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Perini MV, Ischia J, Woon D, Bhaskar J, Starkey G, Qi S, Wetherell D, Ellard L, McCall P, Miles LF, Seevanayagam S. A novel two-stage approach to the treatment of renal cell carcinoma with intra-cardiac tumour extension and Budd-Chiari syndrome. BJU Int 2024; 133:480-486. [PMID: 38102752 DOI: 10.1111/bju.16257] [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] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To present the early results of a new technique for the treatment of renal cell carcinoma with intra-cardiac tumour extension and Budd-Chiari syndrome. PATIENTS AND METHODS The first stage involves transdiaphragmatic debulking of the right heart, inferior vena cava (IVC) and hepatic veins via median sternotomy, followed by a purse-string suture placed in the IVC below the hepatic veins. The second stage is performed separately and involves en bloc resection of the affected kidney, and IVC and vascular reconstruction via an abdominal incision. RESULTS Three of five patients presented with clinical Budd-Chiari syndrome; two had radiological features only. The median time between surgical procedures was 12 days (IQR 13 days). Four of the five patients had a R0 resection. While all five patients successfully completed both operative stages, one patient died 22 days after the second stage. Of the remaining four, all survive with no disease recurrence. CONCLUSION While we continue to compile longer-term data for a larger follow-up series, these preliminary findings show the feasibility of this technique and support the development of this programme of surgery.
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Affiliation(s)
- Marcos V Perini
- Department of Surgery (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
- Urology Unit, Austin Health, Melbourne, Victoria, Australia
| | - Dixon Woon
- Urology Unit, Austin Health, Melbourne, Victoria, Australia
| | - Jayapadman Bhaskar
- Brian F. Buxton Cardiac and Thoracic Aortic Surgery Unit, Austin Health, Melbourne, Victoria, Australia
| | - Graham Starkey
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Sara Qi
- Vascular Surgery Unit, Austin Health, Melbourne, Victoria, Australia
| | | | - Louise Ellard
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Peter McCall
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Lachlan F Miles
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Siven Seevanayagam
- Brian F. Buxton Cardiac and Thoracic Aortic Surgery Unit, Austin Health, Melbourne, Victoria, Australia
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Cox DR, Lee E, Wong BK, McClure T, Zhang F, Goh SK, Vago A, Jackett L, Fink M, Jones R, Perini MV, Dobrovic A, Testro A, Starkey G, Muralidharan V. Graft-derived cfDNA Monitoring in Plasma and Bile During Normothermic Machine Perfusion in Liver Transplantation Is Feasible and a Potential Tool for Assessing Graft Viability. Transplantation 2024; 108:958-962. [PMID: 37902630 PMCID: PMC10962428 DOI: 10.1097/tp.0000000000004842] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Ex vivo normothermic machine perfusion (NMP) is an organ preservation technique that enables an extended assessment of graft suitability before liver transplantation (LT). Established monitoring protocols used during NMP vary significantly in their assessment of transplant suitability when applied to the same grafts. Graft-derived cell-free DNA (gdcfDNA) analysis is an emerging tool for monitoring graft health post-transplantation. We investigated the feasibility of monitoring gdcfDNA during NMP for LT in a proof-of-concept, observational study. METHODS Serial plasma and bile samples were collected during NMP for 10 consecutive grafts, at 15 min post-machine reperfusion and then 2-h intervals. Digital polymerase chain reaction was used to quantify gdcfDNA at each time point. RESULTS Five grafts were suitable for LT, there were no cases of primary nonfunction or death in the recipients. gdcfDNA was quantified in all bile and plasma samples (n > 100). In plasma, gdcfDNA concentrations climbed post-machine reperfusion until 4.25 h (median 2.25 h = 15.98 × 10 6 copies/mL, 4.25 h = 40.21 × 10 6 copies/mL). gdcfDNA levels then diverged significantly when comparing the viable and non-viable graft groups (6.25 h, median viable: 117.15 × 10 6 copies/mL versus non-viable: 16.72 × 10 6 copies/mL, P = 0.01). These opposing trends correlated in each graft and in all cases with the viable/non-viable outcome. There was a trend of gradual decline in bile gdcfDNA from viable grafts post-machine reperfusion; discarded grafts showed more variable patterns of release. CONCLUSIONS gdcfDNA analysis during NMP is a feasible and potential tool to inform viability assessment during NMP for LT. Bile gdcfDNA monitoring offers the prospect of an objective means to assess the degree of biliary injury associated with organ procurement.
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Affiliation(s)
- Daniel R.A. Cox
- Department of Surgery (Austin Precinct), University of Melbourne, Melbourne, VIC, Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, Austin Health, Melbourne, VIC, Australia
- Translational Genomics and Epigenomics Laboratory, Department of Surgery (Austin), University of Melbourne, Melbourne, VIC, Australia
| | - Eunice Lee
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, Austin Health, Melbourne, VIC, Australia
| | - Boris K.L. Wong
- Translational Genomics and Epigenomics Laboratory, Department of Surgery (Austin), University of Melbourne, Melbourne, VIC, Australia
| | - Tess McClure
- Translational Genomics and Epigenomics Laboratory, Department of Surgery (Austin), University of Melbourne, Melbourne, VIC, Australia
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Fan Zhang
- Translational Genomics and Epigenomics Laboratory, Department of Surgery (Austin), University of Melbourne, Melbourne, VIC, Australia
| | - Su Kah Goh
- Department of Surgery (Austin Precinct), University of Melbourne, Melbourne, VIC, Australia
| | - Angela Vago
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Louise Jackett
- Department of Anatomical Pathology, Austin Health, Melbourne, VIC, Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct), University of Melbourne, Melbourne, VIC, Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, Austin Health, Melbourne, VIC, Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct), University of Melbourne, Melbourne, VIC, Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, Austin Health, Melbourne, VIC, Australia
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Marcos V. Perini
- Department of Surgery (Austin Precinct), University of Melbourne, Melbourne, VIC, Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, Austin Health, Melbourne, VIC, Australia
| | - Alexander Dobrovic
- Translational Genomics and Epigenomics Laboratory, Department of Surgery (Austin), University of Melbourne, Melbourne, VIC, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Graham Starkey
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, Austin Health, Melbourne, VIC, Australia
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct), University of Melbourne, Melbourne, VIC, Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, Austin Health, Melbourne, VIC, Australia
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Fink MA, Gow PJ, McCaughan GW, Hodgkinson P, Chen J, McCall J, Jaques B, Crawford M, Strasser SI, Hardikar W, Brooke-Smith M, Starkey G, Jeffrey GP, Gane E, Stormon M, Evans H, Tallis C, Byrne AJ, Jones RM. Impact of Share 35 liver transplantation allocation in Australia and New Zealand. Clin Transplant 2024; 38:e15203. [PMID: 38088459 DOI: 10.1111/ctr.15203] [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: 03/14/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/31/2024]
Abstract
Patients with high model for end-stage liver disease (MELD) scores waiting for liver transplantation in Australia and New Zealand (ANZ) have had limited access to deceased donor livers and therefore binational sharing of livers, for patients with a MELD score ≥35 was introduced in February 2016. Waiting list mortality, post-transplant outcomes and intention-to-treat survival were compared between patients whose MELD score reached 35 on the waiting list between October 2013 and April 2015 (Pre-Share 35 group, n = 23) and patients who were Share 35 listed between February 2016 and May 2022 (Share 35 group, n = 112). There was significantly reduced waiting list mortality in share 35 listed patients in comparison to the pre-Share 35 group (11.7% vs. 52.2%, OR .120 95% CI .044-.328, P < .001). Post-transplant patient and graft survival were not significantly different between the groups (5-year patient survival 82% vs. 84%, P = .991, 5-year graft survival 82% vs. 76%, P = .543). Intention-to-treat survival was superior in the Share 35 group (HR .302, 95% CI .149-.614, P < .001). Introduction of Share 35 in ANZ resulted in a 78% risk reduction in waiting list mortality, equivalent post-transplant survival and an improvement in intention-to-treat survival.
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Affiliation(s)
- Michael A Fink
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Australia and New Zealand Liver and Intestinal Transplant Registry, Melbourne, Australia
| | - Paul J Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Geoffrey W McCaughan
- University of Sydney, Sydney, New South Wales, Australia
- Liver Injury and Cancer, Centenary Institute, Camperdown, New South Wales, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter Hodgkinson
- Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia
| | - John Chen
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - John McCall
- University of Auckland, Auckland, New Zealand
- New Zealand Liver Transplant Service, Auckland City Hospital, Auckland, New Zealand
| | - Bryon Jaques
- Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Michael Crawford
- University of Sydney, Sydney, New South Wales, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simone I Strasser
- University of Sydney, Sydney, New South Wales, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Winita Hardikar
- Gastroenterology and Clinical Nutrition Department Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Graham Starkey
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Gary P Jeffrey
- Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ed Gane
- University of Auckland, Auckland, New Zealand
- New Zealand Liver Transplant Service, Auckland City Hospital, Auckland, New Zealand
| | - Michael Stormon
- University of Sydney, Sydney, New South Wales, Australia
- Australian National Liver Transplantation Service, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Helen Evans
- University of Auckland, Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Caroline Tallis
- Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia
| | - Amanda J Byrne
- Australia and New Zealand Liver and Intestinal Transplant Registry, Melbourne, Australia
| | - Robert M Jones
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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Sharma VJ, Green A, McLean A, Adegoke J, Gordon CL, Starkey G, D'Costa R, James F, Afara I, Lal S, Wood B, Raman J. Towards a point-of-care multimodal spectroscopy instrument for the evaluation of human cardiac tissue. Heart Vessels 2023; 38:1476-1485. [PMID: 37608153 PMCID: PMC10602956 DOI: 10.1007/s00380-023-02292-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/13/2023] [Indexed: 08/24/2023]
Abstract
To demonstrate that point-of-care multimodal spectroscopy using Near-Infrared (NIR) and Raman Spectroscopy (RS) can be used to diagnose human heart tissue. We generated 105 spectroscopic scans, which comprised 4 NIR and 3 RS scans per sample to generate a "multimodal spectroscopic scan" (MSS) for each heart, done across 15 patients, 5 each from the dilated cardiomyopathy (DCM), Ischaemic Heart Disease (IHD) and Normal pathologies. Each of the MSS scans was undertaken in 3 s. Data were entered into machine learning (ML) algorithms to assess accuracy of MSS in diagnosing tissue type. The median age was 50 years (IQR 49-52) for IHD, 47 (IQR 45-50) for DCM and 36 (IQR 33-52) for healthy patients (p = 0.35), 60% of which were male. MSS identified key differences in IHD, DCM and normal heart samples in regions typically associated with fibrosis and collagen (NIR wavenumbers: 1433, 1509, 1581, 1689 and 1725 nm; RS wavelengths: 1658, 1450 and 1330 cm-1). In principal component (PC) analyses, these differences explained 99.2% of the variation in 4 PCs for NIR, 81.6% in 10 PCs for Raman, and 99.0% in 26 PCs for multimodal spectroscopic signatures. Using a stack machine learning algorithm with combined NIR and Raman data, our model had a precision of 96.9%, recall of 96.6%, specificity of 98.2% and Area Under Curve (AUC) of 0.989 (Table 1). NIR and Raman modalities alone had similar levels of precision at 94.4% and 89.8% respectively (Table 1). MSS combined with ML showed accuracy of 90% for detecting dilated cardiomyopathy, 100% for ischaemic heart disease and 100% for diagnosing healthy tissue. Multimodal spectroscopic signatures, based on NIR and Raman spectroscopy, could provide cardiac tissue scans in 3-s to aid accurate diagnoses of fibrosis in IHD, DCM and normal hearts. Table 1 Machine learning performance metrics for validation data sets of (a) Near-Infrared (NIR), (b) Raman and (c and d) multimodal data using logistic regression (LR), stochastic gradient descent (SGD) and support vector machines (SVM), with combined "stack" (LR + SGD + SVM) AUC Precision Recall Specificity (a) NIR model Logistic regression 0.980 0.944 0.933 0.967 SGD 0.550 0.281 0.400 0.700 SVM 0.840 0.806 0.800 0.900 Stack 0.933 0.794 0.800 0.900 (b) Raman model Logistic regression 0.985 0.940 0.929 0.960 SGD 0.892 0.869 0.857 0.932 SVM 0.992 0.940 0.929 0.960 Stack 0.954 0.869 0.857 0.932 (c) MSS: multimodal (NIR + Raman) to detect DCM vs. IHD vs. normal patients Logistic regression 0.975 0.841 0.828 0.917 SGD 0.847 0.803 0.793 0.899 SVM 0.971 0.853 0.828 0.917 Stack 0.961 0.853 0.828 0.917 (d) MSS: multimodal (NIR + Raman) to detect pathological vs. normal patients Logistic regression 0.961 0.969 0.966 0.984 SGD 0.944 0.967 0.966 0.923 SVM 1.000 1.000 1.000 1.000 Stack 1.000 0.944 0.931 0.969 Bold values indicate values obtained from the stack algorithm and used for analyses.
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Affiliation(s)
- Varun J Sharma
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
- Brian F. Buxton Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia.
- Spectromix Laboratory, Melbourne, VIC, Australia.
| | - Alexander Green
- Spectromix Laboratory, Melbourne, VIC, Australia
- Monash Biospectroscopy, Monash University, Melbourne, Australia
| | - Aaron McLean
- Spectromix Laboratory, Melbourne, VIC, Australia
- Monash Biospectroscopy, Monash University, Melbourne, Australia
| | - John Adegoke
- Spectromix Laboratory, Melbourne, VIC, Australia
- Monash Biospectroscopy, Monash University, Melbourne, Australia
| | - Claire L Gordon
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia
- Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- North Eastern Public Health Unit, Austin Health, Melbourne, VIC, Australia
| | - Graham Starkey
- Liver Transplant Unit, Austin Hospital, Melbourne, Australia
| | - Rohit D'Costa
- DonateLife Victoria, Carlton, Melbourne, VIC, Australia
- Department of Intensive Care Medicine, Melbourne Health, Melbourne, VIC, Australia
| | - Fiona James
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia
- North Eastern Public Health Unit, Austin Health, Melbourne, VIC, Australia
| | - Isaac Afara
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Sean Lal
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bayden Wood
- Spectromix Laboratory, Melbourne, VIC, Australia
- Monash Biospectroscopy, Monash University, Melbourne, Australia
| | - Jaishankar Raman
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Brian F. Buxton Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia
- Spectromix Laboratory, Melbourne, VIC, Australia
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Sharma VJ, Adegoke JA, Fasulakis M, Green A, Goh SK, Peng X, Liu Y, Jackett L, Vago A, Poon EKW, Starkey G, Moshfegh S, Muthya A, D'Costa R, James F, Gordon CL, Jones R, Afara IO, Wood BR, Raman J. Point-of-care detection of fibrosis in liver transplant surgery using near-infrared spectroscopy and machine learning. Health Sci Rep 2023; 6:e1652. [PMID: 37920655 PMCID: PMC10618569 DOI: 10.1002/hsr2.1652] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Visual assessment and imaging of the donor liver are inaccurate in predicting fibrosis and remain surrogates for histopathology. We demonstrate that 3-s scans using a handheld near-infrared-spectroscopy (NIRS) instrument can identify and quantify fibrosis in fresh human liver samples. Methods We undertook NIRS scans on 107 samples from 27 patients, 88 from 23 patients with liver disease, and 19 from four organ donors. Results Liver disease patients had a median immature fibrosis of 40% (interquartile range [IQR] 20-60) and mature fibrosis of 30% (10%-50%) on histopathology. The organ donor livers had a median fibrosis (both mature and immature) of 10% (IQR 5%-15%). Using machine learning, this study detected presence of cirrhosis and METAVIR grade of fibrosis with a classification accuracy of 96.3% and 97.2%, precision of 96.3% and 97.0%, recall of 96.3% and 97.2%, specificity of 95.4% and 98.0% and area under receiver operator curve of 0.977 and 0.999, respectively. Using partial-least square regression machine learning, this study predicted the percentage of both immature (R 2 = 0.842) and mature (R 2 = 0.837) with a low margin of error (root mean square of error of 9.76% and 7.96%, respectively). Conclusion This study demonstrates that a point-of-care NIRS instrument can accurately detect, quantify and classify liver fibrosis using machine learning.
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Affiliation(s)
- Varun J. Sharma
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Brian F. Buxton Department of Cardiac and Thoracic Aortic SurgeryAustin HospitalMelbourneVictoriaAustralia
| | - John A. Adegoke
- Centre for BiospectroscopyMonash UniversityMelbourneVictoriaAustralia
| | - Michael Fasulakis
- Department of EngineeringUniversity of MelbourneMelbourneVictoriaAustralia
| | - Alexander Green
- Centre for BiospectroscopyMonash UniversityMelbourneVictoriaAustralia
| | - Su K. Goh
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Liver & Intestinal Transplant UnitAustin HealthMelbourneVictoriaAustralia
| | - Xiuwen Peng
- Department of EngineeringUniversity of MelbourneMelbourneVictoriaAustralia
| | - Yifan Liu
- Department of EngineeringUniversity of MelbourneMelbourneVictoriaAustralia
| | - Louise Jackett
- Department of Anatomical PathologyAustin HealthMelbourneVictoriaAustralia
| | - Angela Vago
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Liver & Intestinal Transplant UnitAustin HealthMelbourneVictoriaAustralia
| | - Eric K. W. Poon
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and ImmunityUniversity of MelbourneMelbourneVictoriaAustralia
| | - Graham Starkey
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Liver & Intestinal Transplant UnitAustin HealthMelbourneVictoriaAustralia
| | - Sarina Moshfegh
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| | - Ankita Muthya
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rohit D'Costa
- DonateLife VictoriaCarltonVictoriaAustralia
- Department of Intensive Care MedicineMelbourne HealthMelbourneVictoriaAustralia
| | - Fiona James
- Department of Infectious DiseasesAustin HealthMelbourneVictoriaAustralia
| | - Claire L. Gordon
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and ImmunityUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Infectious DiseasesAustin HealthMelbourneVictoriaAustralia
| | - Robert Jones
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Liver & Intestinal Transplant UnitAustin HealthMelbourneVictoriaAustralia
| | - Isaac O. Afara
- School of Information Technology and Electrical EngineeringFaculty of Engineering, Architecture, and Information TechnologyBrisbaneQueenslandAustralia
- Biomedical Spectroscopy Laboratory, Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Bayden R. Wood
- Centre for BiospectroscopyMonash UniversityMelbourneVictoriaAustralia
| | - Jaishankar Raman
- Department of Surgery, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Brian F. Buxton Department of Cardiac and Thoracic Aortic SurgeryAustin HospitalMelbourneVictoriaAustralia
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Peri V, Lee E, Fink M, Starkey G, Nikfarjam M, Yoshino O, Furtado R, Sinclair M, Testro A, Majumdar A, Jones R, Muralidharan V, Perini MV. A Single Centre Experience with Pre-Operative Markers in the Prediction of Outcomes after Liver Resection for Hepatocellular Carcinoma. J Gastrointest Surg 2023; 27:1376-1386. [PMID: 37095335 DOI: 10.1007/s11605-023-05681-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/08/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM The C-reactive protein to albumin ratio, albumin-bilirubin index and platelet-albumin-bilirubin index have emerged as prognostic scores in hepatocellular carcinoma, although their clinical utility remains unclear, with ongoing investigation in multiple patient populations. This study aims to report survival outcomes and evaluate these indices in a cohort of patients undergoing liver resection for hepatocellular carcinoma in a tertiary Australian centre. METHODS This retrospective study reviewed data from the Department of Surgery at Austin Health and electronic health records (Cerner corporation). The impact of pre, intra and post-operative parameters on post-operative complications, overall and recurrence free survival were analyzed. RESULTS 163 liver resections were performed in 157 patients between 2007 and 2020. Post-operative complications occurred in 58 patients (35.6%), with pre-operative albumin < 36.5 g/L (3.41(1.41-8.29),p = 0.007) and open liver resection (3.93(1.38-11.21),p = 0.011) demonstrating independent predictive significance. 1,3 and 5-year overall survival was 91.0%, 76.7% and 66.9% respectively, with a median survival time of 92.7 months (81.3-103.9). Hepatocellular carcinoma recurred in 95 patients (58.3%) with a median time to recurrence of 27.8 months (15.6-39.9). 1,3 and 5 year recurrence-free survival rates were 94.0%, 73.7% and 55.1% respectively. Pre-operative C-reactive protein-albumin ratio > 0.034 was significantly associated with reduced overall (4.39(1.19-16.16),p = 0.026) and recurrence-free (2.53(1.21-5.30),p = 0.014) survival. CONCLUSION C-reactive protein-albumin ratio > 0.034 is a strong predictor of poor prognosis following liver resection for hepatocellular carcinoma. In addition, pre-operative hypoalbuminemia was associated with post-operative complications, and future studies are required to assess the potential benefits of albumin replacement in reducing post-surgical morbidity.
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Affiliation(s)
- Varun Peri
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
| | - Eunice Lee
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Graham Starkey
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Osamu Yoshino
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Ruelan Furtado
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Marie Sinclair
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Adam Testro
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Avik Majumdar
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Marcos Vinicius Perini
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia.
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia.
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7
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Sharma V, Grant JA, Gangahanumiah S, Singh A, Gordon CL, James F, D'Costa R, Starkey G, Raman J. Fresh human cardiac tissue for translational research: A novel method of sampling deceased organ donors. JTCVS Tech 2023; 19:77-79. [PMID: 37324328 PMCID: PMC10268497 DOI: 10.1016/j.xjtc.2023.03.020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/15/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Varun Sharma
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - James A.L. Grant
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shivanand Gangahanumiah
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Aashima Singh
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire L. Gordon
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Fiona James
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Rohit D'Costa
- Department of Intensive Care Medicine, Melbourne Health, Melbourne, Victoria, Australia
- Donatelife Victoria, Carlton, Victoria, Australia
| | - Graham Starkey
- Liver Transplant Unit, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Jaishankar Raman
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Health, Heidelberg, Melbourne, Victoria, Australia
- Department of Cardiac Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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8
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Weeden CE, Gayevskiy V, Marceaux C, Batey D, Tan T, Yokote K, Ribera NT, Clatch A, Christo S, Teh CE, Mitchell AJ, Trussart M, Rankin LC, Obers A, McDonald JA, Sutherland KD, Sharma VJ, Starkey G, D'Costa R, Antippa P, Leong T, Steinfort D, Irving L, Swanton C, Gordon CL, Mackay LK, Speed TP, Gray DHD, Asselin-Labat ML. Early immune pressure initiated by tissue-resident memory T cells sculpts tumor evolution in non-small cell lung cancer. Cancer Cell 2023; 41:837-852.e6. [PMID: 37086716 DOI: 10.1016/j.ccell.2023.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/05/2023] [Accepted: 03/24/2023] [Indexed: 04/24/2023]
Abstract
Tissue-resident memory T (TRM) cells provide immune defense against local infection and can inhibit cancer progression. However, it is unclear to what extent chronic inflammation impacts TRM activation and whether TRM cells existing in tissues before tumor onset influence cancer evolution in humans. We performed deep profiling of healthy lungs and lung cancers in never-smokers (NSs) and ever-smokers (ESs), finding evidence of enhanced immunosurveillance by cells with a TRM-like phenotype in ES lungs. In preclinical models, tumor-specific or bystander TRM-like cells present prior to tumor onset boosted immune cell recruitment, causing tumor immune evasion through loss of MHC class I protein expression and resistance to immune checkpoint inhibitors. In humans, only tumors arising in ES patients underwent clonal immune evasion, unrelated to tobacco-associated mutagenic signatures or oncogenic drivers. These data demonstrate that enhanced TRM-like activity prior to tumor development shapes the evolution of tumor immunogenicity and can impact immunotherapy outcomes.
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Affiliation(s)
- Clare E Weeden
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia
| | - Velimir Gayevskiy
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia
| | - Claire Marceaux
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia
| | - Daniel Batey
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Tania Tan
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Kenta Yokote
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Nina Tubau Ribera
- Advanced Technology and Biology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Allison Clatch
- Department of Microbiology and Immunology, the University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Susan Christo
- Department of Microbiology and Immunology, the University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Charis E Teh
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia
| | - Andrew J Mitchell
- Materials Characterisation and Fabrication Platform, Department of Chemical Engineering, the University of Melbourne, Parkville, VIC, Australia
| | - Marie Trussart
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Lucille C Rankin
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia
| | - Andreas Obers
- Department of Microbiology and Immunology, the University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Jackson A McDonald
- ACRF Stem Cells and Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia
| | - Kate D Sutherland
- ACRF Stem Cells and Cancer Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia
| | - Varun J Sharma
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia; Liver and Intestinal Transplant Unit, Austin Health, Heidelberg, VIC, Australia; Department of Cardiothoracic Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Graham Starkey
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia; Liver and Intestinal Transplant Unit, Austin Health, Heidelberg, VIC, Australia
| | - Rohit D'Costa
- DonateLife Victoria, Carlton, VIC, Australia; Department of Intensive Care Medicine, Melbourne Health, Melbourne, VIC, Australia
| | - Phillip Antippa
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Tracy Leong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Daniel Steinfort
- Department of Medicine, the University of Melbourne, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Louis Irving
- Department of Medicine, the University of Melbourne, Parkville, VIC, Australia; The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK; Cancer Evolution and Genome Instability Laboratory, Francis Crick Institute, London, UK; Department of Oncology, University College London Hospitals, London, UK
| | - Claire L Gordon
- Department of Microbiology and Immunology, the University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia; Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia; North Eastern Public Health Unit, Austin Health, Heidelberg, VIC, Australia
| | - Laura K Mackay
- Department of Microbiology and Immunology, the University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Terence P Speed
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; School of Mathematics and Statistics, the University of Melbourne, Parkville, VIC, Australia
| | - Daniel H D Gray
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia.
| | - Marie-Liesse Asselin-Labat
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, the University of Melbourne, Parkville, VIC, Australia.
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9
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Stock AT, Parsons S, D'Silva DB, Hansen JA, Sharma VJ, James F, Starkey G, D'Costa R, Gordon CL, Wicks IP. Mechanistic Target of Rapamycin Inhibition Prevents Coronary Artery Remodeling in a Murine Model of Kawasaki Disease. Arthritis Rheumatol 2023; 75:305-317. [PMID: 36057112 DOI: 10.1002/art.42340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/23/2022] [Accepted: 08/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Remodeling of the coronary arteries is a common feature in severe cases of Kawasaki disease (KD). This pathology is driven by the dysregulated proliferation of vascular fibroblasts, which can lead to coronary artery aneurysms, stenosis, and myocardial ischemia. We undertook this study to investigate whether inhibiting fibroblast proliferation might be an effective therapeutic strategy to prevent coronary artery remodeling in KD. METHOD We used a murine model of KD (induced by the injection of the Candida albicans water-soluble complex [CAWS]) and analyzed patient samples to evaluate potential antifibrotic therapies for KD. RESULTS We identified the mechanistic target of rapamycin (mTOR) pathway as a potential therapeutic target in KD. The mTOR inhibitor rapamycin potently inhibited cardiac fibroblast proliferation in vitro, and vascular fibroblasts up-regulated mTOR kinase signaling in vivo in the CAWS mouse model of KD. We evaluated the in vivo efficacy of mTOR inhibition and found that the therapeutic administration of rapamycin reduced vascular fibrosis and intimal hyperplasia of the coronary arteries in CAWS-injected mice. Furthermore, the analysis of cardiac tissue from KD fatalities revealed that vascular fibroblasts localizing with inflamed coronary arteries up-regulate mTOR signaling, confirming that the mTOR pathway is active in human KD. CONCLUSION Our findings demonstrate that mTOR signaling contributes to coronary artery remodeling in KD, and that targeting this pathway offers a potential therapeutic strategy to prevent or restrict this pathology in high-risk KD patients.
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Affiliation(s)
- Angus T Stock
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Sarah Parsons
- Department of Forensic Medicine, Monash University, and Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Damian B D'Silva
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jacinta A Hansen
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Varun J Sharma
- Liver & Intestinal Transplant Unit, Department of Surgery, and Department of Cardiac Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Fiona James
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Graham Starkey
- Liver & Intestinal Transplant Unit and Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Rohit D'Costa
- DonateLife Victoria, Carlton, Victoria, Australia, and Department of Intensive Care Medicine, Melbourne Health, Melbourne, Victoria, Australia
| | - Claire L Gordon
- Department of Infectious Diseases, Austin Health, Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, and North Eastern Public Health Unit, Austin Health, Melbourne, Victoria, Australia
| | - Ian P Wicks
- Walter and Eliza Hall Institute of Medical Research, Rheumatology Unit, The Royal Melbourne Hospital, and University of Melbourne, Department of Medical Biology, Victoria, Australia
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10
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Stock AT, Parsons S, Sharma VJ, James F, Starkey G, D'Costa R, Gordon CL, Wicks IP. Intimal macrophages develop from circulating monocytes during vasculitis. Clin Transl Immunology 2022; 11:e1412. [PMID: 35991774 PMCID: PMC9375838 DOI: 10.1002/cti2.1412] [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: 03/21/2022] [Revised: 07/12/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Vasculitis is characterised by inflammation of the blood vessels. While all layers of the vessel can be affected, inflammation within the intimal layer can trigger thrombosis and arterial occlusion and is therefore of particular clinical concern. Given this pathological role, we have examined how intimal inflammation develops by exploring which (and how) macrophages come to populate this normally immune‐privileged site during vasculitis. Methods We have addressed this question for Kawasaki disease (KD), which is a type of vasculitis in children that typically involves the coronary arteries. We used confocal microscopy and flow cytometry to characterise the macrophages that populate the coronary artery intima in KD patient samples and in a mouse model of KD, and furthermore, have applied an adoptive transfer system to trace how these intimal macrophages develop. Results In KD patients, intimal hyperplasia coincided with marked macrophage infiltration of the coronary artery intima. Phenotypic analysis revealed that these ‘intimal macrophages’ did not express markers of resident cardiac macrophages, such as Lyve‐1, and instead, were uniformly positive for the chemokine receptor Ccr2, suggesting a monocytic lineage. In support of this origin, we show that circulating monocytes directly invade the intima via transluminal migration during established disease, coinciding with the activation of endothelial cells lining the coronary arteries. Conclusions During KD, intimal macrophages develop from circulating monocytes that infiltrate the inflamed coronary artery intima by transluminal migration.
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Affiliation(s)
- Angus T Stock
- Walter and Eliza Hall Institute of Medical Research Parkville VIC Australia
| | - Sarah Parsons
- Department of Forensic Medicine Monash University Melbourne VIC Australia.,Victorian Institute of Forensic Medicine Melbourne VIC Australia
| | - Varun J Sharma
- Liver & Intestinal Transplant Unit Austin Health Melbourne VIC Australia.,Department of Surgery The University of Melbourne, Austin Health Melbourne VIC Australia.,Department of Cardiac Surgery Austin Health Melbourne VIC Australia
| | - Fiona James
- Department of Infectious Diseases Austin Health Melbourne VIC Australia
| | - Graham Starkey
- Liver & Intestinal Transplant Unit Austin Health Melbourne VIC Australia.,Department of Surgery The University of Melbourne, Austin Health Melbourne VIC Australia
| | - Rohit D'Costa
- DonateLife Victoria Carlton VIC Australia.,Department of Intensive Care Medicine Melbourne Health Melbourne VIC Australia
| | - Claire L Gordon
- Department of Infectious Diseases Austin Health Melbourne VIC Australia.,Department of Microbiology and Immunology The Peter Doherty Institute for Infection and Immunity, The University of Melbourne Melbourne VIC Australia.,North Eastern Public Health Unit Austin Health Melbourne VIC Australia
| | - Ian P Wicks
- Walter and Eliza Hall Institute of Medical Research Parkville VIC Australia.,Rheumatology Unit The Royal Melbourne Hospital Melbourne VIC Australia.,Department of Medical Biology University of Melbourne Melbourne VIC Australia
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11
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Yeow M, Soh S, Starkey G, Perini MV, Koh YX, Tan EK, Chan CY, Raj P, Goh BKP, Kabir T. A systematic review and network meta-analysis of outcomes after open, mini-laparotomy, hybrid, totally laparoscopic, and robotic living donor right hepatectomy. Surgery 2022; 172:741-750. [PMID: 35644687 DOI: 10.1016/j.surg.2022.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A systematic review and network meta-analysis was performed to compare outcomes after living donor right hepatectomy via the following techniques: conventional open (Open), mini-laparotomy (Minilap), hybrid (Hybrid), totally laparoscopic (Lap), and robotic living donor right hepatectomy (Robotic). METHODS PubMed, EMBASE, Cochrane, and Scopus were searched from inception to August 2021 for comparative studies of patients who underwent living donor right hepatectomy. RESULTS Nineteen studies comprising 2,261 patients were included. Operation time was longer in Lap versus Minilap and Open (mean difference 65.09 min, 95% confidence interval 3.40-126.78 and mean difference 34.81 minutes, 95% confidence interval 1.84-67.78), and in Robotic versus Hybrid, Lap, Minilap, and Open (mean difference 144.72 minutes, 95% confidence interval 89.84-199.59, mean difference 113.24 minutes, 95% confidence interval 53.28-173.20, mean difference 178.33 minutes, 95% confidence interval 105.58-251.08 and mean difference 148.05 minutes, 95% confidence interval 97.35-198.74, respectively). Minilap and Open were associated with higher blood loss compared to Lap (mean difference 258.67 mL, 95% confidence interval 107.00-410.33 and mean difference 314.11 mL, 95% confidence interval 143.84-484.37) and Robotic (mean difference 205.60 mL, 95% confidence interval 45.92-365.28 and mean difference 261.04 mL, 95% confidence interval 84.26-437.82). Open was associated with more overall complications compared to Minilap (odds ratio 2.60, 95% confidence interval 1.11-6.08). Recipient biliary complication rate was higher in Minilap and Open versus Hybrid (odds ratio 3.91, 95% confidence interval 1.13-13.55 and odds ratio 11.42, 95% confidence interval 2.27-57.49), and lower in Open versus Minilap (OR 0.07, 95% confidence interval 0.01-0.34). CONCLUSION Minimally invasive donor right hepatectomy via the various techniques is safe and feasible when performed in high-volume centers, with no major differences in donor complication rates and comparable recipient outcomes once surgeons have mounted the learning curve.
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Affiliation(s)
- Marcus Yeow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shauna Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Graham Starkey
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Australia
| | - Marcos V Perini
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Australia; Department of Surgery, The University of Melbourne, Austin Health, Melbourne, Australia
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. https://twitter.com/yexin_koh
| | - Ek-Khoon Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. https://twitter.com/EkKhoonTan
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Prema Raj
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore. https://twitter.com/BrianKGoh
| | - Tousif Kabir
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Australia; Department of General Surgery, Sengkang General Hospital, Singapore.
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12
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Tan HX, Juno JA, Esterbauer R, Kelly HG, Wragg KM, Konstandopoulos P, Alcantara S, Alvarado C, Jones R, Starkey G, Wang BZ, Yoshino O, Tiang T, Grayson ML, Opdam H, D'Costa R, Vago A, Mackay LK, Gordon CL, Masopust D, Groom JR, Kent SJ, Wheatley AK. Lung-resident memory B cells established after pulmonary influenza infection display distinct transcriptional and phenotypic profiles. Sci Immunol 2022; 7:eabf5314. [PMID: 35089815 DOI: 10.1126/sciimmunol.abf5314] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recent studies have established that memory B cells, largely thought to be circulatory in the blood, can take up long-term residency in inflamed tissues, analogous to widely described tissue-resident T cells. The dynamics of recruitment and retention of memory B cells to tissues and their immunological purpose remains unclear. Here, we characterized tissue-resident memory B cells (BRM) that are stably maintained in the lungs of mice after pulmonary influenza infection. Influenza-specific BRM were localized within inducible bronchus-associated lymphoid tissues (iBALTs) and displayed transcriptional signatures distinct from classical memory B cells in the blood or spleen while showing partial overlap with memory B cells in lung-draining lymph nodes. We identified lung-resident markers, including elevated expression of CXCR3, CCR6, and CD69, on hemagglutinin (HA)- and nucleoprotein (NP)-specific lung BRM. We found that CCR6 facilitates increased recruitment and/or retention of BRM in lungs and differentiation into antibody-secreting cells upon recall. Although expression of CXCR3 and CCR6 was comparable in total and influenza-specific memory B cells isolated across tissues of human donors, CD69 expression was higher in memory B cells from lung and draining lymph nodes of human organ donors relative to splenic and PBMC-derived populations, indicating that mechanisms underpinning BRM localization may be evolutionarily conserved. Last, we demonstrate that human memory B cells in lungs are transcriptionally distinct to populations in lung-draining lymph nodes or PBMCs. These data suggest that BRM may constitute a discrete component of B cell immunity, positioned at the lung mucosa for rapid humoral response against respiratory viral infections.
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Affiliation(s)
- Hyon-Xhi Tan
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Jennifer A Juno
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Robyn Esterbauer
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Hannah G Kelly
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,ARC Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Kathleen M Wragg
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Penny Konstandopoulos
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Sheilajen Alcantara
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,ARC Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Carolina Alvarado
- Division of Immunology, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia
| | - Robert Jones
- Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Graham Starkey
- Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Boa Zhong Wang
- Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Osamu Yoshino
- Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Thomas Tiang
- Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia
| | - M Lindsay Grayson
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Helen Opdam
- DonateLife, The Australian Organ and Tissue Authority, Canberra, Australian Capital Territory 2601, Australia.,Department of Intensive Care, Austin Health, Heidelberg, Victoria 3084, Australia
| | - Rohit D'Costa
- DonateLife Victoria, Carlton, Victoria 3053, Australia.,Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Angela Vago
- Department of Surgery, Austin Health, Heidelberg, Victoria 3084, Australia
| | | | - Laura K Mackay
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Claire L Gordon
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Victoria 3084, Australia
| | - David Masopust
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA.,Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Joanna R Groom
- Division of Immunology, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,ARC Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, Victoria 3010, Australia.,Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Adam K Wheatley
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,ARC Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, Victoria 3010, Australia
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13
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Alexandre YO, Schienstock D, Lee HJ, Gandolfo LC, Williams CG, Devi S, Pal B, Groom JR, Cao W, Christo SN, Gordon CL, Starkey G, D'Costa R, Mackay LK, Haque A, Ludewig B, Belz GT, Mueller SN. A diverse fibroblastic stromal cell landscape in the spleen directs tissue homeostasis and immunity. Sci Immunol 2022; 7:eabj0641. [PMID: 34995096 DOI: 10.1126/sciimmunol.abj0641] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Yannick O Alexandre
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Dominik Schienstock
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Hyun Jae Lee
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Luke C Gandolfo
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.,Walter and Eliza Hall Institute of Medical Research (WEHI), Parkville, VIC, Australia
| | - Cameron G Williams
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Sapna Devi
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Bhupinder Pal
- Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Heidelberg, VIC, Australia
| | - Joanna R Groom
- Walter and Eliza Hall Institute of Medical Research (WEHI), Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Wang Cao
- Walter and Eliza Hall Institute of Medical Research (WEHI), Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Susan N Christo
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Claire L Gordon
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.,Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia
| | - Graham Starkey
- Liver and Intestinal Transplant Unit, Austin Health, Melbourne, VIC, Australia.,Department of Surgery, University of Melbourne, Austin Health, Melbourne, VIC, Australia
| | - Rohit D'Costa
- DonateLife Victoria, Carlton, VIC, Australia.,Department of Intensive Care Medicine, Melbourne Health, Melbourne, VIC, Australia
| | - Laura K Mackay
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Ashraful Haque
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Burkhard Ludewig
- Institute of Immunobiology, Medical Research Center, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Institute of Experimental Immunology, University of Zürich, Zürich, Switzerland
| | - Gabrielle T Belz
- Walter and Eliza Hall Institute of Medical Research (WEHI), Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.,University of Queensland Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Scott N Mueller
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
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14
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Goh SK, Naazar A, Issa M, Starkey G, Ranatunga D, Lee E. Delayed diaphragmatic hernia and gastric fundus incarceration: a rare complication after transarterial chemoembolization. ANZ J Surg 2021; 92:1882-1884. [PMID: 34657385 DOI: 10.1111/ans.17295] [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] [Received: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Su Kah Goh
- Hepatopancreatobiliary and Transplant Unit, Department of Surgery (Austin Precinct), The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Ali Naazar
- Hepatopancreatobiliary and Transplant Unit, Department of Surgery (Austin Precinct), The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Michael Issa
- Hepatopancreatobiliary and Transplant Unit, Department of Surgery (Austin Precinct), The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Graham Starkey
- Hepatopancreatobiliary and Transplant Unit, Department of Surgery (Austin Precinct), The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Dinesh Ranatunga
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Eunice Lee
- Hepatopancreatobiliary and Transplant Unit, Department of Surgery (Austin Precinct), The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
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15
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Privett BJ, Perini MV, Weinberg L, Fink MA, Muralidharan V, Lee E, Starkey G, Jones R, Lin YJ, Nikfarjam M. Reduction in post-operative pancreatic fistula with polyethylene glycol and recombinant human albumin sealant following stapled distal pancreatectomy. ANZ J Surg 2021; 91:2459-2465. [PMID: 34514684 DOI: 10.1111/ans.17181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) remains a significant cause of morbidity in patients undergoing distal pancreatectomy (DP). The use of polyethylene glycol (PEG) and recombinant human albumin sealant gel applied to the transected pancreatic margin in DP may reduce POPF rates and was assessed. METHODS A retrospective single centre cohort study of patient undergoing DP at an Australian high volume tertiary institution between January 2015 and January 2021. Rates of POPF in patients undergoing stapled pancreatic transection with PEG sealant were compared to other methods. RESULTS A total of 54 cases were identified for analysis, with 16 undergoing stapled DP combined with staple line application of PEG (PEG group). Most patients in the control group had stapled DP 92% (35 of 38), with 47% (18 of 38) combined with a reinforcing buttress, with or without the use other glue types. Overall, 28 of 54 (52%) developed a POPF, with a significantly lower rate in the PEG group (3 of 16 vs. 25 of 38 in the Control group; p = 0.003). Clinically significant Grade B/C POPF was lower in the PEG group (0 of 16 vs. 9 of 28 in the Control group; p = 0.045), and patients in the PEG group had a shorter median (range) length of hospital stay (6 [4-14] days vs. 10 [6-41] days p = 0.04). CONCLUSION Stapled DP with the application of PEG and recombinant human albumin sealant to the transection line appears to be associated with a lower rate of clinically significant POPF.
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Affiliation(s)
- Benjamin J Privett
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Marcos V Perini
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,The University of Melbourne Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Michael A Fink
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | | | - Eunice Lee
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Graham Starkey
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Robert Jones
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Yi-Ju Lin
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Mehrdad Nikfarjam
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
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16
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Tang GT, Shaylor R, Hui V, Przybylowski G, Jones RM, Starkey G, Perini MV, Wang BZ, Zantomio D, Hogan C, Fink MA. The use of organ donor blood in liver transplantation. Clin Transplant 2021; 35:e14419. [PMID: 34236114 DOI: 10.1111/ctr.14419] [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: 02/16/2021] [Revised: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Blood removed from organs during deceased donor organ procurement is routinely discarded but is a potential resource for donor-specific transfusion (DST) in subsequent liver transplantation (LT). This study retrospectively analyses the impact of DST on intraoperative bank blood product usage, long-term graft and patient survival, as well as frequency of rejection post-LT. METHODS A total of 992 adult LT performed from 1993 to 2018 in a single quaternary centre were included. Intraoperative blood product usage, patient and graft survival, as well as acute and chronic rejection were assessed in patients who received blood retrieved from the organ donor, the 'donor blood' (DB) group (n = 437) and patients who did not, the 'no donor blood' (NDB) group (n = 555). RESULTS Processing of DB ensured safe levels of potassium, magnesium and insulin. There were fewer units of bank red blood cells transfusion required in the DB group compared to NDB group (2 vs 4 units, P = 0.01). Graft survival was significantly superior in the DB group (10-year survival 75% vs 69%, respectively, P = 0.04) but DST was not an independent predictor of graft survival. There was no significant difference in patient survival or rejection between the groups. There was no difference in treated, biopsy-proven rejection between the two groups. CONCLUSIONS This is the first large-cohort study assessing long-term outcomes of intraoperative DST in LT. The collection of organ donor blood and subsequent use in LT recipients appeared feasible with appropriate quality checks ensuring safety. DST resulted in a reduction in the use of packed red blood cells. There was no difference in the rate of rejection or graft or patient survival. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gia Toan Tang
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia
| | - Ruth Shaylor
- Department of Anaesthesia, Austin Health, Melbourne, 3084, Australia
| | - Victor Hui
- Department of Anaesthesia, Austin Health, Melbourne, 3084, Australia
| | - Greg Przybylowski
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia
| | - Robert McLaren Jones
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
| | - Graham Starkey
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia
| | - Marcos Vinicius Perini
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
| | - Bao-Zhong Wang
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
| | - Daniela Zantomio
- Department of Haematology, Austin Health, Melbourne, 3084, Australia
| | - Chris Hogan
- Department of Haematology, Austin Health, Melbourne, 3084, Australia
| | - Michael Anthony Fink
- Victorian Liver Transplant Unit, Austin Health, Melbourne, 3084, Australia.,Department of Surgery, The University of Melbourne, Austin Health, Melbourne, 3084, Australia
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17
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Tan H, Lee WS, Wragg KM, Nelson C, Esterbauer R, Kelly HG, Amarasena T, Jones R, Starkey G, Wang BZ, Yoshino O, Tiang T, Grayson ML, Opdam H, D'Costa R, Vago A, Mackay LK, Gordon CL, Wheatley AK, Kent SJ, Juno JA. Adaptive immunity to human coronaviruses is widespread but low in magnitude. Clin Transl Immunology 2021; 10:e1264. [PMID: 33747512 PMCID: PMC7968850 DOI: 10.1002/cti2.1264] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Endemic human coronaviruses (hCoVs) circulate worldwide but cause minimal mortality. Although seroconversion to hCoV is near ubiquitous during childhood, little is known about hCoV-specific T-cell memory in adults. METHODS We quantified CD4 T-cell and antibody responses to hCoV spike antigens in 42 SARS-CoV-2-uninfected individuals. Antigen-specific memory T cells and circulating T follicular helper (cTFH) cells were identified using an activation-induced marker assay and characterised for memory phenotype and chemokine receptor expression. RESULTS T-cell responses were widespread within conventional memory and cTFH compartments but did not correlate with IgG titres. SARS-CoV-2 cross-reactive T cells were observed in 48% of participants and correlated with HKU1 memory. hCoV-specific T cells exhibited a CCR6+ central memory phenotype in the blood, but were enriched for frequency and CXCR3 expression in human lung-draining lymph nodes. CONCLUSION Overall, hCoV-specific humoral and cellular memory are independently maintained, with a shared phenotype existing among coronavirus-specific CD4 T cells. This understanding of endemic coronavirus immunity provides insight into the homeostatic maintenance of immune responses that are likely to be critical components of protection against SARS-CoV-2.
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Affiliation(s)
- Hyon‐Xhi Tan
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Wen Shi Lee
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Kathleen M Wragg
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Christina Nelson
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Robyn Esterbauer
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Hannah G Kelly
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
- Australian Research Council Centre for Excellence in Convergent Bio‐Nano Science and TechnologyUniversity of MelbourneMelbourneVICAustralia
| | - Thakshila Amarasena
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Robert Jones
- Department of SurgeryAustin HealthHeidelbergVICAustralia
| | - Graham Starkey
- Department of SurgeryAustin HealthHeidelbergVICAustralia
| | - Bao Zhong Wang
- Department of SurgeryAustin HealthHeidelbergVICAustralia
| | - Osamu Yoshino
- Department of SurgeryAustin HealthHeidelbergVICAustralia
| | - Thomas Tiang
- Department of SurgeryAustin HealthHeidelbergVICAustralia
| | | | - Helen Opdam
- DonateLifeThe Australian Organ and Tissue AuthorityCarltonVICAustralia
- Department of Intensive CareAustin HealthHeidelbergVICAustralia
| | - Rohit D'Costa
- DonateLife VictoriaCarltonVICAustralia
- Intensive Care UnitThe Royal Melbourne HospitalParkvilleVICAustralia
| | - Angela Vago
- Department of SurgeryAustin HealthHeidelbergVICAustralia
| | - Laura K Mackay
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Claire L Gordon
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
- Department of Infectious DiseasesAustin HealthHeidelbergVICAustralia
| | - Adam K Wheatley
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
| | - Stephen J Kent
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
- Australian Research Council Centre for Excellence in Convergent Bio‐Nano Science and TechnologyUniversity of MelbourneMelbourneVICAustralia
- Melbourne Sexual Health Centre and Department of Infectious DiseasesAlfred Hospital and Central Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Jennifer A Juno
- Department of Microbiology and ImmunologyUniversity of Melbourne, at the Peter Doherty institute for Infection and ImmunityMelbourneVICAustralia
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18
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Kabir T, Issa M, Starkey G. Rare presentation of a symptomatic primary neuroendocrine tumour of small bowel mesentery. ANZ J Surg 2020; 91:E403-E404. [PMID: 33159428 DOI: 10.1111/ans.16431] [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] [Received: 04/29/2020] [Revised: 09/28/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tousif Kabir
- Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia.,Department of General Surgery, Sengkang General Hospital, Singapore
| | - Michael Issa
- Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia
| | - Graham Starkey
- Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia
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19
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Clarke EM, Stevens SG, Bennett T, Crowley P, Starkey G. The surgical management of metastatic pancreatic acinar cell carcinoma and associated pancreatic panniculitis-A case report and literature review. Int J Surg Case Rep 2020; 76:539-544. [PMID: 33207427 PMCID: PMC7599369 DOI: 10.1016/j.ijscr.2020.10.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/18/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic acinar cell carcinoma (ACC) may present with pancreatic panniculitis. Complete surgical resection of ACC can successfully treat pancreatic panniculitis. Aggressive surgery for ACC can lead to prolonged disease-free survival.
Introduction Pancreatic panniculitis is a rare manifestation of benign and malignant pancreatic disease. The presentation of pancreatic panniculitis is non-specific and thus diagnosis is often delayed. When associated with malignancy, pancreatic panniculitis confers a poor prognosis. This case demonstrates the successful surgical management of this paraneoplastic phenomenon following resection of the underlying pancreatic acinar cell carcinoma and associated liver metastasis. Presentation of case A 71-year-old female with debilitating subcutaneous lower limb lesions had a delayed diagnosis of pancreatic panniculitis. A formal diagnosis of pancreatic acinar cell carcinoma with liver metastasis was established and the disease was determined to be resectable. Pre-operatively, serum lipase measured 10,825 U/L. The patient proceeded to an open left hemihepatectomy and radical distal pancreatectomy with complete resection of malignant disease. Six days post-operatively the serum lipase levels normalised, and the panniculitis began to settle. The patient proceeded to adjuvant FOLFORINOX chemotherapy. Twenty months post-surgery, the patient remains disease-free and without any evidence of panniculitis. Discussion Due to the rarity of pancreatic acinar cell carcinoma, guidelines based on prospective data do not exist. Most management is based on retrospective analyses. A survival benefit may be achieved with more aggressive surgical management compared to other pancreatic cancer types. Pancreatic acinar cell carcinoma may show a slower rate of disease progression, an increased likelihood of resectability of disease at presentation and is more likely to undergo potentially curative resection. Conclusion Aggressive surgical management of resectable metastatic pancreatic acinar cell carcinoma can treat pancreatic panniculitis and provide sustained disease-free survival from pancreatic cancer.
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Affiliation(s)
- Edward M Clarke
- Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia.
| | - Sean G Stevens
- Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia
| | - Tim Bennett
- Department of Rheumatology, Eastern Health, Box Hill, Melbourne, Australia
| | - Peter Crowley
- Dorevitch Pathology, Heidelberg Laboratory, Melbourne, Australia
| | - Graham Starkey
- Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Surgery, Warringal Private Hospital, Heidelberg, Melbourne, Australia
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20
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Jeffrey AW, Jeffrey GP, Stormon M, Thomas G, O'Loughlin E, Shun A, Hardikar W, Jones R, McCall J, Evans H, Starkey G, Hodgkinson P, Ee LC, Moore D, Mews C, McCaughan GW, Angus PW, Wigg AJ, Crawford M, Fawcett J. Outcomes for children after second liver transplantations are similar to those after first transplantations: a binational registry analysis. Med J Aust 2020; 213:464-470. [DOI: 10.5694/mja2.50802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Gary P Jeffrey
- Sir Charles Gairdner Hospital Perth WA
- The University of Western Australia Perth WA
| | - Michael Stormon
- Australian National Liver Transplantation Service Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
| | - Gordon Thomas
- Australian National Liver Transplantation Service Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
| | - Edward O'Loughlin
- Australian National Liver Transplantation Service Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
| | - Albert Shun
- Australian National Liver Transplantation Service Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
| | | | - Robert Jones
- Victorian Liver Transplant Unit Austin Hospital Melbourne VIC
- Victorian Liver Transplant Unit Royal Children's Hospital Melbourne VIC
| | - John McCall
- New Zealand Liver Transplant Unit Auckland City Hospital Auckland New Zealand
- Starship Children's Health Auckland New Zealand
| | - Helen Evans
- Starship Children's Health Auckland New Zealand
| | - Graham Starkey
- Victorian Liver Transplant Unit Austin Hospital Melbourne VIC
- Victorian Liver Transplant Unit Royal Children's Hospital Melbourne VIC
| | - Peter Hodgkinson
- Queensland Liver Transplantation Service Princess Alexandra Hospital Brisbane QLD
- The University of Queensland Brisbane QLD
| | - Looi C Ee
- Lady Cilento Children's Hospital Brisbane QLD
| | | | | | - Geoff W McCaughan
- Australian National Liver Transplantation Unit Royal Prince Alfred Hospital Sydney NSW
- Sydney Medical School , the University of Sydney Sydney NSW
| | - Peter W Angus
- Victorian Liver Transplant Unit Austin Hospital Melbourne VIC
- Victorian Liver Transplant Unit Royal Children's Hospital Melbourne VIC
| | - Alan J Wigg
- South Australian Liver Transplantation Service Flinders Medical Centre Adelaide SA
| | - Michael Crawford
- The University of Sydney Sydney NSW
- Australian National Liver Transplantation Unit Royal Prince Alfred Hospital Sydney NSW
| | - Jonathan Fawcett
- Queensland Liver Transplantation Service Princess Alexandra Hospital Brisbane QLD
- The University of Queensland Brisbane QLD
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21
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Fink M, Starkey G, Perini MV, Wang BZ, Gow P, Jones RM. SHARING OF DECEASED DONOR LIVERS IN AUSTRALIA AND NEW ZEALAND. Transplantation 2020. [DOI: 10.1097/01.tp.0000699492.39930.37] [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] [Indexed: 11/25/2022]
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22
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Hey P, Hanrahan TP, Sinclair M, Testro AG, Angus PW, Peterson A, Warrillow S, Bellomo R, Perini MV, Starkey G, Jones RM, Fink M, McClure T, Gow P. Epidemiology and outcomes of acute liver failure in Australia. World J Hepatol 2019; 11:586-595. [PMID: 31388400 PMCID: PMC6669190 DOI: 10.4254/wjh.v11.i7.586] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/19/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain.
AIM To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia.
METHODS The database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988-2001.
RESULTS Paracetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively.
CONCLUSION Paracetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF.
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Affiliation(s)
- Penelope Hey
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | | | - Marie Sinclair
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Adam G Testro
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Peter W Angus
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Adam Peterson
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
| | - Stephen Warrillow
- Department of Intensive Care, Austin Heath, Melbourne 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Heath, Melbourne 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Marcos V Perini
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Graham Starkey
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Robert M Jones
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Michael Fink
- Department of Surgery, Austin Health, Melbourne 3084, Australia
| | - Tess McClure
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Health, Heidelberg 3084, Australia
- The University of Melbourne, Melbourne 3052, Australia
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23
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Chan J, Bradshaw L, Houli N, Weinberg L, Perini MV, Fink M, Muralidharan V, Starkey G, Jones R, Wang BZ, Christophi C, Nikfarjam M. Outcomes of central hepatectomy versus extended hepatectomy. Hepatobiliary Pancreat Dis Int 2019; 18:249-254. [PMID: 30987899 DOI: 10.1016/j.hbpd.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/12/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Central hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post-hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. METHODS A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. RESULTS The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four (16.7%) in the EH group (P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min (290-840) vs. 523 min (310-860), P = 0.328], intraoperative blood loss [850 mL (400-1500) vs. 650 mL (100-2000), P = 0.746] or patients requiring intraoperative blood transfusion [1 (9.1%) vs. 7 (30.4%), P = 0.227]. There was a trend towards fewer hepatectomy-specific complications in the CH group [3 (27.3%) vs. 13 (54.2%), P = 0.167], including PHLF (CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days (5-23) vs. 12 days (4-85), P = 0.244]. CONCLUSIONS CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.
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Affiliation(s)
- Jenny Chan
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Luke Bradshaw
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Northern Health, Epping, Victoria, Australia
| | - Nezor Houli
- Department of Surgery, University of Melbourne, Northern Health, Epping, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Marcos V Perini
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Michael Fink
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Graham Starkey
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Robert Jones
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Bao Zhong Wang
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Christopher Christophi
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia.
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24
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Cox DRA, Fong J, Liew CH, Goh SK, Yeoh M, Fink MA, Jones RM, Mukkadayil J, Nikfarjam M, Perini MV, Rumler G, Starkey G, Christophi C, Muralidharan V. Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute. ANZ J Surg 2018; 88:1337-1342. [PMID: 30414227 DOI: 10.1111/ans.14898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/21/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Acute biliary pain is the most common presentation of gallstone disease. Untreated patients risk recurrent pain, cholecystitis, obstructive jaundice, pancreatitis and multiple hospital presentations. We examine the outcome of implementing a policy to offer laparoscopic cholecystectomy on index presentation to patients with biliary colic in a tertiary hospital in Australia. METHODS This is a retrospective cohort study of adult patients presenting to the emergency department (ED) with biliary pain during three 12-month periods. Outcomes in Group A, 3 years prior to policy implementation, were compared with groups 2 and 7 years post implementation (Groups B and C). Primary outcomes were representations to ED, admission rate and time to cholecystectomy. RESULTS A total of 584 patients presented with biliary colic during the three study periods. Of these, 391 underwent cholecystectomy with three Strasberg Type A bile leaks and no bile duct injuries. The policy increased admission rates (A = 15.8%, B = 62.9%, C = 29.5%, P < 0.001) and surgery on index presentation (A = 12.0%, B = 60.7%, C = 27.4%, P < 0.001). There was a decline in time to cholecystectomy (days) (A = 143, B = 15, C = 31, P < 0.001), post-operative length of stay (days) (A = 3.6, B = 3.2, C = 2.0, P < 0.05) and representation rates to ED (A = 42.1%, B = 7.1%, C = 19.9%, P < 0.001). There was a decline in policy adherence in the later cohort. CONCLUSION Index hospital admission and cholecystectomy for biliary colic decrease patient representations, time to surgery, post-operative stay and complications of gallstone disease. This study demonstrates the impact of the policy with initial improvement, the dangers of policy attrition and the need for continued reinforcement.
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Affiliation(s)
- Daniel R A Cox
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Jonathan Fong
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Chon Hann Liew
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Su Kah Goh
- Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Michael Yeoh
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia
| | - Michael A Fink
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Robert M Jones
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Jude Mukkadayil
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Marcos V Perini
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Greg Rumler
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Graham Starkey
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Chris Christophi
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - Vijayaragavan Muralidharan
- HPB and Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
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Kim SY, Fink MA, Perini M, Houli N, Weinberg L, Muralidharan V, Starkey G, Jones RM, Christophi C, Nikfarjam M. Age 80 years and over is not associated with increased morbidity and mortality following pancreaticoduodenectomy. ANZ J Surg 2017; 88:E445-E450. [DOI: 10.1111/ans.14039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Sandy Y. Kim
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Michael A. Fink
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Marcos Perini
- Department of Anaesthesia; Austin Health; Melbourne Victoria Australia
| | - Nezor Houli
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Laurence Weinberg
- Department of Anaesthesia; Austin Health; Melbourne Victoria Australia
| | | | - Graham Starkey
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Robert M. Jones
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Christopher Christophi
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Mehrdad Nikfarjam
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
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Perini MV, Starkey G, Fink MA, Bhandari R, Muralidharan V, Jones R, Christophi C. From minimal to maximal surgery in the treatment of hepatocarcinoma: A review. World J Hepatol 2015; 7:93-100. [PMID: 25625000 PMCID: PMC4295198 DOI: 10.4254/wjh.v7.i1.93] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/28/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma represents one of the most challenging frontiers in liver surgery. Surgeons have to face a broad spectrum of aspects, from the underlying liver disease to the new surgical techniques. Safe liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%, offering good long-terms results in selected patients. With the advances in laparoscopic surgery, major liver resections can be performed with minimal harm, avoiding the wound and leak complications related to the laparotomies. Studies have shown that oncological margins are the same as in open surgery. In patients submitted to liver resection (either laparoscopic or open) who experience recurrence, re-resection or salvage liver transplantation has been showing to be an alternative approach in well selected cases. The decision making approach to the cirrhotic patient is becoming more complex and should involve hepatologists, liver surgeons, radiologists and oncologists. Better understanding of the different risk factors for recurrence and survival should be aimed in these multidisciplinary discussions. We here in discuss the hot topics related to surgical risk factors regarding the surgical treatment of hepatocellular carcinoma: anatomical resection, margin status, macrovascular tumor invasion, the place of laparoscopy, salvage liver transplantation and liver transplantation.
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Nikfarjam M, Weinberg L, Fink MA, Muralidharan V, Starkey G, Jones R, Staveley-O'Carroll K, Christophi C. Pressurized pulse irrigation with saline reduces surgical-site infections following major hepatobiliary and pancreatic surgery: randomized controlled trial. World J Surg 2014; 38:447-55. [PMID: 24170152 DOI: 10.1007/s00268-013-2309-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgical site infections (SSI) are a significant cause of postoperative morbidity. Pressurized pulse irrigation of subcutaneous tissues may lower infection rates by aiding in the debridement of necrotic tissue and reducing bacterial counts compared to simply pouring saline into the wound. METHODS A total of 128 patients undergoing laparotomy extending beyond 2 h were randomized to treatment of wounds by pressurized pulse lavage irrigation (<15 psi) with 2 L normal saline (pulse irrigation group), or to standard irrigation with 2 L normal saline poured into the wound, immediately prior to skin closure (standard group). Only elective cases were included, and all cases were performed within a specialized hepatobiliary and pancreatic surgery unit. RESULTS There were 62 patients managed by standard irrigation and 68 were managed by pulse irrigation. The groups were comparable in most aspects. Overall there were 16 (13 %) SSI. Significantly fewer SSI occurred in the pulse irrigation group [4 (6 %) vs. 12 (19 %); p = 0.032]. On multivariate analysis, the use of pulse irrigation was the only factor associated with a reduction in SSI with an odds ratio (OR) of 0.3 [95 % confidence interval (95 % CI) 0.1-0.8; p = 0.031]. In contrast, hospital length of stay of greater than 14 days was associated with increased infections with an OR of 7.6 (95 % CI 2.4-24.9; p = 0.001). CONCLUSIONS Pulse irrigation of laparotomy wounds in operations exceeding 2 h duration reduced SSI after major hepatobiliary pancreatic surgery. (Australian New Zealand Clinical Trials Registry, ACTRN12612000170820).
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Affiliation(s)
- Mehrdad Nikfarjam
- University of Melbourne Department of Surgery, Austin Health, LTB 8, Studley Rd, Heidelberg, VIC, 3084, Australia,
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Iorgulescu DG, Ling S, Nikfarjam M, Fink MA, Jones R, Muralidharan V, Starkey G, Christophi C. Results of pancreatic resection associated with portal vein resection in an Australian tertiary care centre. ANZ J Surg 2014; 85:270-3. [PMID: 24712309 DOI: 10.1111/ans.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Portal vein resection (PVR) with pancreatectomy is now accepted practice in cases with involvement by tumour. We present our experience of this procedure with particular emphasis on morbidity and survival. METHODS A retrospective case-control analysis of a prospectively maintained database between 2004 and 2012 was undertaken. A total of 17 patients had pancreatic resections with PVR for cancer and were compared with 17 patients with identical tumour type and stage who underwent pancreatic resection without PVR next in chronological order. Information obtained included patient demographics, radiological and histological evidence of major vein involvement and post-operative morbidity. Disease- and recurrence-free survival were calculated using Kaplan-Meier curves. RESULTS Procedures associated with PVR included pancreatico-duodenectomy in 11 and total pancreatectomy in six. Three patients underwent pancreatic resection as a re-operation. Pathological staging showed 2× T2N0, 5× T3N0, 1× T1N1, 2× T2N1 and 7× T3N1 tumours. Seven PVR patients (41%) had post-operative morbidity Clavien 3 and 4, compared with none in no-PVR group, but rates of Clavien 1 and 2 complications were similar. Six PVR patients developed PV thrombosis (35%), all with significant clinical consequences. Comparing the PVR group with the no-PVR group, there was significantly reduced median overall survival in (13.8 versus 43.1 months; P = 0.028) and recurrence-free survival (7.5 months versus 39.7; P = 0.004). CONCLUSIONS Survival of patients after pancreatectomy with PVR was reduced and morbidity was high compared with no-PVR. Delayed portal vein thrombosis due to recurrence was common. Routine post-operative anticoagulation may be indicated in this group.
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Nikfarjam M, Yeo D, Perini M, Fink MA, Muralidharan V, Starkey G, Jones RM, Christophi C. Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg 2013; 84:943-8. [DOI: 10.1111/ans.12313] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - David Yeo
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Marcos Perini
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Michael A. Fink
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | | | - Graham Starkey
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Robert M. Jones
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
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Bellomo R, Marino B, Starkey G, Wang BZ, Fink MA, Zhu N, Suzuki S, Houston S, Eastwood G, Calzavacca P, Glassford N, Chambers B, Skene A, Schneider AG, Jones D, Hilton A, Opdam H, Warrillow S, Gauthier N, Johnson L, Jones R. Normothermic extracorporeal human liver perfusion following donation after cardiac death. CRIT CARE RESUSC 2013; 15:78-82. [PMID: 23931037] [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: 06/02/2023]
Abstract
Liver transplantation is a major life-saving procedure and donation after cardiac death (DCD) has increased the pool of potential liver donors. However, livers procured after DCD are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers. We conducted a proof-of-concept experiment using a human liver procured by DCD (deemed not suitable for liver donation) to assess the short-term (3 hours) feasibility, histological effects and functional efficacy of NELP. We used an extracorporeal membrane oxygenation circuit with separate hepatic artery and portal vein perfusion to achieve physiological perfusion pressures, and coupled this with parenteral nutrition and an insulin infusion. We achieved NELP with evidence of liver function (bile production, paracetamol removal and control of ammonia, bilirubin and lactate levels) for 3 hours. There was essentially normal liver and biliary tract histology after 8 hours of perfusion. Our experiment justifies further investigation of the feasibility and efficacy of human DCD liver preservation by NELP.
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Affiliation(s)
- Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
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Affiliation(s)
- Mayur Garg
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
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Nikfarjam M, Weinberg L, Low N, Fink MA, Muralidharan V, Houli N, Starkey G, Jones R, Christophi C. A fast track recovery program significantly reduces hospital length of stay following uncomplicated pancreaticoduodenectomy. JOP 2013. [PMID: 23306337 DOI: 10.6092/1590–8577/1223] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
CONTEXT Factors affecting length of hospital stay after uncomplicated pancreaticoduodenectomy have not been reported. We hypothesized that patients undergoing uncomplicated pancreaticoduodenectomy treated by fast track recovery program would have a shorter length of hospital stay compared to those managed by a standard program. METHODS Patients without surgical or medical complications following pancreaticoduodenectomy managed by fast track or standard protocols, between 2005 and 2011, were identified and prognostic predictors for length of hospital stay determined. RESULTS Forty-one patients treated by pancreaticoduodenectomy had no medical or surgical complications during this period. Of these patients, 20 underwent fast track recovery program compared to 21 who underwent standard care. Patients in the standard group were more likely to have a feeding jejunostomy tube (P<0.001), pylorus preserving procedure (P=0.001) and a nasogastric tube in place longer than 24 hours postoperatively (P<0.001). The median postoperative length of stay was shorter in the fast track recovery program group (8 days, range: 7-16 days) versus 14 days, range: 8-29 days; P<0.001). There were three readmissions in the fast track recovery program related to abdominal pain and none in the standard group. The overall length of stay, accounting for readmissions, still remained significantly shorter in the fast track recovery program group (median 9 days, range: 7-17 days versus median14 days, range: 8-29 days ; P<0.001). There were no significant differences in discharge destination between groups. On multivariate analysis, the only factor independently associated with postoperative discharge by day 8 was fast track recovery program (OR: 37.1, 95% CI: 4.08-338; P<0.001). CONCLUSION Fast track recovery program achieved significantly shorter length of stay following uncomplicated pancreaticoduodenectomy.
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Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
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Nikfarjam M, Weinberg L, Low N, Fink MA, Muralidharan V, Houli N, Starkey G, Jones R, Christophi C. A fast track recovery program significantly reduces hospital length of stay following uncomplicated pancreaticoduodenectomy. JOP 2013; 14:63-70. [PMID: 23306337 DOI: 10.6092/1590-8577/1223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 12/02/2012] [Accepted: 12/06/2012] [Indexed: 12/13/2022]
Abstract
CONTEXT Factors affecting length of hospital stay after uncomplicated pancreaticoduodenectomy have not been reported. We hypothesized that patients undergoing uncomplicated pancreaticoduodenectomy treated by fast track recovery program would have a shorter length of hospital stay compared to those managed by a standard program. METHODS Patients without surgical or medical complications following pancreaticoduodenectomy managed by fast track or standard protocols, between 2005 and 2011, were identified and prognostic predictors for length of hospital stay determined. RESULTS Forty-one patients treated by pancreaticoduodenectomy had no medical or surgical complications during this period. Of these patients, 20 underwent fast track recovery program compared to 21 who underwent standard care. Patients in the standard group were more likely to have a feeding jejunostomy tube (P<0.001), pylorus preserving procedure (P=0.001) and a nasogastric tube in place longer than 24 hours postoperatively (P<0.001). The median postoperative length of stay was shorter in the fast track recovery program group (8 days, range: 7-16 days) versus 14 days, range: 8-29 days; P<0.001). There were three readmissions in the fast track recovery program related to abdominal pain and none in the standard group. The overall length of stay, accounting for readmissions, still remained significantly shorter in the fast track recovery program group (median 9 days, range: 7-17 days versus median14 days, range: 8-29 days ; P<0.001). There were no significant differences in discharge destination between groups. On multivariate analysis, the only factor independently associated with postoperative discharge by day 8 was fast track recovery program (OR: 37.1, 95% CI: 4.08-338; P<0.001). CONCLUSION Fast track recovery program achieved significantly shorter length of stay following uncomplicated pancreaticoduodenectomy.
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Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
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Nikfarjam M, Manya K, Fink MA, Hadj AK, Muralidharan V, Starkey G, Jones RM, Christophi C. Outcomes of patients with histologically proven acute acalculous cholecystitis. ANZ J Surg 2012; 82:918-22. [PMID: 22943584 DOI: 10.1111/j.1445-2197.2012.06202.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is traditionally described in the setting of critical illness, where the diagnosis is based on clinical assessment and imaging criteria. Very few studies have assessed the features and outcomes of AAC in patients treated by cholecystectomy. METHODS Patients with histologically confirmed acute cholecystitis treated in a specialized unit in a tertiary hospital between 2005 and 2011 were identified from prospectively maintained database. Retrospective review of data was undertaken and patients with AAC were compared with those patients with acute cholecystitis and confirmed gallstones. RESULTS AAC was identified in 35 of 412 (8.5%) patients with acute cholecystitis. These patients were older (69 years versus 61 years; P = 0.004) and were more likely to be febrile (46% versus 21%; P = 0.001) and hypotensive (23% versus 5%; P < 0.001) at initial presentation. There was a higher incidence of chronic obstructive airways disease (COAD) in the AAC group (26% versus 6%; P < 0.001). Other co-morbidities were similar among the groups. Operative outcomes were similar between the groups. There were no overall differences in postoperative complications between AAC and calculous acute cholecystitis patients (17% versus 16%; P = 0.063). However, the postoperative length of stay was higher in the AAC group (5 days versus 3 days; P = 0.026). CONCLUSION AAC more commonly occurs in older patients and those with COAD. The operative outcomes and complications of AAC treated by cholecystectomy are similar to cases of acute calculous cholecystitis.
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Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
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Nikfarjam M, Niumsawatt V, Sethu A, Fink MA, Muralidharan V, Starkey G, Jones RM, Christophi C. Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. HPB (Oxford) 2011; 13:551-8. [PMID: 21762298 PMCID: PMC3163277 DOI: 10.1111/j.1477-2574.2011.00327.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared with those of non-gangrenous acute cholecystitis (NGAC) are poorly defined and based largely on findings from older studies. METHODS Patients with histologically confirmed acute cholecystitis treated in specialized units in a tertiary hospital between 2005 and 2010 were identified from a prospectively maintained database. Data were reviewed retrospectively and patients with GC were compared with those with NGAC. RESULTS A total of 184 patients with NGAC and 106 with GC were identified. The risk factors associated with GC included older age (69 years vs. 57 years; P= 0.001), diabetes (19% vs. 10%; P= 0.049), temperature of >38 °C (36% vs. 16%; P < 0.001), tachycardia (31% vs. 15%; P= 0.002), detection of muscle rigidity on examination (27% vs. 12%; P= 0.01) and greater elevations in white cell count (WCC) (13.4 × 10⁹/l vs. 10.7 × 10⁹/l; P < 0.001), C-reactive protein (CRP) (94 mg/l vs. 17 mg/l; P= 0.001), bilirubin (19 µmol/l vs. 17 µmol/l; P= 0.029), urea (5.3 mmol/l vs. 4.7 mmol/l; P= 0.016) and creatinine (82 µmol/l vs. 74 µmol/l; P= 0.001). The time from admission to operation in days was greater in the GC group (median = 1 day, range: 0-14 days vs. median = 1 day, range: 0-10 days; P= 0.029). There was no overall difference in complication rates between the GC and NGAC groups (22% vs. 14%; P= 0.102). There was a lower incidence of common bile duct stones in the GC group (5% vs. 13%; P= 0.017). Gangrenous cholecystitis was associated with increased mortality (4% vs. 0%; P= 0.017), but this was not an independent risk factor on multivariate analysis. CONCLUSIONS Gangrenous cholecystitis has certain clinical features and associated laboratory findings that may help to differentiate it from NGAC. It is not associated with an overall increase in complications when treated in a specialized unit.
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Affiliation(s)
- Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Vic., Australia.
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Cyriac A, Aynsley E, Lee D, Starkey G, Atkinson K, Johnson C. Hospital admissions for chemotherapy-related toxicity in patients with metastatic breast cancer as negative quality-of-life index at Wansbeck Hospital, Northumberland. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11523] [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] [Indexed: 11/20/2022] Open
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Bhati CS, Bhatt AN, Starkey G, Hubscher SG, Bramhall SR. Acute liver failure due to primary angiosarcoma: a case report and review of literature. World J Surg Oncol 2008; 6:104. [PMID: 18826593 PMCID: PMC2567320 DOI: 10.1186/1477-7819-6-104] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 09/30/2008] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatic angiosarcoma is a primary sarcoma of the liver, accounting for only 2% of all primary hepatic malignancies. Acute liver failure is an extremely rare presentation of a primary liver tumour. CASE PRESENTATION We report a case of a seventy year-old man who presented with a very short period of jaundice leading to fulminant hepatic failure (FHF). On further investigation he was found to have primary angiosarcoma of liver. CONCLUSION The treatment outcomes for hepatic angiosarcoma are poor, we discuss the options available and the need for prompt investigation and establishment of a diagnosis.
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Starkey G, Buckels J. Birmingham liver unit: use of marginal donors for liver transplantation. Clin Transpl 2008:137-142. [PMID: 19708452] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There has been an increase in demand for liver transplantation throughout the world. When coupled with static donor rates, this has forced units into adopting strategies to maximise their donor utilisation to minimise waiting list mortality. There have been different approaches to this problem and some centres have adopted living-related liver transplantation as their principal source of organs. In Birmingham the donor pool has been expanded through the liberal use of marginal donors and the splitting of suitable livers to produce 2 grafts, By using marginal grafts, the chance of poor initial liver function is increased and the patient needs to be fit enough to tolerate this insult. For this reason, the use of split livers and marginal donors heightens the importance of recipient selection. Minimising cold ischaemia time is also more critical when dealing with marginal livers. When deciding whether a graft is suitable for splitting, anatomical factors as well as donor characteristics should be taken into account and it is wise to avoid marginal livers for the procedure. When appropriately allocated, marginal livers have been shown to be safe, although their use of will result in increased complications. This increase is probably justifiable given the large number of patients who may benefit from the use of these grafts. There is no ideal marker or scoring system to measure potential donor livers. In the future there may be better markers for predicting out- comes following liver transplantation. For now, the use of marginal donor livers is an important tool in maximising the benefit to patients needing liver transplantation.
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Mathew A, Talbot D, Minford EJ, Rix D, Starkey G, Forsythe JL, Proud G, Taylor RM. Reversal of steroid-resistant rejection in renal allograft recipients using FK506. Transplantation 1995; 60:1182-4. [PMID: 7482730 DOI: 10.1097/00007890-199511270-00022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A Mathew
- Renal Transplant Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Lokich JJ, Bailey H, Dixon DB, Starkey G. Pseudo-chondrosarcoma: solitary osseous metastases from atypical bronchogenic carcinoma. J Surg Oncol 1979; 11:135-9. [PMID: 220468 DOI: 10.1002/jso.2930110207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A patient with bronchogenic carcinoma with a solitary metastases to the femur in whom the clinical, radiologic, and pathologic setting suggested that the primary tumor was the bone lesion (chondrosarcoma) and the pulmonary lesion was a solitary metastasis is presented. This case is added to the limited literature indicating that mucin-secreting tumors metastatic to bone may simulate primary bone tumors radiographically.
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41
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Eckardt VF, Starkey G, LeCompte P, Grace ND. [Unusual esophageal motility disorder (author's transl)]. Leber Magen Darm 1978; 8:21-4. [PMID: 634008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A 31 year-old female initially presented with clinical features consistent with achalasia, which were relieved by the Heller procedure. Several years later manometric tracings excluded the diagnosis of achalasia, and suggested a motility disorder of the esophageal body. A long esophageal myotomy was performed and was followed by a marked improvement in symptoms and a normalization of the manometric tracing. Multiple histologic sections from the surgical specimen revealed the absence of ganglion cells, a feature not previously described in motor disorders other than achalasia. These findings suggest that classification of esophageal motility disorders on the basis of manometric and histologic findings might not be possible and that surgical treatment should be directed towards the predominant symptoms.
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42
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Heller A, Kane F, Starkey G. Narcotic addict treatment by police physician. Int J Soc Psychiatry 1973; 19:230-5. [PMID: 4786027 DOI: 10.1177/002076407301900311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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43
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Patterson H, Starkey G. The Clinical Aspects of Chronic Thyroiditis. Ann Surg 1948; 128:756-68. [PMID: 17859230 PMCID: PMC1514108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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