January 2024
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6 Reads
HPB
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January 2024
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6 Reads
HPB
January 2024
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3 Reads
HPB
January 2024
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22 Reads
HPB
January 2024
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10 Reads
HPB
January 2024
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10 Reads
HPB
June 2023
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34 Reads
BJS (British Journal of Surgery)
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 2014-2019 at 4 high volume transplant centers (>70 LT/year). Outcomes including overall morbidity expressed by the comprehensive complication index (CCI) and graft related complications were compared to the published benchmark cutoffs for whole graft LT. Results We included 129 ex-situ RSLT with 76% H45678 (n=98) and 24% (n=31) H5678 grafts. The median follow-up was 4.8 years. Overall and severe 1-year morbidity expressed by the CCI were within established whole graft LT benchmarks. Biliary complication rates were slightly higher than the benchmark due to the occurrence of cut-surface leaks. The arterial thrombosis rate was outside the benchmark cutoff (7% vs ≤4.4%) leading to a higher retransplantation rate. However, overall 1-year graft and recipient mortality were well within the benchmark cutoffs, resulting in a 5-year overall recipient survival of 88.5%. Selecting benchmark cases for RSLT defined by low-risk recipient-donor criteria including static cold storage time ≤10h and recipient MELD≤20 points, did not significantly reduce overall morbidity nor arterial complication rate. In contrast, the type of split graft (H45678 vs.H5678) did impact on both arterial and biliary complications. Conclusions This large multicenter series of ex-situ right split grafts disclosed an overall 1-year morbi-mortality comparable to the best achievable results in whole graft LT. The results show that the main morbidity burden in adult RSLT is related to technical criteria rather than graft-recipient matching.
January 2023
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6 Reads
HPB
January 2023
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9 Reads
HPB
January 2023
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20 Reads
HPB
January 2023
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1 Read
HPB
... Benchmarking establishes a specific patient population with the best possible outcomes after a certain intervention performed at expert, high-volume centers; also known as lowrisk cases [3,36,37]. This concept enables a standardized performance assessments based on large, multicenter cohorts with limited bias adjusting for donor-recipient risk [3,18,19,36,38,39]. Excellent baseline outcomes with benchmark cases serve as quality control tools and are compared to higher risk cohorts to enable transparent evaluation of the impact of risk factors, novel therapeutics, and preservation strategies [19]. ...
May 2022
BJS (British Journal of Surgery)
... Although minor procedures, in terms of the resection extent, the high conversion rate reflects the difficulty of the procedure. In contrast, LLS is regarded as the easiest and a starter procedure, both in minimally invasive and open surgery [27,37,38,40]. The fact that the association between a longer operative time and postoperative complications differed according to the procedure type and used approach can possibly be explained as follows. ...
January 2020
HPB
... Imaging features of bile duct injury can be categorized as bile duct dilatation, biloma, or bile duct stricture (Fig. 6) [71]. Dilatation of bile ducts commonly occurs during the early stages of ischemic cholangiopathy. ...
January 2020
HPB
... Notably, recent advancements in technologies such as the indocyanine green (ICG) scope, robotic surgery, intraoperative image guidance, and enhanced bleeding control, as discussed in the latest international laparoscopic liver surgery consensus, signify the evolving landscape of LLR [9]. Moreover, the most comprehensive multicenter propensity score-matched observational study reaffirmed the feasibility and safety of LRLR [10]. ...
January 2020
BJS (British Journal of Surgery)
... Liver cancer is the sixth most common cancer worldwide, and the third leading cause of death worldwide killing more than 800,000 people each year [1]. The most widely recognized condition that predisposes HCC is hepatic cirrhosis, and almost 90% of HCC patients have chronic infections with the hepatitis B or C virus [2]. Its incidence is expected to rise and peak within the next 20-30 years mirroring the predicted worldwide epidemiology of viral hepatitis. ...
January 2020
BJS (British Journal of Surgery)
... A significant large volume of blood loss was founded in CPB group and was within an acceptable range compared with the experience at other centers (34,35). In a cohort study of over 5,000 patients in France, Savier et al. (36) found that the median ICU duration after LT was 8 days (5-15 days). Mehrabi et al. (24) reported a 14-day ICU and IMC stay in their experience of 500 LTs using the MPB technique. ...
September 2019
Journal of Visceral Surgery
... 16 Preoperative and postoperative chemotherapy alone or in combination have been attempted for patients with CRLM to decrease recurrences and improve long-term outcomes. [17][18][19][20][21][22][23][24][25][26] Some randomized controlled studies have shown significantly improved DFS or progression-free survival, but not overall survival (OS). [17][18][19][20] We previously conducted a propensity score matching study that used a nationwide database and demonstrated that adjuvant chemotherapy significantly improved DFS and OS after liver resection. ...
May 2019
BJS Open
... R-classification was in several studies (Adam et al. 2006;Groeschl et al. 2012;Holzner et al. 2018;Lendoire et al. 2007;Lucchese et al. 2018;Schiergens et al. 2016;Weitz Fig. 2 Overall survival dependent on location of the primary Content courtesy of Springer Nature, terms of use apply. Rights reserved. ...
June 2018
BJS (British Journal of Surgery)
... A Romanian study reported that 25.4% of patients had clinically asymptomatic disease at diagnosis, 21.8% presented with fulminant hepatic failure and 52.8% with a chronic liver disease [20]. Of the 107 WD patients followed in a French liver centre between 1974 and 2016, two-thirds were suffering from cirrhosis at diagnosis [21]. ...
Reference:
Wilson's disease: A 2017 update
April 2018
Journal of Hepatology
... Multicenter and well-powered studies are needed to confirm the interest of the preoperative use of FibroScan for CAP and HS measurements in the evaluation of liver grafts before organ procurement. (51) Encouraging results have been reported in animal studies with the use of Raman spectroscopy, in pocket infrared human spectroscopy, (52) and in computer vision analysis of graft pictures (53,54) to determine the hepatic fat content of the donor's liver in situ prior to proceeding with organ procurement. (55) However, the advantages of a cheap, easy-to-use, immediate, smaller, portable, and robust tool have to be validated in larger prospective studies. ...
April 2018
Journal of Hepatology