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51.
Y. Patrice Le Treut M.D. Jean Hardwigsen M.D. Pascal Ananian M.D. Jean Saïsse M.D. Emilie Grégoire M.D. Hubert Richa M.D. Pierre Campan M.D. 《Journal of gastrointestinal surgery》2006,10(6):855-862
Tumor thrombus in major vasculature is a frequent finding with a poor long-term prognosis in patients with hepatocellular
carcinoma (HCC). The utility of surgical resection is still controversial. This study compared morbidity and survival after
resection for HCC with and without tumor thrombus. Data of 108 patients who underwent major hepatic resection for HCC were
prospectively recorded. Patients were divided into two groups. The venous thrombectomy (VT) group included 26 patients who
had HCC with tumor thrombus in the portal or hepatic veins. The matched control group included 82 patients who had HCC without
tumor thrombus. Surgical technique, early outcome, and late survival were analyzed in each group. Multivariate analysis was
performed to assess the prognostic value of this feature. Surgical technique was comparable in the VT and control group with
regard to extent of hepatectomy, procedure duration, and transfusion requirements. Early postoperative outcome was also comparable.
Actuarial survival at 1, 3, and 5 years was 38%, 20%, and 13%, respectively, in the VT group (median: 9 months) versus 74%,
56%, and 33%, respectively, in the control group (median: 41 months). In the subgroup of patients with tumor thrombus limited
to the portal vein, actuarial survival at 1, 3, and 5 years was 50%, 26%, and 17%, respectively, (median: 12 months) and two
patients lived longer than 5 years. Multivariate analysis showed that incomplete resection, alphafetoprotein level greater
than 100 N, more than two tumor nodules, and tumor thrombus in major vasculature were independent factors of poor prognosis.
Survival after resection for HCC with tumor thrombus in the major vasculature is poorer than after resection for HCC without
tumor thrombus. However, an aggressive surgical strategy can provide significant survival with comparable morbidity in selected
cases, that is, tumor thrombus located in the portal vein only and expected complete resection of the lesions. 相似文献
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Isabel M. A. Brüggenwirth Maureen J. M. Werner René Adam Wojciech G. Polak Vincent Karam Michael A. Heneghan Arianeb Mehrabi Jürgen L. Klempnauer Andreas Paul Darius F. Mirza Johann Pratschke Mauro Salizzoni Daniel Cherqui Michael Allison Olivier Soubrane Steven J. Staffa David Zurakowski Robert J. Porte Vincent E. de Meijer all the other contributing centers the European Liver Intestine Transplant Association 《Transplant international》2021,34(10):1928-1937
High-risk combinations of recipient and graft characteristics are poorly defined for liver retransplantation (reLT) in the current era. We aimed to develop a risk model for survival after reLT using data from the European Liver Transplantation Registry, followed by internal and external validation. From 2006 to 2016, 85 067 liver transplants were recorded, including 5581 reLTs (6.6%). The final model included seven predictors of graft survival: recipient age, model for end-stage liver disease score, indication for reLT, recipient hospitalization, time between primary liver transplantation and reLT, donor age, and cold ischemia time. By assigning points to each variable in proportion to their hazard ratio, a simplified risk score was created ranging 0–10. Low-risk (0–3), medium-risk (4–5), and high-risk (6–10) groups were identified with significantly different 5-year survival rates ranging 56.9% (95% CI 52.8–60.7%), 46.3% (95% CI 41.1–51.4%), and 32.1% (95% CI 23.5–41.0%), respectively (P < 0.001). External validation showed that the expected survival rates were closely aligned with the observed mortality probabilities. The Retransplantation Risk Score identifies high-risk combinations of recipient- and graft-related factors prognostic for long-term graft survival after reLT. This tool may serve as a guidance for clinical decision-making on liver acceptance for reLT. 相似文献
57.
Nicola De Stefano Victor Navarro-Tableros Dorotea Roggio Alberto Calleri Federica Rigo Ezio David Alessandro Gambella Daniela Bassino Antonio Amoroso Damiano Patrono Giovanni Camussi Renato Romagnoli 《Transplant international》2021,34(9):1607-1617
Livers from donors after circulatory death (DCD) are a promising option to increase the donor pool, but their use is associated with higher complication rate and inferior graft survival. Normothermic machine perfusion (NMP) keeps the graft at 37°C, providing nutrients and oxygen supply. Human liver stem cell-derived extracellular vesicles (HLSC-EVs) are able to reduce liver injury and promote regeneration. We investigated the efficacy of a reconditioning strategy with HLSC-EVs in an experimental model of NMP. Following total hepatectomy, rat livers were divided into 4 groups: (i) healthy livers, (ii) warm ischemic livers (60 min of warm ischemia), (iii) warm ischemic livers treated with 5 × 108 HLSC-EVs/g-liver, and (iv) warm ischemic livers treated with a 25 × 108 HLSC-EVs/g-liver. NMP lasted 6 h and HLSC-EVs (Unicyte AG, Germany) were administered within the first 15 min. Compared to controls, HLSC-EV treatment significantly reduced transaminases release. Moreover, HLSC-EVs enhanced liver metabolism by promoting phosphate utilization and pH self-regulation. As compared to controls, the higher dose of HLSC-EV was associated with significantly higher bile production and lower intrahepatic resistance. Histologically, this group showed reduced necrosis and enhanced proliferation. In conclusion, HLSC-EV treatment during NMP was feasible and effective in reducing injury in a DCD model with prolonged warm ischemia. 相似文献
58.
Dimitri Sneiders Anne-Baue R. M. van Dijk Wojciech G. Polak Darius F. Mirza M. Thamara P. R. Perera Hermien Hartog 《Transplant international》2021,34(12):2534-2546
Full-left-full-right split liver transplantation (FSLT) for adult recipients, may increase the availability of liver grafts, reduce waitlist time, and benefit recipients with below-average body weight. However, FSLT may lead to impaired graft and patient survival. This study aims to assess outcomes after FSLT. Five databases were searched to identify studies concerning FSLT. Incidences of complications, graft- and patient survival were assessed. Discrete data were pooled with random-effect models. Graft and patient survival after FSLT were compared with whole liver transplantation (WLT) according to the inverse variance method. Vascular complications were reported in 25/273 patients after FSLT (Pooled proportion: 6.9%, 95%CI: 3.1–10.7%, I2: 36%). Biliary complications were reported in 84/308 patients after FSLT (Pooled proportion: 25.6%, 95%CI: 19–32%, I2: 44%). Pooled proportions of graft and patient survival after 3 years follow-up were 72.8% (95%CI: 67.2–78.5, n = 231) and 77.3% (95%CI: 66.7–85.8, n = 331), respectively. Compared with WLT, FSLT was associated with increased graft loss (pooled HR: 2.12, 95%CI: 1.24–3.61, P = 0.006, n = 189) and patient mortality (pooled HR: 1.81, 95%CI: 1.17–2.81, P = 0.008, n = 289). FSLT was associated with high incidences of vascular and biliary complications. Nevertheless, long-term patient and graft survival appear acceptable and justify transplant benefit in selected patients. 相似文献
59.
Jacopo Lanari Morten Hagness Alessandra Sartori Eugenia Rosso Enrico Gringeri Svein Dueland Umberto Cillo Pål-Dag Line 《Transplant international》2021,34(9):1722-1732
Liver transplantation (LT) for colorectal liver metastasis (CRLM) may provide excellent survival rates in patients with unresectable disease. High tumor load is a risk factor for recurrence and low overall survival (OS) after liver resection (LR). We tested the hypothesis that LT could offer better survival than LR in patients with high tumor load. LR performed at Padua University Hospital for CRLM was compared with LT for unresectable CRLM performed both at Oslo and Padua. High tumor load was defined as tumor burden score (TBS) ≥ 9, and inclusion criteria were as in the SECA-I transplant study. 184 patients were eligible: 128 LRs and 56 LTs. 5-year OS after LR and LT was 40.5% and 54.7% (P = 0.102). In the high TBS cohort, 5-year OS after LR and LT was 22.7% and 52.2% (P = 0.055). In patients with Oslo score ≤ 2 and TBS ≥ 9 (13 LR; 24 LT) the 5-year OS after LR and LT was 14.6% and 69.1% (P = 0.002). The corresponding disease-free survival (DFS) was 0% and 22.9% (P = 0.005). Selected CRLM patients with low Oslo score and high TBS could benefit from LT with survival outcomes that are far better than what is achieved by LR. 相似文献
60.
Siobhan C. McKay Hanns Lembach Angus Hann Kelvin Okoth Joy Anderton Krishnarajah Nirantharakumar Laura Magill Barbara Torlinska Matthew Armstrong Jorge Mascaro Nicholas Inston Thomas Pinkney Aaron Ranasinghe Richard Borrows James Ferguson John Isaac Melanie Calvert M. Thamara P. R. Perera Hermien Hartog 《Transplant international》2021,34(11):2122-2137
Strict isolation of vulnerable individuals has been a strategy implemented by authorities to protect people from COVID-19. Our objective was to investigate health-related quality of life (HRQoL), uncertainty and coping behaviours in solid organ transplant (SOT) recipients during the COVID-19 pandemic. A cross-sectional survey of adult SOT recipients undergoing follow-up at our institution was performed. Perceived health status, uncertainty and coping strategies were assessed using the EQ-5D-5L, Short-form Mishel Uncertainty in Illness Scale (SF-MUIS) and Brief Cope, respectively. Interactions with COVID-19 risk perception, access to health care, demographic and clinical variables were assessed. The survey was completed by 826 of 3839 (21.5%) invited participants. Overall, low levels of uncertainty in illness were reported, and acceptance was the major coping strategy (92%). Coping by acceptance, feeling protected, self-perceived susceptibility to COVID-19 were associated with lower levels of uncertainty. Health status index scores were significantly lower for those with mental health illness, compromised access to health care, a perceived high risk of severe COVID-19 infection and higher levels of uncertainty. A history of mental health illness, risk perceptions, restricted healthcare access, uncertainty and coping strategies was associated with poorer HRQoL in SOT recipients during strict isolation. These findings may allow identification of strategies to improve HRQoL in SOT recipients during the pandemic. 相似文献