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Maroni L, Musa N, Ravaioli M, Dondossola DE, Germinario G, Sulpice L, Cescon M, Rossi GE, Boudjema K. NORMOTHERMIC WITH OR WITHOUT HYPOTHERMIC OXYGENATED PERFUSION FOR DCD BEFORE LIVER TRANSPLANTATION: EUROPEAN MULTI-CENTRIC EXPERIENCE. Clin Transplant 2021; 35:e14448. [PMID: 34363412 DOI: 10.1111/ctr.14448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/19/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
Grafts from donors with cardiac death (DCD) are subject to warm ischemia time (WIT) due to the no-touch-period (20 min. in Italy and 5 min. in France). These livers (LT) have higher rates of early allograft dysfunction (EAD), primary non-function (PNF), and ischemic cholangiopathy (IC) compared to LT from brain dead donors (DBD). Normothermic regional perfusion (NRP) is a beneficial strategy to mitigate organ damage; a further approach is the application of ex-vivo hypothermic oxygenated perfusion (HOPE) after cold storage (CS). We retrospectively analyzed LTs performed from 2016 to 2019 at three transplant centers using NRP-DCD grafts: Bologna and Milan treated with HOPE (group A), Rennes preserved using CS (group B). No-flow period, total and functional WIT were significantly higher in group A than in group B (30.5±7.7 vs. 20.5±4.1; 56.5±20.4 vs. 39.1±21.6; 41.9±12.5 vs. 25.5±3.7; respectively, p<0.05), without differences in the postoperative course. In particular, the two groups had similar rates of EAD (21.1%vs.25.0%), PNF (5.3%vs.6.3%), IC (0%vs.12.5%, p = 0.112) and non-IC biliary complications (0%vs.6.3%, p = 0.457), re-LT (10.5%vs.12.5%). This occurred despite a high rate of UK DCD risk score >10 (63.2% A vs.17.6% B, p = 0.000) which theoretically would make a large number of these transplants "futile". In conclusion, Italian and French groups had similar post-LT outcomes, probably related to the use of HOPE after CS in the case of long WIT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lorenzo Maroni
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Nicola Musa
- Department of HBP and GI Surgery, Hôpital Pontchaillou, Université de Rennes, Rennes, France
| | - Matteo Ravaioli
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Daniele Eliseo Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Giuliana Germinario
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Laurent Sulpice
- Department of HBP and GI Surgery, Hôpital Pontchaillou, Université de Rennes, Rennes, France
| | - Matteo Cescon
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giorgio Ettore Rossi
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy
| | - Karim Boudjema
- Department of HBP and GI Surgery, Hôpital Pontchaillou, Université de Rennes, Rennes, France
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Nomura A, Ishigami M, Honda T, Kuzuya T, Ishizu Y, Ito T, Kamei H, Onishi Y, Ogura Y, Fujishiro M. Limitation of non-transplant treatment and proper timing for liver transplantation in patients with hepatocellular carcinoma considering long-term survival. Medicine (Baltimore) 2020; 99:e21161. [PMID: 32664152 PMCID: PMC7360274 DOI: 10.1097/md.0000000000021161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In this study, we investigated the long-term survival of patients with hepatocellular carcinoma (HCC) after conventional treatment other than liver transplantation (LT) in our institute and discuss the limitation of non-transplant treatment for HCC and the proper indictors of LT in the recent comprehensive era.Between 2003 and 2016, 181 patients with HCC aged ≦70 years received active treatment including liver resection, radiofrequency ablation (RFA), and transcatheter arterial chemoembolization (TACE). We analyzed the factors associated with overall survival and proposed new priority for the indicators of LT in HCC patients according to the extracted factors by comparing the survival with 39 transplanted patients with HCC.Child-Turcotte-Pugh (CTP) score (HR: 1.276; 95% CI: 1.049-1.552, P = .015), and number of tumors (HR: 1.238; 95% CI: 1.112-1.377, P < .001) were selected as significant factors associated with the survival after active treatments for HCC. Patients with LT had significantly better long-term survival compared with those with non-transplant patients regardless of aforementioned factors. However, regarding relatively short survival (3 years), patients with CTP score of ≧9 and/or ≧3 tumors with non-transplant treatment had poorer survival compared with those of transplanted patients (P < .05).We propose that CTP score of 9 and/or 3 tumors before non-transplant, intensive treatment might be a new priority for considering indicators of LT in patients with HCC.
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Affiliation(s)
- Aya Nomura
- Department of Gastroenterology and Hepatology
| | | | | | | | - Yoji Ishizu
- Department of Gastroenterology and Hepatology
| | | | - Hideya Kamei
- Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Yasuharu Onishi
- Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Yasuhiro Ogura
- Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan
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Cucchetti A, Serenari M. Efficacy of radiofrequency ablation of hepatocellular carcinoma prior to liver transplantation and the need for competing-risk analysis. Hepatobiliary Surg Nutr 2018; 7:294-296. [PMID: 30221158 DOI: 10.21037/hbsn.2018.04.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Serenari
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Daher S, Massarwa M, Benson AA, Khoury T. Current and Future Treatment of Hepatocellular Carcinoma: An Updated Comprehensive Review. J Clin Transl Hepatol 2018; 6:69-78. [PMID: 29607307 PMCID: PMC5863001 DOI: 10.14218/jcth.2017.00031] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/07/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is among the leading causes of cancer-related mortality. The principal treatment is surgical resection or liver transplantation, depending on whether the patient is a suitable transplant candidate. However, in most patients with HCC the diagnosis is often late, thereby excluding the patients from definitive surgical resection. Medical treatment includes sorafenib, which is the most commonly used systemic therapy; although, it has been shown to only minimally impact patient survival by several months. Chemotherapy and radiotherapy are generally ineffective. Due to the poor prognosis of patients with HCC, newer treatments are needed with several being in development, either in pre-clinical or clinical studies. In this review article, we provide an update on the current and future medical and surgical management of HCC.
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Affiliation(s)
- Saleh Daher
- Gastroenterology and Liver Units, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Muhammad Massarwa
- Gastroenterology and Liver Units, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ariel A. Benson
- Gastroenterology and Liver Units, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tawfik Khoury
- Gastroenterology and Liver Units, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- *Correspondence to: Tawfik Khoury, Institute of Gastroenterology and Liver diseases, Hebrew University-Hadassah Medical Center, P.O.B. 12000, Jerusalem IL-91120, Israel. Tel: +972-509870611, E-mail:
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Akamatsu N, Cillo U, Cucchetti A, Donadon M, Pinna AD, Torzilli G, Kokudo N. Surgery and Hepatocellular Carcinoma. Liver Cancer 2016; 6:44-50. [PMID: 27995087 PMCID: PMC5159722 DOI: 10.1159/000449344] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The optimal surgical strategy for hepatocellular carcinoma (HCC) is under active debate. Bio-markers of the liver functional reserve as well as volumetric analysis of the future liver remnant are essential for safe liver resection of HCC. The present algorithms applied to surgical strategies for HCC are not ideal because many patients who could potentially undergo safe resection are deemed liver transplant candidates in Western countries, whereas the opposite is the case in Eastern countries. In addition, there is too much focus on expanded criteria for patients with HCC to undergo liver transplantation. The transplantation benefit for patients with HCC should be considered based not only on the individual's benefit, but also on the effect of other patients waiting for LT for other indications.
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Affiliation(s)
- Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Organ Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Umberto Cillo
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera, Università di Padova, Padova, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, DIMEC; S. Orsola, Malpighi Hospital; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Donadon
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas University and Humanitas Research Hospital, Milan, Italy
| | - Antonio Daniele Pinna
- Department of Medical and Surgical Sciences, DIMEC; S. Orsola, Malpighi Hospital; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas University and Humanitas Research Hospital, Milan, Italy
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Organ Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan,*Norihiro Kokudo, MD, PhD Hepato-Pancreatico-Biliary Surgery Division, and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan), Tel. +81 3 5800 8841, E-Mail
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Comment on: 'Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade'. Br J Cancer 2016; 115:e5. [PMID: 27336607 PMCID: PMC4997540 DOI: 10.1038/bjc.2016.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Cucchetti A, Ross LF, Thistlethwaite JR, Vitale A, Ravaioli M, Cescon M, Ercolani G, Burra P, Cillo U, Pinna AD. Age and equity in liver transplantation: An organ allocation model. Liver Transpl 2015; 21:1241-9. [PMID: 26174971 DOI: 10.1002/lt.24211] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 01/29/2023]
Abstract
A moral liver allocation policy must be fair. We considered a 2-step, 2-principle allocation system called "age mapping." Its first principle, equal opportunity, ensures that candidates of all ages have an equal chance of getting an organ. Its second principle, prudential lifespan equity, allocates younger donor grafts to younger candidates and older donors to older candidates in order to increase the likelihood that all recipients achieve a "full lifespan." Data from 2476 candidates and 1371 consecutive adult liver transplantations (from 1999 to 2012) were used to determine whether age mapping can reduce the gap in years of life lost (YLL) between younger and older recipients. A parametric Weibull prognostic model was developed to estimate total life expectancy after transplantation using survival of the general population matched by sex and age as a reference. Life expectancy from birth was calculated by adding age at transplant and total life expectancy after transplantation. In multivariate analysis, recipient age, hepatitis C virus status, Model for End-Stage Liver Disease score at transplant of >30, and donor age were significantly related to prognosis after surgery (P < 0.05). The mean (and standard deviation) number of years of life from birth, calculated from the current allocation model, for various age groups were: recipients 18-47 years (n = 340) = 65.2 (3.3); 48-55 years (n = 387) = 72.7 (2.1); 56-61 years (n = 372) = 74.7 (1.7) and for recipients >61 years (n = 272) = 77.4 (1.4). The total number of YLL equaled 523 years. Redistributing liver grafts, using an age mapping algorithm, reduces the lifespan gap between younger and older candidates by 33% (from 12.3% to 8.3%) and achieves a 14% overall reduction of YLL (73 years) compared to baseline liver distribution. In conclusion, deliberately incorporating age into an allocation algorithm promotes fairness and increases efficiency.
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Affiliation(s)
- Alessandro Cucchetti
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lainie Friedman Ross
- Departments of Pediatrics, University of Chicago, Chicago, IL.,Departments of Surgery, University of Chicago, Chicago, IL.,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
| | - J Richard Thistlethwaite
- Departments of Surgery, University of Chicago, Chicago, IL.,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
| | - Alessandro Vitale
- Departments of General Surgery and Organ Transplantation, Hepatobiliary Surgery and Liver Transplant Unit, University of Padua, Padua, Italy
| | - Matteo Ravaioli
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Patrizia Burra
- Departments of Surgery, Oncology, and Gastroenterology, Multivisceral Transplant Unit, University of Padua, Padua, Italy
| | - Umberto Cillo
- Departments of General Surgery and Organ Transplantation, Hepatobiliary Surgery and Liver Transplant Unit, University of Padua, Padua, Italy
| | - Antonio Daniele Pinna
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Yang LS, Shan LL, Saxena A, Morris DL. Liver transplantation: a systematic review of long-term quality of life. Liver Int 2014; 34:1298-313. [PMID: 24703371 DOI: 10.1111/liv.12553] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Liver transplantation is the only curative intervention for terminal liver disease. Accurate long-term quality of life (QOL) data are required in the context of improved surgical outcomes and increasing post-transplant survival. This study reviews the long-term QOL after primary liver transplantation in adult patients surviving 5 or more years after surgery. METHODS A literature search was conducted on PubMed for all studies matching the eligibility criteria between January 2000 and October 2013. Bibliographies of included studies were also reviewed. Two authors independently performed screening of titles and abstracts. Consensus for studies included for review was achieved by discussion between authors based on predetermined eligibility criteria. Quality appraisal and data tabulation were performed using predetermined forms. Results were synthesized by narrative review. RESULTS Twenty-three studies (5402 patients) were included. QOL following liver transplantation remains superior to preoperative status up to 20 years post-operatively. More post-operative complications predicted worse QOL scores especially in physical domains. Benefits in functional domains persist long-term with independence in self-care and mobility. Employment rates recover in the short-term but decline after 5 years, and differ significantly between various aetiologies of liver disease. Overall QOL improves to a similar level as the general population, but physical function remains worse. Participation in post-operative physical activity is associated with superior QOL outcomes in liver transplant recipients compared to the general population. QOL improvements are similar compared to lung, kidney and heart transplantation. Heterogeneity between studies precluded quantitative analysis. CONCLUSIONS Liver transplantation confers specific long-term QOL and functional benefits when compared to preoperative status. This information can assist in providing a more complete estimate of the overall health of liver transplant recipients and the effectiveness of surgery. Guidelines for future studies are provided.
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Affiliation(s)
- Linda S Yang
- Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia
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