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Lerosey L, Ksiasek E, Abrahamowicz M, Antoine C, Dharancy S, Dumortier J, Doussot A, Di Martino V, Houssel-Debry P, Conti F, Francoz C, Pageaux GP, Salame E, Faitot F, Coilly A, Hardwigsen J, Decaens T, Chermak F, Muscari F, Anty R, Duvoux C, Abergel A, Minello A, Mouillot T, Binquet C, Latournerie M. Recipient age influences survival after liver transplant: Results of the French national cohort 2007-2017. Liver Int 2024; 44:1396-1408. [PMID: 38451069 DOI: 10.1111/liv.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND In recent years, age at liver transplantation (LT) has markedly increased. In the context of organ shortage, we investigated the impact of recipient age on post-transplantation mortality. METHODS All adult patients who received a first LT between 2007 and 2017 were included in this cross-sectional study. Recipients' characteristics at the time of listing, donor and surgery data, post-operative complications and follow-up of vital status were retrieved from the national transplantation database. The impact of age on 5-year overall mortality post-LT was estimated using a flexible multivariable parametric model which was also used to estimate the association between age and 10-year net survival, accounting for expected age- and sex-related mortality. RESULTS Among the 7610 patients, 21.4% were aged 60-65 years, and 15.7% over 65. With increasing age, comorbidities increased but severity of liver disease decreased. Older recipient age was associated with decreased observed survival at 5 years after LT (p < .001), with a significant effect particularly during the first 2 years. The linear increase in the risk of death associated with age does not allow any definition of an age's threshold for LT (p = .832). Other covariates associated with an increased risk of 5-year death were dialysis and mechanical ventilation at transplant, transfusion during LT, hepatocellular carcinoma and donor age. Ten-year flexible net survival analysis confirmed these results. CONCLUSION Although there was a selection process for older recipients, increasing age at LT was associated with an increased risk of death, particularly in the first years after LT.
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Affiliation(s)
- Lea Lerosey
- Service d'Hépato-gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Elea Ksiasek
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Corinne Antoine
- Agence de Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis, France
| | - Sébastien Dharancy
- Service des maladies de l'appareil digestif, CHRU de Lille, Lille, France
- Université Lille 2 and Inserm U795, Lille, France
| | - Jérôme Dumortier
- Service d'Hépa-gastroentérologie, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Alexandre Doussot
- Service de Chirurgie Hépato-biliaire, Hôpital Jean Minjoz, Besançon, France
| | | | | | - Filomena Conti
- Service d'Hépatologie, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Claire Francoz
- Service d'hépatologie, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Ephrem Salame
- Service de chirurgie digestive et transplantation hépatique, CHU Tours, Tours, France
| | | | - Audrey Coilly
- Service d'Hépatologie, Hôpital Paul Brousse, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jean Hardwigsen
- Service de chirurgie digestive et transplantation hépatique, CHU Marseille, Marseille, France
| | - Thomas Decaens
- Service d'hépato-gastroentérologie, CHU Grenoble, Grenoble, France
| | - Faiza Chermak
- Service d'Hépato-gastro-entérologie, CHU Bordeaux, Bordeaux, France
| | - Fabrice Muscari
- Service Chirurgie Hépato-Bilio-Pancréatique et Transplantation, CHU Toulouse, Toulouse, France
| | | | | | - Armand Abergel
- Hépatologie, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - Anne Minello
- Service d'Hépato-gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Thomas Mouillot
- Service d'Hépato-gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Christine Binquet
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
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Lins PRG, Narciso RC, Ferraz LR, Pereira VG, Ferraz-Neto BH, De Almeida MD, Dos Santos BFC, Dos Santos OFP, Monte JCM, Júnior MSD, Batista MC. Modelling kidney outcomes based on MELD eras - impact of MELD score in renal endpoints after liver transplantation. BMC Nephrol 2022; 23:294. [PMID: 35999518 PMCID: PMC9400232 DOI: 10.1186/s12882-022-02912-6] [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: 08/22/2021] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute kidney injury is a common complication in solid organ transplants, notably liver transplantation. The MELD is a score validated to predict mortality of cirrhotic patients, which is also used for organ allocation, however the influence of this allocation criteria on AKI incidence and mortality after liver transplantation is still uncertain. Methods This is a retrospective single center study of a cohort of patients submitted to liver transplant in a tertiary Brazilian hospital: Jan/2002 to Dec/2013, divided in two groups, before and after MELD implementation (pre-MELD and post MELD). We evaluate the differences in AKI based on KDIGO stages and mortality rates between the two groups. Results Eight hundred seventy-four patients were included, 408 in pre-MELD and 466 in the post MELD era. The proportion of patients that developed AKI was lower in the post MELD era (p 0.04), although renal replacement therapy requirement was more frequent in this group (p < 0.01). Overall mortality rate at 28, 90 and 365 days was respectively 7%, 11% and 15%. The 1-year mortality rate was lower in the post MELD era (20% vs. 11%, p < 0.01). AKI incidence was 50% lower in the post MELD era even when adjusted for clinically relevant covariates (p < 0.01). Conclusion Liver transplants performed in the post MELD era had a lower incidence of AKI, although there were more cases requiring dialysis. 1-year mortality was lower in the post MELD era, suggesting that patient care was improved during this period.
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Affiliation(s)
- Paulo Ricardo Gessolo Lins
- Hospital Israelita Albert Einstein, São Paulo, Brazil. .,Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | - Marcelino Souza Durão Júnior
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo Costa Batista
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.,Division of Nephrology, New England Medical Center, Tufts University, Medford, MA, 02155, USA
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Artzner T, Legeai C, Antoine C, Jasseron C, Michard B, Faitot F, Schneider F, Bachellier P. Liver transplantation for critically ill cirrhotic patients: Results from the French transplant registry. Clin Res Hepatol Gastroenterol 2022; 46:101817. [PMID: 34607069 DOI: 10.1016/j.clinre.2021.101817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 02/04/2023]
Abstract
This study describes the population of cirrhotic patients who were transplanted from the ICU in France, identifying pre-transplant risk factors of post-transplant mortality and describing geographic variations in ICU transplant activity. Cirrhotic patients transplanted between 2008 and 2018 were included through the national transplant registry. The demographic, clinical and biological characteristics of the patients transplanted from the ICU were compared to cirrhotic patients who were transplanted from home or from the hospital. Risk factors of post-transplant one-year mortality were identified in uni- and multivariable analysis within the population transplanted from the ICU. Funnel plots were used to illustrate center-specific differences in ICU transplant activity. 1,047 cirrhotic patients were transplanted from the ICU during the study period. While the national rate of transplants performed from the ICU was 14.3% the absolute number and the rate of cirrhotic patients transplanted from the ICU varied significantly from one center to another, ranging from 6.6% to 22.8% (p < 0.05). Three recipient-associated independent risk factors one-year post-LT mortality were identified in the population transplanted from the ICU: age > 50 years (HR 1.65, 95%CI 1.16-2.36), p = 0.005), diabetes (HR 1.46, 95%CI 1.07-1.98, p = 0.02) and intubation (HR2.12, 95%CI 1.62-2.78), p < 0.001). Donor age was also independently associated with mortality (HR 1.01, 95%CI 1.01-1.02, p < 0.001). Funnel plots showed significant differences in the proportion of patients transplanted from the ICU and the distribution of risk factors across French transplant centers, especially the inclination to transplant intubated patients. This study underlines the increased post-transplant mortality among cirrhotic patients transplanted from the ICU. It identifies four clinically pertinent independent risk factors associated with post-transplant mortality in this specific sub-group of transplant candidates. Finally, it illustrates how diverse the landscape of liver transplantation for critically ill cirrhotic patients is across a single country, despite a unified allocation algorithm.
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4
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Ravaioli M, Lai Q, Sessa M, Ghinolfi D, Fallani G, Patrono D, Di Sandro S, Avolio A, Odaldi F, Bronzoni J, Tandoi F, De Carlis R, Pascale MM, Mennini G, Germinario G, Rossi M, Agnes S, De Carlis L, Cescon M, Romagnoli R, De Simone P. Impact of MELD 30-allocation policy on liver transplant outcomes in Italy. J Hepatol 2022; 76:619-627. [PMID: 34774638 DOI: 10.1016/j.jhep.2021.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS In Italy, since August 2014, liver transplant (LT) candidates with model for end-stage liver disease (MELD) scores ≥30 receive national allocation priority. This multicenter cohort study aims to evaluate time on the waiting list, dropout rate, and graft survival before and after introducing the macro-area sharing policy. METHODS A total of 4,238 patients registered from 2010 to 2018 were enrolled and categorized into an ERA-1 Group (n = 2,013; before August 2014) and an ERA-2 Group (n = 2,225; during and after August 2014). A Cox proportional hazards model was used to estimate the hazard ratio (HR) of receiving a LT or death between the two eras. The Fine-Gray model was used to estimate the HR for dropout from the waiting list and graft loss, considering death as a competing risk event. A Fine-Gray model was also used to estimate risk factors of graft loss. RESULTS Patients with MELD ≥30 had a lower median time on the waiting list (4 vs.12 days, p <0.001) and a higher probability of being transplanted (HR 2.27; 95% CI 1.78-2.90; p = 0.001) in ERA-2 compared to ERA-1. The subgroup analysis on 3,515 LTs confirmed ERA-2 (odds ratio 0.56; 95% CI 0.46-0.68; p = 0.001) as a protective factor for better graft survival rate. The protective variables for lower dropouts on the waiting list were: ERA-2, high-volume centers, no competition centers, male recipients, and hepatocellular carcinoma. The protective variables for graft loss were high-volume center and ERA-2, while MELD ≥30 remained related to a higher risk of graft loss. CONCLUSIONS The national MELD ≥30 priority allocation was associated with improved patient outcomes, although MELD ≥30 was associated with a higher risk of graft loss. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes. CLINICAL TRIAL NUMBER NCT04530240 LAY SUMMARY: Italy introduced a new policy in 2014 to give national allocation priority to patients with a model for end-stage liver disease (MELD) score ≥30 (i.e. very sick patients). This policy has led to more liver transplants, fewer dropouts, and shorter waiting times for patients with MELD ≥30. However, a higher risk of graft loss still burdens these cases. Transplant center volumes and competition among centers may have a role in recipient prioritization and outcomes.
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Affiliation(s)
- Matteo Ravaioli
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, Bologna, Italy.
| | - Quirino Lai
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Davide Ghinolfi
- Chirurgia epatobiliare e trapianto di fegato, Ospedale della Scuola medica dell'Università di Pisa, Italy
| | - Guido Fallani
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Damiano Patrono
- Centro trapianti di fegato, Chirurgia Generale 2U, Università di Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Stefano Di Sandro
- Dipartimento di Chirurgia Generale e Trapianti, Ospedale Niguarda Ca 'Granda, Milano, Italy
| | - Alfonso Avolio
- Dipartimento di Chirurgia - Servizio Trapianti, Università Cattolica "A. Gemelli" di Roma, Italy
| | - Federica Odaldi
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jessica Bronzoni
- Chirurgia epatobiliare e trapianto di fegato, Ospedale della Scuola medica dell'Università di Pisa, Italy
| | - Francesco Tandoi
- Centro trapianti di fegato, Chirurgia Generale 2U, Università di Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Riccardo De Carlis
- Dipartimento di Chirurgia Generale e Trapianti, Ospedale Niguarda Ca 'Granda, Milano, Italy
| | - Marco Maria Pascale
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Gianluca Mennini
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Giuliana Germinario
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, Bologna, Italy
| | - Massimo Rossi
- Unità di Chirurgia Generale e Trapianti d'Organo, Dipartimento di Chirurgia Generale e Specialistica, Sapienza Università di Roma, Azienda Ospedaliero-Universitaria Policlinico Umberto I di Roma, Italy
| | - Salvatore Agnes
- Dipartimento di Chirurgia - Servizio Trapianti, Università Cattolica "A. Gemelli" di Roma, Italy
| | - Luciano De Carlis
- Dipartimento di Chirurgia Generale e Trapianti, Ospedale Niguarda Ca 'Granda, Milano, Italy
| | - Matteo Cescon
- Dipartimento di Chirurgia Generale e Trapianti, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), University of Bologna, Bologna, Italy
| | - Renato Romagnoli
- Centro trapianti di fegato, Chirurgia Generale 2U, Università di Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paolo De Simone
- Chirurgia epatobiliare e trapianto di fegato, Ospedale della Scuola medica dell'Università di Pisa, Italy
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Azoulay D, Feray C, Lim C, Salloum C, Conticchio M, Cherqui D, Sa Cunha A, Adam R, Vibert E, Samuel D, Allard MA, Golse N. A systematic review of auxiliary liver transplantation of small for size grafts in patients with chronic liver disease. JHEP Rep 2022; 4:100447. [PMID: 35310820 PMCID: PMC8927838 DOI: 10.1016/j.jhepr.2022.100447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background & Aims The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD. Methods This is a systematic review on ALT using SFSGs in patients with CLD. The review was completed by updates obtained from the authors of the retained reports. Results Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS stricto sensu, and auxiliary partial orthotopic liver transplantation (APOLT) in 27 cases (from 1999 to 2021), all for SFSG. In APOLT cases, partial native liver resection was performed in most of cases, whereas the second-stage remnant native liver hepatectomy was performed in 9 cases only. The median graft-to-body weight ratio was 0.55, requiring perioperative or intraoperative portal modulation in 16 cases. At least 1 complication occurred in 24 patients following the transplant procedure (morbidity rate, 89%). Four patients (4/27, 15%) died after the APOLT procedure. At the long term, 19 (70%) patients were alive and well at 13 months to 24 years (median, 4.5 years) including 18 with the APOLT graft in place and 1 following retransplantation. Conclusions Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results. Lay summary At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed. Using a small-for-size graft is a risk factor of small-for-size syndrome. Auxiliary liver transplantation can be orthotopic or heterotopic. In auxiliary transplantation, the remnant native liver prevents small-for-size syndrome. Transplantation with a small-for-size graft requires individually tailored portal modulation. Auxiliary liver transplantation might substantially increase the number of available grafts.
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6
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Belli LS, Duvoux C, Artzner T, Bernal W, Conti S, Cortesi PA, Sacleux SC, Pageaux GP, Radenne S, Trebicka J, Fernandez J, Perricone G, Piano S, Nadalin S, Morelli MC, Martini S, Polak WG, Zieniewicz K, Toso C, Berenguer M, Iegri C, Invernizzi F, Volpes R, Karam V, Adam R, Faitot F, Rabinovich L, Saliba F, Meunier L, Lesurtel M, Uschner FE, Fondevila C, Michard B, Coilly A, Meszaros M, Poinsot D, Schnitzbauer A, De Carlis LG, Fumagalli R, Angeli P, Arroyo V, Jalan R. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS). J Hepatol 2021; 75:610-622. [PMID: 33951535 DOI: 10.1016/j.jhep.2021.03.030] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/13/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Liver transplantation (LT) has been proposed as an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to assess the current clinical practice and outcomes of patients with ACLF who are wait-listed for LT in Europe. METHODS This was a retrospective study including 308 consecutive patients with ACLF, listed in 20 centres across 8 European countries, from January 2018 to June 2019. RESULTS A total of 2,677 patients received a LT: 1,216 (45.4%) for decompensated cirrhosis. Of these, 234 (19.2%) had ACLF at LT: 58 (4.8%) had ACLF-1, 78 (6.4%) had ACLF-2, and 98 (8.1%) had ACLF-3. Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and the Netherlands had medium rates (9-15%); and the United Kingdom and Spain had low rates (3-5%) (p <0.0001). The 1-year probability of survival after LT for patients with ACLF was 81% (95% CI 74-87). Pre-LT arterial lactate levels >4 mmol/L (hazard ratio [HR] 3.14; 95% CI 1.37-7.19), recent infection from multidrug resistant organisms (HR 3.67; 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74; 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the waiting list. In an intention-to-treat analysis, 1-year survival of patients with ACLF on the LT waiting list was 73% for ACLF-1 or -2 and 50% for ACLF-3. CONCLUSION The results reveal wide variations in the listing of patients with ACLF in Europe despite favourable post-LT survival. Risk factors for mortality were identified, enabling a more precise prognostic assessment of patients with ACLF. LAY SUMMARY Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation is an effective therapeutic option. This study has demonstrated that in Europe, referral and access to liver transplantation (LT) for patients with ACLF needs to be harmonised to avoid inequities. Post-LT survival for patients with ACLF was >80% after 1 year and some factors have been identified to help select patients with favourable outcomes.
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Affiliation(s)
- Luca S Belli
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy.
| | | | - Thierry Artzner
- C.H.R.U. De Strasbourg, Hôpital Hautepierre, Strasbourg, France
| | - William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London UK
| | - Sara Conti
- Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy; Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Paolo A Cortesi
- Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy; Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sophie-Caroline Sacleux
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; Unité INSERM 1193, Université Paris-Saclay, France
| | - George-Philippe Pageaux
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Sylvie Radenne
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hopital de la Croix-Rousse, Lyon, France
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure (EF Clif), 08021 Barcelona, Spain
| | - Javier Fernandez
- Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain
| | | | - Salvatore Piano
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Italy
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany
| | - Maria C Morelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Martini
- Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Wojciech G Polak
- Erasmus MC, Transplant Institute, University Medical Center Rotterdam Department of Surgery, Division of HPB and Transplant Surgery, Rotterdam, Rotterdam, the Netherlands
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, Ciberehd, and Facultad de Medicina, La Fe University Hospital, Valencia, Spain
| | - Claudia Iegri
- Gastroenterology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federica Invernizzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Centre Hépatobiliaire Hôpital Universitaire Paul Brousse, Villejuif, France
| | - René Adam
- European Liver Transplant Registry, Centre Hépatobiliaire Hôpital Universitaire Paul Brousse, Villejuif, France
| | - François Faitot
- C.H.R.U. De Strasbourg, Hôpital Hautepierre, Strasbourg, France
| | - Liane Rabinovich
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London UK
| | - Faouzi Saliba
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; Unité INSERM 1193, Université Paris-Saclay, France
| | - Lucy Meunier
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Mickael Lesurtel
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hopital de la Croix-Rousse, Lyon, France
| | - Frank E Uschner
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
| | - Costantino Fondevila
- Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain
| | | | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France; Unité INSERM 1193, Université Paris-Saclay, France
| | - Magdalena Meszaros
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
| | - Domitille Poinsot
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hopital de la Croix-Rousse, Lyon, France
| | - Andreas Schnitzbauer
- Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
| | - Luciano G De Carlis
- General Surgery and Transplantation Unit, ASST GOM Niguarda, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesia, Critical Care, ASST GOM Niguarda, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Italy
| | - Vincente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF Clif), 08021 Barcelona, Spain
| | - Rajiv Jalan
- European Foundation for the Study of Chronic Liver Failure (EF Clif), 08021 Barcelona, Spain; Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK
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7
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Dondossola D, Ravaioli M, Lonati C, Maroni L, Pini A, Accardo C, Germinario G, Antonelli B, Odaldi F, Zanella A, Siniscalchi A, Cescon M, Rossi G. The Role of Ex Situ Hypothermic Oxygenated Machine Perfusion and Cold Preservation Time in Extended Criteria Donation After Circulatory Death and Donation After Brain Death. Liver Transpl 2021; 27:1130-1143. [PMID: 33835695 DOI: 10.1002/lt.26067] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
Hypothermic oxygenated machine perfusion (HOPE) has the potential to counterbalance the detrimental consequences of cold and warm ischemia time (WIT) in both donation after brain death (DBD) and donation after circulatory death (DCD). Herein we investigated the protective effects of HOPE in extended criteria donor (ECD) DBD and overextended WIT DCD grafts. The present retrospective case series included 50 livers subjected to end-ischemic HOPE or dual DHOPE in 2 liver transplantation (LT) centers from January 2018 to December 2019. All DCD donors were subjected to normothermic regional perfusion before organ procurement. Results are expressed as median (interquartile range [IQR]). In the study period, 21 grafts were derived from overextended WIT DCD donors (total WIT 54 [IQR, 40-60] minutes and 75% classified as futile), whereas 29 were from ECD DBD. A total of 3 biliary complications and 1 case of ischemia-type biliary lesion were diagnosed. The rate of early allograft dysfunction (EAD) was 20%, and those patients had higher Comprehensive Complication Index scores. Through a changing point analysis, cold preservation time >9 hours was associated with prolonged hospital stays (P = 0.02), higher rates of EAD (P = 0.009), and worst post-LT complications (P = 0.02). Logistic regression analyses indicated a significant relationship between cold preservation time and EAD. No differences were shown in terms of the early post-LT results between LTs performed with DCD and DBD. Overall, our data are fully comparable with benchmark criteria in LT. In conclusion, the application of DHOPE obtained satisfactory and promising results using ECD-DBD and overextended DCD grafts. Our findings indicate the need to reduce cold preservation time also in the setting of DHOPE, particularly for grafts showing poor quality.
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Affiliation(s)
- Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Maroni
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessia Pini
- Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Caterina Accardo
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuliana Germinario
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Barbara Antonelli
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Odaldi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Siniscalchi
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Rossi
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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8
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Frailty as a predictive factor for survival after liver transplantation, especially for patients with MELD≤15-a prospective study. Langenbecks Arch Surg 2021; 406:1963-1969. [PMID: 33847783 PMCID: PMC8481213 DOI: 10.1007/s00423-021-02109-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/25/2021] [Indexed: 12/18/2022]
Abstract
Introduction Frailty has been discussed as a predictor of morbidity and mortality for liver cirrhosis. The aim of our study is to evaluate the role of frailty in liver transplantation, particularly for patients with MELD scores < 15. Methods All patients listed for liver transplantation between September 2015 and November 2018 were prospectively included in the study. Frailty was assessed by Fried’s frailty classification. Pre-, intra-, and postoperative data were prospectively recorded. Univariate and multivariate regression analyses were performed. The ethical approval of the institutional board review was obtained for the study. Results There were 114 patients included in the study, and their median MELD score was 16. Of these, 86 patients were defined as frail (75.4%). A total of 62 patients (54.4%) underwent liver transplantation, 11 (17.7%) died postoperatively, and 24 patients (21.0%) died while on the waitlist. All postoperative mortality cases were frail, and only 3 patients (12.5%) were non-frail in the waitlist mortality group. There were 14 patients who had MELD scores of <15 (58.3%). The overall survival of non-frail patients was significantly better than that of frail patients. The multivariate regression analyses identified frailty criteria, including unintended weight loss and low hand grip strength, and platelet count and being married or living in a solid partnership were prognostic factors for survival in all patients. Conclusion The addition of frailty assessment can be beneficial for predicting mortality after liver transplantation, especially in patients with low MELD score. Frail patients on the waitlist have significant risk for mortality even with low MELD score.
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Bayer F, Audry B, Antoine C, Jasseron C, Legeai C, Bastien O, Jacquelinet C. Removing administrative boundaries using a gravity model for a national liver allocation system. Am J Transplant 2021; 21:1080-1091. [PMID: 32659870 DOI: 10.1111/ajt.16214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 01/25/2023]
Abstract
Geographic disparities emerged as an increasing issue in organ allocation policies. Because of the sequential and discrete geographical models used for allocation scores, artificial regional boundaries may impede the access of candidates with the greatest medical urgency to vital organs. This article describes a continuous geographical allocation model that provides accurate organ access by introducing a multiplicative interaction between the patient's condition and the distance to the graft by using a gravity model. Patients with the most urgent need will thus have access to organs from farther away, while those in less urgent need may only have access to organs geographically closer. Compared to the previous French liver allocation scheme, the gravity model precluded transplantations for candidates with a Model for End-Stage Liver Disease (MELD) ≤ 14 for decompensated cirrhosis from 10.3% to 0.6%. Death and delisting while on the waiting list at 1 year also decreased from 30.1% to 22.4% for MELD ≥ 35. Waiting list (cumulative hazard ratio (CHR) 0.84 after adjustment) and posttransplant survival improved significantly (hazard ratio = 0.83 after adjustment). This new liver allocation system provides more equitable access to liver transplants and an efficient and safe alternative to administrative boundaries for geographical models in organ allocation.
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Affiliation(s)
- Florian Bayer
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Benoît Audry
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Corinne Antoine
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Stratégie Prélèvement Greffe, Saint-Denis-la-Plaine cedex, France
| | - Carine Jasseron
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Evaluation - Biostatistique, Saint-Denis-la-Plaine cedex, France
| | - Camille Legeai
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Evaluation - Biostatistique, Saint-Denis-la-Plaine cedex, France
| | - Olivier Bastien
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Christian Jacquelinet
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France.,Inserm U1018, CESP, Villejuif, France
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10
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Azoulay D, Disabato M, Gomez-Gavara C, Feray C, Salloum C, Ngonggang N, Winter A, Hentati H, Levesque E, Lim C, Compagnon P. Liver Transplantation with "Hors Tour" Allocated Versus Standard MELD Allocated Grafts: Single-Center Audit and Impact on the Liver Pool in France. World J Surg 2019; 44:912-924. [PMID: 31832704 DOI: 10.1007/s00268-019-05271-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The French transplant governing system defined "Rescue" (the so-called "Hors Tour") livers as those livers which were declined for the five top-listed patients. This study compares the outcomes following liver transplantation (LT) in patients who received a donor liver through a rescue allocation (RA) procedure or according to MELD score priority (standard allocation, SA) and evaluates the impact on the graft pool of a proactive policy to accept RA grafts. METHODS Data from all consecutive patients who underwent LT with SA or RA grafts from 2011 to 2015 were compared in terms of short- and long-term outcomes. RESULTS The 249 elective first LTs were performed with 64 (25.7%) RA and 185 (74.3%) SA grafts. RA grafts were obtained from older donors and were associated with a longer cold ischemia time. Recipients of RA livers were older and had lower MELD scores. The rates of delayed graft function, primary nonfunction, retransplantation, complications, and mortality were similar between the RA and SA groups. At 1 and 3 and 5 years, graft and patient survival rates were similar between the groups. These results were maintained after matching on recipient characteristics. Our proactive policy to accept RA grafts increased the liver pool for elective first transplantation by 25%. CONCLUSIONS RA livers can be safely transplanted into selected recipients and significantly expand the liver pool.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Avenue Paul Vaillant Couturier, 94000, Villejuif, France.
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Mara Disabato
- Department of Hepatobiliary Surgery and Transplantation, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Concepcion Gomez-Gavara
- Department of Hépato-Pancreato-Biliary and Transplant Surgery, Vall d'Hébron University Hospital, Barcelona, Spain
| | - Cyrille Feray
- Department of Hepatology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Villejuif, France
| | - Chady Salloum
- Centre Hépato-Biliaire, Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Avenue Paul Vaillant Couturier, 94000, Villejuif, France
| | - Norbert Ngonggang
- Department of Hepatobiliary Surgery and Transplantation, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Audrey Winter
- Laboratoire de Biostatistique, IURC, Montpellier, France
| | - Hassen Hentati
- Department of Hepatobiliary Surgery and Transplantation, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Eric Levesque
- Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Compagnon
- Department of Hepatobiliary Surgery and Transplantation, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France
- Service de Transplantation, Hôpitaux Universitaires de Genève, Université de Genève, Faculté de Médecine, Geneva, Switzerland
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11
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Neuberger J, Heimbach JK. Allocation of deceased-donor livers - Is there a most appropriate method? J Hepatol 2019; 71:654-656. [PMID: 31451285 DOI: 10.1016/j.jhep.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023]
Affiliation(s)
| | - Julie K Heimbach
- Division of Transplantation Surgery, Mayo Clinic, Rochester, USA.
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