3:36 PM Abstract No. 201 Transjugular liver biopsy: safer than ever M. Sue 1 , E. Lee 1 , J. McWilliams 1 , A. Gomes 1 , J. Moriarty 1 , S. Genshaft 2 , J. Park 1 , M. Kuo 3 , S. Kee 1 ; 1 UCLA Medical Center, Los Angeles, CA; 2 UCLA Medical Center, Santa Monica, CA; 3 UCLA Medical School, Los Angeles, CA. Purpose: The purpose of this retrospective study was to investigate the overall complication rate and diagnostic yield of transjugular liver biopsy, with particular focus on patients who underwent multiple biopsies during the study period, and those with severe coagulopathy. Materials: Data on 802 transjugular liver biopsies performed from January 2009 to August 2015 were reviewed to determine the diagnostic efficacy and incidence of major and minor complications in the three-day and one-month period following the transjugular liver biopsy procedure. These biopsies were performed in 638 patients (385 male, 253 female). Demographic information, biopsy indication, and laboratory values for each biopsy were also aggregated for analysis, with a particular focus on two subgroups of patients: those who underwent multiple biopsies during the study period, and those patients at low, moderate, or high risk of coagulopathy. Results: TJLB yielded diagnostic specimens in 97.4% (781/ 802) biopsy procedures, with an overall complication rate was 9.9% (79/802). Patients who underwent multiple biopsies were at 9.9% (27/274). When patients were stratified by platelet count, patients with platelets of 0-50 had a complication rate of 11.6% (10/86), while those with platelet counts of 51-100 had a rate of 13.6% (28/206). Patients with platelet counts of 101-200 experienced complications at a rate of 7.3% (23/313), those with platelets of 201-300 had a rate of 12.2% (18/147) and patients with platets of 301 or more had a rate of 15.0% (6/40). When grouped by INR, complication rates were 7.7% (11/143) for patients with an INR between 0-1, 10.8% (67/618) for INR of 1.1-2.0, and 19.0% for those with an INR of 2.1- 3.0. No complications were observed in patients with an INR of 3.1 or more (n¼5). Conclusions: Transjugular liver biopsy is a well-tolerated procedure with a low incidence of complications and a high rate of technical success. The procedure does not have a significantly increased complication rate in patients who are severely coagulopathic (critically ill patients) or those who receive multiple biopsies. 3:45 PM Abstract No. 202 Impact of adjusting the criteria for selectivity and lateralization in adrenal vein sampling A. Gasparetto 1 , P. Darvishi 2 , C. Freeman 3 , R. Norby 4 , J. Angle 4 ; 1 University of Virginia, Baltimore, MD; 2 University of Virginia, charlottesville, VA; 3 University of Virginia, Charlottesville, VA; 4 N/A, Charlottesville, VA. Purpose: Adrenal venous sampling (AVS) is considered the gold standard for the diagnosis of unilateral versus bilateral primary aldosteronism (PA). However, questions remain about the technique and the interpretation of AVS results. Selectivity index (SI) (adrenal-peripheral cortisol ratio) and lateralization index (LI) (left-right aldosterone/cortisol ratio) thresholds determine the adequacy of adrenal vein sampling (SI) and the degree of lateralization (LI), respectively. The purpose of this study is to investigate how different cutoff values for SI and LI influence the final diagnosis. Materials: Sixty-seven successful procedures were considered. The diagnosis was originally made using “strict criteria” (SC) (SIpre-stimuli 3, SIpost-stimuli 5 and LIpre-stimuli 4, LIpost- stimuli 4). All AVS results were reinterpreted later using recommended criteria (RC) (SIpre-stimuli 2, SIpost-stimuli 3 and LIpre-stimuli 2, LIpost-stimuli 4), and permissive criteria (PC) (SIpre-stimuli 1.1 SIpost-stimuli 2 and LIpre-stimuli 2 LIpost-stimuli 2). Two sets of non-stimulated and two or more sets of stimulated samples were routinely obtained. The diagnosis were based on the majority of the samples suggesting the same diagnosis. Applying each of the above mentioned criteria, the following parameters were calculated: (1) number of adequate blood samples, (2) number of diagnostic blood samples; and (3) diagnoses obtained by applying SC, RC and PC, which were compared with the clinical diagnosis obtained from adrenal pathology reports and clinical outcomes. Results: Using SC, RC and PC 70.9% (CI: 65.2-76.2), 77% (CI:17.6-81.7) and 91.0% (CI:87.1-94.0), respectively, of the samples would have been selective and 63.8% (CI: 57.9-69.4), 72.0% (CI: 66.4-77.1) and 86.6% (CI: 83.6-91.2), respectively, would have been diagnostic. Comparing RC and PC to SC the final diagnosis would have been concordant with SC in 98.5% (CI: 91.9-100.0) and 79.1% (CI:67.4-88.1) of the cases, respectively. Conclusions: No significant differences in the diagnostic per- formance of AVS were identifiable using SC or RC. However, PC criteria would have led to a much higher rate of lateral- ization, resulting in substantially more adrenalectomies. 3:54 PM Abstract No. 203 Feasibility and efficacy of transjugular renal biopsy in patients with cirrhosis: a single centre experience A. Mukund 1 , S. Lata 2 , S. Rajesh 2 , A. Mukund 1 ; 1 Institute of Liver and Biliary Sciences, New Delhi, India; 2 N/A, N/A. Purpose: To evaluate the safety and tissue acquisition with transjugular renal biopsy (TJRB) in patients with deranged coagulation due to cirrhosis. Materials: A retrospective search of the hospital database was conducted for patients who had undergone TJRB at our institute from September 2012 to July 2015, resulting in a total of 26 patients. The indications, number of needle passes, contrast dose, tissue yield, post procedural laboratory parameters and complications were reviewed. Results: 26 patients (20 men and 6 women) with a mean age of 48 years (range 16–56 years), underwent TJRB. Indications for the procedure was deranged coagulation parameters and ascites in all (n ¼ 26) along with need for concomitant liver biopsy (n ¼ 5), or morbid obesity (n ¼ 1). The procedure was technically successful in all the patients. Scientific Session ’ JVIR S94 ’ Monday MONDAY: Scientific Sessions