treat portal hypertension. When TIPS induces disabling encephalopathy or accelerated liver failure, closure of the shunt should be performed early, and alternative treatments can be used, including endoscopic sclerotherapy. variceal ligation, large volume paracentesis, and, most importantly, liver transplantation. Hopefully, lessons from the past gleaned from the evaluation of surgical portacaval shunts in the treatment of portal hypertension will help to better define the appropriate use of TIPS in cirrhotic patients to maximize the beneficial effects of reducing the portal pressure while minimizing the deleterious effects of this procedure. 97021614

Evolution of cardiovascular risk after liver transplantation: A comparison of cyclosporine A and tacrolimus (FK506) Canzanello V.J.; Schwartz L.; Taler S.J.; Textor SC.; Wiesner R.H.: Porayko M.K.; Krom R.A.F. Division of Hypertension,llnternal Med., Mayo Clinic, 200 First Street, Rochester. MN 55905 LIVER TRANSPLANT. SURG. 1997 3/l (l-9)

The development of atherosclerotic cardiovascular complications is a common and serious problem for the long-term survivors of organ transplantation. Cyclosporine A plus steroid-based immunosuppres- sion regimens in these patients are associated with the development of hypertension, hyperlipidemia, obesity, and diabetes mellitus. Whether the new immunosuppressive agent tacrolimus (FK506) confers any advantage in terms of these cardiovascular risk factors has been less well studied. We compared serial changes in blood pressure, lipids, body weight, and glucose levels during the first 12 months after liver transplantation in patients using either cyclosporine A (n = 39) or tacrolimus (n = 24)based immunosuppression. By I2 months, the prevalence of hypertension, hypercholesterolemia, and obesity was increased in the cyclosporine A group compared with tacrolimus: 82% versus 33X, 33% versus O’%,, and 46% versus 29% respectively (all p < 0.05). Triglyceride and total cholesterol levels were 196 + 23 versus 125 k 13 mg/dl and 225 + 9 versus 159 k 7 mgjdl for the cyclosporine A versus tacrolimus groups. respectively (P < 0.05). Cumulative posttransplant steroid close was not related to the observed lipid changes in either group, although the increase in triglycerides was positively correlated to weight gain and diuretic use in the cyclosporine A group. The incidence of diabetes mellitus was not increased from baseline in either group. These results indicate that tacrolimus, compared with cyclosporine A, is associated with s less adverse cardiovascular risk profile in the first year after liver transplantation. Whether these differences persist and become clinically relevant to a liver transplant recipient population that is increasingly older and has more preexisting cardiovascular disease remains to be determined. 97030124

The NIDDK liver transplantation database Wei Y.L.; Detre K.M.; Everhart J.E. 127 Parran Hall, 1.30 DeSoto Street, Pittsburgh, PA 15261-2195 LIVER TRANSPLANT. SURG. 1997 3/l (10-22)

The NIDDK Liver Transplantation Database was established to prospectively investigate questions related to the experience of patients evaluated for and undergoing liver transplantation. This article presents the study design, methods, and quality of data collection, along with some of the overall results. Methods: An initial 4-year planning phase was used to develop data collection instruments and quality control procedures regarding assessment for transplantation. liver donors, and the recipients’ pre-, peri- and postoperativte course. During the 199OGl995 implementation phase, three clinical centers refined the data collection instruments and enrolled and followed consecutive liver transplant candidates who consented to be included in the protocol. Results: The Database contains more than 49 000 data forms from 1563 candidates. 1002 donors, and 916 transplant recipients followed up to 5 years after transplantation. Overall. 95% of protocol forms were completed. The Database includes uniformly defined histology results of liver biopsies performed per protocol and for complications throughout follow-up. In addition, the Database maintains an inventory of available sera for the Serum Bank. All test results of studies performed on the sera are added to the Database. Of 1563 evaluated patients. 59% were deemed eligible for liver transplantation. Of the others who were too well or had contraindications, 15% became eligible later. Characteristics of patients in this study were generally comparable to those of patients nationally. Conclusions: The NIDDK Liver Transplantation Database has yielded comprehen-

146 Abstracts

sive and high quality data and is a rich resource for extensive analysis about many important clinical aspects of liver transplantation. 97030125

Immunonephelometric quantification of group-specific component protein in patients with acute liver failure Wians F.H. Jr.; Lin W.; Brown L.P.; Schiodt F.V.; Lee W.M. Department of Internal Medicine, UT Southwestern Medical School. 5323 Harry, Hines Boulevard, Dallas, TX 7.5235-8887 LIVER TRANSPLANT. SURG. 1997 3/l (28-33)

Serum levels of group-specific component (Cc) protein are useful in evaluating the likelihood of survival in patients with acute liver failure (ALF) who may be candidates for liver transplant surgery. Most methods for quantifying Gc protein concentration are either isotopic, manual, technically demanding, and/or time consuming to perform, and thus, are not well suited for routine clinical use in a hospital setting. We modified and evaluated a recently described nonisotopic, fully automated, immunonephelometric method for quantifying serum Gc protein concentration and compared it to our previous immunoblotting method. In addition, we evaluated the effect of G-actin on the immunoneph- elometric measurement of Gc protein. Serum samples from 20 patients with ALF and from 20 age- and sex-matched clinic patients without liver disease were quantified by both immunoblotting and im- munonephelometry. We assessed the intra-assay precision, correlation, and diagnostic accuracy of these methods in discriminating between individuals with no preexisting liver disease and those with ALF. Actin in 1.33four-fold excess of Gc protein levels demonstrated minimal to no interference in the quantification of Cc protein by immunonephelometry. lmmunonephelometry was more precise than immunoblotting. Gc protein values by immunonephelometry were similar to those obtained by im- munoblotting, and the diagnostic accuracy of Gc protein concentration by immunonephelometry was similar to that observed by immunoblotting. lmmunonephelometry provides a nonisotopic, fully automated. rapid, precise, accurate, and cost-effective method for quantifying serum levels of total Gc protein that is well suited for routine use in a hospital-based clinical laboratory. 97030127

Gastric emptying and orocecal transit in portal hypertension and end-stage chronic liver disease Galati J.S.; Holdeman K.P.; Bottjen P.L.; Quigley E.M.M. Sec. oJ Gastroenterology:Heparology, University of Nebraska Medical Center, 600 So 42nd St., Omaha. NE 68 198-2000 LIVER TRANSPLANT. SURG. 1997 311 (34438)

Our aim WdS to evaluate gastric emptying and orocecal transit in patients with end-stage liver disease and portal hypertension undergoing evaluation for liver transplantation. Although gastric emptying half-times for both liquid and solid emptying were similar in patients with chronic liver disease and control subjects. orocecal transit, as measured by a scintigraphic technique, was significantly prolonged in the patients with liver disease (transit time. minutes, mean + S.E.M., patients versus controls: 127 f 10.5 versus 80 f 9.5, P < 0.003). Serum levels of progesterone and estradiol were similar in patients and controls. We conclude that small intestinal transit is delayed in patients with advanced liver disease and portal hypertension and may contribute to gastrointestinal symptoms and promote sepsis of enteric origin in this patient population. 97030128

Fulminant hepatitis B virus: Recurrence after liver transplantation in two patients also infected with hepatitis delta virus Marsman W.A.; Wiesner R.H.; Batis K.P.; Poterucha J.J.; Porayko M.K.; Niesters H.G.M.; Zondervan P.E.; Krom R.A.F. Division of’ Liver Transplantation, Mayo Clinic, 200 First Street, Rochester, M?V 55905 HEPATOLOGY 1997 25:2 (434-438)

Liver transplantation for hepatitis B virus (HBV)-related liver disease is complicated by HBV recurrence and, consequently, poor patient and graft survival. Patients transplanted for hepatitis delta virus (HDV)-related cirrhosis are reported to have a diminished incidence of HBV recurrence and