Early intervention and novel strategies to target improvement in muscle mass while preventing excessive weight gain and central obesity in the first year of transplantation is recommended for this unique patient population. JA THOMAS,1 A RAJ,1 U CHELVARATNAM,1 M BLACK,1 C TALLIS,1 G HOLTMANN,1 J FAWCETT,2 KA STUART1 1Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, 2Department of Surgery. Princess Alexandra Hospital, Brisbane, Queensland Background and Aim: Novel, non-invasive biomarkers to assess liver function and predict clinical outcomes are urgently needed. BAY 80-6946 datasheet Hepatocellular carcinoma (HCC)

is the fifth most common malignancy worldwide and often occurs in cirrhosis. Surgical resection of HCC is a potentially curative treatment option, however it has the capacity to cause hepatic decompensation. This represents an experimental paradigm to study the ability of novel biomarkers to predict liver decompensation following a well defined insult. No single test currently in clinical use offers reliable risk stratification. This study aims to assess the clinical utility of 13C methacetin breath

test (13CMBT, measure of hepatocyte microsomal function), transient elastography using FibroScan and indocyanine green (ICG) clearance (measure of liver perfusion and excretory function) in predicting hepatic decompensation in patients undergoing liver resection. Methods: 13CMBT, FibroScan and ICG clearance were prospectively measured in 105 patients being assessed Protease Inhibitor Library for liver resection. Patient demographics, clinical and laboratory data were recorded including Child-Pugh Turcotte (CPT) and Model for End-Stage Liver Disease (MELD) scores. 23 patients had surgery. Post-operative hepatic decompensation was determined by biochemical (elevation in bilirubin or INR) and clinical (ascites, encephalopathy) parameters. 2 tailed P values <0.05* or <0.01** were considered statistically significant. Results: There was a significant correlation between 13CMBT, FibroScan and ICG clearance with serum bilirubin (R = −0.43**, 0.21*, 0.42**) and albumin levels (R = 0.37**, −0.41**,

−0.72**), respectively. Sulfite dehydrogenase Only ICG clearance associated with INR (R = 0.26*). Both CPT (R = −0.44**, 0.46**, 0.68**) and MELD scores (R = −0.2 [p = 0.08], 0.28*, 0.38**) correlated with these biomarkers. ICG clearance correlated with FibroScan (R = 0.5**) and 13C MBT (R = −0.55**) as did FibroScan with 13CMBT (R = −0.38**). Receiver operating characteristic (ROC) curve plots were used to assess the performance of these tests in predicting post-operative liver decompensation. The areas under the curve (AUROC) for CPT score (0.46) and MELD (0.55) offered limited clinical utility compared to ICG (0.78). Multivariate analysis was used to control for duration of surgery and weight of resected liver; 13CMBT was strongly associated with post-operative decompensation (R = 0.68*).