These findings support incorporating changes in the AFP into the “”ablate MK0683 clinical trial and
wait”" principle of candidate selection while on the LT waiting list. Disclosures: The following people have nothing to disclose: Jeanne-Marie Giard, Neil Mehta, Jennifer L. Dodge, John P. Roberts, Francis Y. Yao Background/aim: It is known that steroids boluses for the treatment of acute cellular rejection(ACR) greatly increase HCV RNA levels after liver transplantation(LT), but results regarding fibrosis progression rate are controversial. We evaluated the effect of treatment of ACR in a large cohort of patients transplanted for HCV. Methods: 271 consecutive patients with follow up≥12months (median 9 years) were included. ACR was graded using the Royal Free Hospital score which incorporates eosinophilia with the Banff score: If moderate/ severe, we treated with 1g daily methylprednisolone intravenously for 3 days. Ishak stage≥4, collagen proportionate area(CPA)≥12.5%, HVPG≥10mmHg and clinical
decompensation were the endpoints evaluated with Cox regression. Results: Baseline characteristics: median age/donor age 51/42 years, genotype 1/3: 47%/35%, concomitant HCC in 83, antiviral treatment in 78(24 with SVR were censored). 172 patients received tacrolimus and 63 cyclosporine as main immunosuppression. Median tacrolimus levels up to day 30 were 6.9 ng/ml Sorafenib concentration and cyclosporine levels were 132μg/l. These patients had 906 biopsies at yearly interval as part of their routine care. Another
532 biopsies were performed as protocol liver biopsies between the 5th and 10th days post-LT, to assess ACR episodes. Boluses steroids for treatment of ACR episodes were given in 125/246(49%, SVR censored) patients; 121 received a single or 2 courses and another 4 received three courses of steroids in total: 35/121 with no ACR versus 42/121 with 1 or 2 episodes treated reached Ishak stage 4 (p=0.4), 17/87 vs 26/84 reached CPA 12.5% (p=0.1), 22/57 vs 34/79 reached Resminostat HVPG 10mmHg (p=0.9) and 16/121 vs 25/121 decompensated (p=0.1) respectively. In Cox or Kaplan-Meier analysis, steroids boluses were not significant for any of the end-points examined: for Ishak stage 4(Chi square 0.13, p=0.99); for CPA≥12.5%(Chi square 2.1, p=0.36), for HVPG≥10mmH-g(Chi square 0.81, p=0.66), for clinical decompensation(Chi square 1.3, p=0.5). 46% (69 with 1 episode, 24 with 2, 2 with ≥3 of 206 in total) of the patients with lower trough CNI levels(TAC≤10ng/ml or CYA≤300μg/Lt) within the first month post LT, were treated for rejection with steroids boluses compared to 60% (23 with 1 episode, 6 with 2 and 1 with 3 of 53 in total) of those with higher CNI levels(p=0.2). Conclusion: Treatment of ACR with steroid boluses was not associated with fibrosis progression, portal hypertension or clinical decompensation in recurrent HCV post-LT. Lower trough CNI levels within the 1st month post LT, did not predispose to ACR.