for these patients was 309 days. The 6-month mortality of LDLT recipientswas 7.6%.Conclusions: We present the largest single center study of LDLT to date.The biliary complication rate was lower (6.7%) than that reported nation-ally (22%). The vascular complication rate (2.2%)was as compared to thenational data (9.8%)reported recently was also lower. Overall, in ourexperience LDLT is associated with a lower rate of serious complicationsand rejection and may have a slightly higher survival than OLT. We needmore data on the long-term follow up of LDLT recipients especially thosewho underwent LDLT for chronic hepatitis C.

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VALIDATION OF A MODEL TO DIAGNOSIS CIRRHOSIS INPATIENTS WITH CHRONIC HEPATITIS CAli Siddiqui, M.D., Javid Fazili, M.D.*, Sikander Mesiya, M.D.OUHSC, Oklahoma City, OK.

Purpose: Kaul carried out a retrospective study of patients with HCV andusing a multivariable regression model, identified 4 predictors of cirrhosis:platelet count � 140,000/mm3, spider nevi, AST � 40 IU/L, and malegender. The authors compiled a table from which users could predictprobability of cirrhosis. The aim of our study was to carry out prospectivetrial in order to validate Kaul’s model.Methods: We identified 46 patients with HCV infection. HCV was iden-tified by the a presence of antibodies to HCV and elevated HCV RNA. Thepatients underwent an extensive physical exam and were tested for multiplebiochemical variables. The four previously mentioned predictors of cirrho-sis were then applied to Kaul’s model to forecast the probability of thesepatients having cirrhosis. Their liver biopsy specimens were reviewed byan experienced pathologist who was blinded to laboratory results andobjective of the study. The degree of fibrosis was classified according to 0to 4 rank scale (0� no fibrosis, 4� cirrhosis). The predicted probability ofcirrhosis was compared to actual liver histology.Results: A total of 46 patients (f�11, m�35) were evaluated. Their meanage was 47 years (32–72). 11/46 (24%) patients had spider nevi on exam.The mean AST was 61 IU/L ( 27–210) and mean platelet count was 204 103/mm3 (62–394). 12/46 (26%) patients had cirrhosis on liver biopsy. Wetabulated our results and compared them to the predicted probabilities asshown by Kaul’s model (Fig 1). Our results were similar to those predictedby Kaul’s model except in 2 cell blocks that did not correlate with Kaul’smodel.

Conclusions: In patients with chronic HCV, cirrhosis can accurately bepredicted by looking at the platelet count, gender, presence of spider neviand AST levels. This study provides validation of Kaul’s model to predictcirrhosis in patients with HCV. This could save some patients from theunnecessary risks and costs of a liver biopsy. The main limitation of our

study was the small number of patients in certain subgroups which mayhave skewed our statistical analysis.

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RISK OF DEVELOPING LIVER DISEASE IN CHRONIC HBVINFECTED PATIENTS — A 7 YEAR FOLLOWUP STUDYMohammed Aejaz Habeeb, D.M.,Chittoor Mohammed Habibullah, D.M.*. Deccan College of MedicalSciences, Kanchanbagh, Hyderabad, Andhra Pradesh, India.

Purpose: To assess the outcome of HBV infection in subjects with HBsAgpositivity and with normal liver function profile.Methods: A cohort study was planned with a mean followup period of 7years in subjects whose serum HBsAg positivity lasted atleast 6 months;with no clinical or biochemical signs of liver disease in the past as well asduring enrollment.Enrollment and follow-up: Between June 1996 and January 1997 patientsreferred to the liver clinic at Centre for Liver Research and Diagnostics forfurther evaluations were enrolled. Subjects meeting the inclusion criteriawere asked to participate in a long-term followup study, which accordingto protocol included regular clinical and biochemical evaluations once insix months.Results: At baseline 104 subjects were enrolled who were found HBsAgpositive for more than six months, 97 subjects were only HBsAg positiveand negative for HBeAg and HBV DNA with normal liver functionsprofile. 7 subjects were found positive for HBeAg and HBV-DNA with noelevations in ALT. However in 21 subjects Anti HBe was found negative.During followup serum enzyme levels remained normal all through in 100subjects. 3 patients had biochemical changes consistent with chronic hep-atitis though HBeAg and HBV DNA remained negative. A later histolog-ical evaluation of these patients showed progression to chronic hepatitis inone patient / cirrhosis in two patients. While in one patient biochemical andserologic changes were consistent with chronic hepatitis B. Interestingly, aspontaneous seroconversion to Anti HBe was observed in 14 of 21 patientswith significant fall in HBsAg titres. Secondly, a loss of serum HBsAgreactivity in 4 subjects was associated with concomitant seroconversionfrom HBsAg to Anti HBs in 3 subjects and in one subject it did not occur.Conclusions: This data suggests majority of the patients with chronic HBVinfection and normal liver function profile have an excellent prognosis anddirect development of chronic hepatitis / cirrhosis is to the extent of 3–4%only even after 7 years.

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HEPATITIS A EXPOSURE IN PATIENTS WITH CHRONICHEPATITIS C INFECTION IN CENTRAL PENNSYLVANIAAdnan Ahmad, D.O., Thomas Riley, M.D.*. Penn State University,Milton S. Hershey Medical Center, Hershey, PA.

Purpose: Those with chronic hepatitis C virus (HCV) infection are atincreased risk of developing severe acute hepatitis, fulminant hepaticfailure, or even death if super-infected with hepatitis A virus (HAV).Vaccination for HAV is recommended for those infected with HCV whohave not had prior exposure. Prevalence of exposure in a populationdetermines the cost-effective approach; screening with antibody and vac-cinating the non-immune versus vaccinating all. Purpose of this study is todetermine the prevalence of prior HAV exposure in central Pennsylvaniaand to identify possible risk factors for such exposure in those with HCVinfection.Methods: A retrospective chart review was performed on all patients whowere referred for HCV management from January 2000 to June 2002.Patient’s HAV status was determined by the result of HAV total antibody.Age, ALT level, race, gender, alcohol use, risk factors for contractingHCV, HIV status, Knodell scores, fibrosis scores, and the HCV genotypewere used to determine if an association with HAV exposure existed. Chisquare method was used for statistical analysis.

S94 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003

Results: 296 charts were reviewed (200 men, 96 women). 81 patients(27%) had previous HAV exposure (54 men, 27 women). Hispanics(n�23) had a higher risk of having prior exposure (odds ratio 5.89, CI2.4-14.5). Prior exposure to Hepatitis B (n�77) also had a higher risk ofhaving prior exposure to HAV (odds ratio 3.14, CI 1.8–5.4). Age greaterthan 50 (n�65) had a higher risk of having prior exposure (odds ratio 2.5,CI 1.4–4.5). Intravenous drug usage (n�181) had a higher risk of havingprior exposure (odds ratio 1.88, CI 1.08–3.2). Alcohol use (n�158) did notsignificantly increase the risk of having prior HAV exposure (odds ratio1.7, CI 0.9–2.5). No increase in the risk of having prior HAV exposure wasseen when Knodell score, fibrosis scores, HIV status and the HCV geno-type were compared.Conclusions: Less than one third of patients with chronic HCV infectionhave previous exposure to HAV in central Pennsylvania at a tertiary center.Age greater than 50, Hispanic race, intravenous drug usage, and priorexposure to Hepatitis B all independently increase the risk of havingprevious exposure to HAV virus. Previous studies have looked at theprevalence required for HAV immune status testing to be cost effective,and any population with a prevalence of greater then 12% justifies thescreening. Therefore, all patients in Central Pennsylvania with chronicHCV infection should have serological testing for immunity prior tovaccination.

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SERUM ANTIBODY RESPONSE TO HEPATITIS B VACCINE INPATIENTS WITH CHRONIC HEPATITIS CRichard L. Johnston, M.D., Gaga K. Sood, M.D., Maher Azzouz, M.D.*.University of MS Medical Center and VA Medical Center, Jackson, MS.

Purpose: Hepatitis B Virus (HBV) vaccination is recommended for allpatients with chronic Hepatitis C virus (HCV) infection with negativeserological markers for past infection or immunity to HBV. While theseroconversion response to HBV vaccine in healthy individuals has beenreported at 90 to 98 %, response rates in those with chronic HCV is muchlower, varying from 16-89%. Currently, there are no recommendations thatpropose follow up monitoring of the HBV surface antibody in patients withchronic HCV who are immunized. This could lead to assumed immunity toHBV, when in fact the patient is still susceptible.Methods: We retrospectively studied the patients with chronic HCV in-fection attending our liver clinic between 1999–2002. Four hundred andninety three patients were diagnosed with chronic HCV infection, 393patients had evidence of prior exposure to hepatitis B as demonstrated bypresence of hepatitis B core antibody (HBcAb). We also excluded 14patients who had no evidence of prior exposure to HBV, but that either hadnot yet received HBV vaccination or the status of their seroconversion wasundocumented at the time data was compiled. Of the remainder, there were86 patients with no previous exposure to HBV as evidenced by absence of3 serum markers, hepatitis B antigen (HBsAg), HBcAb, and hepatitis Bsurface antibody (HBsAb). This latter group of patients was vaccinatedusing 20 mcg of recombinant HBV vaccine (Engerix-B, SmithKline,Beecham Biological, Philadelphia, PA) administered intramuscular at 0, 1,and 6 months. Patients with decompensated cirrhosis, HIV, renal failure,malignancy or immunosuppressive therapy were excluded. HBsAb re-sponse was defined as a successful seroconversion and was measured onemonth after the last dose of vaccination by EIA (AUSAB; Abbott, NorthChicago, IL).Results: In all, 86 received the vaccination and had their seroconversionfollowed up (males 86; mean age 53.4, range 32–84; 40 blacks, 44 whites,1 Hispanic, and 1 American Indian). Of these 41/ 86 (47.6%) responded tovaccination as evidenced by presence of HBsAb.Conclusions: Response rates of HBV vaccination in patients with chronicHCV is lower than that of healthy individuals and should be routinelymonitored in this patient population by checking serum HBsAb. Moreaccelerated schedules and higher doses of the vaccine may be beneficial inthese patients and need to be studied further.

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INDEPENDENT PREDICTORS OF CIRRHOSIS IN HISPANICPATIENTS WITH NON ALCOHOLIC STEATOHEPATITIS(NASH)Waleed Alazmi, M.D., Colm J. O’Loughlin, M.B.,Enrique Molina, M.D.*. University of Miami/Hospital and Clinics,Miami, FL.

Purpose: Fatty liver affects 25% of the general population. It is estimatedthat 43% of patients with NASH will progress to liver fibrosis and cirrhosis.Most studies have been conducted on Caucasian patients. Ethnic differ-ences may exist and could explain genetic predisposition to disease. Theaim of this study is to identify independent predictors of liver cirrhosis inhispanic patients with NASH.Methods: Chart review identified 80 patients (42 white hispanic and 38white non-hispanic) with histologically proven NASH. Clinical, biochem-ical and histopathologic variables were studied with univariate and multi-variate analysis.Results: Among hispanic patients, the mean age was 51.3 years (range,25–71 years); 30 (71.4%) were females; 18 (47.4%) had diabetes mellitus;and 22 (68.7%) had dyslipidemia. The mean BMI was 32.6. The meanvalues for AST and ALT were 87.7 and 123.7 respectively. Thirteen(30.9%) patients had well-established cirrhosis. Among non-Hispanic pa-tients, the mean age was 53 years (range, 27–74 years); 21 (55.3%) werefemales; 11 (28.9%) patients had diabetes mellitus; and 27 (73%) haddyslipidemia. The mean BMI was 32.8. The mean values for AST and ALTwere 66.8 and 87 respectively. Thirteen (34.2%) patients had well-estab-lished cirrhosis. Comparison of biochemical variables between the twogroups revealed significantly higher values of AST (87.7 Vs 66.8 p�0.05)and ALT (123.7 Vs 87 p�0.05) among hispanic patients. In univariateanalysis of hispanic patients, age (p�0.013), BMI (p�0.008) and AST/ALT ratio (P�0.0001) were significantly associated with liver cirrhosis. Inmultivariate analysis, the only independent predictors of liver cirrhosis,among hispanic patients were age (odds ratio, 1.07; 95% confidence inter-val, 1.01 to 1.14) and AST/ALT ratio (odds ratio, 10.56; 95% confidenceinterval; 2.46 to 45.29).

In univariate analysis of non-hispanic patients, age (p�0.0346) anddiabetes mellitus (p�0.016) were significantly associated with liver cir-rhosis. In multivariate analysis, independent predictors of liver cirrhosisamong non-hispanic patients were age (odds ratio, 1.085; 95% confidenceinterval, 1.0 to 1.186) and diabetes mellitus (odds ratio, 6.46; 95% confi-dence interval, 1.19 to 35.07).Conclusions: In patients with NASH, ethnic differences exist betweenhispanic and non-hispanic populations. Where age and AST/ALT ratio arethe independent predictors of cirrhosis among hispanic patients, age anddiabetes mellites are the independent predictors of cirrhosis in non-hispanicpatients.

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CAN NON-INVASIVE TESTS PREDICT NONALCOHOLICSTEATOHEPATITIS IN MORBIDLY OBESE PATIENTS?Sara H. Mitchell, M.D., Zahid Rashid, M.D.,Nicholas A. Inverso, M.D.*, Michael J. Komar, M.D.,Jeffery Prichard, M.D., Mary J. Reed, M.D., Anthony Petrick, M.D.,William Strodel, M.D., Christopher D. Still, D.O. Geisinger MedicalCenter, Danville, PA.

Purpose: The incidence of nonalcoholic steatohepatitis (NASH) increaseswith an increase in body mass index (BMI). The diagnosis is established byliver histology showing macrosteatosis, lobular inflammation, and perive-nular fibrosis. Liver biochemistries (LFTs), insulin resistance, waist cir-cumference, and imaging studies, namely abdominal ultrasound (US), havebeen used to infer the presence of fatty liver in obese patients. Thereliability of these modalities has been questioned. We present data assess-ing these techniques in patients undergoing liver biopsy at the time ofgastric bypass surgery (GBS) for morbid obesity.

S95AJG – September, Suppl., 2003 Abstracts