Mo1017 Mothers With Chronic Liver Disease Have an Increased Risk for Preterm and Small-for-Gestational-Age Birth Knut Stokkeland, Fereshte Ebrahim, Jonas Ludvigsson, Rolf Hultcrantz, Anders Ekbom, Olof Stephansson Chronic liver diseases may affect women of child-bearing age, such as hepatitis B and C, autoimmune hepatitis, primary biliary cirrhosis and fatty liver disease. Aims: To assess the risks of complication of pregnancy and childbirth in mothers hospitalized with a chronic liver disease compared with women not hospitalized for chronic liver diseases taking maternal characteristics such as cigarette smoking into account. Methods: In a nation-wide study using the Hospital Discharge and Medical Birth Registers we investigated risk of adverse pregnancy outcome in 10 062 births in women with viral hepatitis B and/or C, 1 304 births in women with autoimmune hepatitis, 2 493 births in women with primary biliary cirrhosis and 1 515 women with fatty liver disease and compared them with population-based control births. Results: We found an increased risk for gestational diabetes in mothers with viral hepatitis 1.46 (1.21-1.77), and a low Apgar Score (<7) after 5 minutes 1.39 (1.14-1.68). There was an increased risk of preterm births in women with autoimmune hepatitis, both for very preterm, 2.28 (1.49-3.44) and moderately preterm 2.07 (1.72-2.49). Women with primary biliary cirrhosis had slightly lower risks for preterm births compared to women with autoimmune hepatitis, and an increased risk for gestational diabetes 1.95 (1-23-3-06). Women with non-alcoholic fatty liver disease had an increased risk for gestational diabetes 2.90 (1.80-4.66) and increase risk for very and moderately preterm, 2.69 (1.75-4.13) and 2.22 (1.83-2.69). Conclusions: Women with chronic liver diseases have a high risk of obstetric complication during pregnancy and delivery and should be followed carefully by obstetrician and hepatologist during their pregnancies. Mo1018 Associations Between Thromboelastography (TEG) and Severity of Cirrhosis Stephen New, Kristin Stratton, Alexander B. Benson, Kiran Bambha Background: Coagulation derangements are prominent in cirrhosis, and measures of coagulo- pathy (PT/INR) are integral components of prognostic models in cirrhosis (ie, MELD and CTP). Thromboelastography (TEG) is a dynamic assessment of clot initiation, formation and breakdown reflecting both enzymatic and cellular components of coagulation. In contrast, the widely utilized standard tests of coagulopathy, PT/INR, assess only enzymatic clot initiation. Although TEG is often used as a hemostatic index to help guide intraoperative transfusion management of liver transplant (LT) patients, associations between TEG and cirrhosis severity have not been fully investigated. Aim: To investigate associations between TEG and cirrhosis severity among patients with cirrhosis listed for LT. Methods: Data from adults (≥18 yrs) with cirrhosis listed for and undergoing LT were obtained from a single academic medical center. TEG assessment was performed at the time of LT. Pre-LT lab data and clinical events, including variceal bleeding and ascites, were extracted through detailed chart review. Cirrhosis severity was assessed using both the Stage of Cirrhosis (D'Amico. J Hep 2006) and also using the calculated MELD score at the time of LT. Results: Our analyses included 164 LT patients with TEG data. The median age was 56 yrs, 64% were male, and the median calculated MELD at LT was 25 [IQR 22-28]. With respect to liver disease etiologies, 55% had HCV; and 13% had Cholestatic liver disease (including, PSC and PBC). Increasing Stage of Cirrhosis was significantly associated with increasing hypocoagulability by TEG, as measured by the Kinetic Time (K-time: time between clot initiation and clot firmness, p= 0.04) and Maximum Amplitude (MaxAmp: maximum clot strength, p=0.001). However, there were no significant associations between MELD score at LT and any of the TEG parameters, p>0.05. In the context of disease etiology, Cholestatic liver disease had a less hypocoagulable TEG profile, with shorter K-time, greater MaxAmp, and greater Alpha Angle [rate of fibrin formation and crosslinking], compared to HCV. Conclusions: TEG S-987 AASLD Abstracts parameters are significantly associated with the clinically relevant Stage of Cirrhosis among patients listed for and undergoing LT, and may serve as more objective, clinically relevant markers of disease severity. Mo1019 Differences in Bone Mineral Density Screening Rates and Outcomes in Veteran Patients With Liver Cirrhosis Secondary to Alcohol and Hepatitis C Eliezer Weiss, Garrett Lawlor, Samy McFarlane, Ayse Aytaman Background: Osteoporosis (OP) is a common complication of chronic liver disease (CLD) and cirrhosis, leading to clinical practice recommendations for bone mineral density (BMD) screening in this vulnerable population. Since cirrhosis is a heterogenous condition resulting from multiple different etiologies, it is possible that the effects on BMD may vary based on the underlying cause of CLD. Objective: We aim to assess BMD screening rates and outcomes amongst US veterans with cirrhosis in an urban VA Medical Center among populations with hepatitis C (HCV) and alcohol (ETOH) induced liver disease. Methods: This study represents a retrospective analysis of a database, created by a search of the VA New York Harbor Health System (VA NYHHS) electronic medical software (VistA), for patients with CLD and liver cirrhosis. A chart review was performed and data was collected for patients with HCV, ETOH, and combined HCV/ETOH cirrhosis with reference to prior bone mineral density testing in the form of dual energy x ray absorptiometry (DXA) of the hip and spine. The presence of osteoporosis and osteopenia was based on the lowest t-scores noted for the total lumbar spine, the femoral neck, or the total hip. Statistical analysis, including Mann-Whitney U test and chi-squared test for statistical significance, and calculation of odds ratios was performed using GraphPad Prism (La Jolla, Ca.). Results: Overall, 603 patients were included in the analysis, over 95% of which were male. Of these 338 had HCV cirrhosis, 145 had ETOH cirrhosis, and 120 had combined HCV/ETOH cirrhosis. The mean age among patients undergoing DXA scan was 61.7 (SEM +/- 0.5), with no significant difference noted between the groups. Of the total population, 177 patients (29.4%) had ever had a DXA scan. Patient's with ETOH cirrhosis were less likely to have had a DEXA scan when compared to either patients with HCV cirrhosis [odds ratio (OR) 0.41 (CI 95% 0.25-0.66)] or patients with combined HCV/ETOH [OR 0.37 (CI 95% 0.21-0.66)]. The median t-score for patients with combined HCV/ETOH cirrhosis was -1.7, which was significantly lower than -1.1 for HCV cirrhotics, and -0.95 for ETOH cirrhotics (p-values of 0.007 and 0.012, respectively). Patients with combined HCV/ETOH cirrhosis had greater odds of having osteoporosis than those with HCV alone (OR 4.1, CI 95% 1.3-12.7). Conclusion: Rates of screening for OP in our cohort of cirrhotics was suboptimal, representing less than one-third of the target population. This was particularly true of patients among the ETOH sub-population, possibly due to poor compliance, inadequate follow-up, and physician under-recognition of advanced disease. The combination of HCV and ETOH leading to cirrhosis appears to place patients at particular risk for low BMD and OP, which may be due to both liver related, as well as non-liver related factors. Mo1020 Minimal Hepatic Encephalopathy (MHE) in Post Liver Transplant Population in a Multi-Center Study Using Phes and Ict Sanath Allampati, Anthony B. Post, Adam Perzynski, Ravi K. Prakash, Kevin D. Mullen Prior studies have obtained mixed results in studying minimal Hepatic Encephalopathy (MHE) in patients after orthotopic liver transplantation. Recovery in cognitive function was observed but residual cognitive function abnormalities were noted more so in patients who had history of overt Hepatic Encephalopathy (OHE) before transplant. Most of the studies were done within the first year after transplant and long term follow up was not done and ICT (Inhibitory Control Test) was not used for testing post transplant patients in those studies. Objectives: To look for effects of factors on cognitive function in post transplant patients including history of OHE before transplant, time lag from transplant and immuno- suppressive medications in a multi-center cross sectional study and to use ICT to test post transplant patients for MHE. Methods: 104 healthy controls were tested with Psychometric Hepatic Encephalopathy Score (PHES), 105 Cirrhotics and 20 post transplant patients were tested with PHES and ICT at two medical centers in Cleveland, Ohio. Patients with age adjusted mean scores >4SD poorer than healthy controls on PHES (>2SD in two or more tests) were diagnosed with MHE. For ICT, a lure count of 14 was derived as the cut off for diagnosis of MHE by testing healthy controls and Cirrhotics in Cleveland which is same as the cut off obtained by researchers in India and Italy. Results: Out of the 20 post transplant patients, testing with PHES showed that only 2 patients or 10% tested positive for MHE. Patients with history of OHE before transplant did as well as those without history of OHE (Table 1). Post transplant patients (regardless of OHE history) did as well as the healthy controls and better than Cirrhotics (Table 1). The patients were anywhere from 3 months to 20 years away from transplant with 90% in the 3 to 12 year range. Gender and time since transplant were not associated with a significant effect on cognitive function on PHES. Using ICT lure cut off of 14, 9 patients or 45% had MHE which is significantly higher when compared to PHES results. Conclusion: In this small study, cognitive function after liver transplantation in patients with or without history of OHE was more comparable to that of healthy peers than that of Cirrhotics. The vast majority of post transplant patients screened negative for MHE. ICT has lower specificity when compared to PHES in diagnosing MHE. The reason for this finding is not clear. Further studies are needed to replicate these results and to clarify the influence of important covariates such as long term effect of immunosuppressant type on cognitive function. Table 1.Comparison of Post Transplant patient Cognitive Test Results with Healthy Controls and Cirrhotics AASLD Abstracts