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An Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient, with return of results in clinical timescales. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis. We examined four sources of evidence for the effect of warfarin on stroke risk (efficacy) or all-cause mortality (safety) from: (i) randomised controlled trials (RCTs), (ii) meta- analysis of prior observational studies, (iii) trial emulation (using population electronic health records (N = 3,854,710) and (iv) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems. We found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61) and ischaemic stroke (HR = 0.27). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results within clinical timescales.

Poster discussion hub abstracts from biparietal diameter and abdominal circumference using the eSnurra algorithm. Mean fetal weight gain/day was calculated as the difference between birthweight and estimated fetal weight in the second trimester, and thereafter related to the remaining days in pregnancy from the ultrasound examination to delivery. Results: We observed a significant association between mean flow calculated from PixelFlux and weight gain/day (r =0.33; p =0.02) as presented in the Figure. The correlations remained significant after adjusting for maternal age, BMI, parity and systolic blood pressure (p =0.01 and p =0.02, respectively). Conclusions: We found a significant association between total blood flow based on PixelFlux and fetal weight-gain/day. The PixelFlux method might be a promising tool in predicting birthweight.Supporting information can be found in the online version of this abstract P21.08 Diagnosis of metabolic risk during pregnancy by body mass index (BMI): does a better method exist? Preliminary results

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AimsABO incompatible renal transplantation has been reported as a successful form of renal replacement therapy in children and adults. Antibody removal is required with options of B lymphocyte depletion with splenectomy, plasma exchange, double filtration plasmapheresis or immunoadsorption.MethodsTo report the successful outcome of ABO incompatible renal transplantation using quadruple immunosuppression (basiliximab at days 0 and 4, mycophenolate mofetil and tacrolimus from one week pretransplantation and corticosteroids) with only B lymphocyte depletion (intravenous rituximab 375 mg/m2 at one month pretransplantation). A 14-year-old young man received a living related renal transplantation from his mother for end-stage renal failure (ESRF) on haemodialysis for steroid resistant nephrotic syndrome due to focal and segmental glomerulosclerosis (FSGS) who had a living related renal transplant from his father 18 months previously, which had failed due to a vascular event.ResultsThe recipient and donor (mother) blood groups were A and B Rhesus positive, respectively, with anti-B titres of one in four rising to one in eight pretransplantation. His renal transplant was performed successfully without further antibody removal or surgical complications and immediate renal allograft function. Three months posttransplant his renal function has stabilised with a plasma creatinine of 114μmol/l giving an estimated glomerular filtration rate of 62 ml/min/1.73 m2. He does not have clinical evidence of recurrent FSGS posttransplantation (normal serum albumin levels without albuminuria) with negative anti-B titres and donor specific antibodies and no evidence of EBV, BK or CMV viraemia (having required oral valganciclovir as CMV mismatch). He had a normal transplant renal biopsy at ten days post-transplant without evidence of acute rejection and one focal segmental sclerotic lesion seen on protocol biopsy at three months.ConclusionIn view of the reported success of ABO incompatible renal transplantation, clinicians must consider this option in ESRF patients whose parents have been excluded as living donors in view of ABO blood group incompatibility.

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