Table 1: Cirrhosis severity and microbiota changes in patients with TIPS Su1089 DISRUPTION OF THE INTESTINAL BARRIER AGGRAVATES IMMUNE- MEDIATED HEPATITIS Hongxia Zhang, Zhou Lu, Bangmao Wang Aims: The intestinal mucosa plays an important role as a barrier between intestinal microbiota and circulatory system.This study is to analyze the role of intestinal barrier in AIH to provide a direction for explaining the pathogenesis of AIH and exploring new treatment strategies. Methods: 14 cases of AIH patients(6 without cirrhosis,8 with cirrhosis) and 10 cases of healthy controls were enrolled.The Intestinal permeability was measured by serum D-Lac,- DAO levels.The mechanical and immune intestinal barriers were measured through realtime- PCR,western blot and immunohistochemical method. 30 female BALB/c mice were randomly divided into five groups including blank group, DSS group, ConA group, DSS+ConA group, and DSS+bacteria+ConA group. Groups with DSS drink 1% DSS solution for 7 days.The DSS+bacteria+ConA group was treated with Bifidobacterium daily via gavage.Groups with ConA received ConA intravenously 12 hours before the end of the 7th day.Serum transami- nase levels, liver and intestinal HE staining and the expression of ZO-1, Occludin were measured. Results: Functional and structural changes of intestinal barrier in AIH patients:1.Compared with the healthy controls,the AIH patients without cirrhosis have higher serum D-Lac and DAO levels,and the increased level was more significant in patients with cirrhosis.2.The patients with cirrhosis have significantly lower expression of ZO-1 and Occludin in terminal ileal mucosa.The expression level of ZO-1 in patients without cirrhosis was lower.3.The number of ileal mucosal macrophages increased in AIH patients.Especially in patients with cirrhosis,the number of macrophages significantly increased.4.The expression of IL-2 and IFN-γ in patients with cirrhosis was significantly higher. While the expression of IL-10 in both cirrhosis and non-cirrhosis patients were significantly lower.5.The non- cirrhosis patients have higher TLR4 levels in ileum mucosa,and the increased level was more significant in patients with cirrhosis.6.The level of sIgA protein in patients with cirrhosis was significantly decreased. The role of intestinal barrier in the pathogenesis of ConA- induced hepatitis in mice:1.Compared with the blank group, the DSS group had lower ZO- 1 and Occludin levels only. While the ConA group had higher transaminase levels only. 2.Compared with ConA group, the DSS+ConA group had lower ZO-1 and Occludin levels, higher transaminase levels and higher liver inflammatory activity score.Compared with DSS+ConA group, the DSS+bacteria+ConA group had higher ZO-1 and Occludin levels, lower transaminase levels and the liver inflammatory activity score also decreased. Conclu- sions: This study innovatively suggested that the intestinal barrier in AIH patients was destroyed,and the damage was more significant in patients with cirrhosis.Disruption of the intestinal barrier could aggravate immune-mediated hepatitis. S-1273 AASLD Abstracts Su1090 THE ROLE OF ZONULIN IN BACTERIAL TRANSLOCATION AND IN THE PROGNOSIS OF PATIENTS WITH LIVER CIRRHOSIS John Vlachogiannakos, Dimitrios Karagiannakis, Theodoros Voulgaris, Spyros I. Siakavellas, Theodoros Angelopoulos, Georgios Karamanolis, George Papatheodoridis Background/Aim: Zonulin is a protein of the haptoglobin family, implicated in the regulation of intestinal barrier. It has been demonstrated that zonulin upregulation is associated with increased intestinal permeability in the early stage of celiac disease and in patients with type 1 diabetes. We investigated the role of zonulin in bacterial translocation and its potential role as a prognostic marker in patients with liver cirrhosis. Methods: Consecutive patients with liver cirrhosis, older than 18 years, who attended the outpatient liver clinic in a period of 6 months, were asked to participate in the study. All patients were followed-up for up to two years. Cirrhosis was diagnosed by liver biopsy, elastography, or compatible clinical, biochemical or radiological data. Serum levels of zonulin, IL-6, TNFa, and LBP were deter- mined in all patients. Clinical, laboratory and endoscopic parameters, as well as data regarding the clinical events and outcome were recorded. Results: We enrolled 42 cirrhotic patients (29M-13F), mean age (±SD): 57±12, CTP-A: 62%, CTP-B:19%, CTP-C:19%, MELD score (±SD):11.5±4. Among the studied population, 57% had decompensated cirrhosis, 43% had ascites and 29% had at least one previous episode of hepatic encephalopathy. Mean (±SD) serum zonulin levels were 35.4±10 ng/dl and were significantly higher in CTP-A patients compared to CTP-C cirrhotics (p=0.023). Mean (±SD) values of IL-6 was 2,3±3,2 pg/ml, TNF-a 15.9±6,3 pg/ml and LBP 11550±1164 c ˇg/ml. Serum levels of IL-6, TNFa and LBP were significantly higher in CTP-B/C patients compared to CTP-A (p=0.014, p=0.004 and p<0.001, respectively). Serum zonulin levels were not correlated with serum TNFa and LBP levels while an inverse correlation was found between serum zonulin and serum IL-6 levels (p=0.014). During follow-up, 11% of patients died, whereas in 5% of patients with compensated disease a decompensation event occurred. Serum zonulin levels were signifi- cantly lower in patients with negative outcome (29.8 ng/dl vs, 36.6 ng/dl, p=0.034). Conclu- sions: In this study, no clear-cut correlation between serum zonulin levels and markers of bacterial translocation was documented. However, the strong association of zonulin levels with the outcome of cirrhotic patients strengthens its possible pathophysiological role, especially in the early stages of cirrhosis, and deserves further investigation. Su1473 TECHNOLOGY UTILIZATION IN PATIENTS WITH CIRRHOSIS AND PREFERRED FEATURES OF DIGITAL HEALTH MANAGEMENT TOOLS Patricia P. Bloom, Thomas J. Wang, Bradley Green, Madeline Marx, Jasmine Ha, James Richter Background: Evidence-based guidelines have made important advances in cirrhosis care; however, many of these guidelines are not sustained in practice. Technology represents a promising tool to improve guideline compliance and health care delivery. We aimed to assess cirrhotic patients’ access to, utilization of, and comfort with technology, as well as the preferred features of a digital health management tool. Methods: We performed a mixed- methods study of cirrhotic patients with high healthcare utilization, those readmitted within 90 days for a cirrhosis-related complication. Patients were identified from the inpatient hepatology consult census. We obtained disease data from chart review and performed an in-depth semi-structured interview. Two investigators iteratively read and coded interview transcripts for themes using NVivo 11.0 (QSR International, Melbourne, Australia); 0.55 kappa agreement was achieved. Results: Of 134 cirrhotic inpatients identified from June to November 2018, 69 were readmitted within 90 days for a cirrhosis-related complication, 24 were unable to be approached and 5 refused study participation. Of the 40 participants, 26 (65%) were male, mean (SD) age was 58.4 years (11.7), with a mean (range) MELD of 22 (10-46). Thirty-one (78%) patients own a Smartphone, 15 (48%) iOS and 14 (45%) Android, and 25 (63%) patients have regular access to a computer. Smartphone apps are preferred by 23 (58%) patients, while computers are preferred by 3 (7.5%) patients. Eight (20%) patients have used a health-related Smartphone app, none specific to cirrhosis. When asked if they would use a Smartphone app daily to manage their cirrhosis, 24 (60%) reported yes, 10 (25%) no, and 6 (15%) maybe. Patients are interested in a Smartphone app that could: communicate with their physician (32, 80.0%), send medication notifications (25, 63%), transmit diagnostic results and appointment reminders (30, 75%), educate about cirrhosis (31, 78%), and offer low salt diet recipes (25, 63%). Of 25 patients with prior hepatic encephalopathy, 21 (72%) would play a Smartphone game if it detected cognitive decline. Of 22 patients with volume overload, 19 (86%) would use a Smartphone app to transmit weight data to their doctor. A range of comfort with technology was expressed (see Table for representative quotes). Common themes from qualitative data include a willingness to learn more about digital tools, a desire to learn about liver disease and communicate with providers via digital tools, and an eagerness to utilize digital tools if it could improve health. Conclusion: Among cirrhotic patients with an early readmission at our center, most have Smartphones and would be willing to use a Smartphone to manage their disease. Future technology interventions should be tailored to the specific use patterns and preferences of this population. Representative Quotes about Technology Utilization in Patients with Cirrhosis and Preferred Features of Digital Health Management Tools AASLD Abstracts