1
|
Chebaro A, Jeddou H. Liver transplantation for perihilar cholangiocarcinoma is not a provocative idea. Hepatobiliary Surg Nutr 2023; 12:232-234. [PMID: 37124681 PMCID: PMC10129887 DOI: 10.21037/hbsn-23-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Alexandre Chebaro
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Univ Rennes, Rennes, France
| | - Heithem Jeddou
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Univ Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Univ Rennes, Rennes, France
| |
Collapse
|
2
|
Hoogwater FJH, Kuipers H, de Meijer VE, Maulat C, Muscari F, Polak WG, van Hoek B, Jézéquel C, Alwayn IPJ, Ijzermans JNM, Mohkam K, Mabrut JY, Van Vilsteren FGI, Adam JP, Chiche L, Chebaro A, Boleslawski E, Dubbeld J, Murad SD, Rayar M, Porte RJ. Role of neoadjuvant chemoradiotherapy in liver transplantation for unresectable perihilar cholangiocarcinoma: multicentre, retrospective cohort study. BJS Open 2023; 7:7111385. [PMID: 37032423 PMCID: PMC10083139 DOI: 10.1093/bjsopen/zrad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND The Mayo protocol for liver transplantation in patients with unresectable perihilar cholangiocarcinoma is based on strict selection and neoadjuvant chemoradiotherapy. The role of neoadjuvant chemoradiotherapy in this scenario remains unclear. The aim of this study was to compare outcomes after transplantation for perihilar cholangiocarcinoma using strict selection criteria, either with or without neoadjuvant chemoradiotherapy. METHODS This was an international, multicentre, retrospective cohort study of patients who underwent transplantation between 2011 and 2020 for unresectable perihilar cholangiocarcinoma using the Mayo selection criteria and receiving neoadjuvant chemoradiotherapy or not receiving neoadjuvant chemoradiotherapy. Endpoints were post-transplant survival, post-transplant morbidity rate, and time to recurrence. RESULTS Of 49 patients who underwent liver transplantation for perihilar cholangiocarcinoma, 27 received neoadjuvant chemoradiotherapy and 22 did not. Overall 1-, 3-, and 5-year post-transplantation survival rates were 65 per cent, 51 per cent and 41 per cent respectively in the group receiving neoadjuvant chemoradiotherapy and 91 per cent, 68 per cent and 53 per cent respectively in the group not receiving neoadjuvant chemoradiotherapy (1-year hazards ratio (HR) 4.55 (95 per cent c.i. 0.98 to 21.13), P = 0.053; 3-year HR 2.07 (95 per cent c.i. 0.78 to 5.54), P = 0.146; 5-year HR 1.71 (95 per cent c.i. 0.71 to 4.09), P = 0.229). Hepatic vascular complications were more frequent in the group receiving neoadjuvant chemoradiotherapy compared with the group not receiving neoadjuvant chemoradiotherapy (nine of 27 versus two of 22, P = 0.045). In multivariable analysis, tumour recurrence occurred less frequently in the group receiving neoadjuvant chemoradiotherapy (HR 0.30 (95 per cent c.i. 0.09 to 0.97), P = 0.044). CONCLUSION In selected patients undergoing liver transplantation for perihilar cholangiocarcinoma, neoadjuvant chemoradiotherapy resulted in a lower risk of tumour recurrence, but was associated with a higher rate of early hepatic vascular complications. Adjustments in neoadjuvant chemoradiotherapy reducing the risk of hepatic vascular complications, such as omitting radiotherapy, may further improve the outcome in patients undergoing liver transplantation for perihilar cholangiocarcinoma.
Collapse
Affiliation(s)
- Frederik J H Hoogwater
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrien Kuipers
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent E de Meijer
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Charlotte Maulat
- Department of Digestive Surgery and Liver Transplantation, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Fabrice Muscari
- Department of Digestive Surgery and Liver Transplantation, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Wojciech G Polak
- Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Caroline Jézéquel
- Department of Hepatology, Rennes University Hospital, Rennes, France
| | - Ian P J Alwayn
- Department of Surgery, Division of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kayvan Mohkam
- Department of Digestive Surgery and Liver Transplantation, Hôpital De La Croix Rousse, Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Hôpital De La Croix Rousse, Lyon, France
| | - Frederike G I Van Vilsteren
- Department of Gastroenterology, Division of Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Philippe Adam
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, University Hospital Bordeaux, Bordeaux, France
| | - Laurence Chiche
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, University Hospital Bordeaux, Bordeaux, France
| | - Alexandre Chebaro
- Department of Digestive Surgery and Transplantation, CHU Lille, University of Lille, Lille, France
| | - Emmanuel Boleslawski
- Department of Digestive Surgery and Transplantation, CHU Lille, University of Lille, Lille, France
| | - Jeroen Dubbeld
- Department of Surgery, Division of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michel Rayar
- Institut National de la Santé et de la Recherche Médicale (Inserm), Rennes, France
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, University Hospital Rennes, Rennes, France
| | - Robert J Porte
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Rat P, Piessen G, Vanderbeken M, Chebaro A, Facy O, Rat P, Boisson C, Ortega-Deballon P. C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy. Langenbecks Arch Surg 2022; 407:3377-3386. [PMID: 36207546 DOI: 10.1007/s00423-022-02703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/04/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy. METHODS Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak. RESULTS We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67-0.81). On POD 5, a cut-off value of 130 mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak. CONCLUSIONS CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130 mg/L on POD 5 can safely undertake an enhanced recovery protocol.
Collapse
Affiliation(s)
- Paul Rat
- Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France.
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Univ. Lille, F-59000, Lille, France
| | - Marguerite Vanderbeken
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Univ. Lille, F-59000, Lille, France
| | - Alexandre Chebaro
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Univ. Lille, F-59000, Lille, France
| | - Olivier Facy
- Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France.,Univ. Bourgogne-Franche-Comté, UMR LNC, Dijon, France.,Inserm, U1231, Équipe CADIR, Dijon, France
| | - Patrick Rat
- Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France.,Univ. Bourgogne-Franche-Comté, UMR LNC, Dijon, France.,Inserm, U1231, Équipe CADIR, Dijon, France
| | - Cyril Boisson
- LabEx LipSTIC, Dijon-Bourgogne, University Hospital, Univ. Bourgogne-Franche-Comté, Dijon, France.,Dijon-Bourgogne University Hospital, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive and Oncological Surgery, Dijon-Bourgogne University Hospital, Univ. Bourgogne-Franche-Comté, 14 rue Paul Gaffarel, F-21000, Dijon, France.,Univ. Bourgogne-Franche-Comté, UMR LNC, Dijon, France.,Inserm, U1231, Équipe CADIR, Dijon, France
| |
Collapse
|
4
|
Maillot B, Bouzille G, Mabrut JY, Girard E, Laurent A, Navarro F, Chebaro A, Chiche L, Faitot F, Sulpice L, Vibert E, Boudjema K. The Role of Cavoportal and Renoportal Hemitransposition in Liver Transplantation. Ann Transplant 2022; 27:e935892. [PMID: 35256580 PMCID: PMC8917783 DOI: 10.12659/aot.935892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Betty Maillot
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| | - Guillaume Bouzille
- Department of Medical Information and Medical Records, CHU Rennes, Pontchaillou Hospital, University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, University of Claude Bernard Lyon 1, Hospices Civils de Lyon. National Institute for Health and Medical Research (INSERM) Unit 1052/CNRS-5286, Lyon, France
| | - Edouard Girard
- Department of Digestive Surgery and Emergency, CHU Grenoble Alpes, La Tronche Hospital, University of Grenoble Alpes, Grenoble, France
| | - Alexis Laurent
- Department of Digestive and Hepatobiliopancreatic Surgery, AP-HP, Henri Mondor Hospital, University of Paris-Est Créteil, Inserm, UMR-955, Paris, France
| | - Francis Navarro
- Department of Hepatobiliary Digestive Surgery and Hepatic and Pancreatic Transplantation, CHU Montpellier, Saint Eloi Hospital, University of Medicine Montpellier-Nîmes, Montpellier, France
| | - Alexandre Chebaro
- Department of Digestive Surgery and Transplantation, CHU Lille, Huriez Hospital, University of Medicine Henri Warembourg, Lille, France
| | - Laurence Chiche
- Department of Hepatobiliary and Hepatic Transplantation, CHU Bordeaux, Haut-Lévêque Hospital, University of Bordeaux, Bordeaux, France
| | - Francois Faitot
- Department of General, Hepatic, Endocrine and Transplantation Surgery, CHU Strasbourg, Hautepierre Hospital, University of Strasbourg, Strasbourg, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| | - Eric Vibert
- Hepato-Biliary Center, AP-HP, Paul Brousse Hospital, University of Paris-Saclay, Paris, France
| | - Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| |
Collapse
|
5
|
Rayar M, Tron C, Locher C, Chebaro A, Beaurepaire JM, Blondeau M, Cusumano C, Bardou-Jacquet E, Houssel-Debry P, Camus C, Petitcollin A, Verdier MC, Lakéhal M, Desfourneaux V, Sulpice L, Meunier B, Bellissant E, Boudjema K, Lemaitre F. Tacrolimus Concentrations Measured in Excreted Bile in Liver Transplant Recipients: The STABILE Study. Clin Ther 2018; 40:2088-2098. [PMID: 30467013 DOI: 10.1016/j.clinthera.2018.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Tacrolimus (TAC) is the main immunosuppressive drug in liver transplantation. Despite intensive therapeutic drug monitoring (TDM) that relies on whole blood trough concentration (TACblood), patients still present with acute cellular rejection or TAC-related toxic effects with concentrations within the therapeutic range. TAC concentration in peripheral blood mononuclear cells (TACPBMC) is considered as an efficient surrogate marker of TAC efficacy. However, it is still not applicable in daily practice. New TDM methods are therefore needed, especially during the early postoperative period. TAC is metabolized in the liver and eliminated through biliary excretion. We therefore hypothesised that TAC concentration measured in excreted bile (TACbileC) could be a relevant surrogate marker of its efficacy. METHODS The Therapeutic Drug Monitoring of Tacrolimus Biliary Concentrations for Liver-Transplanted Patients (STABILE) study is a prospective monocentric trial. During the 7 first days after TAC therapy initiation, TACbileC was measured. The correlation between TACbileC and TACPBMC as well as between TACblood and TACPBMC was assessed. The correlations between TACbileC and liver graft function parameter or with occurrence of neurologic toxic effects were also evaluated. FINDINGS Between May 2016 and April 2017, 41 patients were analyzed. TACbileC was significantly correlated with TACPBMC (r = 0.25, P = 0.007). However, a better correlation was found between TACPBMC and TACblood (r = 0.53, P < 0.001) and was confirmed in multivariate analysis. However, only TACbileC was significantly correlated with liver graft function, such as factor V (r = 0.40, P = 0.009) or bilirubin level (r = 0.21, P = 0.01), and significantly lower in patients presenting with neurologic toxic effects (P < 0.001). Receiver operating characteristic curve analysis found that a TACbileC level lower than 0.20 ng/mL on day 2 after TAC therapy initiation was a good predictive marker of occurrence of neurotoxic effects (AUC = 0.81). IMPLICATIONS TACbileC is not a better surrogate maker of TAC activity than TACblood. However, TACbileC could help predict the occurrence of TAC toxic effects when a T-tube is inserted. ClinicalTrials.gov identifier: NCT02820259.
Collapse
Affiliation(s)
- Michel Rayar
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France.
| | - Camille Tron
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Clara Locher
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Alexandre Chebaro
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | | | - Marc Blondeau
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | - Caterina Cusumano
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | - Edouard Bardou-Jacquet
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Service des Maladies du Foie, CHU Rennes, Rennes, France
| | - Pauline Houssel-Debry
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Service des Maladies du Foie, CHU Rennes, Rennes, France
| | - Christophe Camus
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Service de Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
| | - Antoine Petitcollin
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Marie Clémence Verdier
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Mohamed Lakéhal
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | | | - Laurent Sulpice
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France
| | - Eric Bellissant
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France
| | - Florian Lemaitre
- Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France; Faculté de Médecine, Université Rennes, Rennes, France; Department of Clinical and Biological Pharmacology and Pharmacovigilance, CHU Rennes, Rennes, France
| |
Collapse
|