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Background & Aims: Liver transplantation for hepatitis C virus (HCV)-related liver disease is characterized by frequent graft infection by HCV. The prognosis and risk factors for morbidity and mortality in this condition were determined. Methods: A retrospective study of 652 consecutive anti-HCV-positive patients undergoing liver transplantation between 1984 and 1995 in 15 European centers was conducted; 102 patients coinfected with hepatitis B virus (HBV) received immunoglobulin prophylaxis for antibody to hepatitis B surface antigen. Results: Overall, 5-year survival was 72%. Five-year actuarial rates of hepatitis and cirrhosis were 80% and 10%. Genotypes 1b, 1a, and 2 were detected in 214 (80%), 24 (9%), and 24 (9%) of 268 patients analyzed. The only discriminant factor for patient or graft survival was hepatocellular carcinoma as primary indication. Independent risk factors for recurrent hepatitis included the absence of HBV coinfection before transplantation (relative risk [RR], 1.7; 95% confidence interval [CI], 1.2-2.6; P = 0.005), genotype Ib (RR, 2; 95% CI, 1.3-2.9; P = 0.01), and age > 49 years (RR, 1.4; 95% CI, 1.1-1.8; P = 0.01). Conclusions: The results of transplantation for HCV-related disease are compromised by a significant risk of cirrhosis, although 5-year survival is satisfactory. Genotype 1b, age, and absence of pretransplantation coinfection by HBV are risk factors for recurrent HCV.

Introduction: Recent evidences suggest therapeutic value of mesenchymal stem cells (MSCs) as anti-inflammatory and immunomodulatory agent against several autoimmune diseases. Although promising, stem cell based therapies for IBD still requires experimental validation. In the present study we sought to determine whether exogenous administration of human umbilical cord derived cells with phenotype consistent with MSCs (UC-MSCs) can reduce acute colonic damage induced by Dextran Sulphate Sodium (DSS) in immunodeficient NOD.CB17-Prkdcscid/Jmice.Methods: UC-MSCs isolatedwere evaluated by assessing CD73, CD90, CD166, CD105, CD29, CD44, HLA-DR and c-kit expression, by adipocyte, osteocyte differentiation and proliferation potential by cell cycle analysis and wound assay. UC-MSCs were injected in NOD.CB17-Prkdcscid/J mice via tail vein at day 1 and 4. Disease Activity Index, daily body weight changes and colon length, and histological changes evaluated on day 7. Myeloperoxidase, catalase activities, chromosome aberration, sperm head anomaly and metalloproteinase (MMP) 2, 9 expressions were assessed in mice to verify attenuation of DSS induced damage by UC-MSCs. Alteration of ER stress related proteins like BIP, PERK, PDI, CHOP were studied by western blotting. Results: UC-MSC differentiated in osteocytes/ adipocytes, highly expressed CD90, CD73, CD166, CD105 andCD29 typical ofmesenchymal stem cells. UC-MSCs were successfully engrafted in the colon as evident from immunohistochemical staining against anti human nuclei antibody. UC-MSCs administration significantly attenuated bloody stool, weight loss, colon shortening and accelerated healing of damaged mucosa. Decrease in cytotoxicity and genotoxicity was evident from lower MPO level (78.2±9.7 vs 168.9±18.2 U/g, p 3 fold) which were reduced in UC-MSC group. Positive modulation in BIP, PERK, PDI proteins was noticed after MSC administration. Conclusions: NOD.CB17-Prkdcscid/J mice were susceptible to acute DSS colitis, suggesting that T, B and NK cells are not required for the disease. The engrafted UC-MSCs successfully accelerated healing of DSS-induced damaged tissue by promoting tissue repair process by reducing the protease burden through reduced MMP expression in inflammed colon and positively modulating histological score supporting the use of MSCs as a novel therapeutic strategy for colonic injuries. Future works in this direction would hopefully resolve the minutes of this inspiring cell therapy in alleviation of human sufferings involving IBDs.

Objective: Ulcerative Colitis (UC) is rare in Asia but has seen a rise in prevalence over the past decade. Previous studies have suggested that UC is milder in Asians and fewer Asian patients require proctoproctocolectomy. The aim of the studywas to determine the proportion of Singaporean UC patients who required proctoproctocolectomy and the risk factors associated with the need for surgery in our cohort of patients. Methods: This is a retrospective study of 453 Asian UC patients seen at the Singapore General Hospital (SGH), Changi General Hospital (CGH) and National University of Singapore (NUH) from 1970 to 2011. Data was reviewed from case notes and electronic records. Cox proportional hazards model was used to identify univariate and multivariate risk factors for proctocolectomy. Results: There were 317 (70.0%) Chinese, 69 (15.2%) Indian, 45 (9.9%) Malay, and 22 (4.9%) patients of other Asian ethnicities in the study cohort. Male-to-female ratio was 1.5:1 (268:186). The majority of patients presented between the ages of 30 to 40 years old (28.5%), with no bimodal peak in age presentation. The mean duration from symptom onset to diagnosis was 22.9 months. At diagnosis, 116 (25.6%) patients presented with proctitis, 186 (42.6%) with left sided disease, and 139 (31.8%) with extensive colitis. 63 (13.9%) patients were steroid dependent. Azathioprine was eventually started in 61 (19.2%) Chinese, 19 (27.5%) Indian and 10 (22.2%) Malay patients, while proctocolectomy was required in 33 (10.4%) Chinese, 8 (10.1%) Indian and 4 (8.9%) Malay patients. The most common indications for proctocolectomy was medically refractory ulcerative colitis (64.4%) followed by acute severe colitis (15.6%) and cancer or dysplasia (13.3%). Risk factors associated with proctocolectomy were ESR more than 26 mm/h at diagnosis (p = 0.026), hemogoblin less than 12 g/dl at diagnosis (p = 0.015), steroid dependency (p< 0.0001), hospitalizations due to UC flares (p = 0.028) and extensive colitis (p = 0.037). Multivariate analysis showed that steroid dependency was the only variable independently associated with proctocolectomy (p = 0.001). Cumulative proctocolectomy rates were 3.0% at 1 year, 6.6% at 5 year, 9.2% at 10 year and 23.3% at 30 year. Age at diagnosis, gender, race and time to diagnosis did not affect surgical rates. Conclusion: About 10% of Asian UC patients in Singapore required proctocolectomy. While this is higher than the 3% of Koreans who required surgery for UC, it is lower than what has been reported in Caucasian cohorts. Steroid dependency was the only variable found to be associated with the need for proctocolectomy.

579 THE PRESENCE OF DIABETES REDUCES SVR AFTER ANTIVIRAL THERAPY FOR POST-TRANSPLANT HCV RECURRENCE V. Vero, M. Senzolo, L. Pasulo, F.R. Ponziani, R. Vigano, M. Marino, M.F. Donato, M. Rendina, P. Toniutto, M. Cescon, E. De Martin, L. Miglioresi, V. Giannelli, D. Di Paolo, S. Fagiuoli, AISF Study Group RECOLT (RE-currence-C-post-OLT). Internal Medicine, Cattolica Sacro Cuore, Rome, Gastroenterology, Ospedali Riuniti, Bergamo, Gastroenterology, Universita degli Studi di Padova, Padova, Ospedale Niguarda, Milano, Ospedale di Modena, Modena, Ospedale Maggiore Policlinico, Milano, Policlinico di Bari, Bari, Ospedale di Udine, Udine, Policlinico Universitario di Bologna, Bologna, Ospedale di Roma S.Camillo, Policlinico Umberto 1, Ospedale Tor Vergata, Roma, Italy E-mail: vittoriavero@yahoo.it