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Muller X, Rossignol G, Boulanger N, Mohkam K, Mabrut JY. In situ or ex situ split: Does it all come down to static cold storage? J Hepatol 2024; 80:e210-e211. [PMID: 37717599 DOI: 10.1016/j.jhep.2023.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France; Hepatology Institute of Lyon, INSERM U1052, Lyon, France; Ecole Doctorale 340, Biologie Moléculaire et Intégrative, Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France.
| | - Guillaume Rossignol
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France; Hepatology Institute of Lyon, INSERM U1052, Lyon, France; Ecole Doctorale 340, Biologie Moléculaire et Intégrative, Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France; Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Natacha Boulanger
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France; Hepatology Institute of Lyon, INSERM U1052, Lyon, France; Ecole Doctorale 340, Biologie Moléculaire et Intégrative, Université Claude-Bernard Lyon 1, 69622 Villeurbanne, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France; Hepatology Institute of Lyon, INSERM U1052, Lyon, France; Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France; Hepatology Institute of Lyon, INSERM U1052, Lyon, France
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Bienvenu AL, Cour M, Pavese P, Guichon C, Leray V, Chapuis C, Dureault A, Mohkam K, Gallet S, Bourget S, Kahale E, Chaabane W, Subtil F, Maucort-Boulch D, Talbot F, Dode X, Richard JC, Leboucher G. Correlation between antifungal clinical practices and a new clinical decision support system ANTIFON-CLIC® for the treatment of invasive candidiasis: a retrospective multicentre study. J Antimicrob Chemother 2024:dkae118. [PMID: 38656566 DOI: 10.1093/jac/dkae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Invasive candidiasis is still recognized as a major cause of morbidity and mortality. To support clinicians in the optimal use of antifungals for the treatment of invasive candidiasis, a computerized decision support system (CDSS) was developed based on institutional guidelines. OBJECTIVES To evaluate the correlation of this newly developed CDSS with clinical practices, we set-up a retrospective multicentre cohort study with the aim of providing the concordance rate between the CDSS recommendation and the medical prescription (NCT05656157). PATIENTS AND METHODS Adult patients who received caspofungin or fluconazole for the treatment of an invasive candidiasis were included. The analysis of factors associated with concordance was performed using mixed logistic regression models with department as a random effect. RESULTS From March to November 2022, 190 patients were included from three centres and eight departments: 70 patients from centre A, 84 from centre B and 36 from centre C. Overall, 100 patients received caspofungin and 90 received fluconazole, mostly (59%; 112/190) for empirical/pre-emptive treatment. The overall percentage of concordance between the CDSS and medical prescriptions was 91% (173/190) (confidence interval 95%: 82%-96%). No significant difference in concordance was observed considering the centres (P > 0.99), the department of inclusion (P = 0.968), the antifungal treatment (P = 0.656) or the indication of treatment (P = 0.997). In most cases of discordance (n = 13/17, 76%), the CDSS recommended fluconazole whereas caspofungin was prescribed. The clinical usability evaluated by five clinicians was satisfactory. CONCLUSIONS Our results demonstrated the high correlation between current antifungal clinical practice and this user-friendly and institutional guidelines-based CDSS.
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Affiliation(s)
- Anne-Lise Bienvenu
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, Malaria Research Unit, SMITh, ICBMS UMR 5246, Lyon, France
| | - Martin Cour
- Service de Médecine Intensive-Réanimation, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Patricia Pavese
- Service des Maladies Infectieuses, CHU de Grenoble, Grenoble, France
| | - Céline Guichon
- Service d'Anesthésie-Réanimation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Véronique Leray
- Service d'Anesthésie-Réanimation, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | | | - Amélie Dureault
- Service des Maladies Infectieuses, CH de Valence, Valence, France
| | - Kayvan Mohkam
- Service d'Hépato-Gastro-Entérologie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Salomé Gallet
- Service des Maladies Infectieuses, CHU de Grenoble, Grenoble, France
| | | | - Elham Kahale
- Direction de l'Innovation, Hospices Civils de Lyon, Lyon, France
| | - Wajih Chaabane
- Direction des Services Numériques, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France
| | | | - François Talbot
- Direction des Services Numériques, Hospices Civils de Lyon, Lyon, France
| | - Xavier Dode
- Service Pharmacie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive-Réanimation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Gilles Leboucher
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
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Parant F, Delignette MC, Charpiat B, Lacaille L, Lebosse F, Monneret G, Mohkam K, Mabrut JY, Aubrun F, Heyer L, Antonini T. Tacrolimus Monitoring in Liver Transplant Recipients, Posttransplant Cholestasis: A Comparative Between 2 Commercial Immunoassays and a Liquid Chromatography-Tandem Mass Spectrometry Method. Ther Drug Monit 2024:00007691-990000000-00213. [PMID: 38648663 DOI: 10.1097/ftd.0000000000001201] [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: 11/02/2023] [Accepted: 12/23/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND Cholestasis commonly occurs after orthotopic liver transplantation. It can be extrahepatic because of mechanical obstruction or intrahepatic because of various causes. During cholestasis episodes, blood concentrations of tacrolimus (TAC) metabolites may increase, potentially affecting TAC concentrations measured by immunoassays. This study aimed to simultaneously evaluate the analytical performance of 2 TAC immunoassays, a quantitative microsphere system (QMS) immunoassay, and chemiluminescence microparticle immunoassay, using liquid chromatography-tandem mass spectrometry (LC-MS/MS) as a reference method in liver transplant recipients. METHODS This single-center study included 265 patients who underwent orthotopic liver transplantation. In total, 942 blood samples were collected. TAC trough concentrations were measured using LC-MS/MS and 2 immunoassays in parallel. The plasma concentrations of conjugated bilirubin were measured in all samples. The results were analyzed using Bland-Altman plots and Passing-Bablok regressions. RESULTS The Bland-Altman plot analysis showed that the TAC QMS immunoassay has a significant bias (+37%) compared with LC-MS/MS, and this bias was higher in patients with cholestasis with hyperbilirubinemia (≤+70% in patients with conjugated bilirubin >150 µmol/L). In comparison, the chemiluminescence microparticle immunoassay showed acceptable analytical performance in patients with hyperbilirubinemia (bias <10%). CONCLUSIONS In agreement with previous findings, the TAC QMS immunoassay showed a positive bias compared with LC-MS/MS. This bias is remarkably high in patients with cholestasis and hyperbilirubinemia, suggesting the cross-reactivity of TAC metabolites with the monoclonal antibody used in the QMS immunoassay.
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Affiliation(s)
- François Parant
- Service de Biochimie et Biologie Moléculaire, Laboratoire de Biologie Médicale Multi-Sites (LBMMS), Hôpital Lyon-Sud-Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Bruno Charpiat
- Service pharmaceutique, Hôpital de la Croix Rousse-Hospices Civils de Lyon, Lyon, France
| | - Louis Lacaille
- Service de Biochimie et Biologie Moléculaire, Laboratoire de Biologie Médicale Multi-Sites (LBMMS), Hôpital de la Croix Rousse-Hospices Civils de Lyon, Lyon, France
| | - Fanny Lebosse
- Service d'Hépatologie, Hôpital de la Croix Rousse-Hospices Civils de Lyon, Lyon, France
| | - Guillaume Monneret
- Laboratoire d'Immunologie, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Kayvan Mohkam
- Service de chirurgie générale, digestive et transplantations hépatiques et intestinales, Hôpital de la Croix Rousse-Hospices Civils de Lyon, France; and
| | - Jean-Yves Mabrut
- Service de chirurgie générale, digestive et transplantations hépatiques et intestinales, Hôpital de la Croix Rousse-Hospices Civils de Lyon, France; and
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052, Lyon, France
| | - Frederic Aubrun
- Service d'Anesthésie Réanimation, Hôpital de la Croix Rousse-Hospices Civils de Lyon, Lyon, France
| | - Laurent Heyer
- Service d'Anesthésie Réanimation, Hôpital de la Croix Rousse-Hospices Civils de Lyon, Lyon, France
| | - Teresa Antonini
- Service d'Hépatologie, Hôpital de la Croix Rousse-Hospices Civils de Lyon, Lyon, France
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052, Lyon, France
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Rossignol G, Muller X, Couillerot J, Lebosse F, Delignette MC, Mohkam K, Mabrut JY. From large-for-size to large-for-flow: A paradigm shift in liver transplantation. Liver Transpl 2024; 30:277-287. [PMID: 37039739 DOI: 10.1097/lvt.0000000000000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/27/2022] [Accepted: 03/26/2023] [Indexed: 04/12/2023]
Abstract
Liver graft-recipient matching remains challenging, and both morphologic and hemodynamic characteristics have been shown to be relevant indicators of post-transplant outcomes. However, no combined analysis is available to date. To study the impact of both morphologic and hemodynamic characteristics of liver grafts on transplantation outcomes, we retrospectively evaluated all consecutive 257 liver transplantations with prospective hemodynamic measurements from 2017 to 2020 in a single-center perspective. First, a morphologic analysis compared recipients with or without large-for-size (LFS), defined by a graft/recipient weight ratio >2.5% and excluding extreme LFS. Second, a hemodynamic analysis compared recipients with or without low portal flow (LPF; <80 mL/min per 100 g of liver tissue). Third, an outcome analysis combining LPF and LFS was performed, focusing on liver graft-related morbidity (LGRM), graft and patient survival. LGRM was a composite endpoint, including primary nonfunction, high-risk L-Graft7 category, and portal vein thrombosis. Morphologic analysis showed that LFS (n=33; 12.9%) was not associated with an increased LGRM (12.1% vs 9.4%; p =0.61) or impaired graft and patient survival. However, the hemodynamic analysis showed that LPF (n=43; 16.8%) was associated with a higher LGRM (20.9% vs 7.5%, p = 0.007) and a significantly impaired 90-day graft and patient survival. Multivariable analysis identified LPF but not LFS as an independent risk factor for LGRM (OR: 2.8%; CI:1.088-7.413; and p = 0.03), 90-day (HR: 4%; CI: 1.411-11.551; and p = 0 .01), and 1-year patient survival. LPF is a significant predictor of post-liver transplantation morbi-mortality, independent of LFS when defined as a morphologic metric alone. Consequently, we propose the novel concept of large-for-flow, which may guide graft selection and improve perioperative management of LPF.
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Affiliation(s)
- Guillaume Rossignol
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Xavier Muller
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Joris Couillerot
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Fanny Lebosse
- Department of Hepatology, Croix Rousse University Hospital, Lyon, France
| | | | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
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Rossignol G, Muller X, Brunet TA, Bidault V, Hervieu V, Clement Y, Ayciriex S, Mabrut JY, Salvador A, Mohkam K. Comprehensive bile acid pool analysis during ex-vivo liver perfusion in a porcine model of ischemia-reperfusion injury. Sci Rep 2024; 14:2384. [PMID: 38286808 PMCID: PMC10824768 DOI: 10.1038/s41598-024-52504-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
Bile acids (BA) are key for liver regeneration and injury. This study aims at analyzing the changes in the BA pool induced by ischemia-reperfusion (IRI) and investigates the impact of hypothermic oxygenated perfusion (HOPE) on the BA pool compared to static cold storage (SCS). In a porcine model of IRI, liver grafts underwent 30 min of asystolic warm ischemia followed by 6 h of SCS (n = 6) ± 2 h of HOPE (n = 6) and 2 h of ex-situ warm reperfusion. The BA pool in bile samples was analyzed with liquid chromatography coupled with tandem mass spectrometry. We identified 16 BA and observed significant changes in response to ischemia-reperfusion, which were associated with both protective and injury mechanisms. Second, HOPE-treated liver grafts exhibited a more protective BA phenotype, characterized by a more hydrophilic BA pool compared to SCS. Key BA, such as GlycoCholic Acid, were identified and were associated with a decreased transaminase release and improved lactate clearance during reperfusion. Partial Least Square-Discriminant Analysis revealed a distinct injury profile for the HOPE group. In conclusion, the BA pool changes with liver graft IRI, and preservation with HOPE results in a protective BA phenotype compared to SCS.
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Affiliation(s)
- Guillaume Rossignol
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France.
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France.
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France.
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France.
- Institute of Analytical Sciences, CNRS UMR 5280, Claude Bernard University Lyon 1, Villeurbanne, France.
| | - Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France.
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France.
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France.
| | - Thomas Alexandre Brunet
- Institute of Analytical Sciences, CNRS UMR 5280, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Valeska Bidault
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Valerie Hervieu
- Department of Pathology, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Villeurbanne, Lyon, France
| | - Yohann Clement
- Institute of Analytical Sciences, CNRS UMR 5280, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Sophie Ayciriex
- Institute of Analytical Sciences, CNRS UMR 5280, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Arnaud Salvador
- Institute of Analytical Sciences, CNRS UMR 5280, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
- The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
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Muller X, Rossignol G, Mohkam K, Mabrut JY. Back to Basics: Liver Graft Ischemia in the Era of Machine Perfusion. Transplantation 2024:00007890-990000000-00637. [PMID: 38277262 DOI: 10.1097/tp.0000000000004912] [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: 01/28/2024]
Affiliation(s)
- Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM U1052, Lyon, France
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Guillaume Rossignol
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM U1052, Lyon, France
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM U1052, Lyon, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM U1052, Lyon, France
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Muller X, Rossignol G, Couillerot J, Breton A, Hervieu V, Lesurtel M, Mohkam K, Mabrut JY. A Single Preservation Solution for Static Cold Storage and Hypothermic Oxygenated Perfusion of Marginal Liver Grafts: A Preclinical Study. Transplantation 2024; 108:175-183. [PMID: 37410580 DOI: 10.1097/tp.0000000000004714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Hypothermic oxygenated perfusion (HOPE) improves outcomes of marginal liver grafts. However, to date, no preservation solution exists for both static cold storage (SCS) and HOPE. METHODS After 30 min of asystolic warm ischemia, porcine livers underwent 6 h of SCS followed by 2 h of HOPE. Liver grafts were either preserved with a single preservation solution (IGL2) designed for SCS and HOPE (IGL2-Machine Perfusion Solution [MPS] group, n = 6) or with the gold-standard University of Wisconsin designed for for SCS and Belzer MPS designed for HOPE (MPS group, n = 5). All liver grafts underwent warm reperfusion with whole autologous blood for 2 h, and surrogate markers of hepatic ischemia-reperfusion injury (IRI) were assessed in the hepatocyte, cholangiocyte, vascular, and immunological compartments. RESULTS After 2 h of warm reperfusion, livers in the IGL2-MPS group showed no significant differences in transaminase release (aspartate aminotransferase: 65.58 versus 104.9 UI/L/100 g liver; P = 0.178), lactate clearance, and histological IRI compared with livers in the MPS group. There were no significant differences in biliary acid composition, bile production, and histological biliary IRI. Mitochondrial and endothelial damage was also not significantly different and resulted in similar hepatic inflammasome activation. CONCLUSIONS This preclinical study shows that a novel IGL2 allows for the safe preservation of marginal liver grafts with SCS and HOPE. Hepatic IRI was comparable with the current gold standard of combining 2 different preservation solutions (University of Wisconsin + Belzer MPS). These data pave the way for a phase I first-in-human study and it is a first step toward tailored preservation solutions for machine perfusion of liver grafts.
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Affiliation(s)
- Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- Hepatology Institute of Lyon, INSERM U1052, Lyon, France
- Ecole Doctorale 340, Biologie Moléculaire et Intégrative, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Guillaume Rossignol
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- Hepatology Institute of Lyon, INSERM U1052, Lyon, France
- Ecole Doctorale 340, Biologie Moléculaire et Intégrative, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Joris Couillerot
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- Hepatology Institute of Lyon, INSERM U1052, Lyon, France
| | - Antoine Breton
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- Hepatology Institute of Lyon, INSERM U1052, Lyon, France
| | - Valérie Hervieu
- Department of Pathology, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Villeurbanne, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- Hepatology Institute of Lyon, INSERM U1052, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- Hepatology Institute of Lyon, INSERM U1052, Lyon, France
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Pradat P, Pantel S, Maynard M, Lalande L, Thevenon S, Adam R, Allard MA, Robin F, Rayar M, Boleslawski E, Scatton O, Chirica M, Faitot F, Bachellier P, Soubrane O, Mohkam K, Mabrut JY, Lesurtel M. Correction: End-ischemic hypothermic oxygenated perfusion for extended criteria donors in liver transplantation: a multicenter, randomized controlled trial-HOPExt. Trials 2023; 24:530. [PMID: 37580803 PMCID: PMC10424413 DOI: 10.1186/s13063-023-07471-1] [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: 08/16/2023] Open
Affiliation(s)
- Pierre Pradat
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
| | - Solene Pantel
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Marianne Maynard
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Laure Lalande
- Department of Pharmacy, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sylvie Thevenon
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Rene Adam
- Department of HPB Surgery and Liver Transplantation, Paul Brousse University Hospital, Villejuif, France
| | - Marc-Antoine Allard
- Department of HPB Surgery and Liver Transplantation, Paul Brousse University Hospital, Villejuif, France
| | - Fabien Robin
- Department of HPB Surgery and Liver Transplantation, Pontchaillou Univer- Sity Hospital, Rennes, France
| | - Michel Rayar
- Department of HPB Surgery and Liver Transplantation, Pontchaillou Univer- Sity Hospital, Rennes, France
| | - Emmanuel Boleslawski
- Department of HPB Surgery and Liver Transplan- Tation, Claude Huriez University Hospital, Lille, France
| | - Olivier Scatton
- Department of HPB Surgery and Liver Transplantation, Pitié Salpêtrière Hospital, Paris, France
| | - Mircea Chirica
- Department of HPB Surgery and Liver Transplantation, Michallon University Hospital, Grenoble, France
| | - François Faitot
- Department of HPB Surgery and Liver Transplanta- Tion, Hautepierre University Hospital, Strasbourg, France
| | - Philippe Bachellier
- Department of HPB Surgery and Liver Transplanta- Tion, Hautepierre University Hospital, Strasbourg, France
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplantation, Beaujon University Hospital, Clichy, France
| | - Kayvan Mohkam
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
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Chouik Y, Erard D, Demian H, Schulz T, Mazard T, Hartig-Lavie K, Antonini T, Mabrut JY, Mohkam K, Rode A, Merle P. Case Report: Successful liver transplantation after achieving complete clinical remission of advanced HCC with Atezolizumab plus Bevacizumab combination therapy. Front Immunol 2023; 14:1205997. [PMID: 37377975 PMCID: PMC10291060 DOI: 10.3389/fimmu.2023.1205997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Background Atezolizumab plus Bevacizumab combination therapy has recently emerged as the new standard of care for unresectable HCC. Significant tumor burden reduction can be observed under that treatment, raising the question of liver transplantation (LT). The safety of another immune checkpoint inhibitor (ICI), nivolumab, is unclear in the pre-transplant setting. Method We report the case of a 57-y old man, with initial unresectable multinodular HCC contraindicated to LT and locoregional therapies, who achieves complete tumor response after Atezolizumab/Bevacizumab, and subsequently underwent LT for liver failure. Results Explant analysis revealed complete pathological response with no tumor remnant. The patient suffered from several post-operative complications but no HCC recurrence or biopsy-proven acute rejection occurred 10 months after LT. Conclusions Atezolizumab/Bevacizumab therapy may enable complete pathological response of advanced HCC. Safety of prolonged treatment need to be assessed.
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Affiliation(s)
- Yasmina Chouik
- Cancer Research Center of Lyon (CRCL), INSERM U1052, Centre National de la Recherche Scientifique UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Domitille Erard
- Cancer Research Center of Lyon (CRCL), INSERM U1052, Centre National de la Recherche Scientifique UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Hassan Demian
- Department of General Surgery and Liver Transplantation, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Thomas Schulz
- Department of Intensive Care, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Tessa Mazard
- Department of Intensive Care, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Kerstin Hartig-Lavie
- Cancer Research Center of Lyon (CRCL), INSERM U1052, Centre National de la Recherche Scientifique UMR5286, Lyon, France
| | - Teresa Antonini
- Cancer Research Center of Lyon (CRCL), INSERM U1052, Centre National de la Recherche Scientifique UMR5286, Lyon, France
| | - Jean-Yves Mabrut
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Department of General Surgery and Liver Transplantation, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Kayvan Mohkam
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Department of General Surgery and Liver Transplantation, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Agnès Rode
- Department of Radiology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Philippe Merle
- Cancer Research Center of Lyon (CRCL), INSERM U1052, Centre National de la Recherche Scientifique UMR5286, Lyon, France
- Department of Hepatology, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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10
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Pradat P, Pantel S, Maynard M, Lalande L, Thevenon S, Adam R, Allard MA, Robin F, Rayar M, Boleslawski E, Scatton O, Chirica M, Faitot F, Bachellier P, Soubrane O, Mohkam K, Mabrut JY, Lesurtel M. End-ischemic hypothermic oxygenated perfusion for extended criteria donors in liver transplantation: a multicenter, randomized controlled trial-HOPExt. Trials 2023; 24:379. [PMID: 37280696 PMCID: PMC10243046 DOI: 10.1186/s13063-023-07402-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Given the scarce donor supply, an increasing number of so-called marginal or extended criteria donor (ECD) organs are used for liver transplantation. These ECD liver grafts are however known to be associated with a higher rate of early allograft dysfunction and primary non-function because of a greater vulnerability to ischemia-reperfusion injury. The end-ischemic hypothermic oxygenated machine perfusion (HOPE) technique may improve outcomes of liver transplantation with ECD grafts by decreasing reperfusion injury. METHODS HOPExt trial is a comparative open-label, multicenter, national, prospective, randomized, controlled study, in two parallel groups, using static cold storage, the gold standard procedure, as control. The trial will enroll adult patients on the transplant waiting list for liver failure or liver cirrhosis and/or liver malignancy requiring liver transplantation and receiving an ECD liver graft from a brain-dead donor. In the experimental group, ECD liver grafts will first undergo a classical static cold (4 °C) storage followed by a hypothermic oxygenated perfusion (HOPE) for a period of 1 to 4 h. The control group will consist of the classic static cold storage which is the gold standard procedure in liver transplantation. The primary objective of this trial is to study the efficacy of HOPE used before transplantation of ECD liver grafts from brain-dead donors in reducing postoperative early allograft dysfunction within the first 7 postoperative days compared to simple cold static storage. DISCUSSION We present in this protocol all study procedures in regard to the achievement of the HOPExt trial, to prevent biased analysis of trial outcomes and improve the transparency of the trial results. Enrollment of patients in the HOPExt trial has started on September 10, 2019, and is ongoing. TRIAL REGISTRATION ClinicalTrials.gov NCT03929523. Registered on April 29, 2019, before the start of inclusion.
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Affiliation(s)
- Pierre Pradat
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
| | - Solene Pantel
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Marianne Maynard
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Laure Lalande
- Department of Pharmacy, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sylvie Thevenon
- Centre for Clinical Research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Rene Adam
- Department of HPB Surgery and Liver Transplantation, Paul Brousse University Hospital, Villejuif, France
| | - Marc-Antoine Allard
- Department of HPB Surgery and Liver Transplantation, Paul Brousse University Hospital, Villejuif, France
| | - Fabien Robin
- Department of HPB Surgery and Liver Transplantation, Pontchaillou University Hospital, Rennes, France
| | - Michel Rayar
- Department of HPB Surgery and Liver Transplantation, Pontchaillou University Hospital, Rennes, France
| | - Emmanuel Boleslawski
- Department of HPB Surgery and Liver Transplantation, Claude Huriez University Hospital, Lille, France
| | - Olivier Scatton
- Department of HPB Surgery and Liver Transplantation, Pitié Salpêtrière Hospital, Paris, France
| | - Mircea Chirica
- Department of HPB Surgery and Liver Transplantation, Michallon University Hospital, Grenoble, France
| | - François Faitot
- Department of HPB Surgery and Liver Transplantation, Hautepierre University Hospital, Strasbourg, France
| | - Philippe Bachellier
- Department of HPB Surgery and Liver Transplantation, Hautepierre University Hospital, Strasbourg, France
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplantation, Beaujon University Hospital, Clichy, France
| | - Kayvan Mohkam
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
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11
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Allignet B, Merle P, Rode A, Mabrut JY, Mohkam K, Mornex F. Transarterial chemoembolization followed by moderately hypofractionated radiotherapy in hepatocellular carcinoma: Long-term results of RTF3 regimen. Cancer Radiother 2023:S1278-3218(23)00064-1. [PMID: 37150729 DOI: 10.1016/j.canrad.2023.01.004] [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: 11/18/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE In early-stage hepatocellular carcinoma (HCC) patients merely fit for surgery, transarterial chemoembolization (TACE) achieve low long-term disease control. We evaluated the efficacy and safety of its combination with moderately hypofractionated radiotherapy (hRT) using RTF3 regimen. MATERIAL AND METHODS Between 2006 and 2016, 61 consecutive patients treated in our single expert center for a Barcelona Clinic Liver Cancer (BCLC) A HCC by TACE followed by hRT 3Gy/fraction were retrospectively included. RESULTS Sixty of the 61 included presented Child-Pugh A cirrhosis (A5, n=41, 67.2%; A6: n=19, 31.1%). Fourteen patients (22.9%) were already treated for a HCC, mainly by radiofrequency (n=12). All patient received a TACE followed by 3Gy per fraction hRT. Mean radiation dose was 54Gy (range: 48-60). After a median follow-up of 118 months, median time-to-progression, progression-free survival (PFS) and overall survival (OS) was 21.3, 18.1, and 31.5 months, respectively. In univariate analysis, PFS was related to dose > 54Gy (HR: 2, P=0.036), and OS was correlated to Child-Pugh A6 or B7 (HR: 1.93, P=0.03) and overall hRT time (HR: 1.06, P=0.015). At progression, orthotopic liver transplantation was performed in 8 patients (13.1%). Severe symptomatic adverse events occurred in 12 patients (19.7%), mainly ascites (n=7). CONCLUSION In BCLC-A Child-Pugh A HCC patients ineligible to surgery or thermoablation, TACE-hRT is a safe and effective treatment. Prospective studies are needed to compare this association with radioembolization, TACE-stereotactic radiotherapy, and systemic treatments combinations.
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Affiliation(s)
- B Allignet
- Department of Radiotherapy, centre hospitalier Lyon Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Pierre-Bénite, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294 Lyon, France.
| | - P Merle
- Hepatology Unit, hôpital de La Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Inserm 1052/CNRS 5286 Unit, Cancer Research Center of Lyon (CRCL), université Claude-Bernard Lyon 1, Lyon, France
| | - A Rode
- Department of Radiology, hôpital de La Croix-Rousse, hospices civils de Lyon, université-Claude Bernard Lyon 1, Lyon, France
| | - J Y Mabrut
- Inserm 1052/CNRS 5286 Unit, Cancer Research Center of Lyon (CRCL), université Claude-Bernard Lyon 1, Lyon, France; Department of General Surgery and Liver Transplantation, hôpital de La Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - K Mohkam
- Inserm 1052/CNRS 5286 Unit, Cancer Research Center of Lyon (CRCL), université Claude-Bernard Lyon 1, Lyon, France; Department of General Surgery and Liver Transplantation, hôpital de La Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - F Mornex
- Department of Radiotherapy, centre hospitalier Lyon Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Pierre-Bénite, France
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12
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Muller X, Rossignol G, Mohkam K, Mabrut JY. Ex-situ graft reduction (H67) during hypothermic oxygenated perfusion to prevent large-for-size syndrome in liver transplantation-A technical report. Clin Transplant 2023:e14995. [PMID: 37076911 DOI: 10.1111/ctr.14995] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/26/2023] [Accepted: 04/09/2023] [Indexed: 04/21/2023]
Abstract
In this report, we discuss several technical and anatomical details of ex-situ H67 reduction of liver grafts during hypothermic oxygenated perfusion to prevent large-for-size syndrome in the case of anthropometric graft-recipient mismatch.
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Affiliation(s)
- Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM, Lyon, France
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Guillaume Rossignol
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM, Lyon, France
- ED 340 BMIC, Claude Bernard Lyon 1 University, Villeurbanne, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM, Lyon, France
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix Rousse University Hospital, Lyon, France
- Institute of Hepatology Lyon (IHL), INSERM, Lyon, France
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13
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Laurent C, Rayar M, Maulat C, Muscari F, Marichez A, Gregoire E, Chopinet S, Mabrut JY, Boudjema K, Lesurtel M, Adam JP, Mohkam K, Chiche L. Liver transplantation and hepatocellular carcinoma: is TIPS deleterious? A multicentric retrospective study of the ARCHET research group with propensity score matching. Langenbecks Arch Surg 2023; 408:149. [PMID: 37052722 DOI: 10.1007/s00423-023-02875-8] [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: 12/16/2021] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE A transjugular intrahepatic portosystemic shunt (TIPS) before the liver transplantation (LT) has been considered a contraindication in cases of hepatocellular carcinoma (HCC) because of the risk of tumour growth. We aimed to assess the impact of TIPS on incidental HCC and oncological outcomes in transplanted patients with pre-existing HCC. METHODS All consecutive transplanted patients for cirrhosis who had a previous TIPS with or without HCC were included. Between 2007 and 2014, 1912 patients were transplanted. We included 122 (6.3%) patients having TIPS before LT. A 1:3 matched cohort of 366 patients (18.9%) having LT without previous TIPS was selected using a propensity score. Incidental HCC rate and risk factor of HCC recurrence were evaluated using multivariate analysis with a competing risk model. RESULTS Before LT, in the TIPS group, 27 (22.1%) had an HCC vs. 81 (22.1%) in the control group (p = 1). The incidental HCC rate was similar: 10.5% (10/95) in the TIPS group vs. 6.3% (18/285) in the control group (p = 0.17). Recurrence occurred in 1/27 (3.7%) patient in the TIPS group and in 7/81 (8.6%) patients in the control group, without significant difference (p = 0.51). After multivariate regression, patient's gender (p < 0.01) was significantly associated with HCC recurrence while a tumour within Milan criteria (p = 0.01, sHR: 0.17 [0.04; 0.7]) and an incidental HCC (p<0.01) were found to be protector factors against HCC recurrence. CONCLUSION TIPS did not worsen the prognosis of transplanted patients for HCC. TIPS should no longer be contraindicated for oncological reasons in patients with HCC waiting for an LT.
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Affiliation(s)
- Christophe Laurent
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France.
| | - Michel Rayar
- Department of Visceral Surgery, University Hospital of Rennes, Rennes, France
| | - Charlotte Maulat
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Fabrice Muscari
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Arthur Marichez
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France
| | - Emilie Gregoire
- Department of General Surgery and Liver Transplantation, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Sophie Chopinet
- Department of General Surgery and Liver Transplantation, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Jean Yves Mabrut
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Karim Boudjema
- Department of Visceral Surgery, University Hospital of Rennes, Rennes, France
| | - Mickael Lesurtel
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Jean-Philippe Adam
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France
| | - Kayvan Mohkam
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Laurence Chiche
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France
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14
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Rossignol G, Muller X, Dubois R, Rode A, Mabrut JY, Mohkam K. Optimizing graft-recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy. Pediatr Transplant 2023; 27:e14510. [PMID: 36919397 DOI: 10.1111/petr.14510] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/09/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Graft-recipient size matching is a major challenge in pediatric liver transplantation, especially for adolescent recipients. Indeed, adolescents have the lowest transplantation rate among pediatric recipients, despite prioritization policies and the use of split grafts. In case of an important graft-recipient size mismatch, ex situ graft reduction with right posterior sectionectomy (RPS) may optimize the available donor pool to benefit adolescent recipients. METHODS We present three cases of liver graft reduction with ex situ RPS for adolescent recipients. The surgical strategy was guided by GRWR (graft/recipient weight ratio), GW/RAP (right anteroposterior distance ratio), and CT-scan volumetric and anthropometric evaluation. RESULTS Recipients were 12, 13, and 14-year-old and weighed 32, 47, and 35 kg, respectively. All liver grafts were procured from brain-dead donors with a donor/recipient weight ratio >1.5. RPS was performed ex situ, removing 20% of the total liver volume leading to a decrease of the GRWR <4% and the GW/RAP <100 g/cm in each case. All three reduced grafts were successfully transplanted with a static cold storage time ranging from 390 to 510 min without the need for delayed abdominal closure. We did not observe any primary non-function, vascular complication, or delayed graft function with a median follow-up of 6 months. One biliary anastomotic stenosis occurred which required surgical treatment. CONCLUSION Ex situ liver graft reduction with RPS allowed for successful transplantation in case of anthropometric graft-recipient size mismatch in adolescent liver transplant candidates. Although the use of split grafts remains the gold standard, RPS should be acknowledged as a way to optimize the donor pool, especially for adolescent recipients.
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Affiliation(s)
- Guillaume Rossignol
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France.,Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France.,The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France.,The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Remi Dubois
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France
| | - Agnes Rode
- Department of Radiology, Croix-Rousse University Hospital, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France.,The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Kayvan Mohkam
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France.,Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France.,The Cancer Research Center of Lyon, INSERM U1052, Lyon, France
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15
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Fenouil T, Lavrut PM, Rabeyrin M, Adham M, Mohkam K, Mabrut JY, Walter T, Hervieu V. Necrosis as a strong independent prognostic factor required in the implementation of pathological reporting for pancreatic adenocarcinoma resection specimens. Pathol Res Pract 2023; 244:154406. [PMID: 36905694 DOI: 10.1016/j.prp.2023.154406] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Pancreatic ductal adenocarcinoma (PDAC) is a major public health issue with an incidence/mortality ratio reaching 98 %. Only 15-20 % of patients with PDAC can undergo surgery. Following PDAC surgical resection, 80 % of patients will experience local or metastatic recurrence of this disease. pTNM staging is the gold standard for risk stratification but is not sufficient to recapitulate the prognosis. Several prognostic factors are known to impact survival after surgery when uncovered during pathological examination. However, necrosis has been poorly studied in pancreatic adenocarcinoma. MATERIALS & METHODS We retrieved clinical data and reviewed all tumor slides from patients who had a pancreatic surgery between January 2004 and December 2017, in the Hospices Civils de Lyon, to assess the presence of histopathological prognosis factors associated with poor prognosis. RESULTS 514 patients with complete clinico-pathological description were included. Necrosis was found in 231 PDAC (44.9 %) and had an important impact on overall survival with a double risk of death when present in tumor samples (HR: 1.871, 95 % CI [1.523; 2.299], p < 0.001). When integrated in the multivariate model, necrosis is the only morphological aggressive feature to retain high statistical significance associated with the TNM staging but independently of it. This effect is independent of the preoperative treatment. CONCLUSIONS Despites improvement in treatment of PDAC, mortality rates remain relatively stable amongst the last years. There is a desperate need to better stratify patients. Here, we report the strong and prognostic impact of necrosis in surgical PDAC samples and encourage pathologists to report its presence in the future.
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Affiliation(s)
- Tanguy Fenouil
- Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Institute of Pathology, Lyon, France,.
| | - Pierre Marie Lavrut
- Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Institute of Pathology, Lyon, France
| | - Maud Rabeyrin
- Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Institute of Pathology, Lyon, France
| | - Mustapha Adham
- Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Department of Digestive Surgery, Edouard Herriot Hospital, Lyon, France
| | - Kayvan Mohkam
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Jean Yves Mabrut
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Thomas Walter
- Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Department of hepato-gastroenterology and digestive medical oncology, Edouard Herriot Hospital, Lyon, France
| | - Valerie Hervieu
- Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, Institute of Pathology, Lyon, France
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16
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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.
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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
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17
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Seckler F, Turco C, Mohkam K, Addeo P, Robin F, Cauchy F, Maulat C, Brustia R, Paquette B, Faitot F, Weil Verhoeven D, Minello A, Lakkis Z, Di Martino V, Latournerie M, Chiche L, El Amrani M, Bucur P, Navarro F, Chopinet S, Chirica M, Gagnière J, Iannelli A, Cheisson G, Chardot C, Sommacale D, Muscari F, Dondero F, Sulpice L, Bachellier P, Scatton O, Mabrut JY, Heyd B, Doussot A. Liver Transplantation Using Allografts With Recent Liver Blunt Trauma: A Nationwide Audit From the French CRISTAL Biomedicine Agency Registry. Transplantation 2023; 107:664-669. [PMID: 36477606 DOI: 10.1097/tp.0000000000004434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the current setting of organ shortage, brain-dead liver donors with recent liver trauma (RLT) represent a potential pool of donors. Yet, data on feasibility and safety of liver transplantation (LT) using grafts with RLT are lacking. METHODS All liver grafts from brain-dead donors with RLT proposed for LT between 2010 and 2018 were identified from the nationwide CRISTAL registry of the Biomedicine Agency. The current study aimed at evaluating 1-y survival as the primary endpoint. RESULTS Among 11 073 LTs, 142 LTs (1.3%) using grafts with RLT were performed. These 142 LTs, including 23 split LTs, were performed from 131 donors (46.1%) of 284 donors with RLT proposed for LT. Transplanted grafts were procured from donors with lower liver enzymes levels ( P < 0.001) and less advanced liver trauma according to the American Association for the Surgery of Trauma liver grading system ( P < 0.001) compared with not transplanted grafts. Before allocation procedures, 20 (7%) of 284 donors underwent damage control intervention. During transplantation, specific liver trauma management was needed in 19 patients (13%), consisting of local hemostatic control (n = 15), partial hepatic resection on back-table (n = 3), or perihepatic packing (n = 1). Ninety-day mortality and severe morbidity rates were 8.5% (n = 12) and 29.5% (n = 42), respectively. One-year overall and graft survival rates were 85% and 81%, and corresponding 5-y rates were 77% and 72%, respectively. CONCLUSIONS Using liver grafts from donors with RLT seems safe with acceptable long-term outcomes. All brain-dead patients with multiorgan trauma, including liver injury, should be considered for organ allocation.
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Affiliation(s)
- Florian Seckler
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Célia Turco
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Kayvan Mohkam
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pietro Addeo
- Department of Digestive Surgery, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Fabien Robin
- Department of Hepatobiliary and Digestive Surgery, Hôpital Pontchaillou, CHU, Rennes, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Charlotte Maulat
- Department of Visceral Surgery, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Raffaele Brustia
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri-Mondor, Créteil, France
| | - Brice Paquette
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - François Faitot
- Department of Digestive Surgery, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Anne Minello
- Department of Hepatology, CHU Dijon, Dijon, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | | | | | - Laurence Chiche
- Department of Digestive Surgery, CHU Bordeaux, Pessac, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Hôpital Huriez, CHU Lille, Lille, France
| | - Petru Bucur
- Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, CHU Tours, Tours, France
| | - Francis Navarro
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Sophie Chopinet
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital la Timone, Assistance Publique-Hôpitaux de Marseille, France
| | - Mircea Chirica
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, CHU Grenoble Alpes, France
| | - Johan Gagnière
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, CHU Estaing, Clermont-Ferrand, France
| | - Antonio Iannelli
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Archet 2, CHU Nice, France
| | - Gaëlle Cheisson
- Department of Anesthesia and Intensive Care, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Christophe Chardot
- Department of Pediatric Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniele Sommacale
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri-Mondor, Créteil, France
| | - Fabrice Muscari
- Department of Visceral Surgery, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Federica Dondero
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, Hôpital Pontchaillou, CHU, Rennes, France
| | - Philippe Bachellier
- Department of Digestive Surgery, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Scatton
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Jean Yves Mabrut
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bruno Heyd
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
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18
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Mohkam K, Nasralla D, Mergental H, Muller X, Butler A, Jassem W, Imber C, Monbaliu D, Perera MTPR, Laing RW, García‐Valdecasas JC, Paul A, Dondero F, Cauchy F, Savier E, Scatton O, Robin F, Sulpice L, Bucur P, Salamé E, Pittau G, Allard M, Pradat P, Rossignol G, Mabrut J, Ploeg RJ, Friend PJ, Mirza DF, Lesurtel M. In situ normothermic regional perfusion versus ex situ normothermic machine perfusion in liver transplantation from donation after circulatory death. Liver Transpl 2022; 28:1716-1725. [PMID: 35662403 PMCID: PMC9796010 DOI: 10.1002/lt.26522] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/14/2022] [Accepted: 03/19/2022] [Indexed: 12/30/2022]
Abstract
In situ normothermic regional perfusion (NRP) and ex situ normothermic machine perfusion (NMP) aim to improve the outcomes of liver transplantation (LT) using controlled donation after circulatory death (cDCD). NRP and NMP have not yet been compared directly. In this international observational study, outcomes of LT performed between 2015 and 2019 for organs procured from cDCD donors subjected to NRP or NMP commenced at the donor center were compared using propensity score matching (PSM). Of the 224 cDCD donations in the NRP cohort that proceeded to asystole, 193 livers were procured, resulting in 157 transplants. In the NMP cohort, perfusion was commenced in all 40 cases and resulted in 34 transplants (use rates: 70% vs. 85% [p = 0.052], respectively). After PSM, 34 NMP liver recipients were matched with 68 NRP liver recipients. The two cohorts were similar for donor functional warm ischemia time (21 min after NRP vs. 20 min after NMP; p = 0.17), UK-Donation After Circulatory Death risk score (5 vs. 5 points; p = 0.38), and laboratory Model for End-Stage Liver Disease scores (12 vs. 12 points; p = 0.83). The incidence of nonanastomotic biliary strictures (1.5% vs. 2.9%; p > 0.99), early allograft dysfunction (20.6% vs. 8.8%; p = 0.13), and 30-day graft loss (4.4% vs. 8.8%; p = 0.40) were similar, although peak posttransplant aspartate aminotransferase levels were higher in the NRP cohort (872 vs. 344 IU/L; p < 0.001). NRP livers were more frequently allocated to recipients suffering from hepatocellular carcinoma (HCC; 60.3% vs. 20.6%; p < 0.001). HCC-censored 2-year graft and patient survival rates were 91.5% versus 88.2% (p = 0.52) and 97.9% versus 94.1% (p = 0.25) after NRP and NMP, respectively. Both perfusion techniques achieved similar outcomes and appeared to match benchmarks expected for donation after brain death livers. This study may inform the design of a definitive trial.
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Affiliation(s)
- Kayvan Mohkam
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - David Nasralla
- Department of Hepatopancreatobiliary and Liver Transplant SurgeryRoyal Free HospitalLondonUK
| | - Hynek Mergental
- Liver Unit, Queen Elizabeth HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Xavier Muller
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Andrew Butler
- Department of Surgery, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| | - Wayel Jassem
- Institute of Liver StudiesKing's College HospitalLondonUK
| | - Charles Imber
- Department of Hepatopancreatobiliary and Liver Transplant SurgeryRoyal Free HospitalLondonUK
| | - Diethard Monbaliu
- Abdominal Transplant Surgery Unit, Department of SurgeryUniversity Hospitals LeuvenLeuvenBelgium
| | | | - Richard W. Laing
- Liver Unit, Queen Elizabeth HospitalUniversity Hospitals BirminghamBirminghamUK
| | | | - Andreas Paul
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital EssenEssenGermany
| | - Federica Dondero
- Department of Hepatobiliopancreatic SurgeryDepartment of Hepatopancreatobiliary Surgery and Liver TransplantationBeaujon Hospital, Assitance Publique‐Hôpitaux de Paris (AP‐HP), University Paris CitéClichyFrance
| | - François Cauchy
- Department of Hepatobiliopancreatic SurgeryDepartment of Hepatopancreatobiliary Surgery and Liver TransplantationBeaujon Hospital, Assitance Publique‐Hôpitaux de Paris (AP‐HP), University Paris CitéClichyFrance
| | - Eric Savier
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié‐Salpêtrière HospitalSorbonne UniversityParisFrance
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié‐Salpêtrière HospitalSorbonne UniversityParisFrance
| | - Fabien Robin
- Department of Hepatobiliary and Digestive SurgeryPontchaillou University HospitalRennesFrance
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive SurgeryPontchaillou University HospitalRennesFrance
| | - Petru Bucur
- Department of Digestive, Oncological, Endocrine, Hepato‐Biliary, Pancreatic and Liver Transplant SurgeryTrousseau HospitalToursFrance
| | - Ephrem Salamé
- Department of Digestive, Oncological, Endocrine, Hepato‐Biliary, Pancreatic and Liver Transplant SurgeryTrousseau HospitalToursFrance
| | - Gabriella Pittau
- Centre Hépato‐Biliaire, Hôpital Paul Brousse, Assistance Publique‐Hôpitaux de Paris (AP‐HP)Université Paris SudVillejuifFrance
| | - Marc‐Antoine Allard
- Centre Hépato‐Biliaire, Hôpital Paul Brousse, Assistance Publique‐Hôpitaux de Paris (AP‐HP)Université Paris SudVillejuifFrance
| | - Pierre Pradat
- Clinical Research Centre, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Guillaume Rossignol
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Jean‐Yves Mabrut
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Rutger J. Ploeg
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Peter J. Friend
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Darius F. Mirza
- Liver Unit, Queen Elizabeth HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Mickaël Lesurtel
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
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19
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Bertrand-Chapel A, Caligaris C, Fenouil T, Savary C, Aires S, Martel S, Huchedé P, Chassot C, Chauvet V, Cardot-Ruffino V, Morel AP, Subtil F, Mohkam K, Mabrut JY, Tonon L, Viari A, Cassier P, Hervieu V, Castets M, Mauviel A, Sentis S, Bartholin L. SMAD2/3 mediate oncogenic effects of TGF-β in the absence of SMAD4. Commun Biol 2022; 5:1068. [PMID: 36207615 PMCID: PMC9546935 DOI: 10.1038/s42003-022-03994-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
TGF-β signaling is involved in pancreatic ductal adenocarcinoma (PDAC) tumorigenesis, representing one of the four major pathways genetically altered in 100% of PDAC cases. TGF-β exerts complex and pleiotropic effects in cancers, notably via the activation of SMAD pathways, predominantly SMAD2/3/4. Though SMAD2 and 3 are rarely mutated in cancers, SMAD4 is lost in about 50% of PDAC, and the role of SMAD2/3 in a SMAD4-null context remains understudied. We herein provide evidence of a SMAD2/3 oncogenic effect in response to TGF-β1 in SMAD4-null human PDAC cancer cells. We report that inactivation of SMAD2/3 in SMAD4-negative PDAC cells compromises TGF-β-driven collective migration mediated by FAK and Rho/Rac signaling. Moreover, RNA-sequencing analyses highlight a TGF-β gene signature related to aggressiveness mediated by SMAD2/3 in the absence of SMAD4. Using a PDAC patient cohort, we reveal that SMAD4-negative tumors with high levels of phospho-SMAD2 are more aggressive and have a poorer prognosis. Thus, loss of SMAD4 tumor suppressive activity in PDAC leads to an oncogenic gain-of-function of SMAD2/3, and to the onset of associated deleterious effects. In pancreatic ductal adenocarcinoma cells and patient tissue, SMAD2/3 is shown to mediate oncogenic effects of TGF-β in the absence of SMAD4.
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Affiliation(s)
- Adrien Bertrand-Chapel
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Cassandre Caligaris
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Tanguy Fenouil
- Hospices Civils de Lyon, Institute of Pathology, Groupement Hospitalier Est, Bron, France.,Ribosome, Translation and Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Clara Savary
- Cell Death and Childhood Cancers Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Labex DevWeCan, Institut Convergence Plascan, Lyon, France
| | - Sophie Aires
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sylvie Martel
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Paul Huchedé
- Cell Death and Childhood Cancers Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Labex DevWeCan, Institut Convergence Plascan, Lyon, France
| | - Christelle Chassot
- EMT and Cancer Cell Plasticity Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Véronique Chauvet
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Victoire Cardot-Ruffino
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne-Pierre Morel
- EMT and Cancer Cell Plasticity Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Fabien Subtil
- Service de Biostatistiques, Hospices Civils de Lyon, Lyon France, Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive, UMR 5558, Villeurbanne, France
| | - Kayvan Mohkam
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Jean-Yves Mabrut
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Laurie Tonon
- Plateforme de bioinformatique Gilles Thomas, Fondation Lyon Synergie Cancer, Centre Léon Bérard, Lyon, France
| | - Alain Viari
- Plateforme de bioinformatique Gilles Thomas, Fondation Lyon Synergie Cancer, Centre Léon Bérard, Lyon, France
| | - Philippe Cassier
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Département d'oncologie Médicale, unité de phase 1, Centre Léon Bérard, Lyon, France
| | - Valérie Hervieu
- Hospices Civils de Lyon, Institute of Pathology, Groupement Hospitalier Est, Bron, France
| | - Marie Castets
- Cell Death and Childhood Cancers Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Labex DevWeCan, Institut Convergence Plascan, Lyon, France.
| | - Alain Mauviel
- Team "TGF-ß and Oncogenesis", Institut Curie, PSL Research University, INSERM 1021, CNRS 3347, Equipe Labellisée Ligue 2016, 91400, Orsay, France
| | - Stéphanie Sentis
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Bartholin
- TGF-β & Pancreatic Cancer Lab, Centre de Recherche en Cancérologie de Lyon (CRCL), Centre Léon Bérard, INSERM 1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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20
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Muller X, Rossignol G, Mohkam K, Mabrut JY. Novel strategies in liver graft preservation - The French perspective. J Visc Surg 2022; 159:389-398. [PMID: 36109331 DOI: 10.1016/j.jviscsurg.2022.06.006] [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] [Indexed: 10/14/2022]
Abstract
Given the increasing graft shortage, the transplant community is forced to use so called marginal liver grafts with a higher susceptibility to ischemia-reperfusion injury. This exposes the recipient to a higher risk of graft failure and post-transplant complications. While static cold storage remains the gold standard in low-risk transplant scenarios, dynamic preservation strategies may allow to improve outcomes after transplantation of marginal liver grafts. Two dynamic preservation strategies, end-ischemic hypothermic oxygenated perfusion (HOPE) and continuous normothermic machine perfusion (cNMP), have been evaluated in randomized clinical trials. The results show improved preservation of liver grafts after cNMP and reduction of post-transplant biliary complications after HOPE. In comparison to cNMP, HOPE has the advantage of requiring less logistics and expertise with the possibility to return to default static cold storage. Both strategies allow to assess graft viability prior to transplantation and may thus contribute to optimizing graft selection and reducing discard rates. The use of dynamic preservation is rapidly increasing in France and results from a national randomized trial on the use of HOPE in marginal grafts will soon be available. Future applications should focus on controlled donation after circulatory death liver grafts, split grafts and graft treatment during perfusion. The final aim of dynamic liver graft preservation is to improve post-transplant outcomes, increase the number of transplanted grafts and allow expansion of transplant indications.
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Affiliation(s)
- X Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; The Lyon Cancer Research Centre, Inserm U1052 UMR 5286, Lyon, France; ED 340 BMIC, Claude-Bernard Lyon 1 University, 69622 Villeurbanne, France.
| | - G Rossignol
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; The Lyon Cancer Research Centre, Inserm U1052 UMR 5286, Lyon, France; ED 340 BMIC, Claude-Bernard Lyon 1 University, 69622 Villeurbanne, France; Department of Pediatric Surgery and Liver Transplantation, Femme-Mère-Enfant University Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; The Lyon Cancer Research Centre, Inserm U1052 UMR 5286, Lyon, France; Department of Pediatric Surgery and Liver Transplantation, Femme-Mère-Enfant University Hospital, Hospices Civils de Lyon, Lyon, France
| | - J Y Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; The Lyon Cancer Research Centre, Inserm U1052 UMR 5286, Lyon, France
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21
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Rossignol G, Muller X, Hervieu V, Collardeau-Frachon S, Breton A, Boulanger N, Lesurtel M, Dubois R, Mohkam K, Mabrut JY. Liver transplantation of partial grafts after ex situ splitting during hypothermic oxygenated perfusion-The HOPE-Split pilot study. Liver Transpl 2022; 28:1576-1587. [PMID: 35582790 DOI: 10.1002/lt.26507] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/08/2022] [Accepted: 05/10/2022] [Indexed: 01/13/2023]
Abstract
Partial liver grafts from ex situ splitting are considered marginal due to prolonged static cold storage. The use of ex situ hypothermic oxygenated perfusion (HOPE) may offer a strategy to improve preservation of ex situ split grafts. In this single-center pilot study, we prospectively performed ex situ liver splitting during HOPE (HOPE-Split) for adult and pediatric partial grafts over a 1-year period (November 1, 2020 to December 1, 2021). The primary safety endpoint was based on the number of liver graft-related adverse events (LGRAEs) per recipient, including primary nonfunction, biliary complications, hepatic vascular complications, and early relaparotomies and was compared with consecutive single-center standard ex situ split transplantations (Static-Split) performed from 2018 to 2020. Secondary endpoints included preservation characteristics and early outcomes. Sixteen consecutive HOPE-Split liver transplantations (8 HOPE-Split procedures) were included and compared with 24 Static-Splits. All HOPE-Split grafts were successfully transplanted, and no graft loss nor recipient death was encountered during the median follow-up of 7.5 months (interquartile range, 5.5-12.5). Mean LGRAE per recipient was similar in both groups (0.31 ± 0.60 vs. 0.46 ± 0.83; p = 0.78) and split duration was not significantly increased for HOPE-Split (216 vs. 180 min; p = 0.45). HOPE-Split grafts underwent perfusion for a median of 125 min, which significantly shortened static cold storage (472 vs. 544 min; p = 0.001), whereas it prolonged total ex vivo preservation (595 vs. 544 min; p = 0.007) and reduced neutrophil infiltration on reperfusion biopsies (p = 0.04) compared with Static-Split. This clinical pilot study presents first feasibility and safety data for transplantation of partial liver grafts undergoing ex situ split during HOPE and suggests improved preservation compared with static ex situ splitting. These preliminary results will allow to set up large-scale trials on the use of machine perfusion in pediatric and split-liver transplantation.
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Affiliation(s)
- Guillaume Rossignol
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052 UMR 5286, Lyon, France.,ED 340 BMIC, Claude Bernard Lyon 1 University, Lyon, France.,Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Hospices Civils de Lyon, France
| | - Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052 UMR 5286, Lyon, France.,ED 340 BMIC, Claude Bernard Lyon 1 University, Lyon, France
| | - Valérie Hervieu
- Department of Pathology, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | | | - Antoine Breton
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France
| | - Natacha Boulanger
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052 UMR 5286, Lyon, France
| | - Rémi Dubois
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Hospices Civils de Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052 UMR 5286, Lyon, France.,Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Hospices Civils de Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052 UMR 5286, Lyon, France.,ED 340 BMIC, Claude Bernard Lyon 1 University, Lyon, France
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22
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Rossignol G, Muller X, Mohkam K, Dubois R, Lesurtel M, Mabrut JY. Full left/full right liver graft ex situ split during hypothermic oxygenated perfusion. Pediatr Transplant 2022; 26:e14284. [PMID: 35437884 DOI: 10.1111/petr.14284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/17/2022] [Accepted: 03/28/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ex vivo split liver transplantation in pediatric recipients has shown inferior results compared with whole grafts. One factor among others contributing to split grafts being considered as marginal is the prolonged static cold storage time related to ex vivo liver splitting. End ischemic hypothermic oxygenated perfusion is a validated strategy to improve outcomes of marginal whole grafts and may thus also benefit split liver grafts. METHOD We present the first case of full left/full right split procedure performed during hypothermic oxygenated perfusion. RESULTS We present a standardized surgical two-step approach where parenchymal transection was performed during end ischemic hypothermic oxygenated perfusion via the portal vein to shorten static cold storage duration. Both split grafts were successfully transplanted in a 4-year-old pediatric and a 38-year-old adult recipient. Despite high-risk procedure (retransplantation), extended donor criteria including a prolonged cardiac arrest and high donor risk index (2,25), both grafts showed early recovery of hepatic function and low serum transaminase release. At 6 months, both recipients were alive with a normal liver biology and a functioning graft. CONCLUSION Although challenging, full left/full right liver split procedure during end ischemic hypothermic oxygenated perfusion can be successfully performed and is a promising strategy to improve post-transplant outcomes.
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Affiliation(s)
- Guillaume Rossignol
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Hospices Civils de Lyon, France.,Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052, UMR 5286, Lyon, France
| | - Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052, UMR 5286, Lyon, France
| | - Kayvan Mohkam
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Hospices Civils de Lyon, France.,Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052, UMR 5286, Lyon, France
| | - Remi Dubois
- Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Hospices Civils de Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052, UMR 5286, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France.,The Lyon Cancer Research Centre, INSERM U1052, UMR 5286, Lyon, France
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23
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Rossignol G, Muller X, Mohkam K, Dubois R, Mabrut JY. Letter to the editor: Is there a place for machine perfusion strategies in pediatric liver transplantation? Hepatology 2022; 75:1341-1342. [PMID: 35028956 DOI: 10.1002/hep.32343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/12/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Guillaume Rossignol
- Department of Pediatric Surgery and Liver TransplantationFemme Mere Enfant University Hospital, Hospices Civils de LyonLyonFrance.,Department of General Surgery and Liver TransplantationCroix-Rousse University Hospital, Hospices Civils de LyonLyonFrance.,The Lyon Cancer Research CenterINSERM U1052 UMR 5286, ED 340 - BMICLyonFrance
| | - Xavier Muller
- Department of General Surgery and Liver TransplantationCroix-Rousse University Hospital, Hospices Civils de LyonLyonFrance.,The Lyon Cancer Research CenterINSERM U1052 UMR 5286, ED 340 - BMICLyonFrance
| | - Kayvan Mohkam
- Department of Pediatric Surgery and Liver TransplantationFemme Mere Enfant University Hospital, Hospices Civils de LyonLyonFrance.,Department of General Surgery and Liver TransplantationCroix-Rousse University Hospital, Hospices Civils de LyonLyonFrance.,The Lyon Cancer Research CenterINSERM U1052 UMR 5286, ED 340 - BMICLyonFrance
| | - Remi Dubois
- Department of Pediatric Surgery and Liver TransplantationFemme Mere Enfant University Hospital, Hospices Civils de LyonLyonFrance
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver TransplantationCroix-Rousse University Hospital, Hospices Civils de LyonLyonFrance.,The Lyon Cancer Research CenterINSERM U1052 UMR 5286, ED 340 - BMICLyonFrance
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24
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Muller X, Rossignol G, Mohkam K, Lesurtel M, Mabrut JY. Dynamic Liver Graft Preservation in Controlled Donation After Circulatory Death: What Is the Best Fit? Liver Transpl 2022; 28:330-331. [PMID: 34628725 DOI: 10.1002/lt.26333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Xavier Muller
- Service de chirurgie générale, digestive et Transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon I, Lyon, France.,Cancer Research Center of Lyon, Institut national de la santé et de la recherche médicale (INSERM), Unité 1052, Lyon, France
| | - Guillaume Rossignol
- Service de chirurgie générale, digestive et Transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon I, Lyon, France.,Cancer Research Center of Lyon, Institut national de la santé et de la recherche médicale (INSERM), Unité 1052, Lyon, France.,Service de chirurgie uro-viscérale, thoracique et de transplantation de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Lyon I, Bron, France
| | - Kayvan Mohkam
- Service de chirurgie générale, digestive et Transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon I, Lyon, France.,Cancer Research Center of Lyon, Institut national de la santé et de la recherche médicale (INSERM), Unité 1052, Lyon, France.,Service de chirurgie uro-viscérale, thoracique et de transplantation de l'enfant, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Lyon I, Bron, France
| | - Mickaël Lesurtel
- Service de chirurgie générale, digestive et Transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon I, Lyon, France.,Cancer Research Center of Lyon, Institut national de la santé et de la recherche médicale (INSERM), Unité 1052, Lyon, France
| | - Jean-Yves Mabrut
- Service de chirurgie générale, digestive et Transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon I, Lyon, France.,Cancer Research Center of Lyon, Institut national de la santé et de la recherche médicale (INSERM), Unité 1052, Lyon, France
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25
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Muller X, Mohkam K, Mabrut JY. Inflammation is king in liver resection for hepatocellular carcinoma. Hepatobiliary Surg Nutr 2021; 10:839-841. [PMID: 35004949 DOI: 10.21037/hbsn-21-435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/31/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France.,Department of Pediatric Surgery and Liver Transplantation, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Bron, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
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26
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Muller X, Rossignol G, Damotte S, Gregoire A, Matillon X, Morelon E, Badet L, Mohkam K, Lesurtel M, Mabrut JY. Graft utilization after normothermic regional perfusion in controlled donation after circulatory death-a single-center perspective from France. Transpl Int 2021; 34:1656-1666. [PMID: 34448267 DOI: 10.1111/tri.13987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/25/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022]
Abstract
Normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) is a promising procurement strategy. However, a detailed analysis of graft utilization rates is lacking. This retrospective study included all cDCD donors proposed to a single center for NRP procurement of at least one abdominal organ from 2015 to 2020. Utilization rates were defined as the proportion of transplanted grafts from proposed donors in which withdrawal of life sustaining therapies (WLST) was initiated. In total, 125 cDCD donors underwent WLST with transplantation of at least one graft from 109 (87%) donors. In a total of 14 (11%) procedures NRP failure led to graft discard. Utilization rates for kidney and liver grafts were 83% and 59%, respectively. In 44% of the discarded livers, the reason was poor graft quality based on functional donor warm ischemia >45 min, macroscopic aspect, high-transaminases release, or pathological biopsy. In this study, abdominal NRP in cDCD lead to transplantation of at least one graft in the majority of cases. While the utilization rate for kidneys was high, nearly half of the liver grafts were discarded. Cannulation training, novel graft viability markers, and ex-vivo liver graft perfusion may allow to increase graft utilization.
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Affiliation(s)
- Xavier Muller
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Guillaume Rossignol
- Cancer Research Center of Lyon, INSERM U1052, Lyon, France.,Department of Pediatric Surgery and Liver Transplantation, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, University of Lyon I, Bron, France
| | - Sophie Damotte
- Department of Anesthesiology and Critical Care, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Arnaud Gregoire
- Department of Anesthesiology and Critical Care, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Xavier Matillon
- Department of Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Emmanuel Morelon
- Department of Urology and Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Lionel Badet
- Department of Transplantation, Edouard Herriot University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, Lyon, France
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27
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Lunel T, Mohkam K, Merle P, Bonnet A, Gazon M, Dumont PN, Ducerf C, Mabrut JY, Lesurtel M. Impact of 2016 Enhanced Recovery After Surgery (ERAS) Recommendations on Outcomes after Hepatectomy in Cirrhotic and Non-Cirrhotic Patients. World J Surg 2021; 45:2964-2974. [PMID: 34269842 DOI: 10.1007/s00268-021-06229-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Enhanced Recovery After Surgery (ERAS) society published new recommendations for hepatectomy in 2016. Few studies have assessed their clinical impact. The aim of this monocentric study was to assess the impact of those guidelines on outcomes after liver surgery with a special focus on cirrhotic patients. METHOD Postoperative outcomes of patients undergoing hepatectomy 30 months before and after ERAS implementation according to the 2016 ERAS guidelines were compared after inverse probability of treatment weighting (IPTW). Primary endpoint was 90-day morbidity. RESULTS From 2015 to 2020, 430 patients underwent hepatectomy including 226 procedures performed before and 204 after ERAS implementation. After IPTW, overall morbidity (42.5% vs. 64.7%, p < 0.001), Comprehensive Complication Index (CCI) score (14.3 vs. 20.8, p = 0.004), length of stay (10.4 vs. 13.7 days, p = 0.001) and textbook outcome (50% vs. 40.2%, p = 0.022) were significantly improved in the ERAS group, while mortality and severe complications were similar in both groups. In the non-cirrhosis subgroup (n = 321), these results were confirmed. However, in the cirrhosis subgroup (n = 105), no difference appeared on outcomes after hepatectomy with an overall morbidity (47.5% vs. 65.2%, p = 0.069) and a length of stay (8 vs. 9 days, p = 0.310) which were not significantly different. The compliance rate to ERAS guidelines was 60% in both cirrhotic and non-cirrhotic subgroups. CONCLUSION Perioperative ERAS program for hepatectomy results in improved outcomes with decreased rate of non-severe morbidity. Although those guidelines are not deleterious for cirrhotic patients, they probably require revisions to be more effective in this patient population.
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Affiliation(s)
- Thibault Lunel
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Kayvan Mohkam
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Philippe Merle
- Hepatology Unit, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Aurélie Bonnet
- Department of Anesthesiology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Mathieu Gazon
- Department of Anesthesiology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Paul-Noël Dumont
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Christian Ducerf
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.
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28
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Coupier A, Pioche M, Steer N, Zoulim F, Mohkam K, Lebossé F. An exceptional case of refractory variceal bleeding occurring during liver transplantation rescued with esophageal stent. Clin Res Hepatol Gastroenterol 2021; 45:101662. [PMID: 33667727 DOI: 10.1016/j.clinre.2021.101662] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Antoine Coupier
- Hepatology Department, Croix Rousse Hospital, Hospices Civils of Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Mathieu Pioche
- Claude Bernard Lyon 1 University, Lyon, France; Gastroenterology Department, Edouard Heriot Hospital, Hospices Civils of Lyon, Lyon, France
| | - Nadia Steer
- Anesthesiology Department, Croix Rousse Hospital, Hospices Civils of Lyon, Lyon, France
| | - Fabien Zoulim
- Hepatology Department, Croix Rousse Hospital, Hospices Civils of Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Kayvan Mohkam
- Claude Bernard Lyon 1 University, Lyon, France; Digestive Surgery Department, Croix Rousse Hospital, Hospices Civils of Lyon, Lyon, France
| | - Fanny Lebossé
- Hepatology Department, Croix Rousse Hospital, Hospices Civils of Lyon, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1052, Cancer Research Center of Lyon, Lyon, France.
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29
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Bonal M, Mohkam K, Mabrut JY. Cervical esophagostomy, the first stage of esophageal bi-exclusion for intrathoracic aero-digestive fistula. J Visc Surg 2021; 158:455-457. [PMID: 33771489 DOI: 10.1016/j.jviscsurg.2021.02.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Bonal
- Department of General Surgery, Digestive Surgery and Liver and Intestinal Transplantation, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University. University Hospital la Croix-Rousse, 69317 Lyon cedex 04, France.
| | - K Mohkam
- Department of General Surgery, Digestive Surgery and Liver and Intestinal Transplantation, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University. University Hospital la Croix-Rousse, 69317 Lyon cedex 04, France
| | - J-Y Mabrut
- Department of General Surgery, Digestive Surgery and Liver and Intestinal Transplantation, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University. University Hospital la Croix-Rousse, 69317 Lyon cedex 04, France
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30
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Puia-Negulescu S, Lebossé F, Mabrut JY, Muller X, Rossignol G, Antonini T, Erard D, Radenne S, Guillet M, Souquet JC, Mohkam K, Lesurtel M. Liver Transplantation for Colorectal Liver Metastases: Current Management and Future Perspectives. Int J Mol Sci 2021; 22:ijms22063093. [PMID: 33803503 PMCID: PMC8002956 DOI: 10.3390/ijms22063093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with nonresectable liver metastases from colorectal cancer have few therapeutic options and a dismal prognosis. Although liver transplantation for this indication has historically a poor reputation, recent advances in the field of chemotherapy and immunosuppression have paved the way to revisit the concept. New data have shown promising results that need to be validated in several ongoing clinical trials. Since liver grafts represent a scarce resource, several new tools are being explored to expand the donor pool for this indication. The purpose of this review is to present all current available data and perspectives about liver transplantation for nonresectable liver metastases from colorectal cancer.
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Affiliation(s)
- Serban Puia-Negulescu
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (S.P.-N.); (J.-Y.M.); (X.M.); (K.M.)
| | - Fanny Lebossé
- Department of Hepatology, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (F.L.); (T.A.); (D.E.); (S.R.)
- Cancer Research Center of Lyon, INSERM U1052, 69008 Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (S.P.-N.); (J.-Y.M.); (X.M.); (K.M.)
- Cancer Research Center of Lyon, INSERM U1052, 69008 Lyon, France
| | - Xavier Muller
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (S.P.-N.); (J.-Y.M.); (X.M.); (K.M.)
- Cancer Research Center of Lyon, INSERM U1052, 69008 Lyon, France
| | - Guillaume Rossignol
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University of Lyon I, 69500 Lyon, France;
| | - Teresa Antonini
- Department of Hepatology, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (F.L.); (T.A.); (D.E.); (S.R.)
| | - Domitille Erard
- Department of Hepatology, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (F.L.); (T.A.); (D.E.); (S.R.)
| | - Sylvie Radenne
- Department of Hepatology, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (F.L.); (T.A.); (D.E.); (S.R.)
- Department of Hepatogastroenterology, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (M.G.); (J.-C.S.)
| | - Marielle Guillet
- Department of Hepatogastroenterology, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (M.G.); (J.-C.S.)
| | - Jean-Christophe Souquet
- Department of Hepatogastroenterology, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (M.G.); (J.-C.S.)
| | - Kayvan Mohkam
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (S.P.-N.); (J.-Y.M.); (X.M.); (K.M.)
- Cancer Research Center of Lyon, INSERM U1052, 69008 Lyon, France
| | - Mickael Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, 69004 Lyon, France; (S.P.-N.); (J.-Y.M.); (X.M.); (K.M.)
- Cancer Research Center of Lyon, INSERM U1052, 69008 Lyon, France
- Correspondence: ; Tel.: +33-472-071100; Fax: +33-472-072927
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31
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Mourad M, Lebossé F, Merle P, Levrero M, Antonini T, Lesurtel M, Ducerf C, Zoulim F, Mabrut JY, Mohkam K. External validation of the French alpha-fetoprotein model for hepatocellular carcinoma liver transplantation in a recent unicentric cohort - a retrospective study. Transpl Int 2021; 34:535-545. [PMID: 33449394 DOI: 10.1111/tri.13819] [Citation(s) in RCA: 2] [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: 05/25/2020] [Revised: 08/19/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
Prognostic models of liver transplantation (LT) for hepatocellular carcinoma (HCC) mainly derive from LT cohorts with numerous hepatitis C virus (HCV) patients. The AFP model, which is currently used in France to select LT candidates, was derived from a cohort of LT performed between 1988 and 2001, including a majority of HCV-positive recipients. The emergence of new direct-acting antiviral therapies and subsequent decrease of HCV incidence may change the generalizability of such models. We performed an external validation of the AFP model in a cohort of recipients transplanted between 2005 and 2018. Although multivariable analysis identified all three model's factors (AFP level, largest tumor size, number of nodules) as predictors of tumor recurrence, the AFP model showed poor discrimination and calibration in the present cohort. This poor performance could be related to significant differences between the derivation and the present cohort in terms of etiology, severity of underlying liver disease, tumor burden and differentiation, and use of neoadjuvant treatments. The present findings suggest that the decline of HCV-induced HCC among LT candidates may compromise the generalizability of the AFP model in more recent LT cohorts. Further studies are required for updating or building more robust prognostic models.
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Affiliation(s)
- Mohamed Mourad
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,Department of General and Digestive surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Fanny Lebossé
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Philippe Merle
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Massimo Levrero
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Teresa Antonini
- Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Fabien Zoulim
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
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32
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Muller X, Tilmans G, Chenevas-Paule Q, Lebossé F, Antonini T, Poinsot D, Rode A, Guichon C, Schmitt Z, Ducerf C, Mohkam K, Lesurtel M, Mabrut JY. Strategies for liver transplantation during the SARS-CoV-2 outbreak: Preliminary experience from a single center in France. Am J Transplant 2020; 20:2989-2996. [PMID: 32476233 PMCID: PMC7300692 DOI: 10.1111/ajt.16082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 01/25/2023]
Abstract
Liver transplantation (LT) during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging given the urgent need to reallocate resources to other areas of patient care. Available guidelines recommend reorganizing transplant care, but data on clinical experience in the context of SARS-CoV-2 pandemic are scarce. Thus, we report strategies and preliminary results in LT during the peak of the SARS-CoV-2 pandemic from a single center in France. Our strategy to reorganize the transplant program included 4 main steps: optimization of available resources, especially intensive care unit capacity; multidisciplinary risk stratification of LT candidates on the waiting list; implementation of a systematic SARS-CoV-2 screening strategy prior to transplantation; and definition of optimal recipient-donor matching. After implementation of these 4 steps, we performed 10 successful LTs during the peak of the pandemic with a short median intensive care unit stay (2.5 days), benchmark posttransplant morbidity, and no occurrence of SARS-CoV-2 infection during follow-up. From this preliminary experience we conclude that efforts in resource planning, optimal recipient selection, and organ allocation strategy are key to maintain a safe LT activity. Transplant centers should be ready to readapt their practices as the pandemic evolves.
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Affiliation(s)
- Xavier Muller
- Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Gilles Tilmans
- Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Quentin Chenevas-Paule
- Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Fanny Lebossé
- Department of Hepatology, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Teresa Antonini
- Department of Hepatology, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Domitille Poinsot
- Department of Hepatology, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Agnès Rode
- Department of Radiology, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Céline Guichon
- Department of Intensive Care, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Zoé Schmitt
- Department of Intensive Care, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Christian Ducerf
- Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France,Clinical Research Center of Lyon, INSERM Unit 1052, Lyon, France
| | - Kayvan Mohkam
- Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France,Clinical Research Center of Lyon, INSERM Unit 1052, Lyon, France
| | - Mickaël Lesurtel
- Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France,Clinical Research Center of Lyon, INSERM Unit 1052, Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, University Hospital Croix Rousse, Hospices Civils de Lyon, University of Lyon I, Lyon, France,Clinical Research Center of Lyon, INSERM Unit 1052, Lyon, France,Correspondence Jean-Yves Mabrut
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33
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Darnis B, Mohkam K, Golse N, Vibert E, Cherqui D, Cauchy F, Soubrane O, Regimbeau JM, Dembinski J, Hardwigsen J, Bachelier P, Laurent C, Truant S, Millet G, Lesurtel M, Boleslawksi E, Mabrut JY. Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study. Surg Endosc 2020; 35:5034-5042. [PMID: 32989540 DOI: 10.1007/s00464-020-07985-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/07/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopy is nowadays considered as the standard approach for hepatic left lateral sectionectomy (LLS), but its value in the prevention of incisional hernia (IH) has not been demonstrated. METHODS Between 2012 and 2017, patients undergoing laparoscopic (LLLS) or open LLS (OLLS) in 8 centers were compared. Patients undergoing a simultaneous major abdominal procedure were excluded. The incidence of IH was assessed clinically and morphologically on computed tomography (CT) using inverse probability of treatment weighting (IPTW) and multivariable regression analysis. RESULTS After IPTW, 84 LLLS were compared to 48 OLLS. Compared to OLLS, LLLS patients had reduced blood loss (100 [IQR: 50-200] ml vs. 150 [IQR: 50-415] ml, p = 0.023) and shorter median hospital stay (5 [IQR: 4-7] days vs. 7 [6-9] days, p < 0.001), but experienced similar rate of postoperative complications (mean comprehensive complication index: 12 ± 19 after OLLS versus 13 ± 20 after LLLS, p = 0.968). Long-term radiological screening was performed with a median follow-up of 27.4 (12.1-44.9) months. There was no difference between the two groups in terms of clinically relevant IH (10.7% [n = 9] after LLLS, 8.3% [n = 4] after OLLS, p = 0.768). The rate of IH detected on computed tomography was lower after LLLS than after OLLS (11.9% [n = 10] versus 29.2% [n = 14], p = 0.013). On multivariable analysis, the laparoscopic approach was the only independent factor influencing the risk of morphological IH (OR = 0.290 [95% CI: 0.094-0.891], p = 0.031). The 2 preferential sites for specimen extraction after LLLS were Pfannenstiel and midline incisions, with rates of IH across the extraction site of 2.3% [n = 1/44] and 23.8% [n = 5/21], respectively (p = 0.011). CONCLUSION The laparoscopic approach for LLS decreases the risk of long-term IH as evidenced on morphological examinations, with limited clinical impact. Pfannenstiel's incision should be preferred to midline incision for specimen extraction after LLLS.
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Affiliation(s)
- Benjamin Darnis
- Department of General Surgery and Liver Transplantation, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France. .,Cancer Research Center of Lyon, INSERM 1052/CNRS 5286 Unit, Lyon, France.
| | - Nicolas Golse
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France
| | - Eric Vibert
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - Jean-Marc Regimbeau
- Department of Hepatobiliary Surgery, Centre Hospitalier Universitaire D'Amiens, Amiens, France
| | - Jeanne Dembinski
- Department of Hepatobiliary Surgery, Centre Hospitalier Universitaire D'Amiens, Amiens, France
| | - Jean Hardwigsen
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de La Timone, Marseille, France
| | - Philippe Bachelier
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Christophe Laurent
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Haut-Lévèque Bordeaux, Pessac, France
| | - Stéphanie Truant
- Department of Hepatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Guillaume Millet
- Department of Hepatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France.,Cancer Research Center of Lyon, INSERM 1052/CNRS 5286 Unit, Lyon, France
| | - Emmanuel Boleslawksi
- Department of Hepatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France.,Cancer Research Center of Lyon, INSERM 1052/CNRS 5286 Unit, Lyon, France
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34
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Philouze P, Cortet M, Quattrone D, Céruse P, Aubrun F, Dubernard G, Mabrut JY, Delignette MC, Mohkam K. Surgical activity during the Covid-19 pandemic: Results for 112 patients in a French tertiary care center, a quality improvement study. Int J Surg 2020; 80:194-201. [PMID: 32693151 PMCID: PMC7368406 DOI: 10.1016/j.ijsu.2020.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND After the emergence of Covid-19 in China, Hubei Province, the epidemic quickly spread to Europe. France was quickly hit and our institution was one of the first French university to receive patients infected with Sars-COV2. The predicted massive influx of patients motivated the cancellation of all elective surgical procedures planned to free hospitalization beds and to free intensive care beds. Nevertheless, we should properly select patients who will be canceled to avoid life-threatening. The retained surgical indications are surgical emergencies, oncologic surgery, and organ transplantation. MATERIAL AND METHODS We describe the organization of our institution which allows the continuation of these surgical activities while limiting the exposure of our patients to the Sars Cov2. RESULTS After 4 weeks of implementation of intra-hospital protocols for the control of the Covid-19 epidemic, 112 patients were operated on (104 oncology or emergency surgeries and 8 liver transplants). Only one case of post-operative contamination was observed. No mortality related to Covid-19 was noted. No cases of contamination of surgical care personnel have been reported. CONCLUSION We found that the performance of oncological or emergency surgery is possible, safe for both patients and caregivers.
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Affiliation(s)
- P Philouze
- Head and Neck Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - M Cortet
- Gynecology and Obstetrics Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - D Quattrone
- Department of Anesthesiology and Critical Care, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - P Céruse
- Head and Neck Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - F Aubrun
- Department of Anesthesiology and Critical Care, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - G Dubernard
- Gynecology and Obstetrics Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - J Y Mabrut
- Department of General Surgery and Liver Transplantation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University, INSERM Unit 1052 / CNRS 5286 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - M C Delignette
- Department of Anesthesiology and Critical Care, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - K Mohkam
- Department of General Surgery and Liver Transplantation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University, INSERM Unit 1052 / CNRS 5286 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
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35
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Tilmans G, Chenevas-Paule Q, Muller X, Breton A, Mohkam K, Ducerf C, Mabrut JY, Lesurtel M. Surgical outcomes after systematic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening. Surgery 2020; 168:209-211. [PMID: 32425247 PMCID: PMC7231738 DOI: 10.1016/j.surg.2020.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gilles Tilmans
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Quentin Chenevas-Paule
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Xavier Muller
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Antoine Breton
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Kayvan Mohkam
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Christian Ducerf
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Mickaël Lesurtel
- Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.
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36
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Bonal M, Mourad M, Bancel B, Hervieu V, Lebossé F, Heyer L, Ducerf C, Lesurtel M, Mabrut JY, Mohkam K. Cholangitis lenta: An underdiagnosed lesion associated with severe cholestasis following liver transplantation. Clin Transplant 2020; 34:e14016. [PMID: 32583551 DOI: 10.1111/ctr.14016] [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: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cholangitis lenta (CL) represents a specific histological lesion associated with severe cholestasis and related to sepsis. Despite being well known by pathologists, CL has been poorly studied in liver transplantation (LT). METHODS We performed a retrospective 12-year analysis of the incidence, risk factors, and outcome of CL in LT recipients. Biopsy samples performed within 3 months after LT underwent blinded rereading to identify recipients with CL. RESULTS Among 587 LT performed, 45 (7.7%) developed CL. Of these, 7 (15.6%) had no signs of clinical sepsis at the time of biopsy, but further investigations revealed positive cultures. Independent factors associated with CL were sepsis at the time of LT (OR = 3.62 [95%CI = 1.63-8.06]), donor age (OR = 1.05 [1.03-1.08]), and operative time (OR = 1.23 [95%CI = 1.02-1.48]). Cholangitis lenta was associated with increased severe morbidity (71.1% vs 33.0%, P < .001), 90-day mortality (24.4% vs 5.9%, P < .001) and decreased one-year graft (62.1% vs 89.4%, P < .001) and patient survival (55.6% vs 87.9%, P < .001). CONCLUSION Cholangitis lenta represents a possible lesion associated with cholestasis after LT, which strongly affects its outcome. In the event of an unexplained post-transplant cholestasis, the diagnosis of CL must be considered, even in the absence of clinically evident sepsis.
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Affiliation(s)
- Mathieu Bonal
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France
| | - Mohamed Mourad
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
| | - Brigitte Bancel
- Department of Surgical Pathology, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Valérie Hervieu
- Department of Surgical Pathology, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France
| | - Fanny Lebossé
- Department of Hepatology, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France
| | - Laurent Heyer
- Intensive Care Unit, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Croix-Rousse University Hospital, Lyon, France.,INSERM Unit 1052 Epigenetics and Epigenomics in Liver Cancers, Cancer Research Center of Lyon, Lyon, France
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37
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Roger E, Martel S, Bertrand-Chapel A, Depollier A, Chuvin N, Pommier RM, Yacoub K, Caligaris C, Cardot-Ruffino V, Chauvet V, Aires S, Mohkam K, Mabrut JY, Adham M, Fenouil T, Hervieu V, Broutier L, Castets M, Neuzillet C, Cassier PA, Tomasini R, Sentis S, Bartholin L. Correction: Schwann cells support oncogenic potential of pancreatic cancer cells through TGFβ signaling. Cell Death Dis 2020; 11:57. [PMID: 31974340 PMCID: PMC6978359 DOI: 10.1038/s41419-020-2262-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Elodie Roger
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Sylvie Martel
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Adrien Bertrand-Chapel
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Arnaud Depollier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Nicolas Chuvin
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Roxane M Pommier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Karam Yacoub
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Cassandre Caligaris
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Victoire Cardot-Ruffino
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Véronique Chauvet
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Sophie Aires
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Kayvan Mohkam
- Hospices Civils de Lyon, Croix Rousse hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Jean-Yves Mabrut
- Hospices Civils de Lyon, Croix Rousse hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Mustapha Adham
- Hospices Civils de Lyon, Edouard Herriot hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Tanguy Fenouil
- Hospices Civils de Lyon Institute of Pathology EST, CRCL INSERM U1052, University Lyon 1, Lyon, France
| | - Valérie Hervieu
- Hospices Civils de Lyon Institute of Pathology EST, CRCL INSERM U1052, University Lyon 1, Lyon, France
| | - Laura Broutier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Marie Castets
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Cindy Neuzillet
- Medical Oncology Department, Curie Institute, Versailles Saint-Quentin University, 35 rue Dailly, 92210, Saint Cloud, France
| | - Philippe A Cassier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France.,Departement d'Oncologie Médicale, Centre Léon Bérard, Lyon, 69008, France
| | - Richard Tomasini
- Aix-Marseille Université, Institut Paoli-Calmettes, INSERM U1068, CNRS UMR 7258, Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - Stéphanie Sentis
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Laurent Bartholin
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France.
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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Morvan A, Gazon M, Duperret S, Schmitt Z, Pradat P, Mohkam K, Aubrun F. Hepatopulmonary Syndrome and Post-Liver Transplantation Complications: A Case-Control Study. Int J Organ Transplant Med 2020; 11:166-175. [PMID: 33335697 PMCID: PMC7726840] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Although liver transplantation (LT) improves survival in cirrhotic patients with hepatopulmonary syndrome (HPS), few data exist concerning post-operative complications in these patients. OBJECTIVE To compare complications after LT between patients with and without HPS. METHODS In a case-control study, we retrospectively analyzed all patients who underwent LT in our center from January 2010 to July 2016. We compared cases of identified HPS to controls matched for age, MELD score, comorbidities, red blood cells transfused, and highest dosage of norepinephrine perfused during transplantation. RESULTS Among 451 transplanted patients, we identified 71 patients with HPS who could be analyzed. We found a significantly (p<0.001) higher number of post-operative complications in patients with HPS (median 5 vs 3), with more occurrence of cardiac, infectious and surgical complications than in the controls: 39.4% vs 12.7% (p<0.001), 81.7% vs 49.3% (p<0.001), and 59.2% vs 40.1% (p<0.029), respectively. There were also more ICU readmissions at 1 month among HPS patients (10 vs 1, p=0.01). There was no significant difference concerning ventilation data, lengths of ICU or hospital stay (8.5 [range 3-232] and 32 [14-276] days, respectively on the whole cohort) and death in the ICU (4.2% on the whole cohort). The 1-year survival was higher in HPS patients (94.4% vs 81.1%, p=0.034); there was no difference in 5-year survival. CONCLUSION HPS patients seem to have a higher number of complications in the first month following LT.
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Affiliation(s)
- A. Morvan
- Department of Anesthesiology and Critical Care Croix-Rousse University Hospital, Hospices Civils de Lyon (HCL), Lyon, France
| | - M. Gazon
- Department of Anesthesiology and Critical Care Croix-Rousse University Hospital, Hospices Civils de Lyon (HCL), Lyon, France
| | - S. Duperret
- Department of Anesthesiology and Critical Care Croix-Rousse University Hospital, Hospices Civils de Lyon (HCL), Lyon, France
| | - Z. Schmitt
- Department of Anesthesiology and Critical Care Croix-Rousse University Hospital, Hospices Civils de Lyon (HCL), Lyon, France
| | - P. Pradat
- Department of Hepatology, Clinical Research Center Croix-Rousse University Hospital, Hospices Civils de Lyon (HCL), Lyon, France
| | - K. Mohkam
- Department of Digestive, Hepato-biliary and Liver Transplantation Surgery, Croix-Rousse University Hospital, Hospices Civils de Lyon (HCL), Lyon, France
| | - F. Aubrun
- Department of Anesthesiology and Critical Care Croix-Rousse University Hospital, Hospices Civils de Lyon (HCL), Lyon, France
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40
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Magand N, Coronado JL, Drevon H, Manichon A, Mabrut J, Mohkam K, Ducerf C, Boussel L, Rode A. Primary angioplasty or stenting for hepatic artery stenosis treatment after liver transplantation. Clin Transplant 2019; 33:e13729. [DOI: 10.1111/ctr.13729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 08/27/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Nicolas Magand
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - José Luis Coronado
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Harir Drevon
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Anne‐Frédérique Manichon
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Jean‐Yves Mabrut
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Kayvan Mohkam
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Christian Ducerf
- Visceral surgery and liver transplantation Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Loïc Boussel
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
| | - Agnès Rode
- Diagnostic and interventional radiology department Croix Rousse Hospital Hospices Civils de Lyon Lyon France
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41
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Roger E, Martel S, Bertrand-Chapel A, Depollier A, Chuvin N, Pommier RM, Yacoub K, Caligaris C, Cardot-Ruffino V, Chauvet V, Aires S, Mohkam K, Mabrut JY, Adham M, Fenouil T, Hervieu V, Broutier L, Castets M, Neuzillet C, Cassier PA, Tomasini R, Sentis S, Bartholin L. Schwann cells support oncogenic potential of pancreatic cancer cells through TGFβ signaling. Cell Death Dis 2019; 10:886. [PMID: 31767842 PMCID: PMC6877617 DOI: 10.1038/s41419-019-2116-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/09/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the solid tumors with the poorest prognosis. The stroma of this tumor is abundant and composed of extracellular matrix and stromal cells (including cancer-associated fibroblasts and immune cells). Nerve fibers invading this stroma represent a hallmark of PDAC, involved in neural remodeling, which participates in neuropathic pain, cancer cell dissemination and tumor relapse after surgery. Pancreatic cancer-associated neural remodeling is regulated through functional interplays mediated by physical and molecular interactions between cancer cells, nerve cells and surrounding Schwann cells, and other stromal cells. In the present study, we show that Schwann cells (glial cells supporting peripheral neurons) can enhance aggressiveness (migration, invasion, tumorigenicity) of pancreatic cancer cells in a transforming growth factor beta (TGFβ)-dependent manner. Indeed, we reveal that conditioned medium from Schwann cells contains high amounts of TGFβ able to activate the TGFβ-SMAD signaling pathway in cancer cells. We also observed in human PDAC samples that high levels of TGFβ signaling activation were positively correlated with perineural invasion. Secretome analyses by mass spectrometry of Schwann cells and pancreatic cancer cells cultured alone or in combination highlighted the central role of TGFβ in neuro-epithelial interactions, as illustrated by proteomic signatures related to cell adhesion and motility. Altogether, these results demonstrate that Schwann cells are a meaningful source of TGFβ in PDAC, which plays a crucial role in the acquisition of aggressive properties by pancreatic cancer cells.
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Affiliation(s)
- Elodie Roger
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Sylvie Martel
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Adrien Bertrand-Chapel
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Arnaud Depollier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Nicolas Chuvin
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Roxane M Pommier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Karam Yacoub
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Cassandre Caligaris
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Victoire Cardot-Ruffino
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Véronique Chauvet
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Sophie Aires
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Kayvan Mohkam
- Hospices Civils de Lyon, Croix Rousse hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Jean-Yves Mabrut
- Hospices Civils de Lyon, Croix Rousse hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Mustapha Adham
- Hospices Civils de Lyon, Edouard Herriot hospital, Claude-Bernard Lyon 1 University, Department of General Surgery & Liver Transplantation, Lyon, France
| | - Tanguy Fenouil
- Hospices Civils de Lyon Institute of Pathology EST, CRCL INSERM U1052, University Lyon 1, Lyon, France
| | - Valérie Hervieu
- Hospices Civils de Lyon Institute of Pathology EST, CRCL INSERM U1052, University Lyon 1, Lyon, France
| | - Laura Broutier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Marie Castets
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Cindy Neuzillet
- Medical Oncology Department, Curie Institute, Versailles Saint-Quentin University, 35 rue Dailly, 92210, Saint Cloud, France
| | - Philippe A Cassier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France.,Departement d'Oncologie Médicale, Centre Léon Bérard, Lyon, 69008, France
| | - Richard Tomasini
- Aix-Marseille Université, Institut Paoli-Calmettes, INSERM U1068, CNRS UMR 7258, Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - Stéphanie Sentis
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France
| | - Laurent Bartholin
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon (CRCL), Lyon, 69373, France.
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42
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Mourad M, Mabrut JY, Chellakhi M, Lesurtel M, Prevost C, Ducerf C, Rode A, Merle P, Mornex F, Mohkam K. Neoadjuvant conformal radiotherapy before liver transplantation for hepatocellular carcinoma: a propensity score matched analysis of postoperative morbidity and oncological results. Future Oncol 2019; 15:2517-2530. [DOI: 10.2217/fon-2019-0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To assess neoadjuvant conformal radiotherapy (CRT) before orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) not suitable for standard locoregional treatments. Methods: Patients undergoing OLT for HCC with or without prior CRT were compared using 1:3 propensity score matching. Results: After propensity score matching, 23 patients with CRT were compared with 66 control subjects. Severe morbidity rate was 34.8 versus 24.2% in the CRT and non-CRT groups (p = 0.289). Complete pathological response was observed in 47.8% of CRT-targeted nodules. The 1-/3-/5-year disease-free survivals were 77.3, 77.3 and 68.7% in the CRT group versus 85.4, 68.0 and 61.7% in the non-CRT group (p = 0.829). Conclusion: Conformal radiotherapy represents a satisfactory neoadjuvant therapy for OLT candidates not suitable for standard HCC locoregional therapies.
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Affiliation(s)
- Mohamed Mourad
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
- Ecole Doctorale Biologie Moléculaire Intégrative et Cellulaire (BMIC), Claude Bernard Lyon 1 University, Lyon, France
- Department of General & Digestive Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jean-Yves Mabrut
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Madiha Chellakhi
- Department of Oncology & Radiotherapy, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Mickaël Lesurtel
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Célia Prevost
- Department of Oncology & Radiotherapy, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Christian Ducerf
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Agnès Rode
- Department of Radiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Philippe Merle
- Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Françoise Mornex
- Department of Oncology & Radiotherapy, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Kayvan Mohkam
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unit U1052, Cancer Research Center of Lyon, Lyon, France
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Abstract
Low-Phospholipid Associated Cholelithiasis (LPAC) is a genetic disease responsible for the development of intrahepatic lithiasis. It is associated with a mutation of the ABCB4 gene which codes for protein MDR3, a biliary carrier. As a nosological entity, it is defined by presence of two of the three following criteria: age less than 40 years at onset of biliary symptoms, recurrence of biliary symptoms after cholecystectomy, and intrahepatic hyperechogenic foci detected by ultrasound. While the majority of clinical forms are simple, there also exist complicated forms, involving extended intrahepatic lithiasis and its consequences: lithiasis migration, acute cholangitis, intrahepatic abscess. Chronic evolution can lead to secondary sclerosing cholangitis or secondary biliary cirrhosis. In unusual cases, degeneration into cholangiocarcinoma may occur. Treatment is built around ursodeoxycholic acid, which yields dissolution of biliary calculi. Complicated forms may call for interventional, radiological, endoscopic or surgical treatment. This synthetic review illustrates and summarizes the different aspects of this entity, from simple gallbladder lithiasis to cholangiocarcinoma, as well as secondary biliary cirrhosis requiring liver transplant, on the basis of clinical cases and the iconography of patients treated in our ward.
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Affiliation(s)
- P Goubault
- Service de chirurgie générale, digestive et transplantation hépatique et intestinale (general, digestive, liver transplant and intestinal surgery department), hôpital de la Croix Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
| | - T Brunel
- Service de radiologie (radiology department), hôpital de la Croix Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - A Rode
- Service de radiologie (radiology department), hôpital de la Croix Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - B Bancel
- Service d'anatomie et de cytologie pathologiques (pathological anatomy and cytology department), hôpital de la Croix Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - K Mohkam
- Service de chirurgie générale, digestive et transplantation hépatique et intestinale (general, digestive, liver transplant and intestinal surgery department), hôpital de la Croix Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - J-Y Mabrut
- Service de chirurgie générale, digestive et transplantation hépatique et intestinale (general, digestive, liver transplant and intestinal surgery department), hôpital de la Croix Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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Mohkam K, Mabrut JY. Reply to: "Treatment for solitary hepatocellular carcinoma ranging from 2 and 5 cm: Is the curative effect of no-touch multibipolar radiofrequency ablation comparable to that of surgical resection?". J Hepatol 2019; 70:576-577. [PMID: 30591264 DOI: 10.1016/j.jhep.2018.11.028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 12/04/2022]
Affiliation(s)
- Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM Unit 1052, Clinical Research Center of Lyon, France.
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Darnis B, Mohkam K, Cauchy F, Mabrut JY. Double cholecystectomy in case of accessory gallbladder: Not as easy as two cholecystectomies. Hepatobiliary Pancreat Dis Int 2019; 18:93-95. [PMID: 30503858 DOI: 10.1016/j.hbpd.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/21/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Benjamin Darnis
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France.
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France; Ecole Doctorale EDISS 205, Université Lyon 1, EMR 3738, Lyon, France
| | - François Cauchy
- HPB Surgery and Liver Transplantation Unit, Beaujon Hospital, Clichy, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France; Ecole Doctorale EDISS 205, Université Lyon 1, EMR 3738, Lyon, France
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Darnis B, Mohkam K, Cauchy F, Cazauran JB, Bancel B, Rode A, Ducerf C, Lesurtel M, Mabrut JY. A systematic review of the anatomical findings of multiple gallbladders. HPB (Oxford) 2018; 20:985-991. [PMID: 29887260 DOI: 10.1016/j.hpb.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/06/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multiple gallbladders (MG) are a rare malformation, with no clear data on its clinical impact, therapeutic indications or risk for malignancy. METHODS A systematic review of all published literature between 1990 and 2017 was performed using the PRISMA guidelines. RESULTS Data of 181 patients extracted from 153 studies were reviewed. MG were diagnosed during the treatment of a gallstone-related disease in 83% of patients, of which 13% had previous cholecystectomy and had a recurrence of biliary stone disease. The sensitivity of ultrasound scan was 66%, and that of magnetic resonance imaging cholangio-pancreatography, 97%. The cystic duct was common to both gallbladders (type1) in 43% and separated (type 2) in 50% of patients. In the latter case, there was no way to differentiate preoperatively an accessory gallbladder from a Todani II bile duct cyst. Cholecystectomy was performed in 129 patients by laparotomy (43%) or laparoscopy (56%). MG was undiagnosed before surgery in 24% of the patients. The postoperative biliary leakage rate was 0.7%. In two patients, gallbladder cancers were detected. CONCLUSION MG are difficult to diagnose and share a common natural history with single gallbladders, without evidence of increased risk for malignancy. Excision of both gallbladders is indicated in symptomatic stone disease. However, prophylactic cholecystectomy must be considered for type 2 MG, since it cannot be preoperatively differentiated from a Todani II bile duct cyst, which is associated with a risk of malignant transformation.
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Affiliation(s)
- Benjamin Darnis
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, France; Ecole Doctorale EDISS 205, Université Lyon 1, EMR, 3738, Lyon, France.
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, France; Ecole Doctorale EDISS 205, Université Lyon 1, EMR, 3738, Lyon, France
| | - François Cauchy
- HPB Surgery and Liver Transplantation Unit, Beaujon Hospital, Clichy, France
| | - Jean-Baptiste Cazauran
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, France
| | - Brigitte Bancel
- Department of Pathology, Hospices Civils de Lyon, Croix-Rousse University Hospital, France
| | - Agnès Rode
- Department of Radiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, France
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Golse N, El Bouyousfi A, Marques F, Bancel B, Mohkam K, Ducerf C, Merle P, Sebagh M, Castaing D, Sa Cunha A, Adam R, Cherqui D, Vibert E, Mabrut JY. Large hepatocellular carcinoma: Does fibrosis really impact prognosis after resection? J Visc Surg 2018. [DOI: 10.1016/j.jviscsurg.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mohkam K, Rayar M, Adam JP, Muscari F, Rode A, Merle P, Pradat P, Bauler S, Delfour I, Chiche L, Ducerf C, Boudjema K, Lesurtel M, Laurent C, Mabrut JY. Evaluation of postoperative ascites after somatostatin infusion following hepatectomy for hepatocellular carcinoma by laparotomy: a multicenter randomized double-blind controlled trial (SOMAPROTECT). BMC Cancer 2018; 18:844. [PMID: 30139340 PMCID: PMC6108122 DOI: 10.1186/s12885-018-4667-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background The majority of patients undergoing hepatectomy for hepatocellular carcinoma (HCC) suffer from underlying liver disease and are exposed to the risk of postoperative ascites, which is favored by an imbalance between portal venous inflow and a diminished hepatic volume. Finding a reversible, non-invasive method for modulating the portal inflow would be of interest as it could be used temporarily during the early postoperative course. Somatostatin, a well-known drug already used in several indications, may limit the risk of postoperative ascites and liver failure by decreasing portal pressure after hepatectomy for HCC in patients with underlying liver disease. We aimed to evaluate the impact of somatostatin postoperative infusion on the incidence of ascites following hepatectomy by laparotomy for HCC in patients with underlying liver disease. Methods/design The SOMAPROTECT study is a multicenter randomized double-blind placebo controlled phase III trial comparing two arms of patients with underlying liver disease undergoing hepatectomy for HCC by open approach. All patients will have primary abdominal drainage before closure. Patients in the experimental arm will receive a postoperative intravenous infusion of somatostatin during 6 days. Patients in the control group will receive a placebo infusion for the same duration. The primary endpoint will be the presence or absence of postoperative ascites occurring during the 90-day postoperative course, defined as ≥500 ml/24 h of fluid in the drains during at least 3 days or any ascites requiring an invasive procedure comprising percutaneous puncture or drainage. Secondary endpoints will be duration and total volume of ascites, postoperative 90-day mortality and morbidity, liver failure, acute renal failure, length of stay in intensive care unit and hospital stay. The total number of patients to be enrolled was calculated to be 152. Discussion Postoperative ascites remains a major issue after hepatectomy for HCC as it is associated with increased morbidity, liver and renal failure, the need for specific treatments and prolonged hospital stay. This study represents the first randomized controlled trial to assess the benefits of somatostatin on the risk of postoperative ascites after surgery for HCC. Trial registration NCT02799212 (ClinicalTrials.gov identifier). Registered prior to conducting the research on 9 June 2016.
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Affiliation(s)
- Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France.,Ecole Doctorale EDISS 205, EMR 3738, Claude Bernard Lyon 1 University, Lyon, France
| | - Michel Rayar
- Department of Digestive Surgery and Liver Transplantation, Hôpital Pontchaillou, Rennes, France
| | - Jean-Philippe Adam
- Department of Digestive Surgery and Liver Transplantation, Hôpital Haut-Lévêque, Bordeaux, France
| | - Fabrice Muscari
- Department of Digestive Surgery and Liver Transplantation, Hôpital Rangueil, Toulouse, France
| | - Agnès Rode
- Department of interventional radiology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Philippe Merle
- Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Pierre Pradat
- Centre for clinical research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Stéphanie Bauler
- Department of clinical pharmacy, Croix-Rousse University Hospital, Lyon, France
| | - Isabelle Delfour
- Centre for clinical research, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Laurence Chiche
- Department of Digestive Surgery and Liver Transplantation, Hôpital Haut-Lévêque, Bordeaux, France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France
| | - Karim Boudjema
- Department of Digestive Surgery and Liver Transplantation, Hôpital Pontchaillou, Rennes, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France
| | - Christophe Laurent
- Department of Digestive Surgery and Liver Transplantation, Hôpital Haut-Lévêque, Bordeaux, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France. .,Ecole Doctorale EDISS 205, EMR 3738, Claude Bernard Lyon 1 University, Lyon, France.
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Mohkam K, Dumont PN, Manichon AF, Jouvet JC, Boussel L, Merle P, Ducerf C, Lesurtel M, Rode A, Mabrut JY. No-touch multibipolar radiofrequency ablation vs. surgical resection for solitary hepatocellular carcinoma ranging from 2 to 5 cm. J Hepatol 2018; 68:1172-1180. [PMID: 29410287 DOI: 10.1016/j.jhep.2018.01.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS No-touch multibipolar radiofrequency ablation (NTM-RFA) represents a novel therapy that surpasses standard RFA for hepatocellular carcinoma (HCC), but it has not been compared to surgical resection (SR). We aimed to compare the outcomes of NTM-RFA and SR for intermediate-sized HCC. METHODS Between 2012 and 2016, 141 patients with solitary HCC ranging from 2 to 5 cm were treated by NTM-RFA or SR at a single-center. The outcomes of 128 patients were compared after using inverse probability of treatment weighting (IPTW). RESULTS Seventy-nine patients had NTM-RFA and 62 had SR. After IPTW, the two groups were well-balanced for most baseline characteristics including tumor size, location, etiology, severity of underlying liver disease and alpha-fetoprotein level. Morbidity was higher (67.9% vs. 50.0%, p = 0.042) and hospital stay was longer (12 [IQR 8-13] vs. 7 [IQR 5-9] days, p <0.001) after SR. Local recurrence rates at one and three years were 5.5% and 10.0% after NTM-RFA and 1.9% and 1.9% after SR, respectively (p = 0.065). The rates of systematized recurrence (within the treated segment or in an adjacent segment within a 2 cm distance from treatment site) were higher after NTM-RFA (7.4% vs. 1.9% at one year, 27.8% vs. 3.3% at three years, p = 0.008). Most patients with recurrence were eligible for rescue treatment, resulting in similar overall survival (86.7% after NTM-RFA, 91.4% after SR at three years, p = 0.954) and disease-free survival (40.8% after NTM-RFA, 56.4% after SR at three years, p = 0.119). CONCLUSION Compared to SR, NTM-RFA for solitary intermediate-sized HCC was associated with less morbidity and more systematized recurrence, while the rate of local recurrence was not significantly different. Most patients with intrahepatic recurrence remained eligible for rescue therapies, resulting in equivalent long-term oncological results after both treatments. LAY SUMMARY Outcomes of patients treated for intermediate-sized hepatocellular carcinoma by surgical resection or no-touch multibipolar radiofrequency ablation were compared. No-touch multibipolar radiofrequency ablation was associated with a lower overall morbidity and a higher rate of systematized recurrence within the treated segment or in an adjacent segment within a 2 cm distance from the initial tumor site. Most patients with intrahepatic recurrence remained eligible for rescue curative therapy, enabling them to achieve similar long-term oncological results after both treatments.
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Affiliation(s)
- Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, EMR3738, Université Lyon 1, Lyon, France
| | - Paul-Noël Dumont
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, EMR3738, Université Lyon 1, Lyon, France
| | - Anne-Frédérique Manichon
- Department of Diagnostic and Interventional Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Jean-Christophe Jouvet
- Department of Diagnostic and Interventional Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Loïc Boussel
- Department of Diagnostic and Interventional Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Philippe Merle
- Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, EMR3738, Université Lyon 1, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, EMR3738, Université Lyon 1, Lyon, France
| | - Agnès Rode
- Department of Diagnostic and Interventional Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, EMR3738, Université Lyon 1, Lyon, France.
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Mohkam K, Fuks D, Vibert E, Nomi T, Cauchy F, Kawaguchi Y, Boleslawski E, Regimbeau JM, Gayet B, Mabrut JY. External Validation and Optimization of the French Association of Hepatopancreatobiliary Surgery and Transplantation's Score to Predict Severe Postoperative Biliary Leakage after Open or Laparoscopic Liver Resection. J Am Coll Surg 2018; 226:1137-1146. [PMID: 29574179 DOI: 10.1016/j.jamcollsurg.2018.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Biliary leakage is a major contributor to morbidity after hepatectomy. A score to predict severe posthepatectomy biliary leakage (PHBL) was recently developed by the French Association of Hepatopancreatobiliary Surgery and Transplantation (ACHBT). The aim of the study was to validate and optimize the score on an external cohort. STUDY DESIGN The ACHBT score uses 5 factors (blood loss, remnant ischemia, anatomic resection of segment 8, transection along right aspect of the left intersectional plane and associating liver partition and portal vein ligation for staged hepatectomy) to predict severe PHBL. The score was tested on an external cohort of patients undergoing hepatectomy without hepaticojejunostomy between 1994 and 2016 at a single center. Association between the score, pre- and intraoperative variables, and severe PHBL was assessed in an attempt to improve the score. RESULTS Among 778 procedures performed (including 679 [87.3%] laparoscopic and 260 [34.3%] major hepatectomies), 31 (4.0%) were complicated with severe PHBL. The ACHBT score showed good discrimination (AUROC [area under the receiver operating characteristic curve] 0.747, 95% CI 0.652 to 0.841), calibration and accuracy (diagnostic odds ratio for a score ≥1: 6.217 [95% CI 2.642 to 14.627], for a score ≥2: 6.059 [95% CI 2.858 to 12.846],and for a score ≥3: 9.589 [95% CI 2.868 to 32.066]). On multivariable analysis, the ACHBT score was the only predictor of severe PHBL. A model combining the ACHBT score and conversion to open surgery was significantly more discriminating than the ACHBT score alone (AUROC 0.790 [95% CI 0.711 to 0.870], Delong's test p = 0.002). CONCLUSIONS The ACHBT score represents an externally validated tool to predict severe PHBL. Inclusion of conversion to open surgery as an additional factor to the score allowed it to improve its performance to predict severe PHBL after laparoscopic hepatectomy.
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Affiliation(s)
- Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France; Research Unit EMR 3738, Ecole Doctorale EDISS 205, Claude Bernard Lyon 1 University, Lyon, France
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Eric Vibert
- Department of Hepatobiliary Surgery and Liver Transplantation, Paul Brousse University Hospital, Villejuif, France
| | - Takeo Nomi
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon University Hospital, Clichy, France
| | - Yoshikuni Kawaguchi
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Emmanuel Boleslawski
- Department of Hepatobiliary Surgery and Liver Transplantation, Claude Hurriez University Hospital, Lille, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncologic Surgery, Amiens University Medical Center, Amiens, France
| | - Brice Gayet
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France; Research Unit EMR 3738, Ecole Doctorale EDISS 205, Claude Bernard Lyon 1 University, Lyon, France.
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