Liver transplant with controlled donors after circulatory death with normothermic regional perfusion and brain dead donors: A multicenter cohort study of transfusion, one-year graft survival and mortality

BACKGROUND

Controlled donation after circulatory death (cDCD) has expanded the donor pool for liver transplantation (LT). However, transfusion requirements and perioperative outcomes should be elucidated. The aim of this multicenter study was to assess red blood cell (RBC) transfusions, one-year graft and patient survival after LT after cDCD with normothermic regional perfusion (NRP) compared with donors after brain death (DBD).

METHODS

591 LT carried out in ten centers during 2019 were reviewed. Thromboelastometry was used to manage coagulation and blood product transfusion in all centers. Normothermic regional perfusion was the standard technique for organ recovery.

RESULTS

447 patients received DBD and 144 cDCD with NRP. Baseline MCF Extem was lower in the cDCD group There were no differences in the percentage of patients (63% vs. 61% p = 0.69), nor in the number of RBC units transfused (4.7 (0.2) vs 5.5 (0.4) in DBD vs cDCD, p = 0.11. Twenty-six patients (6%) died during admission for LT in the DBD group compared with 3 patients (2%) in the cDCD group (p = 0.15). To overcome the bias due to a worse coagulation profile in cDCD recipients, matched samples were compared. No differences in baseline laboratory data, or in intraoperative use of RBC or one-year outcome data were observed between DBD and cDCD recipients.

CONCLUSIONS

cDCD with NRP is not associated with increased RBC transfusion. No differences in graft and patient survival between cDCD and DBD were found. Donors after controlled circulatory death with NRP can increasingly be utilized with safety, improving the imbalance between organ donors and the ever-growing demand.

Baseline haemoglobin and thromboelastometry are predictive of red blood cell requirements and one-year mortality in liver transplantation

BACKGROUND

To determine the predictive capacity of baseline haemoglobin and maxim clot firmness (MCF) EXTEM thromboelastometry for intraoperative red blood cell (RBC) requirements and its influence on mortality.

METHODS

591 adult liver transplant (LT) recipients from ten Spanish centres were reviewed. The main outcomes were the percentage of patients who received RBC and massive transfusion (≥ 6 RBC units), RBC units transfused, and mortality.

RESULTS

76 % received a donor after brain death graft and 24 % a controlled donor after circulatory death graft. Median (interquartile ranges) RBC transfusion was 2 (0-4) units, and 63 % of patients were transfused. Comparing transfused and non-transfused patients, mean (standard deviation) for baseline haemoglobin was 10.4 (2.1) vs. 13.0 (1.9) g/dl (p = 0.001), EXTEM MCF was 51(11) vs. 55(9) mm (p = 0.001). Haemoglobin and EXTEM MCF were inversely associated with the need of transfusion odds ratio (OR) of 0.558 (95 % CI 0.497-0.627, p < 0.001) and OR 0.966 (95 % CI0.945-0.987, p = 0.002), respectively. Pre-operative baseline haemoglobin ≤ 10 g/dL predicted RBC transfusion, sensitivity of 93 % and specificity of 47 %. Massive transfusion (MT) was received by 19 % of patients. Haemoglobin ≤10 g/dL predicted MT with sensitivity 73 % and specificity of 52 %. One-year patient and graft survival were significantly lower in patients who required MT (78 % and 76 %, respectively) vs. those who did not (94 % and 93 %, respectively).

DISCUSSION

whereas EXTEM MCF is less dreterminant predicting RBC requirements, efforts are required to improve preoperative haemoglobin up to 10 g/dl in patients awaiting LT.

Perioperative complications following bariatric surgery according to the clavien-dindo classification. Score validation, literature review and results in a single-centre series

BACKGROUND

There is no unified system for reporting surgical complications after bariatric surgery. One increasingly used system for notifying postoperative complications is the Clavien-Dindo classification, which focuses on their therapeutic implications.

OBJECTIVE

The aim of this study is to validate and apply the Clavien-Dindo scale to a series of cases of bariatric surgery and systematically review its use worldwide.

SETTING

University hospital.

METHODS

A cohort of 321 patients with morbid obesity (Mean BMI: 45.4±5.5 kg/m²) underwent surgery by the same team of surgeons, fundamentally using a laparoscopic gastric bypass. Initially, the Clavien-Dindo scale was translated and validated for its acceptability and reproducibility using the Kappa index. The scale was then applied to the whole of the bariatric series. A systematic review was also conducted in the literature regarding the use of the Clavien-Dindo classification after bariatric surgery. Lastly, a comparison was made with our results.

RESULTS

The classification was validated without any difficulty. Most of the postoperative complications are grades I (8.4%) and III (7.8%). We found it used in 15 series (including our own), which accounts for 10,347 patients. The overall results are analogous to our series.

CONCLUSIONS

The Clavien-Dindo scale has been validated and translated into Spanish. Application is quick and simple and enables comparisons to be made between centers and series. Our results are similar to those reported by other authors.

Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure

BACKGROUND

In staged liver resections, associating liver partition and portal ligation for staged hepatectomy (ALPPS) achieves sufficient hypertrophy of the future liver remnant (FLR) in 7 days. This is based on portal vein ligation and transection, and on occlusion of intrahepatic collaterals. This article presents a new surgical technique for achieving rapid hypertrophy of the FLR, which also involves adding intrahepatic collateral occlusion to portal vein transection.

METHODS

Patients scheduled for two-stage liver resection for primary or secondary liver tumours, in whom the FLR was considered too small, were enrolled prospectively. In the first stage, a tourniquet was placed around the parenchymal transection line, and the right portal vein was ligated and cut (associating liver tourniquet and portal ligation for staged hepatectomy, ALTPS). The tourniquet was placed on the umbilical ligament if a staged right trisectionectomy was planned, and on Cantlie's line for staged right hepatectomy.

RESULTS

From September 2011, 22 ALTPS procedures were carried out (right trisectionectomy in 15, right hepatectomy in 7). Median FLR at 7 days increased from 410 to 700 ml (median increase 61 (range 33-189) per cent). The median duration of the first stage was 125 min and no patient received a blood transfusion. The median duration of the second stage was 150 min and five patients required a blood transfusion. Fourteen patients had complications, most frequently infected collections, and five patients developed postoperative liver failure. Two patients died.

CONCLUSION

The ALTPS technique achieved adequate hypertrophy of the FLR after 7 days. It may provide a less aggressive modification of the ALPPS procedure.

Presence of pharmacoepidemiology in three bibliographic databases: Medline, IPA and SCI

OBJECTIVE

The objective of this study is to make a comparative description of the evolution and distribution of international research into pharmacoepidemiology, using three bibliographic databases, in order to select the most appropriate for future bibliometric studies.

METHODS

Bibliographic searches were performed using the following databases: Medline (1966-99), IPA (1970-99) and SCI (1990-99), using the term 'pharmacoepidemiology'. On the basis of these searches, the number of original articles per year and per journal title were noted. The growth of the output of scientific writing was found to fit Price's law.

RESULTS

A total of 845 original articles were recovered: 467 from IPA, 219 from Medline and 159 from SCI. The highest mean number of original articles per year (33.4) was obtained with the IPA database. Price's exponential growth pattern was observed among all three databases. The total numbers of journals in which the original articles were published were 102 in Medline, 65 in IPA and 60 in SCI. The journals providing a single original article comprised 65% of the Medline titles and 61% of those in IPA and SCI.

CONCLUSIONS

International research into pharmacoepidemiology presents an exponential growth pattern, in accordance with Price's law. There is a large degree of publishing dispersion. IPA was found to be the bibliographic database that recovered the greatest number of original articles, nearly half of which were published in Pharmacoepidemiology and Drug Safety. We therefore consider the latter database appropriate for bibliometric studies in the field of pharmacoepidemiology.

Bibliometric analysis of Spanish scientific publications on tobacco use during the period 1970-1996

Spanish scientific publications on tobacco use during the period 1970-1996 were studied, including all published work carried out in Spanish institutions indexed in IME or in MEDLINE and available on CD-ROM, using the search criteria fuma* and taba* in the first database, and tobacco and smoking in the second. A total of 405 papers were found by IME, published in Spanish journals, and another 194 in MEDLINE, published in foreign journals. In the latter database, a time-related increase in the number of papers was detected. Original articles accounted for 80.6% of the papers analyzed. The degree of collaboration between authors, research centres and institutions was 88.6%, 30.7% and 21.8%, respectively. The most productive Spanish communities were Catalonia and Madrid. The Spanish papers were published in 83 Spanish journals, of which 36 (43.4%) published just one paper, and in 124 foreign journals, of which 85 (68.5%) published a single paper. The average number of authors per paper was 4.02+/-2.46 in Spanish journals and 4.96+/-2.26 in foreign ones. The total number of authors was 1633, of whom 1162 (71.2%) appeared on a single paper. The contribution of Spanish scientific production concerning tobacco use, in international terms, has increased in recent years, but a higher level of cooperation between research centres and institutions is desirable.