A 34-year-old-man with short-bowel syndrome received an isolated small bowel graft. On postoperative day (POD) 11, ileal biopsy specimen demonstrated mild to moderate rejection that did not respond to corticosteroid bolus therapy. On POD... more
A 34-year-old-man with short-bowel syndrome received an isolated small bowel graft. On postoperative day (POD) 11, ileal biopsy specimen demonstrated mild to moderate rejection that did not respond to corticosteroid bolus therapy. On POD 14, endoscopy and histologic examination revealed exfoliative rejection that was not controlled after 14 days of therapy with thymoglobulin. On POD 95, the patient underwent surgery again because of intestinal obstruction. The graft was removed 6 months after transplantation because of continuous severe abdominal pain with weight loss. After enterectomy, the patient developed multiple-organ failure and died on POD day 8. This case underlines the severity of exfoliative rejection and suggests that early enterectomy be performed when the diagnosis is made, before deterioration of clinical status and development of infectious and nutritional complications.
Research Interests: Surgery, Medicine, Biopsy, Transplantation, Case Report, and 14 moreHumans, Weight Loss, Male, Intestinal Obstruction, Adult, Graft Rejection, Abdominal Pain, Multiple Organ Failure, Small Intestine, Postoperative Complications, Reoperation, small bowel, Medical and Health Sciences, and Fatal outcome
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La Fédération de Chirurgie Viscérale et Digestive (FCVD) a enquêté sur les conséquences personnelles et professionnelles des décisions prises pour faire face à la pandémie COVID 19 chez les chirurgien(ne)s de la spécialité. Matériel et... more
La Fédération de Chirurgie Viscérale et Digestive (FCVD) a enquêté sur les conséquences personnelles et professionnelles des décisions prises pour faire face à la pandémie COVID 19 chez les chirurgien(ne)s de la spécialité. Matériel et méthodes : Du 1er mai au 11 mai 2020, 565 Chirurgien(ne)s (105 femmes) ont répondu à un questionnaire explorant 3 domaines : répercussions personnelles, retentissement sur les activités professionnelles au sein de leur(s) établissement(s), perspectives quant à un impact ultérieur sur leur activité chirurgicale. Les Chirurgien(ne)s témoignant un mal être sévère ont répondu à un deuxième questionnaire spécifique. Résultats : Environ 75% des chirurgien(ne)s étaient impactés moralement et 10% allaient moralement et professionnellement mal. L’impact était plus fort pour les praticiens libéraux (p=0.008). La moitié (53 %) des Chirurgien(ne)s déclaraient avoir eu des cas de COVID parmi les chirurgien(ne)s et/ou anesthésistes de leur établissement. Une réduction des activités de consultations et d’actes chirurgicaux de 70 à 100% s’est imposée pour 70% des chirurgien(ne)s, tout particulièrement pour l’activité chirurgicale libérale (p=0.003). Un chirurgien sur 5 n’avait plus aucune activité chirurgicale et un sur deux a participé à des tâches non chirurgicales, plus souvent dans le secteur public (p=0.003). La majorité des chirurgien(ne)s prévoyait un impact de la pandémie sur les conditions futures de l’activité chirurgicale. Conclusion : Pour les chirurgien(ne)s, cette crise a été / est douloureuse dans ses conséquences immédiates et inquiétantes quant à ses conséquences pour l’avenir. The Federation of Visceral and Digestive Surgery (FVDS) has investigated the personal and professional consequences of decisions taken to deal with the COVID 19 pandemic among surgeons in the specialty. Material and method : From May 1st to May 11th, 2020, 565 surgeons (105 women) answered a questionnaire exploring 3 areas: personal repercussions, repercussions on professional activities within their institution(s), and prospects for a future impact on their surgical activity. Surgeons who testified to a severe ailment answered a second specific questionnaire. Results : About 75% of the surgeons were morally impacted and 10% were morally and professionally ill. The impact was stronger for liberal practitioners (p=0.008). Half (53%) of the Surgeons reported having had cases of VIDOC among the surgeons and/or anesthetists in their institution. A reduction in consultation activities and surgical acts from 70 to 100% was necessary for 70% of the surgeons, especially for the liberal surgical activity (p=0.003). One in five surgeons had no surgical activity and one in two participated in non-surgical tasks, more often in the public sector (p=0.003). The majority of surgeons predicted the impact of the pandemic on future conditions of surgical activity. Conclusion: For surgeons, this crisis has been/is painful in its immediate consequences and worrying about its consequences for the future.
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Resume Le defaut de communication orientee sur la tâche a executer ou sur la relation inter-individu se definit comme une rupture ou une perte de fluidite dans le processus de soin. Il est responsable d’evenement indesirable associe aux... more
Resume Le defaut de communication orientee sur la tâche a executer ou sur la relation inter-individu se definit comme une rupture ou une perte de fluidite dans le processus de soin. Il est responsable d’evenement indesirable associe aux soins ayant des consequences comme le retard de prise en charge qui peuvent etre de significatives a graves et parfois entrainer le deces. La connaissance des types de communication, des zones d’echanges et de ruptures de communications et les situations a risque avant pendant et apres l’hospitalisation est indispensable pour la conception de solutions d’amelioration de la communication pour la securite du patient. Les objectifs et les outils d’ameliorations ont ete definis en fonction de chaque parcours de soin du patient.
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The results of liver transplantation for hepatocellular carcinoma are disappointing. Thus, in 11 patients transplanted for hepatocellular carcinoma on cirrhosis, the actuarial survival rate at 3 years was 20 percent, with a postoperative... more
The results of liver transplantation for hepatocellular carcinoma are disappointing. Thus, in 11 patients transplanted for hepatocellular carcinoma on cirrhosis, the actuarial survival rate at 3 years was 20 percent, with a postoperative mortality of 27 percent and 4 deaths caused by recurrence of the malignancy. These poor results contrast with those we obtained after liver transplantation for cirrhosis and finding of incidental hepatocellular carcinoma in the resected part of the liver. Out of 6 patients with incidental carcinoma only 1 died postoperatively (16.6 percent), and no case of recurrent malignancy was observed. These results confirm that the malignancy recurrence rate is high after transplantation for large carcinoma. On the other hand, the absence of recurrence after transplantation for incidental hepatocellular carcinoma encourages us to look for small carcinomas on cirrhosis.
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BACKGROUND After liver transplantation (LT),de novo malignancies are one of the leading causes of late mortality. The aim of the present retrospective study was to identify the risk factors of de novo malignancies in a large cohort of LT... more
BACKGROUND After liver transplantation (LT),de novo malignancies are one of the leading causes of late mortality. The aim of the present retrospective study was to identify the risk factors of de novo malignancies in a large cohort of LT recipients in France, using Fine and Gray competing risks regression analysis. METHODS The study population consisted in 11004 adults transplanted between 2000 and 2013, who had no history of pre-transplant malignancy, except primary liver tumor. A Cox model adapted to the identification of prognostic factors (competitive risks) was used. RESULTS From the entire cohort, one (or more)de novo malignancy was reported in 1480 L T recipients (13.45%). The probability to develop a de novo malignancy after LT was 2.07% at 1 year, 13.30% at 5 years, and 28.01% at 10 years. Of the known reported malignancies, the most common malignancies were hematological malignancy (22.36%), non-melanoma skin cancer (19.53%) and lung cancer (12.36%). According to Fine and Gray competing risks regression multivariate analysis, were significant risk factors for post-LT de novo malignancy: recipient age (Subdistribution Hazard Ratio (SHR) = 1.03 95%CI 1.03-1.04), male gender (SHR = 1.45 95%CI 1.27-1.67), non-living donor (SHR = 1.67 95%CI 1.14-2.38), a first LT (SHR = 1.35 95%CI 1.09-1.69) and the type of initial liver disease (alcohol-related liver disease (SHR = 1.63 95%CI 1.22-2.17), primary sclerosing cholangitis (SHR = 1.98 95%CI 1.34-2.91), and primary liver tumor (SHR = 1.88 95%CI 1.41-2.54)). Initial immunosuppressive regimen had no significant impact. CONCLUSION The present study confirms that LT recipient characteristics are associated with the risk ofde novo malignancy and this underlines the need for personalized screening in order to improve survival.
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Background & AimsAutoimmune hepatitis (AIH) is a rare indication for liver transplantation (LT). The aims of this study were to evaluate long‐term survival after LT for AIH and prognostic factors, especially the impact of... more
Background & AimsAutoimmune hepatitis (AIH) is a rare indication for liver transplantation (LT). The aims of this study were to evaluate long‐term survival after LT for AIH and prognostic factors, especially the impact of recurrent AIH (rAIH).MethodsA multicentre retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Early deaths and retransplantations (≤6 months) were excluded.ResultsThe study population consisted of 301 patients transplanted from 1987 to 2018. Median age at LT was 43 years (IQR, 29.4–53.8). Median follow‐up was 87.0 months (IQR, 43.5–168.0). Seventy‐four patients (24.6%) developed rAIH. Graft survival was 91%, 79%, 65% at 1, 10 and 20 years respectively. Patient survival was 94%, 84% and 74% at 1, 10 and 20 years respectively. From multivariate Cox regression, factors significantly associated with poorer patient survival were patient age ≥58 years (HR = 2.9; 95% CI, 1.4–6.2; p = 0.005) and occurrence of an infectious episode within the first year after LT (HR = 2.5; 95% CI, 1.2–5.1; p = 0.018). Risk factors for impaired graft survival were: occurrence of rAIH (HR = 2.7; 95% CI, 1.5–5.0; p = 0.001), chronic rejection (HR = 2.9; 95% CI, 1.4–6.1; p = 0.005), biliary (HR = 2.0; 95% CI, 1.2–3.4; p = 0.009), vascular (HR = 1.8; 95% CI, 1.0–3.1; p = 0.044) and early septic (HR = 2.1; 95% CI, 1.2–3.5; p = 0.006) complications.ConclusionOur results confirm that survival after LT for AIH is excellent. Disease recurrence and chronic rejection reduce graft survival. The occurrence of an infectious complication during the first year post‐LT identifies at‐risk patients for graft loss and death.
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The aim of this study was to generate an improved prognostic model for predicting recurrence in liver transplant candidates with hepatocellular carcinoma (HCC). Predictors of recurrence were tested by a Cox model analysis in a training... more
The aim of this study was to generate an improved prognostic model for predicting recurrence in liver transplant candidates with hepatocellular carcinoma (HCC). Predictors of recurrence were tested by a Cox model analysis in a training cohort of 537 patients transplanted for HCC. A prognostic score was developed and validated in a national cohort of 435 patients followed up prospectively. α-Fetoprotein (AFP) independently predicted tumor recurrence and correlated with vascular invasion and differentiation. At a Cox score threshold of 0.7 (area under the receiver operating characteristic curve, 0.701; 95% confidence interval, 0.63-0.76; accuracy, 75.8%), a model combining log(10) AFP, tumor size, and number was highly predictive of tumor recurrence and death. By using a simplified version of the model, with untransformed AFP values, a cut-off value of 2 was identified. In the validation cohort, a score greater than 2 predicted a marked increase in 5-year risk of recurrence (50.6% ± 10.2% vs 8.8% ± 1.7%; P < .001) and decreased survival (47.5% ± 8.1% vs 67.8% ± 3.4%; P = .002) as compared with others. Among patients exceeding Milan criteria, a score of 2 or lower identified a subgroup of patients with AFP levels less than 100 ng/mL with a low 5-year risk of recurrence (14.4% ± 5.3% vs 47.6% ± 11.1%; P = .006). Among patients within Milan criteria, a score greater than 2 identified a subgroup of patients with AFP levels greater than 1000 ng/mL at high risk of recurrence (37.1% ± 8.9% vs 13.3% ± 2.0%; P < .001). Net reclassification improvement showed that predictability of the AFP model was superior to Milan criteria. Prediction of tumor recurrence is improved significantly by a model that incorporates AFP. We propose the adoption of new selection criteria for HCC transplant candidates, taking into account AFP.
Research Interests: Gastroenterology, Medicine, Multivariate Analysis, Humans, Internal Medicine, and 15 moreFemale, Male, Hepatocellular Carcinoma, Liver Transplantation, Cohort, Clinical Sciences, Middle Aged, Neoplasm Invasiveness, Adult, AFP, Neurosciences, Area Under Curve, Confidence Interval, Decision Support Techniques, and Liver neoplasms
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Objective: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. Background: Outcomes after open major hepatectomies vary widely lacking... more
Objective: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. Background: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. Methods: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a five-year period (2016–2020). Benchmark cases were low-risk non-cirrhotic patients without significant co-morbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. Results: Of 8044 patients, 2908 (36%) qualified as benchmark (low risk) cases. Benchmark cutoffs for all indications include R0 resectio...
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Background and AimsTo report 5‐year outcomes of the CERTITUDE study.MethodsAn observational study in patients with liver transplantation (LTx) compared the long‐term impact of immunosuppression (with/without a calcineurin inhibitor) on... more
Background and AimsTo report 5‐year outcomes of the CERTITUDE study.MethodsAn observational study in patients with liver transplantation (LTx) compared the long‐term impact of immunosuppression (with/without a calcineurin inhibitor) on renal function, cancers, major cardiovascular events (MACEs) and other safety parameters. All patients completing the 6‐month SIMCER study were recruited and analysed according to treatment received at randomization and actual treatment received during the follow‐up.ResultsOf the 143 enrolled patients, 119 completed the 5‐year follow‐up (everolimus [EVR], n = 55; tacrolimus [TAC], n = 64). The mean absolute change in estimated glomerular filtration rate was not statistically different between both groups (TAC, −15.53 ml/min/1.73 m2 and EVR, –14.56 ml/min/1.73 m2). In the treatment subgroups based on actual treatment received, renal function was preserved better in the EVR subgroup compared with other subgroups (p = .051). Treated biopsy‐proven acute r...
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Background & Aims Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are... more
Background & Aims Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3–6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101–1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber’s c-index was 0.76 (95% CI 0.72–0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72–0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1–2 points; 15.1%), high (3–6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber’s c-index of 0.78; 95% CI 0.73–0.83). Conclusions The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration NCT03775863. Lay summary Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT.
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Research Interests: Medicine, France, Biopsy, Prospective studies, Humans, and 15 moreFemale, Feasibility Studies, Male, Liver Transplantation, Aged, Middle Aged, Adult, Graft Rejection, Calcineurin inhibitors, Regimen, Immunosuppressive Agents, neutropenia, leukopenia, Adrenal cortex hormones, and Medical and Health Sciences
Research Interests: Virology, Medicine, Transplantation, Hepatitis B, Humans, and 15 moreLiver Cirrhosis, Female, Male, Liver Transplantation, Recurrence, Middle Aged, Antibody, Time Factors, Survival Rate, Retrospective Studies, Hepatitis B virus, Immunoglobulins, Immunoglobulin, Liver neoplasms, and Medical and Health Sciences
The Up7 criteria for HCC have recently emerged to identify potential candidates for OLT. The aim of this study was to assess the validity of the Up7 criteria according to the pathological analysis of the explanted livers. For recurrence... more
The Up7 criteria for HCC have recently emerged to identify potential candidates for OLT. The aim of this study was to assess the validity of the Up7 criteria according to the pathological analysis of the explanted livers. For recurrence risk calculation 669 HCC transplanted patients were classified according to both the pathological Milan and Up7 criteria. In order to identify potential predictors of recurrence, selected biological tumor markers and morphological features were then tested by Cox regression. The 5-year HCC recurrence rate for the Milan out/Up7 in subgroup (n=87), was significantly higher than patients meeting Milan criteria (n=299), 15.8% vs. 9.4% (p=0.0290). For patients within the Up7 criteria (n=383), only pre-OLT AFP level >1000ng/mL and microvascular invasion were significant predictors for recurrence, and for those beyond the Up7 criteria (n=286), pre-OLT AFP level >1000ng/mL, poor differentiation grade and microvascular invasion remained significant. Com...
Research Interests: Gastroenterology, Risk assessment, Medicine, France, Humans, and 15 moreInternal Medicine, Female, Pubmed, Male, Hepatocellular Carcinoma, Liver Transplantation, Clinical Sciences, Middle Aged, Proportional hazards model, Retrospective Studies, Risk Assessment, Pathological, Patient selection, Liver neoplasms, and Medical and Health Sciences
Nineteen orthotopic liver transplantations (OLT) were performed in patients with hepatocellular carcinoma, between March 1988 and December 1990, in our Department. Thirteen patients (68.4%), 10 men and 3 women, mean age 48.2 +/- 2.8... more
Nineteen orthotopic liver transplantations (OLT) were performed in patients with hepatocellular carcinoma, between March 1988 and December 1990, in our Department. Thirteen patients (68.4%), 10 men and 3 women, mean age 48.2 +/- 2.8 years, were clear cut neoplastic disease, six patients (31.6%), 4 men and 2 women, mean age 48.6 +/- 4.2 years, were incidental tumors. Three years survival rate was 20% in clear cut neoplastic diseases (4 patients died for neoplastic recurrence) and 66% in incidental tumors. Our results demonstrate that liver transplantation for hepatobiliary malignancy is still justified, patient selection is important in predicting outcome.
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Trotz der groβen Anzahl effektiver medikamentoser Behandlungen liegt die Rezidivrate der medikamentos behandelten Ulzera in einem Jahr in der Groβenordnung von 90%, unabhangig davon, welche Medikation
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Thirty three Ag positive patients without sign of HBV replication underwent orthotopic liver transplantation. Long term passive immunoprophylaxis reduced HBV reinfection of the grafted liver.
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Research Interests: Metastasis, Medicine, Hepatology, Humans, Internal Medicine, and 15 moreAlbumin, Female, Male, Hepatocellular Carcinoma, Polymerase Chain Reaction, Clinical Sciences, Aged, Middle Aged, Adult, Prognosis, Negative predictive value, Liver neoplasms, Neoplasm metastasis, Medical biochemistry and metabolomics, and mRNA expression
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IMPORTANCE In patients with low viral loads, high levels of hepatitis B surface antigen (HBsAg) have been shown to predict development of hepatocellular carcinoma (HCC). Whether high levels of HBsAg increase the risk for HCC recurrence... more
IMPORTANCE In patients with low viral loads, high levels of hepatitis B surface antigen (HBsAg) have been shown to predict development of hepatocellular carcinoma (HCC). Whether high levels of HBsAg increase the risk for HCC recurrence after hepatic resection remains unknown. OBJECTIVE To investigate the association between levels of HBsAg and the risk for tumor recurrence after curative resection in HCC patients with low levels of hepatitis B virus (HBV) DNA. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective analysis of the clinical data of 1062 patients with low HBV DNA levels (<200 IU/mL) who underwent partial hepatectomy for HCC. In particular, we investigated the association between levels of HBsAg and recurrence of HCC. EXPOSURE Partial hepatectomy for HCC. MAIN OUTCOMES AND MEASURES The risk for first tumor recurrence between patients with high and low HBsAg levels. We calculated cumulative incidences and hazard ratios after adjusting for competing mortality. ...
Research Interests: Gastroenterology, Medicine, Humans, Internal Medicine, Female, and 15 moreMale, Hepatocellular Carcinoma, Polymerase Chain Reaction, Diagnostic Imaging, Clinical Sciences, Middle Aged, Retrospective Studies, Hepatitis B virus, Predictive value of tests, HBsAg, Hepatectomy, Disease Free Survival, Liver neoplasms, Medical and Health Sciences, and hazard ratio
ABSTRACT
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Research Interests: Gastroenterology, STEROIDS, Medicine, Liver diseases, Humans, and 15 moreInternal Medicine, Liver, Female, Male, Monoclonal Antibodies, Liver Transplantation, Incidence, Renal Function, Middle Aged, Adult, Calcineurin, Creatinine, immunoglobulin G, Immunosuppressive Agents, and Medical and Health Sciences
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We studied the outcome of 345 liver transplant patients who received tacrolimus-based immunosuppressive therapy either as a dual regimen (with corticosteroids, n=172) or as a triple regimen (with corticosteroids and azathioprine, n=173)... more
We studied the outcome of 345 liver transplant patients who received tacrolimus-based immunosuppressive therapy either as a dual regimen (with corticosteroids, n=172) or as a triple regimen (with corticosteroids and azathioprine, n=173) for 3 months after transplantation (3-month cohort). A further analysis was conducted for the first 195 patients randomised (dual n=100, triple n=95) who were followed up for 12 months after transplantation (12-month cohort). For the 3-month cohort, patient survival was 90.7% (dual) and 91.9% (triple), graft survival after 3 months was 88.4% (dual therapy) and 89.6% (triple therapy). Acute rejections were experienced by 67/172, 39.0% of patients on dual therapy and by 60/173, 34.7% of patients on triple therapy; corticosteroid-resistant rejections were reported in 9 patients (5.2%) in either treatment group. The overall safety profile was similar for the two treatment groups. Significant differences, however, were found for thrombocytopenia (dual 13/172, 7.6%, triple 37/173, 21.4%, p&amp;amp;amp;amp;amp;amp;lt;0.001) and leukopenia (dual 4/172, 2.3%, triple 24/173, 13.9%, p&amp;amp;amp;amp;amp;amp;lt;0.001). For the 12-month cohort, patient survival was 85.6% (dual) and 88.4% (triple) after 1 year. Graft survival was 81.7% (dual) and 85.2% (triple) 12 months after transplantation. Acute rejections were reported for 38/100, 38.0% of patients on dual therapy and 36/95, 37.9% of patients on triple therapy, corticosteroid-resistant rejections were 7/100, 7.0% (dual) and 7/95, 7.4% (triple) of patients. In the 12-month cohort, no significant differences in the safety profiles of the treatment groups were found. We conclude that both tacrolimus-based dual and triple drug regimens provide effective and safe immunosuppression following orthotopic liver transplantation.
Research Interests: Surgery, Gastroenterology, Medicine, Prospective studies, Humans, and 15 moreInternal Medicine, Female, Male, Immunosuppression, Liver Transplantation, Cohort, Clinical Sciences, Middle Aged, Combination drug therapy, Graft Rejection, Regimen, Azathioprine, Cohort Studies, Methylprednisolone, and Immunosuppressive Agents
Background The potential anti-cancer effects of mammalian target of rapamycin (mTOR) inhibitors are being intensively studied. To date, however, few randomised clinical trials (RCT) have been performed to demonstrate anti-neoplastic... more
Background The potential anti-cancer effects of mammalian target of rapamycin (mTOR) inhibitors are being intensively studied. To date, however, few randomised clinical trials (RCT) have been performed to demonstrate anti-neoplastic effects in the pure oncology setting, and at present, no oncology endpoint-directed RCT has been reported in the high-malignancy risk population of immunosuppressed transplant recipients. Interestingly, since mTOR inhibitors have both immunosuppressive and anti-cancer effects, they have the potential to simultaneously protect against immunologic graft loss and tumour development. Therefore, we designed a prospective RCT to determine if the mTOR inhibitor sirolimus can improve hepatocellular carcinoma (HCC)-free patient survival in liver transplant (LT) recipients with a pre-transplant diagnosis of HCC. Methods/Design The study is an open-labelled, randomised, RCT comparing sirolimus-containing versus mTOR-inhibitor-free immunosuppression in patients unde...
Research Interests: Australia, Quality of life, Comparative Study, Medicine, Canada, and 15 moreProspective studies, Humans, Internal Medicine, Europe, mTOR, Hepatocellular Carcinoma, Immunosuppression, Liver Transplantation, Randomized Controlled Trial, DDC, Multicenter Study, Immunosuppressive Agents, BMC, Disease Free Survival, and Liver neoplasms
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Introduction La lesion du canal biliaire sectoriel postero-lateral droit apres cholecystectomie (LCSP) represente une complication rare dont la prise en charge est complexe. Methodes A partir de l’etude retrospective multicentrique de... more
Introduction La lesion du canal biliaire sectoriel postero-lateral droit apres cholecystectomie (LCSP) represente une complication rare dont la prise en charge est complexe. Methodes A partir de l’etude retrospective multicentrique de l’AFC concernant 640 plaies biliaires apres cholecystectomie entre 1990 et 2010, ont ete selectionnees les LCSP isolees ou associees a une plaie de la voie biliaire principale (types B, C et E5 selon Strasberg). Le type et le delai de la reparation chirurgicale ont ete evalues, ainsi que le taux de succes defini comme une absence de traitement supplementaire chirurgical, endoscopique ou radiologique. La reparation a ete definie comme precoce si realisee dans les 3 mois (RP) ou tardive (RT). Resultats Quarante-deux cas d’âge moyen 52 ans ont ete selectionnes : 11 de type B, 9 de type C, 22 de type E5. Une RP a ete realisee dans 14 cas (10 sutures directes, 4 anastomoses biliodigestives) et une RT chez 28 patients (19 anastomoses biliodigestives, 9 resections hepatiques). Avec un suivi moyen de 39 mois (range 6 – 180) le taux de succes en fonction du delai a ete de 36 % pour les RP et de 93 % pour les RT. Le taux de succes selon le type de procedure a ete de 30 % pour les sutures directes, de 82 % pour les anastomoses bilio-digestives et de 100 % pour les resections hepatiques. Conclusion L’anastomose bilio-digestive tardive represente l’option chirurgicale de reference ; la resection hepatique est utilisee dans des cas bien selectionnes.
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Hepatitis C virus recurrence is frequent after orthotopic liver transplantation. The aim of this study was to evaluate the clinical, biological, and histological characteristics of recurrence. One hundred and ten patients (91 males, mean... more
Hepatitis C virus recurrence is frequent after orthotopic liver transplantation. The aim of this study was to evaluate the clinical, biological, and histological characteristics of recurrence. One hundred and ten patients (91 males, mean age 49 years) with liver transplantation were followed up for more than 1 year (mean: 26 months, range: 12-71). Hepatitis C virus serologic 2nd generation tests were performed before and every 3 months after transplantation in all patients. Serum RNA was detected every 6 months after transplantation by polymerase chain reaction. A percutaneous liver biopsy was performed every year in all patients and in case of abnormal biological liver tests. In 44 patients (40%), hepatitis C virus serology was positive before transplantation, and was unchanged after transplantation. In this group histologic chronic hepatitis was observed in 35 patients (79.5%). The mean Knodell score was 8.4 +/- 2.3, associated with an increase in serum aminotransferases (> twi...