhanpat Jain
Background: Etiology of cirrhosis has been well studied in adults and incidence of cryptogenic
cirrhosis in various studies ranges from 5-30%; however, surprisingly similar data in young
adults and children is lacking. With better understanding and diagnosis of inherited disorders,
the etiology of cryptogenic cirrhosis is likely to decrease in younger patients. The aim of
this study was to determine the incidence of various etiologies of cirrhosis in ≤40 year old
patients. Design: Cirrhotic patients were identified from our pathology database from 2000-
2013. Clinical charts and pathology reports were reviewed to identify etiologies of cirrhosis.
Patients were divided into 4 groups (<1, 1-5, 5 to <18, and 18-40 years old) for analysis.
Results: We identified 189 patients (78 female, 111 male, average age 24.8). In <18 year
old patients, developmental disorders (extrahepatic biliary atresia, congenital hepatic fibrosis,
Alagille syndrome) were the most common cause of cirrhosis (43.6%, 24/55). Metabolic
and genetic diseases (tyrosinemia, arginase deficiency, glycogen storage diseases) were also
seen more commonly in this age group. Viral hepatitides were the most common cause of
cirrhosis in 18-40 year old patients(44.0%, 59/134) followed by fatty and autoimmune liver
disease (18.7%, 25/134 and 17.9%, 24/134, respectively). Alcoholic liver disease (76.0%,
19/25) was seen most frequently in 18-40 year old patients. Cryptogenic cirrhosis (overall
10.1%, 19/189) was seen in 5.3% (1/19), 12.5% (1/8), 10.7% (3/28) and 10.4% (14/
134) of patients aged <1, 1 to <5, 5 to <18, and 18-40 years, respectively. Conclusion:
Developmental and metabolic disorders are the most common causes of cirrhosis in <18
year old patients, while viral hepatitides are leading causes in 18-40 year old patients. The
incidence of cryptogenic cirrhosis in <1 year old children is the lowest, while it is similar
in older children and young adults. Undiagnosed metabolic disorders are likely underlying
causes for cryptogenic cirrhosis in children young adults and need further study.
S-997
Variability of Hepatitis C Screening in Birth Age Cohort U.S. Veterans Born
1945-1965: National Analysis of 4.2 Million Veterans 2000-2013
Souvik Sarkar, Denise A. Esserman, Forrest L. Levin, Amy C. Justice, Joseph K. Lim
Background: Hepatitis C virus (HCV) infection poses an immense national burden with
risk of progression to cirrhosis, liver failure, and hepatocellular carcinoma. Although highly
efficacious treatment regimens are available, ongoing deficits in diagnosis, linkage to care,
and care delivery blunt their impact. Both the CDC and USPSTF recommend universal birth
cohort screening for HCV in individuals born between 1945-1965. However, limited data
are available on HCV screening practice patterns that may inform policy development.
Utilizing the U.S. Veterans Administration (VA), the largest provider of HCV care in the
U.S., we evaluated the variability in screening for HCV across the VA. Method: We queried
the national VA Corporate Data Warehouse (CDW) to identify HCV screening rates and
predictors of screening among all birth cohort veterans presenting for care within the VA
between 2000-2013 with at least two VA visits. HCV screening was defined as completion
of any diagnostic test such as HCV antibody, HCV genotype, or HCV RNA/viral load. We
then queried the rate (defined as number screened at the station of first encounter/total
number who presented to that station) of screening at VA centers across the US. Results:
There were 6,669,388 veterans born 1945-1965 who presented at the VA 2000-2013, of
whom 4,221,204 had two or more visits. This cohort was 88.3% male and 20.9% had
serum ALT>40. Overall 2,199,469 (52.1%) had completed HCV testing as of December 31,
2013. This sub-cohort was 92% male, and 27.6% had serum ALT>40, with the odds of
HCV testing two fold among those with ALT>40 (OR 2.53, 95% CI 2.52-2.54), controlling
for gender and station. Average time to screening from first VA encounter was a mean ±
standard deviation of 784±1121 days (median: 260; Q1/Q3: 8/1111 days). The overall
testing for HCV varied across 130 VA centers ranging from 6.5% to 84.6%, with 54 (41.5%)
AASLD Abstracts
stations having a testing rate less than 50%. Conclusion: Comprehensive analysis of HCV
screening practices in a large national cohort of U.S. veterans born between 1945-1965
reveals that over 50% completed a qualifying HCV screening test from 2000-2013. However,
significant variation in HCV testing was observed between centers, signaling the need for
broader policy interventions to improve screening in target populations. These results have
implications for implementation of birth age cohort HCV screening in large health care sys-
tems.
808
Despite the Declining Prevalence of Hepatitis C Virus (HCV) Infection in the
U.S., Rates of HCV-Related Liver Transplantation Continue to Increase, More
Than Doubling Among Blacks
Maria Aguilar, Harleen K. Dyal, Benny Liu, Taft Bhuket, Zobair M. Younossi, Aijaz
Ahmed, Robert J. Wong
Background: The implementation of hepatitis C virus (HCV) screening among high risk
groups and birth cohorts will contribute to earlier detection and treatment of HCV, thereby
preventing progression to cirrhosis-related complications and need for liver transplantation
(LT). However, it is not clear whether the impact of HCV screening programs has effectively
reduced HCV-related LT in the U.S. Aims: To compare the trends in HCV prevalence with
HCV-related LT waitlist registrations and HCV-related LT surgeries performed in the U.S.
Methods: Using data from the most recent update of the National Health and Nutrition
Examination Survey, the prevalence of chronic HCV in the U.S. was determined based on
HCV viral load positivity. To correlate the prevalence of HCV with HCV-related new LT
waitlist registrations and LT surgeries performed, we utilized data from the United Network
for Organ Sharing LT registry. HCV trends were calculated from 2001 to 2012 using two-
year groupings and further stratified to determine sex-specific and race/ethnicity-specific
variations. Comparisons between time periods utilized chi-square testing for categorical
variables and analysis of variance for continuous variables. Results: The overall prevalence
of HCV in the U.S. decreased by 17.2% from 3.5 x 106 (95% CI, 2.7 - 4.2 x106) in 2001-
02 to 2.9 x 106 (95% CI, 2.2 - 3.6 x106) in 2011-12. Among men, HCV prevalence decreased
by 26.2% (2.5 x 106 to 1.9 x 106), whereas among women HCV prevalence increased by
5.8% (9.2 x 105 to 9.7 x 106). During this same period, HCV prevalence decreased by
11.6% among non-Hispanic whites, 5.1% among blacks, and 13.1% among Hispanics.
However, new LT waitlist registrations among patients with chronic HCV increased by
32.1% overall, from 5,200 in 2001-02 to 6,869 in 2011-12. HCV-related waitlist registrations
increased by 39.0% among men and increased by 18.2% among women. When stratified
by race/ethnicity, HCV-related LT waitlist registrations increased by 24.2% among non-
Hispanic whites, 109.2% among blacks, and 29.7% among Hispanics from 2001-02 to
2011-12. Overall LT surgeries performed for HCV-related liver disease also increased by
32.2%, from 2,697 in 2001-02 to 3,565 in 2011-12. HCV-related LT surgeries increased
by 36.0% among men and by 23.2% among women. When stratified by race/ethnicity,
HCV-related LT surgeries increased by 19.2% among non-Hispanic whites, 138.1% among
blacks, and 38.6% among Hispanics. Conclusions: Despite the overall decreasing prevalence
of HCV in the U.S., the number of patients with progressive HCV leading to LT waitlist
registration and need for LT surgery continues to increase. While non-Hispanic white men
accounted for the majority of LT patients, black HCV patients listed for LT and undergoing
LT demonstrated the largest increase, more than doubling during the study period.
AASLD Abstracts