M Audet

University of Strasbourg, Strasburg, Alsace, France

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Publications (52)146 Total impact

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    ABSTRACT: CD40-CD154 pathway blockade prolongs renal allograft survival in nonhuman primates (NHPs). However, antibodies targeting CD154 were associated with an increased incidence of thromboembolic complications. Antibodies targeting CD40 prolong renal allograft survival in NHPs without thromboembolic events but with accompanying B cell depletion, raising the question of the relative contribution of B cell depletion to the efficacy of anti-CD40 blockade. Here, we investigated whether fully silencing Fc effector functions of an anti-CD40 antibody can still promote graft survival. The parent anti-CD40 monoclonal antibody HCD122 prolonged allograft survival in MHC-mismatched cynomolgus monkey renal allograft transplantation (52, 22, and 24 days) with accompanying B cell depletion. Fc-silencing yielded CFZ533, an antibody incapable of B cell depletion but still able to potently inhibit CD40 pathway activation. CFZ533 prolonged allograft survival and function up to a defined protocol endpoint of 98-100 days (100, 100, 100, 98, and 76 days) in the absence of B cell depletion and preservation of good histological graft morphology. CFZ533 was well-tolerated, with no evidence of thromboembolic events or CD40 pathway activation and suppressed a gene signature associated with acute rejection. Thus, use of the Fc-silent anti-CD40 antibody CFZ533 appears to be an attractive approach for preventing solid organ transplant rejection. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
    No preview · Article · Jul 2015 · American Journal of Transplantation
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    ABSTRACT: Human alveolar echinococcosis (AE) is a severe hepatic disease caused by Echinococcus multilocularis. In France, the definitive and intermediate hosts of E. multilocularis (foxes and rodents, respectively) have a broader geographical distribution than that of human AE. In this two-part study, we describe the link between AE incidence in France between 1982 and 2007 and climatic and landscape characteristics. National-level analysis demonstrated a dramatic increase in AE risk in areas with very cold winters and high annual rainfall levels. Notably, 52% (207/401) of cases resided in French communes (smallest French administrative level) with a mountain climate. The mountain climate communes displayed a 133-fold (95% CI: 95–191) increase in AE risk compared with communes in which the majority of the population resides. A case–control study performed in the most affected areas confirmed the link between AE risk and climatic factors. This arm of the study also revealed that populations residing in forest or pasture areas were at high risk of developing AE. We therefore hypothesised that snow-covered ground may facilitate predators to track their prey, thus increasing E. multilocularis biomass in foxes. Such climatic and landscape conditions could lead to an increased risk of developing AE among humans residing in nearby areas. © 2015 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
    Full-text · Article · Jan 2015
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    ABSTRACT: Background: Preoperative locoregional treatments (PLT) are performed to avoid progression before liver transplantation for hepatocellular carcinoma (HCC). The objective of this study was to analyze the prognostic factors affecting the outcome in patients who received PLT. Material and methods: A retrospective analysis of patients who underwent liver transplantation (LT) was performed. All patients who underwent PLT with confirmed pathological diagnosis of HCC were included. The rate of tumor necrosis (TN) was assessed by microscopic histological examination. Results: From January 1997 to December 2010, PLT was performed in 154 patients ROC analysis individuated a TN cut-off value at 40%. Ninety-one patients (59.1%) of the patients presented TN>40%. At multivariate analysis, TN<40% (HR=1.76; p=0.04) and vascular invasion (VI) (HR=2.16; p<0.01) were associated with lower Overall Survival (OS). At multivariate analysis, TN<40% (HR=1.59; p=0.001) and VI (HR=2.51; p=0.001) were significant associated with lower Disease Free Survival (DFS). One, 3 and 5 years OS was 87.9%, 82.0% and 69.1% for patients with TN>40% and 82.5%, 64.2% and 53.2% for those with TN<40% (p=0.02). Tumour size <5 cm (p=0.02); age <55 years (p=0.02); absence of VI (p=0.02) and multiple procedures (p=0.04) were predictive factors for TN>40%. Conclusions: Response to preoperative locoregional treatment can be used as potential selection criteria for LT.
    Full-text · Article · Jun 2013
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    ABSTRACT: Hepatic artery (HA) rupture after liver transplantation is a rare complication with high mortality. This study aimed to review the different managements of HA rupture and their results. From 1997 to 2007, data from six transplant centers were reviewed. Of 2649 recipients, 17 (0.64%) presented with HA rupture 29 days (2-92) after transplantation. Initial management was HA ligation in 10 patients, reanastomosis in three, aorto-hepatic grafting in two and percutaneous arterial embolization in one. One patient died before any treatment could be initiated. Concomitant biliary leak was present in seven patients and could be subsequently treated by percutaneous and/or endoscopic approaches in four patients. Early mortality was not observed in patients with HA ligation and occurred in 83% of patients receiving any other treatment. After a median follow-up of 70 months, 10 patients died (4 after retransplantation), and 7 patients were alive without retransplantation (including 6 with HA ligation). HA ligation was associated with better 3-year survival (80% vs. 14%; p = 0.002). Despite its potential consequences on the biliary tract, HA ligation should be considered as a reasonable option in the initial management for HA rupture after liver transplantation. Unexpectedly, retransplantation was not always necessary after HA ligation in this series.
    Full-text · Article · Feb 2013 · American Journal of Transplantation
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    ABSTRACT: Introduction: Cirrhosis and portal hypertension are correlated with a high prevalence of bacterial translocation (BT) that is associated with severe episodes of sepsis especially in patients underwent liver transplantation (LT). Methods: Between October 2007 and September 2009, 86 patients underwent LT without temporally portal shunt. A routinely peripheral venous sampling was performed at induction of anaesthesia, at the end of vacular clamping, in Intensive care unit, and in cases of post-transplantation Systemic Infl ammatory Response Syndrome. A routinely portal vein blood culture was performed at the end of the vascular clamping. Portal blood cultures were compared with the systemic blood cultures. Risk factors of BT were analyzed. Results: There were 65 men and 21 women. The mean clamping time was 122 min (range: 60–250). Portal blood culture was positive in 23 patients among 11 had systemic blood positive culture. The blood culture was positive for gram+ bacteria. The overall and infectious morbidity rate were 36% (n = 31) and 14% (n = 12) respectively. The mortality rate was 6.9% (n = 6). There was not difference between the 2 groups BT and no BT in term of overall morbidity (52% vs 30%, p = 0.06) and infectious complications (21.7% vs 11.1%, p = 0.21). There was no statistically correlation between BT and the duration of portal clamping and the mean MELD score. Conclusion: Despite the absence of statistically differences, it appears a trend of increased complication rate with BT. A study comparing the achievement of a temporary portal shunt on the occurrence of BT and infectious complications should be performed.
    No preview · Article · Jul 2012 · HPB
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    ABSTRACT: Introduction: The microbial contamination of liver graft preservation liquid (PL) is not an uncommon event related to the procedure of organ harvesting. The aim of this study was to evaluate the correlation between the contamination of PL and post transplantation morbidity and mortality. Methods: An analysis of 179 prospective and consecutive patients who underwent whole liver transplantation (LT) was undertaken. PL contamination was identifi ed by routine bacteriologic analysis during the graft ex-vivo. All patients received perioperative antibioprophylaxy. When PL was contaminated with fungal or others microbes of Staphylococcus coag (−), patients received antibiotic treatment as for systemic mycosis. Data regarding contamination of the PL of the other organs procured from the same donor were acquired from the National Organ Transplantation Agency. The contamination of the PL was analysed in respect to postoperative one month morbidity and mortality defined by Dindo’s classification. Results: The liver PL was contaminated in 80 donors (44.7%) and the PL of any organ procured was found contaminated in 120 donors (67%). The microbial fl ora isolated was poly-microbial in 18 (10%). The most frequently discovered microbes were: Staphylococcus coag (−) 53%, E.coli 8%, Streptococcus sp. 5%, and Propionibacterium acnes 4%. The pathogen was a fungus (Candida sp., Aspergilus sp.) in 5%. Contamination of the liver PL was not a risk factor for overall morbidity or mortality. However, liver PL contamination was associated with a higher rate of biliary complications (13.6% vs 4.5%, p = 0.045). The localisation of the organ procurement centre appears to be a risk factor for PL contamination (local vs regional vs national = 43% vs 69.2% vs 37.8%, p = 0.021). Conclusion: Contamination of graft PL is common during organ procurement and for the most part seems to be caused by skin germs due to breaches in the sterilisation during the operation or the graft manipulation. It is more frequent in organ procurements done at small regional hospitals. However it does not seem to increase post-operative morbidity, mortality or infection rate at least in a context of antibioprophylaxis or antibiotic therapy based on the results of PL cultures.
    No preview · Article · Jul 2012 · HPB
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    ABSTRACT: Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI). From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded. HCC was confirmed in 168 patients (85.7%). The median follow-up was 74 months. The pathologic findings showed that 106 patients (54.1%) satisfied the Milan criteria, 134 (68.4%) the UCSF criteria of whom 28 (14.3%) were beyond the Milan criteria but within the UCSF criteria, and 34 (17.3%) beyond the UCSF criteria. VI was detected in 41 patients (24%). The 1-, 3-, and 5-year overall survival rates were 90%, 85%, and 77%, respectively, according to the Milan criteria and 90%, 83%, and 76%, respectively, according to the UCSF criteria (P = NS). In univariate and multivariate analyses, tumor size and VI were significant prognostic factors affecting survival (P < 0.001). Two factors were significantly associated with VI: alfa-fetoprotein level of >400 ng/ml and tumor grade G3. Tumor size and VI were the only significant prognostic factors affecting survival of HCC patients. Primary liver resection could be a potential selection treatment before LT.
    Full-text · Article · Dec 2011 · Annals of Surgical Oncology
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    ABSTRACT: Sotrastaurin (STN), a novel oral protein kinase C inhibitor that inhibits early T-cell activation, was assessed in non-human primate recipients of life-supporting kidney allografts. Cynomolgus monkey recipients of life-supporting kidney allografts were treated orally with STN alone or in combination with cyclosporine A (CsA). STN monotherapy at 50 mg/kg once daily prolonged recipient survival times to the predefined endpoint of 29 days (n=2); when given at 25 mg/kg twice daily, the median survival time (MST) was 27 days (n=4). Neither once-daily monotherapy of STN 20 mg/kg nor CsA 20 mg/kg was effective (MST 6 days [n=2] and 7 days [n=5], respectively). In combination, however, STN 20 mg/kg and CsA 20 mg/kg prolonged MST to more than 100 days (n=5). By combining lower once-daily doses of STN (7 or 2 mg/kg) with CsA (20 mg/kg), MST was more than 100 (n=3) and 22 days (n=2), respectively. Neither in single-dose pharmacokinetic studies nor the transplant recipients were STN or CsA blood levels for combined treatment greater than when either drug was administered alone. STN blood levels in transplant recipients during combination therapy were dose related (20 mg/kg, 30-182 ng/mL; 7 mg/kg, 7-41 ng/mL; and 2 mg/kg, 3-5 ng/mL). STN at a daily dose of up to 20 mg/kg was relatively well tolerated. STN prolonged survival times of non-human primate kidney allograft recipients both as monotherapy and most effectively in combination with CsA. Pharmacokinetic interactions were not responsible for the potentiation of immunosuppressive efficacy by coadministering STN and CsA.
    No preview · Article · Dec 2011 · Transplantation
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    ABSTRACT: The objective of this 11-year cohort retrospective study conducted in adult patients with chronic hepatitis C virus (HCV) who underwent liver transplantation (LT) was to identify whether human leukocyte antigen (HLA) mismatching is associated with the recurrence of HCV and with the time to recurrence of HCV. Among the 181 patients (74% men; mean age: 54 years, range 25-71) who underwent a LT between 1995 and 2006 in the study center, 163 had relevant data in their medical chart documenting HCV recurrence, and 107 (65.64%) reported a histological evidence of HCV recurrence. Survival was 78% at 5 years. There was no significant relationship between the total score of HLA-mismatches and the recurrence of HCV. Similarly, there was no significant relationship between the total score of HLA mismatches and the time to recurrence of HCV. For the analyses at each individual locus, a significant relationship between the individual scores of HLA-mismatches and the recurrence of HCV were observed. Out of the 40 patients who experienced a rejection, the rate of recurrence was not different according to the severity of the rejection (75% mild, 64% moderate and 64% for severe rejection). In conclusion, this large study did not demonstrate any relationship between the total score of HLA mismatches and HCV-recurrence. Contrarily a significant relationship between the individual scores of HLA mismatches (HLA-A3, HLA-B35, HLA-DR3, HLA-DR7, HLA-DQ2, HLA-DQ2-0) and the recurrence of HCV were observed.
    No preview · Article · Dec 2011 · Journal of Gastroenterology and Hepatology
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    ABSTRACT: Background: Liver transplantation (LT) is indicated for patients (pts) with autoimmune hepatitis (AIH) presenting with acute liver failure, and is the treatment of choice for pts with decompensated cirrhosis and a MELD score ≧15. The efficacy of steroids in severe forms remains debated. Patients and Methods: We retrospectively evaluated, the predictive factors of LT and the role of steroids, in pts with acute severe or fulminant type 1 AIH. Results: Between 1995 and 2010, 17 pts (12 females, 4 males; mean age 56.4 ± 13.4 years) were hospitalized for acute severe or fulminant type 1 AIH. At admission 8 out of 17 (47%) presented with encephalopathy. Median INR, bilirubin, AST, and creatinine values were 2.5 (range 1.4-5.4), 396 μmol/L (range 83-797), 792 IU/L (range 90-2708), respectively. A total of 15 pts received steroids with a mean delay of 15±9.1 days from admission. In two pts steroids were avoided due to ongoing sepsis and were transplanted 2 and 13 days later. Totally, 9 out of 17 pts underwent LT with a median delay of 15 days (range 2-61). Predictive factors of LT at admission were a higher median MELD score (38, range 25-47 versus 24, range 20-29, p=0.002), a higher median INR (3.4, range 2.3-5.4, versus 1.7, range 1.4-2.5, p<0.001), and a lower median AST values (581, range 90-1913 versus 1369, range 615-2708, p=0.046). 8 out of 15 pts responded to steroids within a week, with a decrease of INR and bilirubin, at a median delay of 4.5 days (range 2-8) and 2.5 days (range 1-5), respectively. Treatment delay with steroids, bilirubin levels at admission and presence of cirrhosis did not differ significantly between non-transplanted and transplanted pts. 16 out 17 pts are still alive; 1 died 1 year later of unrelated causes. Conclusion: This study outlines the predictive value of MELD score at admission in the management of patients with severe or fulminant AIH. Patients with a lower MELD score and within the first week improvement of serum bilirubin and INR may respond to steroid therapy and avoid LT.
    Full-text · Article · Nov 2011 · Hepatology
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    ABSTRACT: Today local anesthetic wound infiltration is widely recognized as a useful adjunct in a multimodality approach to postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after laparoscopic living donor nephrectomy was analyzed in this retrospective, comparative analysis. Twenty patients undergoing living donor nephrectomy were divided into two groups: standard analgesic therapy (n=10) and ropivacaine continuous infusion group (n = 10). We observed a significant difference in term of visual analogue scale scores, use of morphine, hospital stay, and bowel recovery in favor of the ropivacaine group. The cost analysis demonstrated an overall savings of 985 Euros/patient. Surgical wound infusion with ropivacaine was safe and seemed to improve pain relief and accelerate recovery and discharge, reducing the overall costs of care. Postoperative pain control in the donor is of primary importance for better patient compliance and greater perceived quality of health care service.
    No preview · Article · May 2011 · Transplantation Proceedings
  • F Panaro · T Piardi · F Gheza · B Ellero · M Audet · M Cag · J Cinqualbre · P Wolf
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    ABSTRACT: Sirolimus is a potent immunosuppressant with a mechanism of action different from calcineurin inhibitors (CNIs). It has increasing importance for liver transplant (OLT) patients, in particular if when there is decreased renal function. We evaluated the efficacy and the causes for discontinuation of sirolimus-based immunosuppression among OLT recipients. We retrospectively analyzed 97 liver transplanted patients who were prescribed sirolimus as the principal immunosuppressant. Of these, 61 patients discontinued treatment. Herein we have reported the causes, the timing, and the effects of sirolimus discontinuation. The overall patient survival at 3 years follow-up was 89%. Hepatotoxicity and blood disorders were the most frequent, severe reported side effects. Acute cellular rejection episodes appeared in seven patients and was relieved in 1 to 2 weeks after the sirolimus administration. In 10 patients, the cholestasis associated with chronic rejection was sharply reduced after the introduction of sirolimus. No increase in vascular thrombosis and/or poor wound healing were reported. Sirolimus given alone or in combination with CNIs appears to be an effective primary immunosuppressant regimen for OLT patients. However, in the late postoperative period (>3 months) the drug is associated with a relatively high rate of side effects.
    No preview · Article · May 2011 · Transplantation Proceedings
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    ABSTRACT: BACKROUNDS/PURPOSE: Hereditary hemorrhagic telangiectasia or Rendu-Weber-Osler is an autosomal dominant inherited disorder characterized by arteriovenous malformations and telangiectasia that may affect the nose, skin, lungs, brain and gastrointestinal tract. Liver involvement of the disease has been described to be responsible of biliary tract necrosis, high cardiac output and portal hypertension, due to intra-hepatic vascular shunts. We aimed to present four cases of successful orthotopic liver transplantations in this indication performing our modified Piggy-back technique. Between 2002 and 2008, four patients have been diagnosed for Rendu-Weber-Osler disease and underwent liver transplantation. Three of them suffered from high cardiac output with heart failure, two presented HBV infection and one patient suffered from renal failure requiring a liver-kidney transplantation. We performed our modified Piggy-back technique for liver implantation, which consists to clamp selectively the hepatic veins during the hepatectomy, without venous bypass, the retro-hepatic vena cava is preserved. No hemodynamic concerns disturbed the surgery and no massive transfusions were needed. The liver replacement corrected the cardiac insufficiency due to high cardiac output for the three patients. At present, the four patients are getting well. Despite new advances in immunotherapy for the medical treatment of Rendu-Weber-Osler disease, liver transplantation remains the curative option for hepatic based-hereditary hemorrhagic telangiectasia.
    No preview · Article · Feb 2011 · Hepatology International
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    ABSTRACT: M. Audet, T. Piardi, F. Panaro, E. Ghislotti, F. Gheza, M. Cag, T.M. Jarzembowski, H. Flicoteaux, P. Wolf, J. Cinqualbre. Incidence and clinical significance of bacterial and fungal contamination of the preservation solution in liver transplantation. Transpl Infect Dis 2011: 13: 84–88. All rights reserved Abstract: A perfusion fluid used in the preservation of the grafted liver represents a medium suitable for microorganism growth. In this observational study, a sample of 232 transplanted livers was collected. Perfusion fluid samples were stored for microbiological analysis from harvested donors. Bacteria were isolated in 91 out of 232 samples, post-operative infections related to contaminated perfusion solution occurred in 13 cases. The contamination rate of the preservation medium appears to be high, but postoperative infections occurs rarely. We suggest periodic detection and a protocol in place designed for antibiotic use for transplanted patients exposed to contaminated perfusion solution.
    No preview · Article · Feb 2011 · Transplant Infectious Disease
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    ABSTRACT: The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentation. Robotic surgery for hepatic resection has not yet been extensively reported. The aim of this article is to report the first known case of liver resection with the use of a robot in France. A 61-year-old male with hepatitis C liver cirrhosis and hepatocellular carcinoma was referred for surgical treatment. Preoperative clinical evaluation and laboratory data disclosed a Child-Pugh class A5 patient. Magnetic resonance imaging showed a 3.4-cm tumor in segment III. Liver size was normal, and there were not signs of portal hypertension. Five trocars were used. Liver transection was achieved with Harmonic scalpel and bipolar forceps without pedicle clamping. Hemostasis of raw surface areas was accomplished with interrupted stitches. Operative time was 180 minutes. Blood loss was minimal, and the patient did not receive transfusion. The recovery was uneventful, and the patient was discharged on the fifth postoperative day without ascites formation. The robotic approach may enable liver resection in patients with cirrhosis. The da Vinci robotic system allowed for technical refinements of laparoscopic liver resection due to 3-dimensional visualization of the operative field and instruments with wrist-type end-effectors.
    Full-text · Article · Jan 2011 · JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
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    ABSTRACT: In the cardiac death donor era, many reports deal with biliary tract complications and concerns about ischemic reperfusion injury owing to the exclusive arterial vascularization of the biliary tree, the warm ischemia time has been implicated as responsible for biliary lesions during organ procurement. We defined the arterialization time as the second warm ischemia time. Our purpose was to study the correlation between the arterialization time during liver implantation and the appearance of biliary lesions. We retrospectively collected data from the last 5-years of orthotopic liver transplantation: namely, indications, cold perfusion fluid, cold ischemia time, operative procedure times, and acute rejection events. We excluded split-liver transplantations, retransplantations, pediatric patients, transplantations for cholestatic disease, cases where hepatic artery thrombosis happened before biliary complications, or patients with posttransplant cytomegalovirus infection. We defined 2 groups: A) without biliary complications; and B) with biliary complications. We compared the mean arterialization time using Student t test to define whether the warm ischemic time during implantation was responsible for biliary tract complications. A P value of <.05 was considered to be significant. Between 2004 and the end of 2008, we grafted 402 patients among whom 243 met the inclusion criteria: 198 in group A and 45 in group B. Only the cold ischemia time was significantly different between the 2 groups (P = .039). After the anhepatic time, the surgeon may take time for the arterial anastomosis without fearing increased biliary damage.
    No preview · Article · Nov 2010 · Transplantation Proceedings
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    ABSTRACT: Introduction L’hépatocarcinome (CHC) est une indication de résection hépatique ou de transplantation hépatique (TH). Dans la plupart des centres, seuls les patients dont le CHC répond aux critères de Milan sont éligibles pour la TH. L’objectif de l’étude est d’analyser la corrélation entre les caractéristiques pathologiques de la tumeur, la survie et le taux de récidive. Patients et Méthodes Dans la période 1997-2007, un diagnostic de CHC a été porté chez 196 patients. Ont été analysés dans cette série l’âge, le sexe, la nature de la cirrhose, les examens biologiques, l’alphafœtoprotéine. Pour tous les patients, les score MELD (Model for End-stage liver disease) et Child-Pugh ont été calculés. S’agissant du CHC, ont été précisés la localisation tumorale, la taille, le nombre de nodules, l’atteinte de la capsule, la différenciation histologique et la présence de micro ou macro-envahissement vasculaires (EV). Résultats L’examen histologique a confirmé le diagnostic de CHC chez 168 (85,7 %) patients dont la médiane de survie était de 74 mois (23-154 mois). La mortalité à un mois était de 5,6 %. À l’examen anatomo pathologique des foies explantés, 106 (63 %) patients respectaient les critères de Milan, 28 (16,7 %) ceux de San Fancisco (UCSF), 34 (20,3 %) étaient audelà de ces critères. L’envahissement vasculaires (EV) a été mis en évidence chez 41 patients (24,4 %) : macroscopiques dans 10,7 % des cas (n = 18) et microscopiques dans 13,6 % (n = 23). La survie globale et sans récidive à 5 ans était respectivement de 66,1 % et 64,1 %. Les survies globales à 1, 3 et 5 ans selon les critères de Milan étaient respectivement de 90 %, 85 % et 77 % et selon les critères de UCSF de 88 %, 81 % et 74 % (NS). On a noté une différence de taux de survie entre les patients avec EV et ceux sans EV (p ≤ 0,001). L’analyse univariée et multivariée des facteurs prédictifs de la survie seule l’EV était statistiquement significatif (p < 0,001). Deux facteurs étaient associés à l’EV, l’AFP 400 ng/ml (HR = 13,167, p < 0,002) et la classification histologique G3 (HR = 12,6, p < 0,0003). Conclusion Dans cette série, le seul facteur pronostique significatif est l’EV. Dans la mesure où on ne dispose pas de marqueurs prédictifs de l’EV fiables, la résection hépatique, lorsque la fonction hépatique le permet, représente non seulement un traitement de première intention, mais une étape décisionnelle avant la TH.
    No preview · Article · Sep 2010 · Journal de Chirurgie Viscerale
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    ABSTRACT: The aim of this study was to assess the impact of laparoscopic thermoablation (LTA) as a neoadjuvant therapy prior to orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). Between January 2008 and January 2009, 12 consecutive patients, including 10 males and 2 females with unresectable HCC within liver cirrhosis, were treated with LTA under ultrasound (US) guidance. Most patients were in Child-Pugh class B (54.1%) with a mean age of 60.7 +/- 7.74 years (range, 45-69; median, 60). The LTA procedure was completed in all patients with thermoablation of 23 HCC nodules. LTA identified 4 new malignant lesions (20%) undetected by preoperative imaging (<0.5 cm). The mean length of surgery was 96 minutes (range, 45-118). Six procedures were performed in 4 patients. No postoperative hepatic insufficiency was reported. The mean hospital stay was 4.5 days; no postoperative morbidity was reported. Complete tumor necrosis was achieved in 19/23 thermoablated nodules (82.6%) as evidenced computed tomography (CT) scan by at 3 weeks after the treatment. All patients underwent OLT without complications. The histology of the native liver showed complete necrosis in 17/23 (74%) treated nodules. There is currently no convincing evidence that LTA allows one to expand the current selection criteria for OLT, nor that LTA decreases dropout rates on the waiting list. However, LTA does not increase the risk of postoperative complications. There is insufficient evidence that LTA offers any benefit when used prior to OLT either for early or for advanced HCC.
    No preview · Article · May 2010 · Transplantation Proceedings
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    ABSTRACT: Patients undergoing orthotopic liver transplantation (OLT) show a high risk of developing an incisional hernia. The aim of this retrospective study was to establish the incidence and the factors influencing the outcomes of this complication. We reviewed 450 consecutive OLT performed in 422 adult recipient between January 2000 and December 2005. Herniae were analysed with aspect to localization, classification, repair technique, and recurrence. All treated herniae were followed for a median of 50.5 months. Incisional herniae occurred in 36 patients (8.5%, Group 1). Their mean age OLT was 51.4 years with 94.4% male subjects. No significant difference was observed between affects and unaffected individuals for age, OLT indication, Child-Pugh score, albumin, comorbidities, operative time, transfusions, immunosuppressant regimen, and graft rejection episodes as well as for the incisional approach and hospital stay. Gender, body mass index (BMI), preoperative ascites, and pulmonary complications after OLT were significantly different (P < .01). Herniae were small (<5 cm; n = 12), medium (5-10 cm; n = 28), or large (> 10 cm; n = 2). Herniorrhaphy techniques included primary suture repair in 5 (13.9%) and mesh repair in 31 (86.1%) cases. In 3 patients with a primary repair and 1 patient with a mesh repair there were recurrences. Preoperative ascites, gender, BMI, and pulmonary complications after OLT seemed to have significant influences on the formation of incisional herniae. Polypropylene mesh may be a first choice for the surgical treatment of there transplant recipients.
    No preview · Article · May 2010 · Transplantation Proceedings
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    ABSTRACT: Reye syndrome is a rare, but severe and often fatal disease. The etiology of the classical Reye syndrome is unknown, but it is typically preceded by a viral infection with a free interval of three to five days. The main physiopathological hypothesis is a mitochondrial metabolism insult causing acute liver failure and encephalopathy. Survivors present serious neurological sequelae. The treatment of Reye syndrome is usually medical with intensive care management. Herein, we present the clinical case of a six-month-old baby diagnosed with Reye syndrome with a fulminant hepatitis, who was successfully liver transplanted with an auxiliary partial orthotopic liver transplantation.
    No preview · Article · Jan 2010 · The Turkish journal of pediatrics