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Salimi S, Pandya K, Sastry V, West C, Virtue S, Wells M, Crawford M, Pulitano C, McCaughan GW, Majumdar A, Strasser SI, Liu K. Impact of Having a Planned Additional Operation at Time of Liver Transplant on Graft and Patient Outcomes. J Clin Med 2020; 9:jcm9020608. [PMID: 32102393 PMCID: PMC7073734 DOI: 10.3390/jcm9020608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022] Open
Abstract
Advances in liver transplantation (LT) have allowed for expanded indications and increased surgical complexity. In select cases, additional surgery may be performed at time of LT rather than prior to LT due to the significant risks associated with advanced liver disease. We retrospectively studied the characteristics and outcomes of patients who underwent an additional planned abdominal or cardiac operation at time of LT between 2011–2019. An additional operation (LT+) was defined as a planned operation performed under the same anesthetic as the LT but not directly related to the LT. In total, 547 patients were included in the study, of which 20 underwent LT+ (4%). Additional operations included 10 gastrointestinal, 5 splenic, 3 cardiac, and 2 other abdominal operations. Baseline characteristics between LT and LT+ groups were similar. The median total operating time was significantly longer in LT+ compared to LT only (451 vs. 355 min, p = 0.002). Graft and patient survival, intraoperative blood loss, transfusion of blood products, length of hospital stay, and post-operative complications were not significantly different between groups. In carefully selected patients undergoing LT, certain additional operations performed at the same time appear to be safe with equivalent short-term outcomes and liver graft survival as those undergoing LT alone
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Affiliation(s)
- Shirin Salimi
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Keval Pandya
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Vinay Sastry
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Claire West
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Susan Virtue
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Mark Wells
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Michael Crawford
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Carlo Pulitano
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
| | - Geoffrey W. McCaughan
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
- Sydney Medical School, University of Sydney, Sydney NSW 2050, Australia
- Liver Injury and Cancer Program, The Centenary Institute, Sydney NSW 2050, Australia
| | - Avik Majumdar
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
- Sydney Medical School, University of Sydney, Sydney NSW 2050, Australia
| | - Simone I. Strasser
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
- Sydney Medical School, University of Sydney, Sydney NSW 2050, Australia
| | - Ken Liu
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia; (S.S.); (K.P.); (V.S.); (C.W.); (S.V.); (M.W.); (M.C.); (C.P.); (G.W.M.); (A.M.); (S.I.S.)
- Sydney Medical School, University of Sydney, Sydney NSW 2050, Australia
- Liver Injury and Cancer Program, The Centenary Institute, Sydney NSW 2050, Australia
- Correspondence: ; Tel.: +612-9515-8578
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Núñez F P, Quera P R, Gomollón F. Primary sclerosing cholangitis and inflammatory bowel disease: Intestine-liver interrelation. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:316-325. [PMID: 30948141 DOI: 10.1016/j.gastrohep.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 02/08/2023]
Abstract
The association between inflammatory bowel disease (IBD) and primary sclerosing cholangitis should be considered a distinct clinical entity. This association involves genetic abnormalities, epidemiological factors (more common in men, with no a geographical pattern) and, commonly, subclinical inflammation, predominance of the right colon (endoscopic and histological), backwash ileitis and rectal sparing. Furthermore, there is an increased risk of colorectal cancer and cholangiocarcinoma. The aim of this review is to show how IBD influences the progression of this entity, transplantation requirements and recurrence. We also discuss the current evidence on the use of biological therapy in this group of patients.
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Affiliation(s)
- Paulina Núñez F
- Fellow Programa Enfermedad Inflamatoria Universidad de Chile-Clínica Las Condes. Servicio de Gastroenterología, Hospital San Juan de Dios, Santiago, Chile.
| | - Rodrigo Quera P
- Programa Enfermedad Inflamatoria; Servicio de Gastroenterología, Clínica Las Condes, Santiago, Chile
| | - Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Ciberehd, Zaragoza, España
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Abstract
PURPOSE OF REVIEW To review the characteristics of IBD and PSC that occur in association, as well as their reciprocal influences on disease evolution, in adult and pediatric populations. RECENT FINDINGS IBD co-existing with PSC is genetically and clinically distinct from IBD alone. It is frequently characterized by pancolitis, rectal sparing, and possibly backwash ileitis, as well as a threefold increased risk of colorectal dysplasia. Adults and children with colitis and PSC appear to be at increased risk of active endoscopic and histologic disease in the absence of symptoms compared to individuals without PSC. PSC occurring with Crohn's disease has been observed to be less severe than PSC co-existing with ulcerative colitis, independent of its association with small duct disease. Recent studies suggest that colectomy is associated with a decreased risk of recurrent PSC after liver transplantation, challenging the traditional teaching that PSC and IBD evolve independently. While much about the gut-liver axis in PSC-IBD remains poorly understood, the IBD associated with PSC has a unique phenotype, of which subclinical inflammation is an important component. Additional research is needed to characterize further the potentially protective role of colectomy against recurrent PSC post-liver transplantation and to investigate the influence of IBD control and/or colectomy on PSC progression.
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Affiliation(s)
- Amanda Ricciuto
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G1X8, Canada.
| | - Binita M Kamath
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G1X8, Canada
| | - Anne M Griffiths
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G1X8, Canada
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Strasser SI. Longterm outcome of the liver graft: A clinician's perspective-recurrent disease, the universal shifting. Liver Transpl 2017; 23:S64-S69. [PMID: 28779560 DOI: 10.1002/lt.24839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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