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Introduction
Skills and Expertise
Current institution
Publications
Publications (84)
Background
Infections are a leading cause of early mortality after liver transplantation (LT). Prior to transplantation, cirrhosis-associated immune dysfunction significantly increases the risk of infection. This study investigated the potential of immune monitoring, with a focus on monocytic HLA-DR (mHLA-DR) expression, as a predictor of post-LT c...
Background Infections are a leading cause of early mortality after liver transplantation (LT). Prior to transplantation, cirrhosis-associated immune dysfunction significantly increases the risk of infection. This study investigated the potential of immune monitoring, with a focus on monocytic HLA-DR (mHLA-DR) expression, as a predictor of post-LT c...
Objective
To analyse outcomes after adult right ex-situ split graft liver transplantations (RSLT) and compare with available outcome benchmarks from whole liver transplantation (WLT).
Summary Background Data
Ex-situ SLT may be a valuable strategy to tackle the increasing graft shortage. Recently established outcome benchmarks in WLT offer a novel...
Bile acids (BA) are key for liver regeneration and injury. This study aims at analyzing the changes in the BA pool induced by ischemia-reperfusion (IRI) and investigates the impact of hypothermic oxygenated perfusion (HOPE) on the BA pool compared to static cold storage (SCS). In a porcine model of IRI, liver grafts underwent 30 min of asystolic wa...
Background:
Hypothermic oxygenated perfusion (HOPE) improves outcomes of marginal liver grafts. However, to date, no preservation solution exists for both static cold storage (SCS) and HOPE.
Methods:
After 30 min of asystolic warm ischemia, porcine livers underwent 6 h of SCS followed by 2 h of HOPE. Liver grafts were either preserved with a sin...
Background
The gold standard in pediatric split liver transplantation (SLT) is living donation (LD) providing high-quality grafts with short static cold storage (SCS).
Aims
This study investigates the protective effect of hypothermic oxygenated perfusion (HOPE) on ex-situ partial grafts from deceased donors in comparison to standard ex-situ Static...
Background
A comprehensive outcome analysis of ex situ right split liver graft transplantation (RSLT) is currently lacking.
Aims
Benchmarking outcomes of RSLT against best achievable results from whole LT offers a novel comparative approach.
Methods
This retrospective study includes all consecutive ex-situ RSLT for adult recipients performed from...
In this report, we discuss several technical and anatomical details of ex‐situ H67 reduction of liver grafts during hypothermic oxygenated perfusion to prevent large‐for‐size syndrome in the case of anthropometric graft‐recipient mismatch.
Liver graft-recipient matching remains challenging and both morphological and hemodynamic characteristics have been shown to be relevant indicators of post-transplant outcomes. However, no combined analysis is available to date. To study the impact of both morphological and hemodynamic characteristics of liver grafts on transplantation outcomes, we...
Background:
Graft-recipient size matching is a major challenge in pediatric liver transplantation, especially for adolescent recipients. Indeed, adolescents have the lowest transplantation rate among pediatric recipients, despite prioritization policies and the use of split grafts. In case of an important graft-recipient size mismatch, ex situ gra...
Background and aim:
Liver graft utilization rates are a hot topic due to the worldwide organ shortage and an increasing number of transplant candidates on waiting lists. Liver perfusion techniques have been introduced in several countries, and may help to increase the organ supply, as they potentially allow the assessment of livers before use.
Me...
Background & aims:
Machine perfusion is a novel method intended to optimize livers before transplantation. Its effect, however, on morbidity within a one-year period after transplantation has remained unclear.
Methods:
In this multicenter controlled trial, we randomly assigned livers donated after brain death (DBD) for liver transplantation (LT)...
Background:
Pulmonary metastases (PM) are the most frequent extra-abdominal metastases from colorectal cancer. Lung resection and imaging-guided thermal ablation (IGTA) are used as curative-intent treatment. We compared the outcomes of patients with PM, treated with resection or ablation.
Methods:
We retrospectively analyzed data from patients w...
Given the increasing graft shortage, the transplant community is forced to use so called marginal liver grafts with a higher susceptibility to ischemia-reperfusion injury. This exposes the recipient to a higher risk of graft failure and post-transplant complications. While static cold storage remains the gold standard in low-risk transplant scenari...
Résumé
La pénurie de greffons hépatiques, disponibles pour la greffe, justifie une utilisation croissante de greffons dits marginaux. Ces derniers sont plus sensibles aux lésions d’ischémie-reperfusion, ce qui expose le receveur à un risque majoré de dysfonction du greffon et, donc, à une morbidité post-transplantation plus importante. Alors que la...
Objective:
To define benchmark cutoffs for redo liver transplantation (redo-LT).
Background:
In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT.
Methods:
We collected data on redo-LT betwee...
Background:
In-situ normothermic regional perfusion (NRP) and ex-situ normothermic machine perfusion (NMP) aim to improve outcomes of liver transplantation (LT) using controlled donation after circulatory death (cDCD). NRP and NMP have not yet been compared directly.
Methods:
In this international observational study, outcomes of LT performed be...
Objective
In the era of organ shortage, redo liver transplantation (reLT) is frequently discussed in terms of expected poor outcome, high cost and therefore wasteful resources. However, there is a lack of benchmark data to reliably assess outcomes after reLT. The aim of this study was to define the ideal reLT case, and to establish clinically relev...
Partial liver grafts from ex‐situ splitting are considered as marginal due to prolonged static cold storage. The use of ex‐situ Hypothermic Oxygenated Perfusion (HOPE) may offer a strategy to improve preservation of ex‐situ split grafts. In this single‐center pilot study, we prospectively performed ex‐situ liver splitting during HOPE (HOPE‐Split) f...
Background:
Ex vivo split liver transplantation in pediatric recipients has shown inferior results compared with whole grafts. One factor among others contributing to split grafts being considered as marginal is the prolonged static cold storage time related to ex vivo liver splitting. End ischemic hypothermic oxygenated perfusion is a validated s...
In France, the program of controlled donation after circulatory death (cDCD) was established with routine use of in situ normothermic regional perfusion (NRP). There is currently no consensus on its optimal duration. The purpose was to assess the impact of NRP duration on liver graft function and biliary outcomes. 156 liver recipients from NRP-cDCD...
We read with great interest the study by Ruiz et al and we would like to discuss three issues raised by their results.(1) First, as highlighted by the authors , their specific NRP protocol with pre‐mortem cannulation in an interventional radiology facility leads to less technical failures (1%) compared to post‐mortem cannulation (5,6%) but is not a...
Normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) is a promising procurement strategy. However, a detailed analysis of graft utilization rates is lacking. This retrospective study included all cDCD donors proposed to a single center for NRP procurement of at least one abdominal organ from 2015 to 2020. Util...
Contexte
La circulation régionale normothermique (CRN) et la machine de perfusion normothermique ex vivo (MPN) ont pour but d’améliorer les résultats de la transplantation hépatique (TH) de greffons issus de donneurs décédés par arrêt circulatoire (DDAC). Cependant, ces 2 techniques n’ont jamais été comparées.
Méthodes
Cette étude multicentrique i...
According to Aristotle, medical practice relies on practical knowledge to care for individual patients. This is especially true for surgery, where the surgeon directly acts on a patient using not only technical skills but also acquired experience. We first describe the surgeon’s technical activity, which is directly linked to surgical tools and the...
According to Aristotle, medical practice relies on practical knowledge to care for individual patients. This is especially true for surgery, where the surgeon directly acts on a patient using not only technical skills but also acquired experience. We first describe the surgeon’s technical activity, which is directly linked to surgical tools and the...
Patients with nonresectable liver metastases from colorectal cancer have few therapeutic options and a dismal prognosis. Although liver transplantation for this indication has historically a poor reputation, recent advances in the field of chemotherapy and immunosuppression have paved the way to revisit the concept. New data have shown promising re...
Background:
Mitochondrial succinate accumulation has been suggested as key event for ischemia reperfusion injury in mice. No specific data are however available on behavior of liver mitochondria during ex situ machine perfusion in clinical transplant models.
Methods:
We investigated mitochondrial metabolism of isolated perfused rat livers before...
Objective:
The aim of this study was to investigate tumor recurrence after liver transplantation for hepatocellular carcinoma (HCC), with and without hypothermic oxygenated liver perfusion (HOPE) before transplantation.
Patients and methods:
We analyzed all liver recipients with HCC, transplanted between January 2012 and September 2019 with dona...
Objective:
To compare HOPE and NRP in liver transplantation from cDCD.
Summary of background data:
Liver transplantation after cDCD is associated with higher rates of graft loss. Dynamic preservation strategies such as NRP and HOPE may offer safer use of cDCD grafts.
Methods:
Retrospective comparative cohort study assessing outcomes after cDCD...
Liver transplantation during the ongoing SARS‐CoV‐2 pandemic is challenging given the urgent need to reallocate resources to other areas of patient care. Available guidelines recommend to reorganize transplant care but data on clinical experience in the context of SARS‐CoV‐2 pandemic are scarce. Thus, we report strategies and preliminary results in...
Objective:
To define a standardized methodology for establishing benchmarks for relevant outcomes in surgery.
Summary background data:
Benchmarking is an established tool to improve quality in industry and economics, and is emerging in assessing outcome values in surgery. Despite a recent 10-step approach to identify such benchmark values, a sta...
Article Summary
In the context of the COVID-19 pandemic this study showed feasibility and efficacy of systematic preoperative screening for SARS-CoV-2 by chest CT and RT-PCR on nasopharyngeal swabs. This screening strategy allowed performing safely the majority of scheduled oncological interventions.
With oxygenation proposed as a resuscitative measure during hypothermic models of preservation, the aim of this study was to evaluate the optimal start time of oxygenation during continuous hypothermic machine perfusion (HMP). In this porcine ischemia-reperfusion autotransplant model, the left kidney of a ±40 kg pig was exposed to 30 minutes of war...
The ability to preserve metabolically active livers ex vivo for 1 week or more could allow repair of poor-quality livers that would otherwise be declined for transplantation. Current approaches for normothermic perfusion can preserve human livers for only 24 h. Here we report a liver perfusion machine that integrates multiple core physiological fun...
Machine perfusion is a hot topic in liver transplantation and several new perfusion concepts are currently developed. Prior to introduction into routine clinical practice, however, such perfusion approaches need to demonstrate their impact on liver function, post-transplant complications, utilization rates of high-risk organs, and cost benefits. Th...
Objective:
The aim of this study was to determine the predictive value of machine perfusate analysis on graft outcome.
Background:
Ex situ machine perfusion (MP) is gaining increasing interest to potentially repair injured organs and to assess organ function. In the field of liver transplantation, however, no studies exist on reliable prediction...
Objective:
The hepatic arterial buffer response is a well known phenomenon in hepatic circulation, describing the response of hepatic arterial resistance to changes in portal vein flow. Several vasoactive metabolites underlying its mechanism have been proposed, however, there is currently no clear consensus. The aim of this study was to investigat...
Objective:
To use the concept of benchmarking to establish robust and standardized outcome references after pancreatico-duodenectomy (PD).
Background:
Best achievable results after PD are unknown. Consequently, outcome comparisons among different cohorts, centers or with novel surgical techniques remain speculative.
Methods:
This multicenter s...
Background:
Hypothermic oxygenated perfusion (HOPE) has been shown to protect liver recipients from acute rejection in an allogeneic model of liver transplantation in rats. Here we investigate the impact of HOPE on the T cell-mediated immune response following kidney transplantation.
Methods:
Kidneys from Lewis rats were transplanted into Brown...
Background: The new UK-DCD-Risk-Score has been recently developed to predict graft loss in DCD
liver transplantation. Donor-recipient combinations with a cumulative risk of >10 points were classified as
futile and achieved an impaired one-year graft survival of <40%. The aim of this study was to show, if
hypothermic oxygenated perfusion (HOPE) can...
BACKGROUND & AIMS: Donation after circulatory death (DCD) liver transplantation is known for potentially worse outcomes because of higher rates of graft non-function or irreversible cholangiopathy. The impact of machine liver perfusion techniques on these complications remains elusive. We aimed to provide data on 5-year outcomes in patients receivi...
Background & Aims
Donation after circulatory death (DCD) liver transplantation is known for potentially worse outcomes because of higher rates of graft non-function or irreversible cholangiopathy. The impact of machine liver perfusion techniques on these complications remains elusive. We aimed to provide data on 5-year outcomes in patients receivin...
We highly appreciate the interest expressed in the letter by de Vries et all concerning our recent systematic review (1, 2), and congratulate for the successful transplantation using HBOC during normothermic perfusion. We agree, that ex situ normothermic and also subnormothermic liver perfusion using HBOC is per se an interesting option to spare re...
Liver machine perfusion at normothermic temperature (NMP) is a promising way to preserve and evaluate extended criteria donor livers. Currently, no consensus exists in methodology and perfusion protocols. Here, the authors performed a systematic literature search to identify human and porcine studies reporting on liver NMP with red blood cells. A q...
Background:
In 2016, the International Study Group of Pancreatic Fistula (ISGPS) proposed an updated definition for postoperative pancreatic fistula (POPF). Pancreas texture (PT) is an established risk factor of POPF. The definition of soft vs. hard texture, however, remains elusive.
Methods:
A systematic search was performed to identify PT defi...
Purpose of Review
In this review, we highlight which livers may benefit from additional treatment before implantation and describe the concept of hypothermic machine liver perfusion. Furthermore, we explain why cold oxygenated perfusion concepts could potentially lead to a breakthrough in this challenging field of transplantation. Accordingly, we s...
The article Hypothermic Machine Preservation of the Liver: State of the Art, written by Andrea Schlegel, Xavier Muller, and Philipp Dutkowski, was originally published electronically on the publisher’s internet portal (currently SpringerLink) on January 22, 2018, without open access.
Objective:
To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups.
Background:
Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative.
Meth...
Purpose of review:
The review describes recent developments in hypothermic machine liver perfusion with a special focus on underlying protective mechanisms, and the role of this perfusion technique in high-risk donor-recipient combinations.
Recent findings:
To maximize the number of transplantable donor livers, several centres are exploring new...
Liver transplantation has improved dramatically over the past three decades, mainly as a result of advances in surgical techniques and management of post-transplant complications. The focus has now turned towards rescuing additional organs in the face of scarce organ supply, or prevention of long-term toxicity associated with immunosuppression. The...
