1
|
Magand N, Coronado JL, Drevon H, Manichon A, Mabrut J, Mohkam K, Ducerf C, Boussel L, Rode A. Primary angioplasty or stenting for hepatic artery stenosis treatment after liver transplantation. Clin Transplant 2019; 33:e13729. [DOI: 10.1111/ctr.13729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Nicolas Magand
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - José Luis Coronado
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Harir Drevon
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Anne‐Frédérique Manichon
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Jean‐Yves Mabrut
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Kayvan Mohkam
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Christian Ducerf
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Loïc Boussel
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Agnès Rode
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| |
Collapse
|
2
|
Mourad M, Mabrut JY, Chellakhi M, Lesurtel M, Prevost C, Ducerf C, Rode A, Merle P, Mornex F, Mohkam K. Neoadjuvant conformal radiotherapy before liver transplantation for hepatocellular carcinoma: a propensity score matched analysis of postoperative morbidity and oncological results. Future Oncol 2019; 15:2517-2530. [DOI: 10.2217/fon-2019-0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To assess neoadjuvant conformal radiotherapy (CRT) before orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) not suitable for standard locoregional treatments. Methods: Patients undergoing OLT for HCC with or without prior CRT were compared using 1:3 propensity score matching. Results: After propensity score matching, 23 patients with CRT were compared with 66 control subjects. Severe morbidity rate was 34.8 versus 24.2% in the CRT and non-CRT groups (p = 0.289). Complete pathological response was observed in 47.8% of CRT-targeted nodules. The 1-/3-/5-year disease-free survivals were 77.3, 77.3 and 68.7% in the CRT group versus 85.4, 68.0 and 61.7% in the non-CRT group (p = 0.829). Conclusion: Conformal radiotherapy represents a satisfactory neoadjuvant therapy for OLT candidates not suitable for standard HCC locoregional therapies.
Collapse
Affiliation(s)
- Mohamed Mourad
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
- Ecole Doctorale Biologie Moléculaire Intégrative et Cellulaire (BMIC), Claude Bernard Lyon 1 University, Lyon, France
- Department of General & Digestive Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jean-Yves Mabrut
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Madiha Chellakhi
- Department of Oncology & Radiotherapy, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Mickaël Lesurtel
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Célia Prevost
- Department of Oncology & Radiotherapy, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Christian Ducerf
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Agnès Rode
- Department of Radiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Philippe Merle
- Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Françoise Mornex
- Department of Oncology & Radiotherapy, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Kayvan Mohkam
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unit U1052, Cancer Research Center of Lyon, Lyon, France
| |
Collapse
|
3
|
Use of Systemic Vasodilators for the Management of Doppler Ultrasound Arterial Abnormalities After Orthotopic Liver Transplantation. Transplantation 2016; 100:2671-2681. [DOI: 10.1097/tp.0000000000001450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
4
|
Navez J, Golse N, Bancel B, Rode A, Ducerf C, Mezoughi S, Mohkam K, Mabrut JY. Traumatic biliary neuroma after orthotopic liver transplantation: a possible cause of “unexplained” anastomotic biliary stricture. Clin Transplant 2016; 30:1366-1369. [DOI: 10.1111/ctr.12802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Julie Navez
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Nicolas Golse
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Brigitte Bancel
- Department of Pathology; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Agnès Rode
- Department of Radiology; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Salim Mezoughi
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
- Université Claude Bernard Lyon 1; EMR 3738, EDISS 205 Lyon France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
- Université Claude Bernard Lyon 1; EMR 3738, EDISS 205 Lyon France
| |
Collapse
|
5
|
Mabrut JY, Abdullah SS, Rode A, Bourgeot JP, Eljaafari A, Baulieux J, Ducerf C. Cryopreserved iliac artery allograft for primary arterial revascularization in adult liver transplantation. Clin Transplant 2011; 26:E12-6. [PMID: 21919967 DOI: 10.1111/j.1399-0012.2011.01518.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arterial allograft represents a material of choice for primary arterial revascularization in liver transplantation (LT) when interposition of a vascular conduit is required. In case of non-availability of such graft, the use of cryopreserved vessels should be an interesting option. Three patients were grafted using a cryopreserved iliac artery allograft (CIAA) previously harvested and stored at -140°C in a tissue bank. An auxiliary partial LT was performed in one patient for acute liver failure. During follow-up, an efficient regeneration of the native hemi-liver was observed while atrophy of the auxiliary graft occurred, leading to functional portal vein and hepatic artery thrombosis at six and nine months, respectively. Two other patients presented with celiac trunk compression because of arcuate ligament without available arterial allograft in the donor. Late arterial thrombosis occurred at six months in one patient without impairment of graft function. The last patient was alive and symptom free 29 months after LT with a patent cryopreserved arterial conduit. Our preliminary results suggest that CIAA might represent an efficient solution as vessel interposition for primary arterial hepatic revascularization in LT setting when no other suitable graft is available. However, long-term patency of CIAA remains questionable.
Collapse
Affiliation(s)
- Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon Cedex, France.
| | | | | | | | | | | | | |
Collapse
|
6
|
McNamara MM, Lockhart ME, Robbin ML. Emergency Doppler evaluation of the liver and kidneys. Radiol Clin North Am 2004; 42:397-415. [PMID: 15136024 DOI: 10.1016/j.rcl.2003.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Doppler ultrasound is useful in the emergent evaluation of the liver and kidney transplant patient. Arterial stenosis, pseudoaneurysm, and venous thrombosis are treatable causes of allograft failure that can be detected easily with color and spectral Doppler. Doppler has a limited but important role in the emergent evaluation of the native liver and kidneys, usually involving prior biopsy or instrumentation.
Collapse
Affiliation(s)
- Michelle M McNamara
- Abdominal Imaging Section, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 353, Birmingham, AL 35249-6830, USA.
| | | | | |
Collapse
|
7
|
Uchiyama H, Hashimoto K, Hiroshige S, Harada N, Soejima Y, Nishizaki T, Shimada M, Suehiro T. Hepatic artery reconstruction in living-donor liver transplantation: a review of its techniques and complications. Surgery 2002; 131:S200-4. [PMID: 11821811 DOI: 10.1067/msy.2002.119577] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hepatic arterial reconstruction is one of the most difficult procedures in living-donor liver transplantation (LDLT) because the artery used is generally small in diameter and has a short stalk. If hepatic artery thrombosis (HAT) occurs, the recipient clinical course will be unstable. The introduction of microvascular hepatic arterial reconstruction has significantly decreased the incidence of HAT. METHODS Fifty-two cases of LDLT were performed from October 1995 to May 2001 in our institution. Hepatic arterial reconstruction was performed under microscopic guidance. RESULTS HATs were recognized in 2 cases (3.8%), both of which needed reoperation. CONCLUSIONS Surgeons who perform hepatic arterial reconstruction in LDLT should be highly trained in microvascular techniques to decrease the incidence of HAT. This commentary reviews the surgical techniques of hepatic arterial reconstruction and possible complications that may arise in a reconstructed hepatic artery.
Collapse
Affiliation(s)
- Hideaki Uchiyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Maceneaney PM, Malone DE, Skehan SJ, Curry MP, Miller JC, Gibney RG, Traynor O, Mccormick PA. The role of hepatic arterial Doppler ultrasound after liver transplantation: an 'audit cycle' evaluation. Clin Radiol 2000; 55:517-24. [PMID: 10924374 DOI: 10.1053/crad.1999.0486] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To compare the diagnostic performance of hepatic arterial (HA) Doppler ultrasound post-liver transplantation for hepatic artery thrombosis and stenosis in our unit with the literature. To evaluate the role of the technique in clinical practice. MATERIALS AND METHODS In a two-phase 'audit cycle' study, adult OLT patients had Doppler studies comprising detection of HA flow and measurements of peak systolic velocity, resistive index and systolic acceleration time. In phase I, patients had Doppler examinations 'routinely' and for any hepatic biochemical abnormality. In phase II, Doppler ultrasound was performed early post-OLT and later only if a senior transplant clinician suspected graft ischaemia. In addition to HA measurements the waveform was visually assessed. Clinical outcome was the 'gold standard'. RESULTS Phase 1: 38 patients, 40 OLT operations, 125 Doppler studies; 14 arteriograms. Phase 2: 35 patients, 42 OLT operations, two HA angioplasties, one HA revision, one non-occlusive thrombus, 140 studies; 17 arteriograms. Results; Phase 1 [Phase 2]: sensitivity 80% [100%]; specificity 71% [81%]; PPV 28% [56%]; NPV 96% [100%]; incidence of HA abnormality 12.5% [19. 5%]; likelihood ratio of negative result 0.28 [0]; of positive result 2.8 [5.3]. CONCLUSION Previously reported results are reproducible. Normal HA waveform should also be a criterion of normality. The technique is very sensitive but relatively non-specific. Predictive values improve with discriminate use. MacEneaney, P. M. (2000). Clinical Radiology55, 517-524.
Collapse
Affiliation(s)
- P M Maceneaney
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Ducerf C, Mechet I, Landry JL, DeLaRoche E, Berthoux N, Bourdeix O, Adham M, Bizollon T, Baulieux J. Hemodynamic profiles during piggyback liver grafts using arterial or portal revascularization. J Am Coll Surg 2000; 190:89-93. [PMID: 10625238 DOI: 10.1016/s1072-7515(99)00227-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The order of revascularization in human liver grafts is still discussed. This study tries to answer this question in terms of hemodynamic data. STUDY DESIGN Fifty-nine patients were randomized in this study to compare hemodynamic data just before and 15 minutes after revascularization of liver grafts in relation to first hepatic artery (n = 29) or first portal vein (n = 30) revascularization procedure. RESULTS Hemodynamic variations were significantly greater in the portal vein group than in the hepatic artery group in terms of mean arterial pressure, cardiac index, central venous pressure, pulmonary capillary pressure, and systemic vascular resistance. The latter decreased from 741.8 +/- 390.3 to 659.9 +/- 411.1 dynes/ cm5 (NS) in the hepatic artery group versus 807.7 +/-336.7 to 439.7 +/- 215 dynes/cm5 (p < 0.05) in the portal vein group. Clinical results and postoperative complications, graft characteristics, patient survival, and graft survival were not significantly different between the groups. CONCLUSIONS Initial arterial revascularization of the liver graft leads to a more stable hemodynamic profile during revascularization of the liver graft after vascular unclamping. This technique is always feasible and has become our reference procedure.
Collapse
Affiliation(s)
- C Ducerf
- Department of Digestive Surgery and Transplantation, Croix-Rousse Hospital, Lyon, France
| | | | | | | | | | | | | | | | | |
Collapse
|