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Dousse D, Vibert E, Nicolas Q, Terasawa M, Cano L, Allard MA, Salloum C, Ciacio O, Pittau G, Sa Cunha A, Cherqui D, Adam R, Samuel D, Vignon-Clementel I, Golse N. Indocyanine Green Fluorescence Imaging to Predict Graft Survival After Orthotopic Liver Transplantation: A Pilot Study. Liver Transpl 2020; 26:1263-1274. [PMID: 32402148 DOI: 10.1002/lt.25796] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/23/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023]
Abstract
The incidence of primary nonfunction (PNF) after liver transplantation (LT) remains a major concern with the increasing use of marginal grafts. Indocyanine green (ICG) fluorescence is an imaging technique used in hepatobiliary surgery and LT. Because few early predictors are available, we aimed to quantify in real time the fluorescence of grafts during LT to predict 3-month survival. After graft revascularization, ICG was intravenously injected, and then the fluorescence of the graft was captured with a near infrared camera and postoperatively quantified. A multiparametric modeling of the parenchymal fluorescence intensity (FI) curve was proposed, and a predictive model of graft survival was tested. Between July 2017 and May 2019, 76 LTs were performed, among which 6 recipients underwent retransplantation. No adverse effects of ICG injection were observed. The parameter a150 (temporal course of FI) was significantly higher in the re-LT group (0.022 seconds-1 (0.0011-0.059) versus 0.012 seconds-1 (0.0001-0.054); P = 0.01). This parameter was the only independent predictive factor of graft survival at 3 months (OR, 2.4; 95% CI, 1.05-5.50; P = 0.04). The best cutoff for the parameter a150 (0.0155 seconds-1 ) predicted the graft survival at 3 months with a sensitivity (Se) of 83.3% and a specificity (Spe) of 78.6% (area under the curve, 0.82; 95% CI, 0.67-0.98; P = 0.01). Quantitative assessment of intraoperative ICG fluorescence on the graft was feasible to predict graft survival at 3 months with a good Se and Spe. Further prospective studies should be undertaken to validate these results over larger cohorts and evaluate the clinical impact of this tool.
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Affiliation(s)
- Damien Dousse
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 1193, INSERM, Villejuif, France
- Department of Digestive Surgery, Rangueil University Hospital, Toulouse, France
| | - Eric Vibert
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 1193, INSERM, Villejuif, France
| | | | - Muga Terasawa
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
| | | | - Marc-Antoine Allard
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 1193, INSERM, Villejuif, France
| | - Chady Salloum
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
| | - Oriana Ciacio
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
| | - Gabriella Pittau
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
| | - Antonio Sa Cunha
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 1193, INSERM, Villejuif, France
| | - Daniel Cherqui
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 1193, INSERM, Villejuif, France
| | - René Adam
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 985, INSERM, Villejuif, France
| | - Didier Samuel
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 1193, INSERM, Villejuif, France
| | | | - Nicolas Golse
- Department of Hepato-Biliary and Liver Transplant, AP-HP Paul Brousse Hospital, Centre Hépato-Biliaire, Villejuif, France
- Unit 1193, INSERM, Villejuif, France
- Inria, Paris, France
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Dousse D, Bloom E, Suc B. Pancreaticoduodenectomy complicated by Budd-Chiari syndrome: A case report and review of literature. World J Gastrointest Surg 2018; 10:107-110. [PMID: 30622679 PMCID: PMC6314861 DOI: 10.4240/wjgs.v10.i9.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreaticoduodenectomy (PD)-induced morbidity, consisting mainly of the pancreatic fistula and its hemorrhagic and infectious consequences, is well described in the literature, in terms of its definition, risk factors, preventive measures, and standardized management of complications. However, some life-threatening complications remain atypical and undescribed.
CASE SUMMARY We report here the case of a 69-year-old patient with Budd-Chiari syndrome that occurred after arterial embolization of postpancreatectomy hemorrhage. Diagnosis was established with biological findings (i.e., acute liver failure) and radiological findings (i.e., compressive hematoma of the retrohepatic vena cava). Emergency surgical revision was performed to evacuate the hematoma. The postoperative course was uneventful, with rapid recovery of liver function. To our knowledge, post-PD Budd-Chiari syndrome has never been described in the literature.
CONCLUSION Acute liver failure in early post-PD should prompt investigation to rule out Budd-Chiari syndrome.
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Affiliation(s)
- Damien Dousse
- Department of Visceral Surgery, Toulouse-Purpan University Hospital, 31059 Toulouse Cedex 9, France
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
| | - Eric Bloom
- Department of Visceral Surgery, Toulouse-Purpan University Hospital, 31059 Toulouse Cedex 9, France
| | - Bertrand Suc
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
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Dousse D, Otal P, Suc B. Biliary repair after main bile duct injury in a patient with "fusion of hepatic planes" anatomical variation (with video). J Visc Surg 2018; 155:153-155. [PMID: 29311000 DOI: 10.1016/j.jviscsurg.2017.12.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D Dousse
- Service de chirurgie digestive, CHU Rangueil, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France.
| | - P Otal
- Service de radiologie, CHU Rangueil, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
| | - B Suc
- Service de chirurgie digestive, CHU Rangueil, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
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Rabinel P, Dousse D, Muscari F, Suc B. Management of liver cancer. The Surgeon's point of view. Rep Pract Oncol Radiother 2017; 22:176-180. [PMID: 28490990 DOI: 10.1016/j.rpor.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/08/2016] [Revised: 12/27/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023] Open
Abstract
During the last twenty years, a huge progress has been achieved in the treatment of liver cancer and recent strategies include interventional radiology, chemotherapy regimens and surgery. Meanwhile, Stereotactic Body Radiation Therapy (SRBT) has developed in the treatment of all organs with millimetre accuracy, very few side effects and a high control rate. So, SRBT has become a therapeutic weapon in his own right in liver tumour treatment. Many publications have reported encouraging results in colorectal liver metastasis, hepatocellular carcinoma on cirrhosis and peripheric cholangiocarcinoma. It is important that radiation therapists involve systematic multidisciplinary "liver tumour" meetings to discuss therapeutic indications and initiate treatments quickly.
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Affiliation(s)
- Pierre Rabinel
- Department of Digestive Surgery and Liver Transplantation, Rangueil Hospital, 1, Avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Damien Dousse
- Department of Digestive Surgery and Liver Transplantation, Rangueil Hospital, 1, Avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Fabrice Muscari
- Department of Digestive Surgery and Liver Transplantation, Rangueil Hospital, 1, Avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Bertrand Suc
- Department of Digestive Surgery and Liver Transplantation, Rangueil Hospital, 1, Avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
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