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Background/aim Hepatic cirrhosis is a frequent reason for ordinary hospital admission (OA). The RING study collected hospital discharge files (HDF) from Italian hospital gastroenterology units (IGU). This caselist provides a broad picture of the patients admitted for this pathology. Material/methods More than 50,000 HDF for OA were collected between 2001 and 2004 from 26 IGU. Results Eight thousand four hundred and eighty-seven HDF (16%) had a diagnosis of hepatic cirrhosis; Child-Pugh classes were 20.2% A, 34.8% B and 45.0% C. Patients’ mean age was 63.7 ± 12.1 years and 62.5% were male. A 61.1% of the cirrhosis cases had ascites, 29.9% portal-systemic encephalopathy, 29.2% hepatocellular carcinoma (HCC), 10% bleeding varices, 3.0% hepatorenal syndrome (HRS). Mortality for OA for cirrhosis was 5.7% versus 2.6% for other diagnoses. The proportion varied with the severity of the cirrhosis: 0% for Child A, 1.1% B, 10.5% C. Mortality was significantly associated with: Child-Pugh at admission (odds ratio: OR 9.2), HRS (OR 11.7), bleeding varices (OR 2.2), HCC (OR 1.8). Conclusions Hepatic cirrhosis was found in 16% of the OA to IGU and mortality was double the rate for all the other pathologies in the same wards. Child-Pugh is a useful prognostic tool, higher classes implying a greater risk of death. HRS and bleeding varices were the complications with most influence on in-hospital mortality.

Background and aims : Little information are available on the relationship between energy balance and the alterations in nutritional status occurring in cirrhotic patients. The aim of the present study was to evaluate the daily energy balance in clinically stable cirrhotic patients with or without malnutrition. Patients : Seventy-four consecutive cirrhotic patients and nine healthy controls were studied. Methods : Basal energy expenditure was measured by indirect calorimetry and adjusted according to the patients' physical activity to estimate the daily energy expenditure. Food intake was evaluated based on a 3-day dietary diary. Nutritional status and body composition were assessed using skinfold anthropometry and dual energy X-ray absorptiometry, respectively. Results : Thirty-two patients in the cirrhotic group were classified as severely malnourished according to anthropometric parameters. Two different patterns of soft-tissue loss were observed in the malnourished cirrhotic group: a significant reduction in fat mass and in fat-free mass was observed in males, whereas, females showed a significant reduction in fat mass only. Basal energy expenditure was similar in all groups, while the non-protein respiratory quotient was lower in cirrhotics notwithstanding their nutritional status. This suggests that lipids were the preferred oxidized fuel in the post-absorptive state in these patients. No difference in the estimated daily energy expenditure and energy intake was observed among groups. Lipid content of the diet was significantly lower in malnourished cirrhotics than in controls (33.1±1% vs 37.8±1%, P =0.02). Conclusions : Cirrhotic patients in stable clinical condition with malnutrition show a normal energy balance.

Background and aims. Hepatic expression of several proteins, includng albumin, is reduced during ischaemia and restored upon reperfusion n human liver transplantation (LT) [J Pathol 2005;207:111–8]. Compleent activation during ischaemia reperfusion (IR) injury has been reported n renal, liver, intestine and heart allografts. A link between proteolysis nd complement activation has been demonstrated in myocardial IR damge [Proteomics 2002;2:988–95]. To better elucidate the mechanism and rognostic significance of complement activation in hepatic IR injury we easured early changes of liver graft C4d expression and total protein ontent (TP) during LT. Methods. Liver graft samples were obtained from heartbeating donors efore the aorta was clamped (T1) and 2 h after reperfusion in the recipint (T2) during primary whole organ LT. TP was measured by the Bio-Rad rotein assay method in freeze-dried liver homogenates from 47 grafts. In a ubgroup of 29 grafts C4d immunohistochemistry was performed on paraffin ections and positive hepatocytes were scored on a semiquantitative scale. he data were evaluated comparing grafts which were lost (LG) or survivng (SG) at 1-year follow-up. Intergroup differences were assessed by the ann–Whitney U-test. Correlations were analysed by the Spearman rank est. Results. LG (n= 10) had a significantly (p< 0.05) higher difference etween TP in T1 and in T2 ( TP) than SG (n= 37) (31.55± 31.51 vs. .41± 33.16 g/mg dry liver, respectively). C4d hepatocyte immunohistohemistry was negative in both LG and SG T1 samples. LG (n= 9) showed significantly (p< 0.05) higher T2 C4d hepatocyte score than SG (n= 20) 4.44± 1.67 vs. 2.55± 2.28 C4d, respectively). A positive correlation was ound between T2 C4d hepatocyte score and TP (r= 0.547, p< 0.01). Conclusions. Early complement activation and impaired restoring of raft protein content after reperfusion are linked events in hepatic ischaemia eperfusion injury and are associated with graft loss within the first year after uman LT.

23 RECIPIENT MTHFR C677T POLYMORPHISM PREDICTS PRE-TRANSPLANT CIRRHOSIS PROGRESSION AND SURVIVAL AFTER LIVER TRANSPLANTATION S. Ginanni Corradini1, M.A. Burza1, F. Ferri1, A. Molinaro1, A. Cantafora1, I. Blotta1, M. Mordenti1, M.G. Mazzucconi2, G. Ferretti1, V. Giannelli1, M. Merli1, A.F. Attili1, P.B. Berloco1, M. Rossi1. Liver Transplant Unit and Dep of Cell. Biotechnology and Hematology, Sapienza Univ. of Rome, Italy

The metabolic fate of exogenous deoxycholate administered either intraperitoneally or intragastrically to male Hartley guinea-pigs was investigated. Two animals received a constant infusion of [24-14C]deoxycholate through an intraperitoneal catheter for 2 hr. Bile was quantitatively collected in 30 min samples during infusion and for 2 additional hours. Each bile sample was analyzed for composition and radioactivity. Five animals received for 15 days, through an intragastric catheter, 35 mg/kg/day of deoxycholate. The biliary bile acid composition was compared with that of a sham-operated control group. The studies with both animal models indicated that guinea-pigs, as the only species so far known, extensively oxidize deoxycholate to form 3-oxo,12 alpha-hydroxy-cholanic acid, which is secreted in bile mostly conjugated with glycine. In addition a small fraction (approx. 7%) of the administered deoxycholate is 7 alpha hydroxylated to form cholic acid. The metabolites being more hydrophilic than administered deoxycholate, it is suggested that guinea-pig liver counteracts the adverse increase in bile acids detergency, which follows deoxycholate administration, by converting most of the latter into less detergent compounds.

23-Nor-deoxycholic acid is widely used as internal standard in gas-liquid chromatographic studies of bile acids. Two batches of this compound, submitted to conventional alkaline hydrolysis of bile acid conjugates, were found to be transformed into a product with chromatographic properties different from those of ''authentic'' 23-nor-deoxycholic acid. To identify this ''new'' product a comparison was made between chromatographic properties, mass spectra, and NMR spectra of 23-nor-deoxycholic acid before and after alkaline hydrolysis. The results indicate that the ''new'' compound is the true 23-nor-deoxycholic acid while the product present in the two batches examined is a monoacetate derivative.

The cholesterol:phospholipid molar ratio, the fatty acid composition, and the distribution of individual phospholipids within erythrocyte membranes were studied in eight patients with alcoholic liver cirrhosis and seven healthy subjects. The total red cell phospholipid content was significantly (P

In this presentation, we will limit our interest to the modifications in bile acids (BA) during the course of liver cirrhosis (LC), thus excluding the behaviour in cholestasis. There is little doubt, on the other hand, that LC is the typical model of parenchymal chronic liver disease. Moreover, hepatocellular disorders and cholestatic processes are often associated in LC and thus the major points of cholestasis will also be included.

Within a cross-sectional study on the epidemiology of gallstone disease (GD) and its related factors, relation of GD to habitual dietary fat types has been investigated. Gallbladder status was assessed by ultrasound; fatty acid composition of the habitual diet was estimated by GLC of erythrocyte fatty acids. No differences in erythrocyte fatty acid composition were observed between women without gallstones, women with gallstones (aware and unaware of their condition), and women who had cholecystectomies. Multivariate analysis, including other diet-dependent and gallstone-related variables, showed no significant association between erythrocyte fatty acids and risk for gallstones. However, raised erythrocyte linoleic:saturated ratio was associated with increased risk for gallstones only in women with very low serum triglycerides. This latter finding needs further confirmation and is presently unexplainable. Our results suggest that dietary fatty acids do not play a major role in GD.

The aim of the present study was to establish whether the oral administration of bile acids with different hydrophilic properties affects the amount of phosphatidylcholine as well as the pattern of PC molecular species secreted in bile. We studied the biliary output of total and individual PC species in cholecystectomized T-tube patients, with a total biliary outflow, after oral administration of 750 mg of ursodeoxycholate (3 patients) or deoxycholate (3 patients). The latter experiments were repeated after 3 days of taurine supplementation (1500 mg daily) in order to increase, by means of the tauro-conjugation, the hydrophilicity of the secreted BA. A linear function was observed, during all the studies, between BA and PC biliary secretion, but the amount of PC secreted per mole of BA was higher for the less hydrophilic BA, such as deoxycholate, than for the more hydrophilic ursodeoxycholate or during deoxycholate plus taurine experiments. With regard to the pattern of PC molecular species, we observed no changes after administration of ursodeoxycholate. An increase in the secretion of the major polyenoic species (i.e., 16:0-18:2 and 16:0-20:4), with respect to the secretion of the monoenoic, was revealed during deoxycholate experiments. Conversely, during the deoxycholate plus taurine experiments, the secretion of the major monoenoic PC species (i.e., 16:0-18:1) increased more than that of the polyenoic species. We suggest that the observed modifications of the pattern of PC molecular species, secreted in bile, represent the result of a physicochemical effect of BA on liver membranes.

This study has been aimed at improving some steps in the gas-liquid chromatographic determination of sulfated bile acids. The best conditions for the enzymatic hydrolysis with cholylglycine hydrolase of sulfolithocholylglycine and sulfolithocholyltaurine are described. Recoveries of more than 85% were obtained after prolonging the incubation to 12 h. A single-step procedure for solvolysis and methylation of bile acids was achieved by using, as a water scavenger, 2,2-dimethoxypropane added directly to the hydrolysis mixture. This procedure avoided the difficulty of the extraction of sulfated bile acids from aqueous solutions.

Serum bile acids were determined in 13 cirrhotic patients with portacaval shunt and in 15 with mesocaval shunt. 20 nonshunted cirrhotics were used as controls. Serum bile acid levels were higher in portacaval (26.7 +/- 14.3 micrograms/ml) than in mesocaval shunt patients (16.9 +/- 8.1 micrograms/ml) and controls (14.1 +/- 11.5 micrograms/ml). The cholic/chenodeoxycholic ratio was lower after portacaval shunt than after mesocaval shunt (0.36 +/- 0.15 and 0.63 +/- 0.26, respectively). It is hypothesized that these findings may be consistent with a larger hepatic blood flow present in mesocaval shunted patients and with chenodeoxycholic absorption in the upper small intestine.