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ASPIRIN INDUCED HEPATITIS IN A LUPUS PATIENTFritz Francois, M.D., David Jager and Elizabeth Weinshel, M.D.*.Gastroenterology, New York University Medical Center, New York, NYand Internal Medicine, Albert Einstein School of Medicine, Bronx, NY.

Purpose: A 47–year–old female with systemic lupus erythematosus (SLE),was admitted to the hospital with a four–day history of right calf pain,fever, and elevated liver enzymes.

Two months prior to admission, she was started on daily Aspirin (ASA)at 325mg for rheumatism. Liver function tests and complement levels, atthe start of treatment and one month later, were normal. Four days prior toadmission, she experienced pain in her right calf, for which she tookAnacin (ASA 400 mg, caffeine 32 mg), along with her prescribed salicylatepreparation. She ingested a total of approximately 2.3 gms of aspirin per 24hours, for three days. One day before presentation, she experienced bodyaches and fevers up to 102 F. She was admitted for a work up of right calfpain, fever, body aches, and noted glutamic–oxalacetic transaminase(SGOT) of 357, and serum glutamic–pyruvic transaminase (SGPT) of 347.The patient was diagnosed with a right popliteal deep vein thrombosis byDoppler evaluation, and was started on anticoagulation. She had no priorhistory of liver disease, blood transfusions, and drug or alcohol use. Heronly other medications were Ferrous Sulfate and Calcium carbonate. As-pirin was discontinued due to the suspected drug induced hepatitis. Hertransaminases peaked on day three (SGOT 429 and SGPT 483) and

returned to normal within four days. Further laboratory evaluation wasnotable for markedly decreased complement levels and 6gms of protein ona 24–hour urine collection, which correlated with active lupus.

Many over–the–counter preparations and prescription narcotics containASA, and patients may take too much for analgesia or for anti–inflammatorypurposes. The occurrence of salicylate hepatoxicity is more common and moresevere in patients with SLE than in patients with other rheumatologic diseasesand the occurrence of the transaminitis correlates with clinical evidence ofdisease activity. The true incidence of aspirin induced hepatitis remains un-known in part because it may go unrecognized but should be considered whenthere are no other likely etiologies for acute hepatitis.

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INTERFERON–ALPHA 2b AND RIBAVIRIN FOR RECURRENTHEPATITIS C IN LIVER TRANSPLANTATION–A SINGLECENTER EXPERIENCESandeep Mukherjee, M.D., Richard K. Gilroy, M.D., Timothy M.McCashland, M.D., Daniel F. Schafer, M.D., Rowen K. Zetterman,M.D., FACG and Michael F. Sorrell, M.D.,FACG*. Department ofMedicine, Section of Gastroenterology and Hepatology, University ofNebraska Medical Center, Omaha, NE.

Background: Recurrent hepatitis C (HCV) is universal following ortho-topic liver transplantation and is emerging as an important cause of re-transplantation. To prevent this complication, patients are often treated withinterferon and/or ribavirin.We describe our experience with the treatmentof 38 patients with recurrent HCV.Methods: Between October 2000 and November 2001, all patients diag-nosed with recurrent HCV were screened to determine if they were eligiblefor treatment. Recurrent HCV was defined as the presence of HCV viremia(HCVRNA) with a liver biopsy demonstrating recurrent hepatitis, steatosisor non–specific changes in patients. This cohort of patients was followedprospectively after starting a treatment protocol of interferon alpha 2b 3million units tiw and ribavirin 1000–1200mg qd (Schering–Plough, Ken-ilworth, New Jersey) with folic acid 1 mg qd. They were treated for 6–12months depending on their genotype and doses adjusted per treatmentprotocol. Steroids were discontinued in all patients prior to treatment.HCVRNA was checked prior to treatment, 3 months into treatment, end oftreatment (EOT) and 6 months after EOT for those who were HCVRNAnegative at EOT. Complete blood counts were performed weekly for thefirst month and monthly thereafter with liver function tests.Results: 45 patients were screened and 38 were eligible for treatment.There were 28 males and 10 females with an average age of 55 years. 34patients were genotype 1.19 patients completed treatment, 3 are still ontreatment and 16 patients were intolerant to treatment. Of the 19 patientswho completed treatment, 13 were non–responders and 6 were respondersat EOT. 4 of these 6 responders remain HCVRNA negative 6 months afterEOT and the other 2 are awaiting their 6 month post HCVRNA tests. One

S94 Abstracts AJG – Vol. 97, No. 9, Suppl., 2002

patient who was intolerant to treatment has developed a sustained responseto HCVRNA eradication.Conclusions: Interferon alpha 2b and Ribavirin were poorly tolerated inthis series of patients with only 50% completing treatment and 13%achieving a sustained response to HCV eradication. Pegylated–interferonand ribavirin should be considered for treating recurrent HCV.

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HOW LONG SHOULD WE TREAT PRIOR NON–RESPONDERSFOR? AN INTERIM ANALYSIS OF THE “FRONTIER TRIAL”Marcelo Kugelmas, M.D.* and Lisa M. Forman, M.D. Medicine,University of Colorado, Health Sciences Center, Denver, CO.

Purpose: Treatment with Pegylated interferon and ribavirin may be anoption for patients with chronic hepatitis C who have failed Rebetroncombination therapy and/or interferon monotherapy. Our aim is to treatpreviously non–responders patients with chronic hepatitis C with Peg–Intron and ribavirin for 24, 36, or 48 weeks, and assess safety, sustainedviral and histologic response rates.Methods: Two hundred patients with compensated liver function have beenaccrued so far. All receive Peg –Intron 1.5 mcg/kg/weekly and ribavirin 800mg/d. This is an interim report of early virologic response (EVR) and end oftreatment viral response (ETR) in the first 100 patients. Complete data forsustained virologic responses will be presented at the meeting.Results: Twenty–three patients had a negative qualitative HCV–RNA PCRat the end of the first 12 weeks on therapy (EVR�23%). Different lengthsof treatment had no association with ETR (p�0.837) as eight of thirty–twopatients treated for 24 weeks achieved an ETR (25%), eight of thirty–threetreated for 36 weeks had an ETR (24.2%), and eight of thirty–five treatedfor 48 weeks had an ETR (22.9%). Table 1 depicts the analysis of ETRaccording to prior treatment and genotype. No association was found inbetween gender, age, or race and ETR to Peg–Intron and ribavirin therapy.Six serious adverse events were recorded in this cohort: suicidal ideationW2, pancreatitis W3, gastritis with hematemesis W6, APAP OD W11, and2 episodes of chest pain at W6 and 20.

Table 1: ETR according to genotype and prior treatment in 100 patients treatedwith Peg–Intron and Ribavirin for different lengths of time

Rebetron Interferon Genotype 1 Genotype not–1

24W 5/27* 3/5 6/27 2/536W 4/26 4/7 6/30 2/348W 4/29 4/6 6/31 2/4p value �0.001 0.033

* HCV RNA Neg./Total treated

Conclusions: The combination of Peg–Intron and ribavirin seems to offerbenefit for patients who previously failed interferon–based therapies. Thesepreliminary data also raise the possibility that 24 weeks of therapy ratherthan 36 or 48 weeks may suffice for these patients. Prior failure tointerferon monotherapy and HCV genotype not–1 seem to be associatedwith a better chance of ETR.

Grant support: NIH M01 RR00051 and Schering–Plough.

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TRANSJUGULAR LIVER BIOPSY: AN ANALYSIS OF 650PROCEDURESGuilherme Macedo, M.D.,FACG*, Susana Lopes, M.D., FatimaCarneiro, M.D.,Ph.D. and Fernando Tavarela Veloso, M.D, Ph.D.,FACG. Gastroenterology Unit, H.S.Joao, Porto, Portugal.

Purpose: There is a substantial risk of bleeding in percutaneous liverbiopsies performed in acute liver disease patients or in chronic liverdiseases associated with blood dyscrasia or coagulopathy. Also in largevolume ascites, percutaneous route may also be contraindicated. In livertransplant centers, the availability of the transjugular (TLB) procedure

allows a support for precise diagnosis and for supplementary decisions,either in elucidating cirrhosis etiology or in having liver tissue sample inacute liver failure situations.Methods: We analysed the cumulative experience in 8 years with thisprocedure. In 370 TLB, we used TJ Henriksen needle, which allows tissuesampling by aspiration. In 280 procedures we used the modified TJ TruCutneedle, with a variation of the initial described technique. We describe thedominant indications and observed diagnosis.Results: In 110 patients, TLB was performed in acute liver disease setting.The diagnostic efficacy was 99% with TruCut needle and 70% withaspiration needle.

Complications were: carotid puncture in 4% (25 patients) and extracap-sular puncture with aspiration of ascitic fluid in 0,5% (3 patients). Bothcomplications were uneventful. The procedures were temporarily sus-pended in 4 patients because of arrythmia or dorsolombar pain. Becauseseveral difficulties in right internal jugular vein access, TLB was performedin 8 patients through the left vein.Conclusions: We conclude that this is an extremely useful and safetechnique in hospitals with highly prevalent liver disease, particularly ifenvolved in every step of staging and treatment of acute or end stagechronic liver disease patients.

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PEGYLATED–INTERFERON FOR RECURRENT HEPATITIS CIN LIVER TRANSPLANT RECIPIENTS WITH RENAL FAILURESandeep Mukherjee, M.D., Richard K. Gilroy, M.D., Timothy M.McCashland, M.D., Daniel F. Schafer, M.D., Rowen K. Zetterman,M.D.,FACG and Michael F. Sorrell, M.D.,FACG*. Department ofMedicine, Section of Gastroenterology and Hepatology, University ofNebraska Medical Center, Omaha, NE.

Purpose: Recurrent hepatitis C (HCV) is universal following liver trans-plantation (OLT) and is an important cause of retransplantation. It is treatedwith interferon and ribavirin and more recently pegylated–interferon withribavirin has been used. We describe our experience with pegylated–interferon monotherapy in a small series of patients in whom ribavirin wascontra–indicated due to the presence of renal failureMethods: Between June 2001 and the present, patients diagnosed withrecurrent HCV were screened to determine if they were eligible for treat-ment. Recurrent HCV was defined as the presence of HCV viremia(HCVRNA) with a liver biopsy demonstrating recurrent hepatitis, steatosisor non–specific changes. This cohort of patients was followed prospec-tively after starting a treatment protocol of Pegylated–Interferon alpha 2b1.0 mcg/kg qweekly (Schering–Plough, Kenilworth, New Jersey). Allpatients were treated for 1 year irrespective of genotype and doses adjustedper treatment protocol. Steroids were discontinued in all patients prior totreatment. Complete blood counts were performed weekly for the firstmonth and monthly thereafter with liver function tests. HCVRNA and liverbiopsies were performed prior to treatment, end of treatment (EOT) and 6months after EOT for those who were HCVRNA negative at EOT.HCVRNA was also checked 3 months into treatment.Results: 39 patients with recurrent HCV were screened. 8 were eligible fortreatment with Pegylated –Interferon monotherapy as they had a serumcreatinine � 1.8 mg/dl. 4 of these patients had also failed Interferon alphaand ribavirin previously. There were 7 males and 1 females with an averageage of 55 years. All patients were genotype 1. 7 patients were intolerant totreatment requiring Peg–interferon discontinuation within the first 3months.1 patient has completed 4 months of treatment and was HCVRNAnegative at 3 months.Interestingly, 2 of the 7 intolerant patients haveundetectable HCVRNA more than 6 months after Peg–interferon discon-tinuation.Conclusions: Pegylated –Interferon alpha 2b is poorly tolerated in livertransplant recipients with recurrent HCV and chronic renal failure. Largerstudies and long–term follow up of this group of patients will be requiredto determine the effectiveness of this therapy.

S95AJG – September, Suppl., 2002 Abstracts