Roberto Hernandez-Alejandro

Western University, London, Ontario, Canada

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Publications (40)99.35 Total impact

  • Sarah A Knowles, Kimberly Bertens, Kristopher P Croome, Roberto Hernandez-Alejandro
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    ABSTRACT: Liver resections with negative margins improve survival in patients with colorectal liver metastases (CRLM). Intraoperative ultrasound (IOUS) is a valuable tool that gives information about lesions that ultimately changes surgical strategy to ensure complete removal, which subsequently improves disease free survival (DFS). A retrospective review of patients who underwent a resection for CRLM from 2009 to 2012 was completed to determine the impact of IOUS. A total of 103 patients had a hepatic resection for CRLM. All patients had a preoperative imaging to assist with operative planning. IOUS was performed in 72 cases. Surgical strategy changed in 31 (43.1%) cases with IOUS, compared to three (9.7%) with no IOUS (P < 0.001). A new lesion was detected in 13 (18.1%) of the cases. A higher proportion of nonanatomic liver resections were performed in the IOUS group (N=27, 37.5%) compared to the non-IOUS group (N=6, 19.4%) (P = 0.07). Achievement of a negative resection margin was comparable between the two groups. However, there was a trend toward improved DFS in the IOUS group. Despite advances in preoperative imaging, IOUS demonstrates utility in providing novel information that allows removal of the entire tumor burden, using parenchymal-preserving techniques when feasible, leading to improved DFS. Copyright © 2015. Published by Elsevier Ltd.
    International Journal of Surgery (London, England) 06/2015; DOI:10.1016/j.ijsu.2015.05.052 · 1.65 Impact Factor
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    PLoS ONE 03/2015; 10(3). DOI:10.1371/journal.pone.0120569 · 3.53 Impact Factor
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    ABSTRACT: The selection of liver transplant candidates with hepatocellular carcinoma (HCC) is currently validated based on Milan criteria. The use of extended criteria has remained a matter of debate, mainly because of the absence of prospective validation. The present prospective study recruited patients according to the previously proposed Total Tumor Volume (TTV ≤115 cm(3) )/alpha fetoprotein (AFP ≤400 ng/ml) score. Patients with AFP >400 ng/ml were excluded, and as such the Milan group was modified to include only patients with AFP <400 ng/ml; these patients were compared to patients beyond Milan, but within TTV/AFP. From January 2007 to March 2013, 233 patients with HCC were listed for liver transplantation. Of them, 195 patients were within Milan, and 38 beyond Milan but within TTV/AFP. The average follow-up from listing was 33,9 ±24,9 months. The risk of drop-out was higher for patients beyond Milan but within TTV/AFP (16/38, 42,1%), than for patients within Milan (49/195, 25,1%, p=0,033). In parallel, intent-to-treat survival from listing was lower in the patients beyond Milan (53,8% vs. 71,6% at four years, p<0,001). After a median waiting time of 8 months, 166 patients were transplanted, 134 patients within Milan criteria, and 32 beyond Milan but within TTV/AFP. They demonstrated acceptable and similar recurrence rates (4,5% vs. 9,4%, p=0,138) and post-transplant survivals (78,7% vs. 74,6% at four years, p=0,932). Based on the present prospective study, HCC liver transplant candidate selection could be expanded to the TTV (≤115 cm(3) )/AFP (≤400 ng/ml) criteria in centers with at least 8-month waiting time. An increased risk of drop-out on the waiting list can be expected but with equivalent and satisfactory post-transplant survival. This article is protected by copyright. All rights reserved. © 2015 by the American Association for the Study of Liver Diseases.
    Hepatology 03/2015; DOI:10.1002/hep.27787 · 11.19 Impact Factor
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    ABSTRACT: We read with interest the letter by Rohatgi et al. concerning our study comparing ALPPS with PVE/PVL in a population with mixed liver tumors [1]. Our study does not focus only on colorectal liver metastases, as is suggested in the letter’s title. We studied a mixed population with different tumor etiologies. The authors main concern is the increased morbidity and mortality associated with ALPPS. They also take issues with a lack of adjustment for confounders in comparing the groups. The authors do not agree with our conclusion that rapid tumor removal in ALPPS may be advantageous, citing the argument frequently raised by the opponents of this new procedure, that failure to reach the second stage in staged procedures for cancer is just an unavoidable unmasking of the natural history of the disease [2]. Ultimately, they disagree that there is an advantage to ALPPS at all.We acknowledge—as we do in our paper—that ALPPS is associated with a higher complication rate than conventional appro ...
    World Journal of Surgery 03/2015; 39(7). DOI:10.1007/s00268-015-2964-1 · 2.35 Impact Factor
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    ABSTRACT: Liver remnant function limits major liver resections to generally leave patients with ≥2 Couinaud segments. Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) induces extensive hypertrophy and allows surgeons to perform extreme liver resections. The international ALPPS registry (NCT01924741; 2011-2014) was screened for novel resection type with only 1 segment remnant. The anatomy of lesions and indications for ALPPS, operative technique, complications, survival, and recurrence were evaluated. Among 333 patients, 12 underwent monosegment ALPPS hepatectomies in 6 centers, all for extensive bilobar colorectal liver metastases. All patients were considered unresectable by conventional means, and all had a response to or no progression after chemotherapy before surgery. In 2 patients, the liver remnant consisted of segment 2, in 2 of segment 3, in 6 of segment 4, and in 2 of segment 6. Median time to proceed to stage 2 was 13 days and median hypertrophy of the liver remnant was 160%. There was no mortality. Four patients experienced liver failure, but all recovered. Complications higher than Dindo-Clavien IIIa occurred in 4 patients with no long-term sequelae. At a median follow-up of 14 months, 6 patients are tumor free and 6 patients have developed recurrent metastatic disease. ALPPS allows systematic liver resections with monosegment remnants, a novelty in liver surgery. Because such resections are difficult to conceive without rapid hypertrophy, we propose to name such resections after the segments constituting the liver remnant rather than the segments removed. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 02/2015; 157(4). DOI:10.1016/j.surg.2014.11.015 · 3.11 Impact Factor
  • Michael Meschino, Carlos García-Ochoa, Roberto Hernandez-Alejandro
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    ABSTRACT: We present the rare case of a ruptured choledochal cyst (CC) in a young woman presenting with a two-day history of worsening upper abdominal pain. Imaging revealed a contracted gallbladder, dilated common bile duct (CBD), and a large amount of peritoneal fluid. Percutaneous paracentesis was performed, obtaining bilious fluid. Further imaging revealed cystic dilatation of the CBD and the diagnosis of rupture CC type I was made. The patient was initially managed conservatively with percutaneous drains, IV antibiotic therapy, and sphincterotomy through an ERCP. Elective cyst resection and Roux-en-Y hepatojejunostomy was performed 8 weeks later. It is important to differentiate a ruptured CC from other surgical emergencies without exploratory laparotomy. Initial conservative management could be considered, followed by elective resection once inflammation, infection, and other complications have resolved, avoiding the increased risk associated with an emergency operation or two-stage laparotomy.
  • K. A. Bertens, K. N. Vogt, R. Hernandez-Alejandro, D. K. Gray
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    ABSTRACT: A paradigm shift toward non-operative management (NOM) of blunt hepatic trauma has occurred. With advances in percutaneous interventions, even severe liver injuries are being managed non-operatively. However, although overall mortality is decreased with NOM, liver-related morbidity remains high. This study was undertaken to explore the morbidity and mortality of blunt hepatic trauma in the era of angioembolization (AE). A retrospective cohort of trauma patients with blunt hepatic injury who were assessed at our centre between 1999 and 2011 were identified. Logistic regression was undertaken to identify factors increasing the likelihood of operative management (OM) and mortality. We identified 396 patients with a mean ISS of 33 (±14). Sixty-two (18 %) patients had severe liver injuries (≥AAST grade IV). OM occurred in 109 (27 %) patients. Logistic regression revealed high ISS (OR 1.07; 95 % CI 1.05-1.10), and lower systolic blood pressure on arrival (OR 0.98; 95 % CI 0.97-0.99) to be associated with OM. The overall mortality was 17 %. Older patients (OR 1.05; 95 % CI 1.03-1.07), those with high ISS (OR 1.11; 95 % CI 1.08-1.14) and those requiring OM (OR 2.89; 95 % CI 1.47-5.69) were more likely to die. Liver-related morbidities occurred in equal frequency in the OM (23 %) and AE (29 %) groups (p = 0.32). Only 3 % of those with NOM experienced morbidity. The majority of patients with blunt hepatic trauma can be successfully managed non-operatively. Morbidity associated with NOM was low. Patients requiring AE had morbidity similar to OM.
    European Journal of Trauma and Emergency Surgery 02/2015; 41(1). DOI:10.1007/s00068-014-0431-6 · 0.38 Impact Factor
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    ABSTRACT: Introduction: Hepatic resection for malignancy is limited by the amount of liver parenchyma left behind. As a result, two-staged hepatectomy and portal vein occlusion (PVO) have become part of the treatment algorithm. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently described as a method to stimulate rapid and profound hypertrophy. Materials and methods: A systematic review of the literature pertaining to ALPPS was undertaken. Peer-reviewed articles relating to portal vein ligation (PVL) and in situ split (ISS) of the parenchyma were included. Results: To date, ALPPS has been employed for a variety of primary and metastatic liver tumors. In early case series, the perioperative morbidity and mortality was unacceptably high. However with careful patient selection and improved technique, many centers have reported a 0% 90-day mortality. The benefits of ALPPS include hypertrophy of 61-93% over a median 9-14 days, 95-100% completion of the second stage, and high likelihood of R0 resection (86-100%). Discussion: ALPPS is only indicated when a two-stage hepatectomy is necessary and the future liver remnant (FLR) is deemed inadequate (<30%). Use in patients with poor functional status, or advanced age (>70 years) is cautioned. Discretion should be used when considering this in patients with pathology other than colorectal liver metastases (CRLM), especially hilar tumors requiring biliary reconstruction. Biliary ligation during the first stage and routine lymphadenectomy of the hepatoduodenal ligament should be avoided. Conclusions: A consensus on the indications and contraindications for ALPPS and a standardized operative protocol are needed. Copyright © 2014. Published by Elsevier Ltd.
    International Journal of Surgery (London, England) 12/2014; 13. DOI:10.1016/j.ijsu.2014.12.008 · 1.65 Impact Factor
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    ABSTRACT: Aim: To investigate whether the long-term outcomes of hepatocellular carcinoma (HCC) was adversely impacted by intermittent hepatic inflow occlusion (HIO) during hepatic resection.Methods: 1549 HCC patients who underwent hepatic resection between 1998 and 2008 were identified from a prospectively maintained database. Intermittent HIO was performed in 931 patients (HIO group); of which 712 patients had a Pringle maneuver as the mechanism for occlusion (PM group), and 219 patients had selective hemi-hepatic occlusion (SO group). There were 618 patients that underwent partial hepatectomy without occlusion (occlusion-free, OF group).Results: The 1-, 3-, and 5- year overall survival (OS) rates were 79%, 59%, and 42% in the HIO group, and 83%, 53%, and 35% in the OF group, respectively. The corresponding recurrence free survival (RFS) rates were 68%, 39%, and 22% in the HIO group, and 74%, 41%, and 18% in the OF group, respectively. There was no significant difference between the 2 groups in OS or RFS (P = 0.325 and P = 0.416). Subgroup analysis showed patients with blood loss over 3000 mL and those requiring transfusion suffered significantly shorter OS and RFS. Blood loss over 3000 mL and blood transfusion were independent risk factors to OS and RFS.Conclusions: The application of intermittent HIO (PM and SO) during hepatic resection did not adversely impact either OS or RFS in patients with HCC. Intermittent HIO is still a valuable tool in hepatic resection, because high intraoperative blood loss resulting in transfusion is associated with a reduction in both OS and RFS.
    Medicine 12/2014; 93(28):e288. DOI:10.1097/MD.0000000000000288 · 4.87 Impact Factor
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    ABSTRACT: On behalf of the ALPPS Registry Group Objectives: To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. Background: ALPPS induces accelerated growth of small future liver rem-nants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. Methods: A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with com-plete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Results: Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standard-ized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo ≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALLPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. Conclusions: This is the first analysis of the ALPPS registry showing that ALPPS shows increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.
    Annals of surgery 11/2014; DOI:10.1097/SLA.0000000000000947 · 7.19 Impact Factor
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    ABSTRACT: Background. Meticulous selection of patients who can undergo the associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) procedure safely will be paramount to minimize the associated morbidity and mortality. Methods. We collected data prospectively on 14 consecutive patients who underwent the ALPPS procedure for planned resection of colorectal liver metastases at London Health Sciences Centre, Canada, between April 2012 and November 2013. Results. The median relative increase of the standardized future liver remnant after the ALPPS procedure was 93 +/- 28 %. The standardized future liver remnant rate of volume increase was 35 +/- 13 mL/day. Biopsies of the FLR were taken during stage 1 and 2. These biopsies showed a mean preregeneration Ki-67 index of 0% and a postregeneration index of 14 +/- 3%. All 14 ALPPS patients completed the 2-stage hepatectomy. No complications occurred after ALPPS stage I. After ALPPS stage 2, 5 patients had complications (36%), with 2 patients (14%) having a severe complication (Clavien-Dindo >= IIIB). Median follow-up was 9 months. Overall survival at the time of follow-up was 100%. Recurrence developed in 2 patients. One patient had recurrence in the liver and lungs 5 months after stage 2 and was offered more chemotherapy. The other patient developed recurrence in the liver remnant 9 months after stage 2 and underwent additional chemotherapy with a possible future resection of the recurrence. Conclusion. Low morbidity and negligible mortality can be achieved with the ALPPS procedure, and the high rates published in previous reports can be improved with refinements in technique and patient selection. The ALPPS approach may be a valid option to enable resection in selected patients with colorectal liver metastases considered unresectable previously by standard techniques.
    Surgery 10/2014; 157(2). DOI:10.1016/j.surg.2014.08.041 · 3.11 Impact Factor
  • Keegan Selby, Roberto Hernandez-Alejandro
    Canadian Medical Association Journal 05/2014; 186(15). DOI:10.1503/cmaj.131022 · 5.81 Impact Factor
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    ABSTRACT: Portal vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal vein ligation (PVL) or embolization (PVE) followed by resection 4-8 weeks later. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1-2 weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection. A retrospective review of all patients undergoing ALPPS or conventional staged hepatectomies using PVL or PVE at four high-volume HPB centres between 2003 and 2012 was performed. Patients with primary liver tumors and liver metastases were included. Primary endpoint was complete tumor resection. Secondary endpoints include 90-day mortality, complications, FLR increase, time to resection, and tumor recurrence. Forty-eight patients with ALPPS were compared with 83 patients with conventional-staged hepatectomies. Eighty-three percent (40/48 patients) of ALPPS patients achieved complete resection compared with 66 % (55/83 patients) in PVE/PVL (odds ratio 3.34, p = 0.027). Ninety-day mortality in ALPPS and PVE/PVL was 15 and 6 %, respectively (p = 0.2). Extrapolated growth rate was 11 times higher in ALPPS (34.8 cc/day; interquartile range (IQR) 26-49) compared with PVE/PVL (3 cc/day; IQR2-6; p = 0.001). Tumor recurrence at 1 year was 54 versus 52 % for ALPPS and PVE/PVL, respectively (p = 0.7). This study provides evidence that ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors at the cost of a high mortality. The technique is promising but should currently not be used outside of studies and registries.
    World Journal of Surgery 04/2014; 38(6). DOI:10.1007/s00268-014-2513-3 · 2.35 Impact Factor
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    ABSTRACT: The influence of donor-recipient gender mismatch on outcomes after liver transplantation (LT) is controversial. The aim of this study was to evaluate the effect of donor and recipient gender discordance on graft survival. All patients who underwent primary LT from 1994-2012 at a single-center were identified prospectively. Clinico-demographic data were collected at the time of LT and last follow-up. Gender match included both male donor to male recipient (MM) and female donor to female recipient (FF), while gender mismatch included female donor to male recipient (FM) and male donor to female recipient (MF). Survival curves for graft survival were generated using Kaplan-Meier method and compared by log-rank test. Unadjusted and multivariate adjusted COX regression analyzing graft survival at up to 10 years post-transplant was performed. A total of 1,042 subjects fulfilled the criteria. Graft survival in patients receiving a donor-recipient gender match was better than those receiving a gender mismatch (P = 0.047). Female-to-male transplants had the worst graft survival of all combinations (P < 0.001); this difference was maintained in multivariate regression after adjustment for recipient and donor variables (hazards ratio 2.09, P = 0.013). Female-to-male liver transplants are associated with a statistically significant poorer graft survival as compared with other donor-recipient gender groups.
    Journal of Hepato-Biliary-Pancreatic Sciences 04/2014; 21(4). DOI:10.1002/jhbp.40 · 2.31 Impact Factor
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    ABSTRACT: The optimal initial treatment of splanchnic vein thrombosis is uncertain. Anticoagulant therapy has been shown to be associated with vessel recanalization and decreased recurrence. Furthermore, information regarding potential predictors of chronic complications is not well understood. A retrospective cohort study involving consecutive patients diagnosed with first-episode noncirrhotic splanchnic vein thrombosis referred to the thrombosis clinic of the authors' institution between 2008 and 2011 was conducted. Demographic and clinical information was collected. The response to initial anticoagulant therapy was evaluated by determining radiographic recanalization of vessels and clinical resolution (defined as the absence of ongoing splanchnic vein thrombosis symptoms or complications requiring treatment beyond anticoagulant therapy). Twenty-two patients were included. Anticoagulant therapy alone resulted in vessel recanalization in 41% of patients and 68% achieved clinical resolution. Two patients experienced bleeding events. Factors associated with a lack of clinical resolution included signs of portal hypertension⁄liver failure on presentation, complete vessel occlusion at diagnosis, presence of a myeloproliferative disorder or JAK2V617F tyrosine kinase mutation and the absence of a local⁄transient predisposing factor. Anticoagulant therapy appeared to be an effective initial treatment in patients with splanchnic vein thrombosis. Clinical factors may help to identify patients who are at risk for developing complications thus requiring closer monitoring. These findings were limited by the small sample size and need to be explored in larger prospective studies.
    04/2014; 28(4):207-11.
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    Malcolm Wells, Kris M Croome, Toni Janik, Roberto M Hernandez-Alejandro, Natasha M Chandok
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    ABSTRACT: Liver transplantation (LT) using organs donated after cardiac death (DCD) is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV) infection remains unclear due to the limited experience and number of publications addressing this issue. OBJECTIVE: To evaluate the clinical outcomes of DCD versus donation after brain death (DBD) in HCV-positive patients undergoing LT. METHODS: Studies comparing DCD versus DBD LT in HCV-positive patients were identified based on systematic searches of seven electronic databases and multiple sources of gray literature. Results: The search identified 58 citations, including three studies, with 324 patients meeting eligibility criteria. The use of DCD livers was associated with a significantly higher risk of primary nonfunction (RR 5.49 [95% CI 1.53 to 19.64]; P=0.009; I2=0%), while not associated with a significantly different patient survival (RR 0.89 [95% CI 0.37 to 2.11]; P=0.79; I2=51%), graft survival (RR 0.40 [95% CI 0.14 to 1.11]; P=0.08; I2=34%), rate of recurrence of severe HCV infection (RR 2.74 [95% CI 0.36 to 20.92]; P=0.33; I2=84%), retransplantation or liver disease-related death (RR 1.79 [95% CI 0.66 to 4.84]; P=0.25; I2=44%), and biliary complications. CONCLUSIONS: While the literature and quality of studies assessing DCD versus DBD grafts are limited, there was significantly more primary nonfunction and a trend toward decreased graft survival, but no significant difference in biliary complications or recipient mortality rates between DCD and DBD LT in patients with HCV infection. There is insufficient literature on the topic to draw any definitive conclusions.
    01/2014; 28(2):103-8.
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    Bilal Munir, Michael Meschino, Ashley Mercado, Roberto Hernandez-Alejandro
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    ABSTRACT: The classic presentation of cystic hepatobiliary lesions is usually nonspecific and often identified incidentally. Here we describe the case of a patient presenting with acute pancreatitis resulting from a large centrally located biliary cystadenoma compressing the pancreas. Determination of the origin of the cystic lesion was difficult on imaging studies. Due to the difficult location of the lesion, a complete surgical resection was achieved with mesohepatectomy and the suspected diagnosis confirmed by pathology. The patient continues to do well 2 years post-op with no signs of recurrence.
    01/2014; 2014:643032. DOI:10.1155/2014/643032
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    ABSTRACT: The impact of ischemia/reperfusion injury in the setting of transplantation for hepatocellular carcinoma (HCC) has not been thoroughly investigated. The present study examined data from the Scientific Registry of Transplant Recipients for all recipients of deceased donor liver transplants performed between January 1, 1995 and October 31, 2011. In a multivariate Cox analysis, significant predictors of patient survival included the following: HCC diagnosis (P < 0.01), donation after cardiac death (DCD) allograft (P < 0.001), hepatitis C virus-positive status (P < 0.01), recipient age (P < 0.01), donor age (P < 0.001), Model for End-Stage Liver Disease score (P < 0.001), recipient race, and an alpha-fetoprotein level > 400 ng/mL at the time of transplantation. In order to test whether the decreased survival seen for HCC recipients of DCD grafts was more than would be expected because of the inferior nature of DCD grafts and the diagnosis of HCC, a DCD allograft/HCC diagnosis interaction term was created to look for potentiation of effect. In a multivariate analysis adjusted for all other covariates, this interaction term was statistically significant (P = 0.049) and confirmed that there was potentiation of inferior survival with the use of DCD allografts in recipients with HCC. In conclusion, patient survival and graft survival were inferior for HCC recipients of DCD allografts versus recipients of donation after brain death allografts. This potentiation of effect of inferior survival remained even after adjustments for the inherent inferiority observed in DCD allografts as well as other known risk factors. It is hypothesized that this difference could reflect an increased rate of recurrence of HCC. Liver Transpl 19:1214-1223, 2013. (c) 2013 AASLD.
    Liver Transplantation 11/2013; 19(11). DOI:10.1002/lt.23715 · 3.79 Impact Factor
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    ABSTRACT: Background: Liver organ donor characteristics have a significant impact on graft quality and in turn recipient outcome. In this study, we examined deceased liver donor characteristics and Donor Risk Index (DRI) trends in Canada over the past decade. Methods: Data were extracted from the Canadian Organ Replacement Register (CORR) and Quebec Transplant for the decade (2000-2010). Trends in the DRI and donor characteristics were examined including: age, race, height, cause of death (COD), location, cold ischemia time (CIT), and type of donation. Results: 3745 transplants using deceased liver donors were analyzed. Donor age, proportion of black donors, proportion of cerebrovascular accident as a COD, and proportion of donation after cardiac death (DCD) donors all increased over the aforementioned time period. The proportion of transplants classified geographically as local increased and the CIT for donor livers decreased. Although many of the parameters that adversely affect DRI increased over the study period, the DRI only showed a small significant trend in increasing value. The increase in these parameters has been counteracted by a decrease in modifiable risk factors such as CIT and distance traveled. Recipient 5-year survival rates increased from 71.43% (1999-2001) to 75.5% (2005-2007), however this trend was not significant. Although there was an increase in the utilization of older and DCD donor organs, recipient survival was not compromised. Conclusions: Liver donor demographic trends in Canada suggest an increase in utilization of higher risk donors. However, overall graft quality is not compromised due to a decreasing trend in CIT and increase in local transplants. Better coordination and allocation practices in liver transplantation across Canada minimize the risk for graft failure and results in good recipient outcomes. Liver Transpl , 2013. © 2013 AASLD.
    Liver Transplantation 11/2013; 19(11). DOI:10.1002/lt.23718 · 3.79 Impact Factor
  • 09/2013;

Publication Stats

164 Citations
99.35 Total Impact Points

Institutions

  • 2014–2015
    • Western University
      London, Ontario, Canada
  • 2011–2015
    • London Health Sciences Centre
      • Department of Surgery
      London, Ontario, Canada
    • Sichuan University
      • Department of General Surgery
      Hua-yang, Sichuan, China
  • 2011–2014
    • The University of Western Ontario
      • Department of Surgery
      London, Ontario, Canada