1
|
Suarez-Zdunek MA, Arentoft NS, Krohn PS, Lauridsen EHE, Afzal S, Høgh J, Thomsen MT, Knudsen AD, Nordestgaard BG, Hillingsø JG, Villadsen GE, Holland-Fischer P, Rasmussen A, Fialla AD, Feldt-Rasmussen U, Nielsen SD. Prevalence of hyperthyroidism and hypothyroidism in liver transplant recipients and associated risk factors. Sci Rep 2024; 14:7828. [PMID: 38570629 PMCID: PMC10991542 DOI: 10.1038/s41598-024-58544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/01/2024] [Indexed: 04/05/2024] Open
Abstract
The prevalence of hyperthyroidism and hypothyroidism and associated risk factors are unknown in liver transplant recipients. We aimed to determine the prevalence of hyperthyroidism and hypothyroidism and associated risk factors in liver transplant recipients and to compare it with controls from the general population. As part of the Danish Comorbidity in Liver Transplant Recipients (DACOLT) Study, all Danish liver transplant recipients over the age of 20 were invited for measurements of concentrations of thyrotropin and thyroid hormones. The prevalence of hyperthyroidism and hypothyroidism was compared to age- and sex-matched controls from the Copenhagen General Population Study. Using logistic regression adjusted for age, sex, smoking, and body-mass index, we investigated potential risk factors. We recruited 489 liver transplant recipients and 1808 controls. Among liver transplant recipients, 14 (2.9%) had hyperthyroidism compared with 21 (1.2%) of controls (adjusted odds ratio [aOR] 2.24, 95% confidence interval [CI] 1.05-4.75, P = 0.04), while 42 (5.7%) had hypothyroidism compared with 139 (7.7%) of controls (aOR 0.68, 95% CI 0.43-1.08, P = 0.10). Female sex, and autoimmune hepatitis and primary sclerosing cholangitis as causes of transplantation were associated with hyperthyroidism after adjustments. Age, female sex, and autoimmune liver diseases as cause of transplantation were associated with hypothyroidism after adjustments. DACOLT is registered in ClinicalTrials.gov (NCT04777032).
Collapse
Affiliation(s)
- Moises Alberto Suarez-Zdunek
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Nicoline Stender Arentoft
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Høgh
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Magda Teresa Thomsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
| | - Børge Grønne Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Georg Hillingsø
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Allan Rasmussen
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anette Dam Fialla
- Department of Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department Endocrinology and Metabolism, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark.
- Department of Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
2
|
Spore LM, Dencker EE, Kvanner EA, Hansen CP, Burgdorf SK, Krohn PS, Kollbeck SLG, Storkholm JH, Sillesen M. Perioperative factors associated with survival following surgery for pancreatic cancer - a nationwide analysis of 473 cases from Denmark. BMC Surg 2024; 24:76. [PMID: 38431571 PMCID: PMC10908011 DOI: 10.1186/s12893-024-02369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal cancers worldwide, with an overall 5-year survival rate of only 5%. The effect of perioperative treatment factors including duration of surgery, blood transfusions as well as choice of anesthesia and analgesia techniques on overall survival (OS) following pancreatic resections for PDAC, is currently not well known. We hypothesized that these perioperative factors might be associated with OS after pancreatic resections for PDAC. METHODS This is a retrospective study from a nationwide cohort of patients who underwent surgery for PDAC in Denmark from 2011 to 2020. Kaplan-Meier 1, 2 and 5-year survival estimates were 73%, 49% and 22%, respectively. Data were obtained by joining the national Danish Pancreatic Cancer Database (DPCD) and the Danish Anaesthesia Database (DAD). Associations between the primary endpoint (OS) and perioperative factors including duration of surgery, type of anesthesia (intravenous, inhalation or mixed), use of epidural analgesia and perioperative blood transfusions were assessed using Hazard Ratios (HRs). These were calculated by Cox regression, controlling for relevant confounders identified through an assessment of the current literature. These included demographics, comorbidities, perioperative information, pre and postoperative chemotherapy, tumor staging and free resection margins. RESULTS Overall, data from 473 resected PDAC patients were available. Multivariate Cox regression indicated that perioperative blood transfusions were associated with shorter OS (HR 2.53, p = 0.005), with survival estimates of 8.8% in transfused vs. 28.0% in non-transfused patients at 72 months after surgery. No statistically significant associations were identified for the duration of surgery or anesthesia/analgesia techniques. CONCLUSION In this study, the use of perioperative blood transfusions was associated with shorter OS.
Collapse
Affiliation(s)
- Laura Marr Spore
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Emilie Even Dencker
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Eske Aasvang Kvanner
- Department of Anesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark
- Institute of Clinical Medicine, University of Copenhagen Medical School, Copenhagen, Denmark
| | - Carsten Palnaes Hansen
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Stefan Kobbelgaard Burgdorf
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
- Institute of Clinical Medicine, University of Copenhagen Medical School, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Jan Henrik Storkholm
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Martin Sillesen
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark.
- Institute of Clinical Medicine, University of Copenhagen Medical School, Copenhagen, Denmark.
| |
Collapse
|
3
|
Harboe ZB, Hald A, Ekenberg C, Ete Wareham N, Fogt Lundbo L, Holler JG, Qvist T, Rask Hamm S, Bjerrum S, Rezahosseini O, Suno Krohn P, Gustafsson F, Perch M, Rasmussen A, Dam Nielsen S. Implementation of a vaccination clinic for adult solid organ transplant candidates: A single-center experience. Vaccine 2023; 41:6637-6644. [PMID: 37775467 DOI: 10.1016/j.vaccine.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
Vaccination is an evidence-based strategy to prevent or reduce the severity of infectious diseases (ID). Here, we aimed to describe the experience of implementing a vaccination clinic specifically targeting liver, heart, lung, and combined dual organ transplantation at a single transplantation center in Denmark. In this cohort of 242 solid organ transplant (SOT) candidates, we investigated seroprotection and the proportion of recommended vaccinations documented before transplantation. Furthermore, we registered completed vaccinations after ID consultations. The median age in our cohort was 53 years (IQR, 42-60), 60% were males (n = 135), and liver transplants (n = 138; 57%) were the most frequently planned organ transplants. Before the consultation to the vaccination clinic, influenza and pneumococcal vaccines had the highest proportion of documented vaccination (58% and 37%, respectively). Serological protection was more frequently observed for measles, mumps, or rubella (MMR, approximately 90% for each), while only 30% (n = 72) of SOT candidates showed seroprotection against pneumococcal disease. All SOT candidates required at least one of the recommended vaccines, and over 90% required three or more. At least 10% of patients in our cohort needed a live attenuated vaccine for either MMR or yellow fever. The most frequently administered vaccine was the tetanus-diphtheria-acelullar pertussis (Tdap) booster (n = 217; 90%), influenza vaccination was either administered (n = 16; 7%) or recommended (n = 226; 93%), PCV13 was administered (n = 155; 64%) or recommended (n = 27; 11%), and PPSV23 was either administered (n = 18; 7.4%) or recommended (n = 140; 58%). All SOT candidates adhered completely to their vaccination schedules. Based on our findings, we recommend prioritizing vaccination before transplantation by providing ID consultations for SOT candidates.
Collapse
Affiliation(s)
- Zitta Barrella Harboe
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
| | - Annemette Hald
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christina Ekenberg
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Neval Ete Wareham
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lene Fogt Lundbo
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jon Gitz Holler
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Tavs Qvist
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Rask Hamm
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Stephanie Bjerrum
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Omid Rezahosseini
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand, Denmark
| | - Paul Suno Krohn
- Department of Surgical Gastroenterology, Liver Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Heart and Lung Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Heart and Lung Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology, Liver Transplant Unit, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Sillesen M, Hansen CP, Burgdorf SK, Dencker EE, Krohn PS, Gisela Kollbeck SL, Stender MT, Storkholm JH. Impact of para aortic lymph node removal on survival following resection for pancreatic adenocarcinoma. BMC Surg 2023; 23:214. [PMID: 37528360 PMCID: PMC10394933 DOI: 10.1186/s12893-023-02123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION For PDAC patients undergoing resection, it remains unclear whether metastases to the paraaortic lymph nodes (PALN+) have any prognostic significance and whether metastases should lead to the operation not being carried out. Our hypothesis is that PALN + status would be associated with short overall survival (OS) compared with PALN-, but longer OS compared with patients undergoing surgical exploration only (EXP). METHODS Patients with registered PALN removal from the nationwide Danish Pancreatic Cancer Database (DPCD) from May 1st 2011 to December 31st 2020 were assessed. A cohort of PDAC patients who only had explorative laparotomy due to non-resectable tumors were also included (EXP group). Survival analysis between groups were performed with cox-regression in a multivariate approach including relevant confounders. RESULTS A total of 1758 patients were assessed, including 424 (24.1%) patients who only underwent explorative surgery leaving 1334 (75.8%) patients for further assessment. Of these 158 patients (11.8%) had selective PALN removal, of whom 19 patients (12.0%) had PALN+. Survival analyses indicated that explorative surgery was associated with significantly shorter OS compared with resection and PALN + status (Hazard Ratio 2.36, p < 0.001). No difference between PALN + and PALN- status could be demonstrated in resected patients after controlling for confounders. CONCLUSION PALN + status in patients undergoing resection offer improved survival compared with EXP. PALN + should not be seen as a contraindication for curative intended resection.
Collapse
Affiliation(s)
- Martin Sillesen
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark.
- Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Denmark.
- Institute of Clinical Medicine, University of Copenhagen, København, Denmark.
| | - Carsten Palnæs Hansen
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Stefan Kobbelgaard Burgdorf
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Emilie Even Dencker
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
- Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Paul Suno Krohn
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Sophie Louise Gisela Kollbeck
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
- Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Jan Henrik Storkholm
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark
- Dep. of Surgery, Imperial College NHS trust, Hammersmith Hospital, London, UK
| |
Collapse
|
5
|
Sillesen M, Hansen CP, Dencker EE, Burgdorf SK, Krohn PS, Stender MT, Fristrup CW, Storkholm JH. Long-Term Outcomes of Venous Resections in Pancreatic Ductal Adenocarcinoma Patients: A Nationwide Cohort Study. Ann Surg Open 2022; 3:e219. [PMID: 37600295 PMCID: PMC10406038 DOI: 10.1097/as9.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/25/2022] [Indexed: 03/05/2023] Open
Abstract
To investigate whether pancreatic resections (PR) for pancreatic ductal adenocarcinoma (PDAC) is associated with worse survival when resection of the superior mesenteric vein/portal vein (SMV/PV) is required. Background PR for PDAC with resection of the superior mesenteric vein/portal vein (SMV/PV, PR+V resection) may be associated with inferior overall survival (OS) compared with PR without the need for SMV/PV resection (PR-V). We hypothesized that PR+V results in lower OS compared with PR-V. Method Retrospective study using data from the nationwide Danish Pancreatic Cancer Database from 2011 to 2020. Data on patients who underwent PR for PDAC were extracted. A group of PR patients found nonresectable on exploratory laparotomy (EXP) was also included. OS was assessed using Kaplan-Meier and Cox proportional hazards models adjusting for confounders (age, sex, R-resection level, chemotherapy, comorbidities, histology T and N classification, procedure subtype as well as tumor distance to the SMV/PV). Results Overall, 2403 patients were identified. Six hundred two underwent exploration only (EXP group), whereas 412 underwent pancreatic resection with (PR+V group) and 1389 (PR-V) without SMV/PV resection. Five-year OS for the PR+V group was lower (20% vs 30%) compared with PR-V, although multivariate Cox proportional hazards modeling could not associate PR+V status with OS (Hazard ratio 1.11, P = 0.408). Conclusion When correcting for confounders, PR+V was not associated with lower OS compared with PR-V.
Collapse
Affiliation(s)
- Martin Sillesen
- From the Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
- Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Carsten Palnæs Hansen
- From the Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Emilie Even Dencker
- From the Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
- Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Stefan Kobbelgaard Burgdorf
- From the Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Paul Suno Krohn
- From the Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | - Jan Henrik Storkholm
- From the Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, United Kingdom
| |
Collapse
|
6
|
Farooqu W, Penninga L, Burgdorf SK, Krohn PS, Storkholm JH, Hansen CP. Relieving the bile ducts prior to pancreatoduodenectomy – A retrospective cohort study. Ann Med Surg (Lond) 2022; 84:104894. [DOI: 10.1016/j.amsu.2022.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/08/2022] [Accepted: 11/06/2022] [Indexed: 11/14/2022] Open
|
7
|
Søborg A, Reekie J, Rasmussen A, Cunha-Bang CD, Gustafsson F, Rossing K, Perch M, Krohn PS, Sørensen SS, Lund TK, Sørensen VR, Ekenberg C, Lundgren L, Lodding IP, Moestrup KS, Lundgren J, Wareham NE. Trends in underlying causes of death in solid organ transplant recipients between 2010 and 2020: Using the CLASS method for determining specific causes of death. PLoS One 2022; 17:e0263210. [PMID: 35877606 PMCID: PMC9312393 DOI: 10.1371/journal.pone.0263210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
Monitoring specific underlying causes of death in solid organ transplant (SOT) recipients is important in order to identify emerging trends and health challenges. This retrospective cohort study includes all SOT recipients transplanted at Rigshospitalet between January 1st, 2010 and December 31st, 2019. The underlying cause of death was determined using the newly developed Classification of Death Causes after Transplantation (CLASS) method. Cox regression analyses assessed risk factors for all-cause and cause-specific mortality. Of the 1774 SOT recipients included, 299 patients died during a total of 7511 person-years of follow-up (PYFU) with cancer (N = 57, 19%), graft rejection (N = 55, 18%) and infections (N = 52, 17%) being the most frequent causes of death. We observed a lower risk of all-cause death with increasing transplant calendar year (HR 0.91, 95% CI 0.86–0.96 per 1-year increase), alongside death from graft rejection (HR 0.84 per year, 95% CI 0.74–0.95) and death from infections (HR 0.86 per year, 95% CI 0.77–0.97). Further, there was a trend towards lower cumulative incidence of death from cardiovascular disease, graft failure and cancer in more recent years, while death from other organ specific and non-organ specific causes did not decrease. All-cause mortality among SOT recipients has decreased over the past decade, mainly due to a decrease in graft rejection- and infection-related deaths. Conversely, deaths from a broad range of other causes have remained unchanged, suggesting that cause of death among SOT recipients is increasingly diverse and warrants a multidisciplinary effort and attention in the future.
Collapse
Affiliation(s)
- Andreas Søborg
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Caspar Da Cunha-Bang
- Department of Hematology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Thomas Kromann Lund
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Rømming Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Louise Lundgren
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Isabelle Paula Lodding
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Kasper Sommerlund Moestrup
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections (CHIP), Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
8
|
Müller PC, Breuer E, Nickel F, Zani S, Kauffmann E, De Franco L, Tschuor C, Suno Krohn P, Burgdorf SK, Jonas JP, Oberkofler CE, Petrowsky H, Saint-Marc O, Seelen L, Molenaar IQ, Wellner U, Keck T, Coratti A, van Dam C, de Wilde R, Koerkamp BG, Valle V, Giulianotti P, Ghabi E, Moskal D, Lavu H, Vrochides D, Martinie J, Yeo C, Sánchez-Velázquez P, Ielpo B, Ajay PS, Shah MM, Kooby DA, Gao S, Hao J, He J, Boggi U, Hackert T, Allen P, Borel-Rinkes IHM, Clavien PA. Robotic Distal Pancreatectomy, a Novel Standard of Care? Benchmark Values for Surgical Outcomes from 16 International Expert Centers. Ann Surg 2022:00000658-990000000-00163. [PMID: 35861061 DOI: 10.1097/sla.0000000000005601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Robotic distal pancreatectomy (DP) is an emerging attractive approach, but its role compared to laparoscopic or open surgery remains unclear. Benchmark values are novel and objective tools for such comparisons. The aim of this study was to identify benchmark cutoffs for many outcome parameters for DP with or without splenectomy beyond the learning curve. METHODS This study analyzed outcomes from international expert centers from patients undergoing robotic DP for malignant or benign lesions. After excluding the first 10 cases in each center to reduce the effect of the learning curve, consecutive patients were included from the start of robotic DP up to June 2020. Benchmark patients had no significant comorbidities. Benchmark cutoff values were derived from the 75th or the 25th percentile of the median values of all benchmark centers. Benchmark values were compared to a laparoscopic control group from four high-volume centers and published open DP landmark series. RESULTS Sixteen centers contributed 755 cases, whereof 345 benchmark patients (46%) were included the analysis. Benchmark cut-offs included: operation time ≤300min, conversion rate ≤3%, clinically relevant POPF ≤32%, 3 months major complication rate ≤26.7% and lymph node retrieval ≥9. The CCI® at 3 months was ≤8.7 without deterioration thereafter. Compared to robotic DP, laparoscopy had significantly higher conversion rates (5x) and overall complications, while open DP was associated with more blood loss and longer hospital stay. CONCLUSION This first benchmark study demonstrates that robotic DP provides superior postoperative outcomes compared to laparoscopic and open DP. Robotic DP may be expected to become the approach of choice in minimally invasive DP.
Collapse
Affiliation(s)
- Philip C Müller
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Eva Breuer
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabino Zani
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Emanuele Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo De Franco
- Division of General and Minimally Invasive Surgery, Misericordia Hospital of Grosseto, Grosseto, Italy
| | - Christoph Tschuor
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan K Burgdorf
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Philipp Jonas
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christian E Oberkofler
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Henrik Petrowsky
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Olivier Saint-Marc
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
| | - Leonard Seelen
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Izaak Quintus Molenaar
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Ulrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Andrea Coratti
- Division of General and Minimally Invasive Surgery, Misericordia Hospital of Grosseto, Grosseto, Italy
| | - Coen van Dam
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Roeland de Wilde
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Erasmus MC Transplant Institute, Department of Surgery Division of HPB & Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Valentina Valle
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pier Giulianotti
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Elie Ghabi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Moskal
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Harish Lavu
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, USA
| | - John Martinie
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, USA
| | - Charles Yeo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Patricia Sánchez-Velázquez
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Benedetto Ielpo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Pranay S Ajay
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mihir M Shah
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David A Kooby
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Song Gao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jihui Hao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Allen
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Inne H M Borel-Rinkes
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Pierre Alain Clavien
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
Hansen CP, Storkholm JH, Sillesen MH, Krohn PS, Burgdorf SK, Hillingsø JG. Pancreatic surgery during the COVID-19 pandemic 2020-2021: an observational cohort study from a third level referral center. BMC Surg 2022; 22:200. [PMID: 35597984 PMCID: PMC9124050 DOI: 10.1186/s12893-022-01651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background During the COVID pandemic there has been limited access to elective surgery including oncologic surgery in several countries world-wide. The aim of this study was to investigate if there was any lockdown effect on pancreatic surgery with special focus on malignant pancreatic and periampullary tumours. Methods Patients who underwent pancreatic surgery during the two Danish lockdown periods from 11. March 2020 and the following 12 months were compared with patients who were operated the preceding 3 years. Data on patients’ characteristics, waiting time, operations, and clinical outcomes were evaluated. Results During lockdown and the previous three years the annual number of resections were 242, 232, 253, and 254, respectively (p = 0.851). Although the numbers were not significantly different, there were fluctuations in operations and waiting time during the lockdown. During the second outbreak of COVID October 2020 to March 2021 the overall median waiting time increased to 33 days (quartiles 26;39) compared to 23 (17;33) days during the first outbreak from March to May 2020 (p = 0.019). The same difference was seen for patients with malignant tumours, 30 (23;36) vs. 22 (18;30) months (p = 0.001). However, the fluctuations and waiting time during lockdown was like the preceding three years. Neither 30- nor 90-days mortality, length of stay, number of extended operations, and complications and tumour stage were significantly different from previous years. Conclusions There were significant fluctuations in waiting time for operations during the lockdown, but these variations were not different from the preceding three years, wherefore other explanations than an impact from COVID are conceivable.
Collapse
Affiliation(s)
- Carsten Palnæs Hansen
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark.
| | - Jan Henrik Storkholm
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Martin Hylleholt Sillesen
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Stefan Kobbelgaard Burgdorf
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Jens Georg Hillingsø
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark
| |
Collapse
|
10
|
Wareham NE, Da Cunha-Bang C, Borges ÁH, Ekenberg C, Gerstoft J, Gustafsson F, Hansen D, Heilmann C, Helleberg M, Hillingsø J, Krohn PS, Lodding IP, Lund TK, Lundgren L, Mocroft A, Perch M, Petersen SL, Petruskevicius I, Rasmussen A, Rossing K, Rostved AA, Sengeløv H, Sørensen VR, Sørensen SS, Lundgren JD. Classification of death causes after transplantation (CLASS): Evaluation of methodology and initial results. Medicine (Baltimore) 2018; 97:e11564. [PMID: 30024557 PMCID: PMC6086480 DOI: 10.1097/md.0000000000011564] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Correct classification of death causes is an important component of transplant trials.We aimed to develop and validate a system to classify causes of death in hematopoietic stem cell (HSCT) and solid organ (SOT) transplant recipients.Case record forms (CRF) of fatal cases were completed, including investigator-designated cause of death. Deaths occurring in 2010 to 2013 were used for derivation; and were validated by deaths occurring in 2013 to 2015. Underlying cause of death (referred to as recorded underlying cause) was determined through a central adjudication process involving 2 external reviewers, and subsequently compared with the Danish National Death Cause Registry.Three hundred eighty-eight recipients died 2010 to 2015 (196 [51%] SOT and 192 [49%] HSCT). The main recorded underlying causes of death among SOT and HSCT were classified as cancer (20%, 48%), graft rejection/failure/graft-versus-host-disease (35%, 28%), and infections (20%, 11%). Kappa between the investigator-designated and the recorded underlying cause of death was 0.74 (95% CI 0.69-0.80) in derivation and comparable in the validation cohort. Death causes were concordant with the Danish National Death Cause Registry in 37.2% (95% CI 31.5-42.9) and 38.4% (95% CI 28.8-48.0) in the derivation and validation cohorts, respectively.We developed and validated a method to systematically and reliably classify the underlying cause of death among transplant recipients. There was a high degree of discordance between this classification and that in the Danish National Death Cause Registry.
Collapse
Affiliation(s)
- Neval Ete Wareham
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | | | - Álvaro H. Borges
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Christina Ekenberg
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital/Herlev Hospital, Herlev
| | | | - Marie Helleberg
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Jens Hillingsø
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Paul Suno Krohn
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Isabelle Paula Lodding
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Thomas Kromann Lund
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Louise Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Michael Perch
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | | | - Irma Petruskevicius
- Department of Hematology, Aarhus University Hospital/Skejby Hospital, Aarhus N
| | - Allan Rasmussen
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | - Andreas A. Rostved
- Department of Surgery, Copenhagen University Hospital/Rigshospitalet, Copenhagen
| | | | - Vibeke Rømming Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Jens D. Lundgren
- Department of Infectious Diseases
- Centre of Excellence for Health, Immunity and Infections (CHIP)
| |
Collapse
|
11
|
Belmouhand M, Krohn PS, Svendsen LB, Henriksen A, Hansen CP, Achiam MP. The occurrence of Enterococcus faecium and faecalis Is significantly associated With anastomotic leakage After pancreaticoduodenectomy. Scand J Surg 2017; 107:107-113. [PMID: 28980499 DOI: 10.1177/1457496917731188] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Enterococcus has emerged as a virulent species; Enterococcus faecium especially has arisen as a source of nosocomial infections. Furthermore, specific Enterococcus faecalis species are significantly associated with anastomotic leakage in rodent studies. The objective of this study was to investigate whether the occurrence of Enterococci ( E. faecium and E. faecalis) obtained from drain samples was associated with leakage in humans undergoing pancreaticoduodenectomy. MATERIALS AND METHODS All patients undergoing pancreaticoduodenectomy had a peritoneal drain sample sent for culturing between postoperative days 3 and 10. Postoperative pancreatic fistulas were defined and classified according to the International Study Group of Pancreatic Fistula. Bile leakage was radiologically verified. Postoperative complications were classified according to the Dindo-Clavien classification. RESULTS A total of 70 patients were eligible and enrolled in this study. Anastomosis leakage was observed in 19 patients; 1 leakage corresponding to the hepaticojejunostomy and 18 pancreatic fistulas were identified. In total, 10 patients (53%) with leakage had Enterococci-positive drain samples versus 12 patients (24%) without leakage [odds ratio (OR) = 5.1, 95% confidence interval (CI) = 1.4-19.4, p = 0.02]. Preoperative biliary drainage with either endoscopic stenting or a percutaneous transhepatic cholangiography catheter was associated with the occurrence of Enterococci in drain samples (OR = 5.67, 95% CI = 1.8-12.9, p = 0.003), but preoperative biliary drainage was not associated with leakage (OR = 0.45, 95% CI = 0.1-1.7, p = 0.23). CONCLUSION Enterococci in drain sample cultures in patients undergoing pancreaticoduodenectomy occurs significantly more among patients with anastomotic leakage compared to patients without leakage.
Collapse
Affiliation(s)
- M Belmouhand
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - P S Krohn
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L B Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Henriksen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C P Hansen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M P Achiam
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
12
|
Wareham NE, Da Cunha-Bang C, Borges ÁH, Ekenberg C, Gerstoft J, Gustafsson F, Hansen D, Helleberg M, Heilmann C, Hillingsø J, Krohn PS, Lodding IP, Lund TK, Lundgren L, Mocroft A, Perch M, Petersen SL, Petruskevicius I, Rasmussen A, Rossing K, Rostved A, Sengeløv H, Sørensen VR, Sørensen SS, Lundgren J. Classification of Death Causes after Transplantation (CLASS): Evaluation of Methodology and Initial Results. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Álvaro H Borges
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jan Gerstoft
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ditte Hansen
- Copenhagen University Hospital, Herlev Hospital, Copenhagen, Denmark
| | - Marie Helleberg
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Heilmann
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Hillingsø
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Paul Suno Krohn
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Louise Lundgren
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Perch
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Allan Rasmussen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Rossing
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Rostved
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Sengeløv
- Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | | |
Collapse
|
13
|
Brandt AH, Hemmsen MC, Hansen PM, Madsen SS, Krohn PS, Lange T, Hansen KL, Jensen JA, Nielsen MB. Clinical evaluation of synthetic aperture harmonic imaging for scanning focal malignant liver lesions. Ultrasound Med Biol 2015; 41:2368-2375. [PMID: 26095533 DOI: 10.1016/j.ultrasmedbio.2015.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/13/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
The purpose of the study was to perform a clinical comparison of synthetic aperture sequential beamforming tissue harmonic imaging (SASB-THI) sequences with a conventional imaging technique, dynamic receive focusing with THI (DRF-THI). Both techniques used pulse inversion and were recorded interleaved using a commercial ultrasound system (UltraView 800, BK Medical, Herlev, Denmark). Thirty-one patients with malignant focal liver lesions (confirmed by biopsy or computed tomography/magnetic resonance) were scanned. Detection of malignant focal liver lesions and preference of image quality were evaluated blinded off-line by eight radiologists. In total, 2,032 evaluations of 127 image sequences were completed. The sensitivity (77% SASB-THI, 76% DRF-THI, p = 0.54) and specificity (71% SASB-THI, 72% DRF-THI, p = 0.67) of detection of liver lesions and the evaluation of image quality (p = 0.63) did not differ between SASB-THI and DRF-THI. This study indicates the ability of SASB-THI in a true clinical setting.
Collapse
Affiliation(s)
- Andreas Hjelm Brandt
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Martin Christian Hemmsen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Peter Møller Hansen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Sloth Madsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Theis Lange
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | | |
Collapse
|
14
|
Hansen PM, Hemmsen M, Brandt A, Rasmussen J, Lange T, Krohn PS, Lönn L, Jensen JA, Nielsen MB. Clinical evaluation of synthetic aperture sequential beamforming ultrasound in patients with liver tumors. Ultrasound Med Biol 2014; 40:2805-2810. [PMID: 25308936 DOI: 10.1016/j.ultrasmedbio.2014.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/24/2014] [Accepted: 07/14/2014] [Indexed: 06/04/2023]
Abstract
Medical ultrasound imaging using synthetic aperture sequential beamforming (SASB) has for the first time been used for clinical patient scanning. Nineteen patients with cancer of the liver (hepatocellular carcinoma or colorectal liver metastases) were scanned simultaneously with conventional ultrasound and SASB using a commercial ultrasound scanner and abdominal transducer. SASB allows implementation of the synthetic aperture technique on systems with restricted data handling capabilities due to a reduction in the data rate in the scanner by a factor of 64. The image quality is potentially maintained despite the data reduction. A total of 117 sequences were recorded and evaluated blinded by five radiologists from a clinical perspective. Forty-eight percent of the evaluations were in favor of SASB, 33% in favor of conventional ultrasound and 19 % were equal, that is, a clear, but non-significant trend favoring SASB over conventional ultrasound (p = 0.18), despite the substantial data reduction.
Collapse
Affiliation(s)
- Peter Møller Hansen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Martin Hemmsen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Andreas Brandt
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Joachim Rasmussen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Theis Lange
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Paul Suno Krohn
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Lönn
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | | |
Collapse
|
15
|
Krohn PS, Ambrus R, Zaar M, Secher NH, Svendsen LB. [Mesenteric traction syndrome]. Ugeskr Laeger 2014; 176:V09130546. [PMID: 25350303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mesenteric traction syndrome (MTS) manifests in 58-87% of patients undergoing upper abdominal surgery and is characterised by a triad of hypotension, tachycardia, and flushing. Prostacyclin is released from the gut mucosa following intestinal eventration and cyclooxygenase antagonists prevent the development of MTS. Also the use of remifentanil appears to increase the incidence of MTS and hypotension is aggravated by epidural analgesia. Yet, prostacyclin may be important for maintaining microcirculation within the splanchnic area and preserve its mucosal barrier.
Collapse
Affiliation(s)
- Paul Suno Krohn
- Kirurgisk gastroenterologisk klinik C-Tx, Rigshospitalet 2122, Blegdamsvej 9, 2100 København Ø.
| | | | | | | | | |
Collapse
|