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Brüggenwirth IM, Lantinga VA, Lascaris B, Thorne AM, Meerdink M, de Kleine RH, Blokzijl H, van den Berg AP, Reyntjens KM, Lisman T, Porte RJ, de Meijer VE. Prolonged hypothermic machine perfusion enables daytime liver transplantation - an IDEAL stage 2 prospective clinical trial. EClinicalMedicine 2024; 68:102411. [PMID: 38235423 PMCID: PMC10789636 DOI: 10.1016/j.eclinm.2023.102411] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
Background Liver transplantation is traditionally performed around the clock to minimize organ ischemic time. However, the prospect of prolonging preservation times holds the potential to streamline logistics and transform liver transplantation into a semi-elective procedure, reducing the need for nighttime surgeries. Dual hypothermic oxygenated machine perfusion (DHOPE) of donor livers for 1-2 h mitigates ischemia-reperfusion injury and improves transplant outcomes. Preclinical studies have shown that DHOPE can safely extend the preservation of donor livers for up to 24 h. Methods We conducted an IDEAL stage 2 prospective clinical trial comparing prolonged (≥4 h) DHOPE to conventional (1-2 h) DHOPE for brain-dead donor livers, enabling transplantation the following morning. Liver allocation to each group was based on donor hepatectomy end times. The primary safety endpoint was a composite of all serious adverse events (SAE) within 30 days after transplantation. The primary feasibility endpoint was defined as the number of patients assigned and successfully receiving a prolonged DHOPE-perfused liver graft. Trial registration at: WHO International Clinical Trial Registry Platform, number NL8740. Findings Between November 1, 2020 and July 16, 2022, 24 patients were enrolled. The median preservation time was 14.5 h (interquartile range [IQR], 13.9-15.5) for the prolonged group (n = 12) and 7.9 h (IQR, 7.6-8.6) for the control group (n = 12; p = 0.01). In each group, three patients (25%; 95% CI 3.9-46%, p = 1) experienced a SAE. Markers of ischemia-reperfusion injury and oxidative stress in both perfusate and recipients were consistently low and showed no notable discrepancies between the two groups. All patients assigned to either the prolonged group or control group successfully received a liver graft perfused with either prolonged DHOPE or control DHOPE, respectively. Interpretation This first-in-human clinical trial demonstrates the safety and feasibility of DHOPE in prolonging the preservation time of donor livers to enable daytime transplantation. The ability to extend the preservation window to up to 20 h using hypothermic oxygenated machine preservation at a 10 °C temperature has the potential to reshape the landscape of liver transplantation. Funding University Medical Center Groningen, the Netherlands.
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Affiliation(s)
- Isabel M.A. Brüggenwirth
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Veerle A. Lantinga
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Bianca Lascaris
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Adam M. Thorne
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Mark Meerdink
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruben H. de Kleine
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans Blokzijl
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Aad P. van den Berg
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Koen M.E.M. Reyntjens
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ton Lisman
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert J. Porte
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincent E. de Meijer
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- UMCG Comprehensive Transplant Center, University Medical Center Groningen, Groningen, the Netherlands
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Verhagen MV, de Kleine RH, Groen H, van der Doef HPJ, Kwee TC, de Haas RJ. Doppler-ultrasound reference values after pediatric liver transplantation: a consecutive cohort study. Eur Radiol 2023; 33:6404-6413. [PMID: 36930263 PMCID: PMC10415481 DOI: 10.1007/s00330-023-09522-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Doppler ultrasound (DUS) is the main imaging modality to evaluate vascular complications of pediatric liver transplants (LT). The current study aimed to determine reference values and their change over time. METHODS A consecutive cohort of pediatric patients undergoing an LT were retrospectively included between 2015 and 2020. Timepoints for standardized DUS were intra-operative and postoperative (day 0), days 1-7, months 1 and 3, and years 1 and 2. DUS measurements of the hepatic artery (HA), portal vein (PV), and hepatic vein(s) (HV) were included if there were no complications during 2 years follow-up. Measurements consisted of: peak systolic velocity (PSV) and resistive index (RI) for the HA, PSV for the PV, and venous pulsatility index (VPI) for the HV. Generalized estimating equations were used to analyze change over time. RESULTS One hundred twelve pediatric patients with 123 LTs were included (median age 3.3 years, interquartile range 0.7-10.1). Ninety-five HAs, 100 PVs, and 115 HVs without complications were included. Reference values for HA PSV and RI, PV PSV, and HV VPI were obtained for all timepoints (4043 included data points in total) and presented using 5th-95th percentiles and threshold values. All reference values changed significantly over time (p = 0.032 to p < 0.001). CONCLUSIONS DUS reference values of hepatic vessels in children after LT are presented, reference values change over time with specific vessel-dependent patterns. Timepoint-specific reference values improve the interpretation of DUS values and may help to better weigh their clinical significance. KEY POINTS • Doppler ultrasound reference values of pediatric liver transplantations are not static but change over time. Applying the correct reference values for the specific timepoint may further improve the interpretation of the measurements. • The pattern of change over time of Doppler ultrasound measurements differs between the hepatic vessel and measurement; knowledge of these patterns may help radiologists to better understand normal postoperative hemodynamic changes.
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Affiliation(s)
- Martijn V Verhagen
- Department of Radiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - Ruben H de Kleine
- Department of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hubert P J van der Doef
- Department of Pediatric Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
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3
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Dibbits MHJ, Rodijk LH, den Heijer AE, Bos AF, Verkade HJ, de Kleine RH, Alizadeh BZ, Hulscher JBF, Bruggink JLM. Neurodevelopment in patients with biliary atresia up to toddler age: Outcomes and predictability. Early Hum Dev 2023; 180:105754. [PMID: 37030125 DOI: 10.1016/j.earlhumdev.2023.105754] [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: 02/10/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/10/2023]
Abstract
AIM To assess neurodevelopment in young patients with biliary atresia (BA) and to determine the predictive value of General Movement Assessment (GMA) at infant age for neurodevelopmental impairments at toddler age. METHOD Infants diagnosed with BA were prospectively included in a longitudinal study. Neurodevelopmental status was previously assessed before Kasai porto-enterostomy (KPE) and one month after KPE using Prechtl's GMA, including motor optimality scores. At 2-3 years, neurodevelopment was assessed using the Bayley Scales of Infant Development, and compared to the Dutch norm population. The predictive value of GMA at infant age for motor skills and cognition at toddler age was determined. RESULTS Neurodevelopment was assessed in 41 BA patients. At toddler age (n = 38, age 29 ± 5 months, 70 % liver transplantation), 13 (39 %) patients scored below-average on motor skills, and 6 (17 %) patients on cognition. Abnormal GMA after KPE predicted both below-average motor skills and cognitive score at toddler age (sensitivity, 91 % and 80 %; specificity 83 % and 67 %; negative predictive value, 94 % and 94 %; and, positive predictive value, 77 % and 33 %, resp.). INTERPRETATION One-third of toddlers with BA show impaired motor skills. GMA post-KPE has a high predictive value to identify infants with BA at risk of neurodevelopmental impairments.
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Affiliation(s)
- Marloes H J Dibbits
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Lyan H Rodijk
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Anne E den Heijer
- Section of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, the Netherlands
| | - Arend F Bos
- Section of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, the Netherlands
| | - Henkjan J Verkade
- Section of Pediatric Gastroenterology/Hepatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, the Netherlands
| | - Ruben H de Kleine
- Section of Hepato-pancreatico-biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jan B F Hulscher
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Janneke L M Bruggink
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands.
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4
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Lexmond WS, de Meijer VE, Scheenstra R, Bontemps STH, Duiker EW, Schölvinck EH, Zhou X, von Eije KJ, Reyntjens KMEM, Verkade HJ, Porte RJ, de Kleine RH. Indeterminate pediatric acute liver failure: Clinical characteristics of a temporal cluster of five children in the Netherlands in the spring of 2022. United European Gastroenterol J 2022; 10:795-804. [PMID: 35773246 PMCID: PMC9557968 DOI: 10.1002/ueg2.12269] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023] Open
Abstract
There is increasing global concern of severe acute hepatitis of unknown etiology in young children. In early 2022, our center for liver transplantation in the Netherlands treated five children who presented in short succession with indeterminate acute liver failure. Four children underwent liver transplantation, one spontaneously recovered. Here we delineate the clinical course and comprehensive diagnostic workup of these patients. Three of five patients showed a gradual decline of liver synthetic function and had mild neurological symptoms. Their clinical and histological findings were consistent with hepatitis. These three patients all had a past SARS-CoV-2 infection and two of them were positive for adenovirus DNA. The other two patients presented with advanced liver failure and encephalopathy and underwent dialysis as a bridge to transplantation. One of these children spontaneously recovered. We discuss this cluster of patients in the context of the currently elevated incidence of severe acute hepatitis in children.
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Affiliation(s)
- Willem S Lexmond
- Department of Pediatrics, Section of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent E de Meijer
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - René Scheenstra
- Department of Pediatrics, Section of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sander T H Bontemps
- Department of Pediatric Intensive Care, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien W Duiker
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth H Schölvinck
- Department of Pediatric Infectious Diseases / Immunology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Xuewei Zhou
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin J von Eije
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen M E M Reyntjens
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatrics, Section of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J Porte
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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5
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de Kleine RH, Lexmond WS, Buescher G, Sturm E, Kelly D, Lohse AW, Lenz D, Hørby Jørgensen M. Severe acute hepatitis and acute liver failure of unknown origin in children: a questionnaire-based study within 34 paediatric liver centres in 22 European countries and Israel, April 2022. Euro Surveill 2022; 27. [PMID: 35551705 PMCID: PMC9101968 DOI: 10.2807/1560-7917.es.2022.27.19.2200369] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To detect potential concern about severe acute hepatitis in children, we conducted a survey among 50 ERN RARE-LIVER centres. By 26 April 2022, 34 centres, including 25 transplant centres, reported an estimated median of 3–5, 0–2 and 3–5 cases in 2021, 2020 and 2019 and a mean of 2 (range: 0–8) cases between January and April 2022 (mean in 10 large liver transplant centres: 3). Twelve centres reported suspicion of an increase, but no rise.
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Affiliation(s)
- Ruben H de Kleine
- Department of Surgery, Division of Hepatobiliairy Surgery and Liver Transplantation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,European Reference Network for hepatological diseases (ERN RARE-LIVER)
| | - Willem S Lexmond
- European Reference Network for hepatological diseases (ERN RARE-LIVER).,Department of Paediatrics, Division of Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands
| | - Gustav Buescher
- European Reference Network for hepatological diseases (ERN RARE-LIVER).,Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ekkehard Sturm
- European Reference Network for hepatological diseases (ERN RARE-LIVER).,Paediatric Gastroenterology/ Hepatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Deidre Kelly
- European Reference Network for hepatological diseases (ERN RARE-LIVER).,University of Birmingham, and The Liver Unit, Birmingham Women & Children's Hospital, Birmingham, UK
| | - Ansgar W Lohse
- European Reference Network for hepatological diseases (ERN RARE-LIVER).,Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Dominic Lenz
- European Reference Network for hepatological diseases (ERN RARE-LIVER).,Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marianne Hørby Jørgensen
- European Reference Network for hepatological diseases (ERN RARE-LIVER).,Department of Paediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
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- The contributors to the survey are acknowledged at the end of the article
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6
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Klunder MB, Bruggink JLM, Huynh LDH, Bodewes FAJA, van der Steeg AFW, Kraal KCJM, van de Ven CP(K, van Grotel M, Zsiros J, Wijnen MHWA, Molenaar IQ(Q, Porte RJ, de Meijer VE, de Kleine RH. Surgical Outcome of Children with a Malignant Liver Tumour in The Netherlands: A Retrospective Consecutive Cohort Study. Children (Basel) 2022; 9:children9040525. [PMID: 35455569 PMCID: PMC9028819 DOI: 10.3390/children9040525] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
Abstract
Introduction: Six to eight children are diagnosed with a malignant liver tumour yearly in the Netherlands. The majority of these tumours are hepatoblastoma (HB) and hepatocellular carcinoma (HCC), for which radical resection, often in combination with chemotherapy, is the only curative treatment option. We investigated the surgical outcome of children with a malignant liver tumour in a consecutive cohort in the Netherlands. Methods: In this nationwide, retrospective observational study, all patients (age < 18 years) diagnosed with a malignant liver tumour, who underwent partial liver resection or orthotopic liver transplantation (OLT) between January 2014 and April 2021, were included. Children with a malignant liver tumour who were not eligible for surgery were excluded from the analysis. Data regarding tumour characteristics, diagnostics, treatment, complications and survival were collected. Outcomes included major complications (Clavien−Dindo ≥ 3a) within 90 days and disease-free survival. The results of the HB group were compared to those of a historical HB cohort. Results: Twenty-six children were analysed, of whom fourteen (54%) with HB (median age 21.5 months), ten (38%) with HCC (median age 140 months) and one with sarcoma and a CNSET. Thirteen children with HB (93%) and three children with HCC (30%) received neoadjuvant chemotherapy. Partial hepatic resection was possible in 19 patients (12 HB, 6 HCC, and 1 sarcoma), whilst 7 children required OLT (2 HB, 4 HCC, and 1 CNSET). Radical resection (R0, margin ≥ 1.0 mm) was obtained in 24 out of 26 patients, with recurrence only in the patient with CNSET. The mean follow-up was 39.7 months (HB 40 months, HCC 40 months). Major complications occurred in 9 out of 26 patients (35% in all, 4 of 14, 29% for HB). There was no 30- or 90-day mortality, with disease-free survival after surgery of 100% for HB and 80% for HCC, respectively. Results showed a tendency towards a better outcome compared to the historic cohort, but numbers were too small to reach significance. Conclusion: Survival after surgical treatment for malignant liver tumours in the Netherlands is excellent. Severe surgical complications arise in one-third of patients, but most resolve without long-term sequelae and have no impact on long-term survival.
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Affiliation(s)
- Merel B. Klunder
- Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.B.K.); (R.J.P.); (V.E.d.M.)
| | - Janneke L. M. Bruggink
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Leon D. H. Huynh
- Department of Surgery, Princess Máxima Center for Pediatric Oncology, 2584 CS Utrecht, The Netherlands; (L.D.H.H.); (A.F.W.v.d.S.); (C.P.v.d.V.); (M.H.W.A.W.)
| | - Frank A. J. A. Bodewes
- Department of Pediatric Hepatology and Gastroenterology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Alida F. W. van der Steeg
- Department of Surgery, Princess Máxima Center for Pediatric Oncology, 2584 CS Utrecht, The Netherlands; (L.D.H.H.); (A.F.W.v.d.S.); (C.P.v.d.V.); (M.H.W.A.W.)
| | - Kathelijne C. J. M. Kraal
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, 2584 CS Utrecht, The Netherlands; (K.C.J.M.K.); (M.v.G.); (J.Z.)
| | - C. P. (Kees) van de Ven
- Department of Surgery, Princess Máxima Center for Pediatric Oncology, 2584 CS Utrecht, The Netherlands; (L.D.H.H.); (A.F.W.v.d.S.); (C.P.v.d.V.); (M.H.W.A.W.)
| | - Martine van Grotel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, 2584 CS Utrecht, The Netherlands; (K.C.J.M.K.); (M.v.G.); (J.Z.)
| | - József Zsiros
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, 2584 CS Utrecht, The Netherlands; (K.C.J.M.K.); (M.v.G.); (J.Z.)
| | - Marc H. W. A. Wijnen
- Department of Surgery, Princess Máxima Center for Pediatric Oncology, 2584 CS Utrecht, The Netherlands; (L.D.H.H.); (A.F.W.v.d.S.); (C.P.v.d.V.); (M.H.W.A.W.)
| | - I. Q. (Quintus) Molenaar
- Department of Surgery, University of Utrecht, University Medical Center Utrecht, 2584 CX Utrecht, The Netherlands;
| | - Robert J. Porte
- Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.B.K.); (R.J.P.); (V.E.d.M.)
| | - Vincent E. de Meijer
- Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.B.K.); (R.J.P.); (V.E.d.M.)
| | - Ruben H. de Kleine
- Department of Surgery, Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.B.K.); (R.J.P.); (V.E.d.M.)
- Correspondence:
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7
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de Ville de Goyet J, Baumann U, Karam V, Adam R, Nadalin S, Heaton N, Reding R, Branchereau S, Mirza D, Klempnauer JL, Fischer L, Kalicinski P, Colledan M, Lopez Santamaria M, de Kleine RH, Chardot C, Yilmaz S, Kilic M, Boillot O, di Francesco F, Polak WG, Verkade HJ. European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children. Hepatology 2022; 75:634-645. [PMID: 34724224 DOI: 10.1002/hep.32223] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 01/26/2021] [Revised: 09/12/2021] [Accepted: 10/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968. APPROACH AND RESULTS Over a 50-year period (1968-2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000-2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found. CONCLUSIONS Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.
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Affiliation(s)
- Jean de Ville de Goyet
- Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
| | - Ulrich Baumann
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany.,European Liver and Intestine Transplant Association, Padua, Italy
| | - Vincent Karam
- European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
| | - René Adam
- European Liver and Intestine Transplant Association, Padua, Italy.,European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | | | - Raymond Reding
- Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sophie Branchereau
- Service de Chirurgie Viscérale Pédiatrique Bicêtre University Hospital, Faculty of Medicine Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Darius Mirza
- Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jürgen L Klempnauer
- Klinik für Viszeral und Transplantations-chirurgie, Hannover Medical School, Hannover, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Piotr Kalicinski
- Department of Pediatric and Transplant Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Michele Colledan
- Università degli studi di Milano Bicocca, ASST Giovanni XXIII, Department of Organ Failure and Transplantation, Bergamo, Italy
| | | | - Ruben H de Kleine
- Department of Surgery, Section of Hepato-Pancreatico-Biliary Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christophe Chardot
- Service de Chirurgie Pediatrique, Hôpital Necker Enfants Malades, Paris, France
| | - Sezai Yilmaz
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Murat Kilic
- Liver Transplant Program, Izmir Kent Hospital, Izmir, Turkey
| | - Olivier Boillot
- Pediatric Liver Transplant Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
| | - Wojciech G Polak
- European Liver and Intestine Transplant Association, Padua, Italy.,Erasmus MC, Transplant Institute, Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henkjan J Verkade
- European Liver and Intestine Transplant Association, Padua, Italy.,Department of Pediatrics, University Medical Center Groningen, University of Groningen, Hospital, Groningen, the Netherlands
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- European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
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8
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Karangwa SA, Adelmeijer J, Burgerhof JGM, Lisman T, de Meijer VE, de Kleine RH, Reyntjens KMEM, van den Berg AP, Porte RJ, de Boer MT. Controlled DCD Liver Transplantation Is Not Associated With Increased Hyperfibrinolysis and Blood Loss After Graft Reperfusion. Transplantation 2022; 106:308-317. [PMID: 33606482 DOI: 10.1097/tp.0000000000003698] [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: 11/26/2022]
Abstract
BACKGROUND The specific effect of donation after circulatory death (DCD) liver grafts on fibrinolysis, blood loss, and transfusion requirements after graft reperfusion is not well known. The aim of this study was to determine whether transplantation of controlled DCD livers is associated with an elevated risk of hyperfibrinolysis, increased blood loss, and higher transfusion requirements upon graft reperfusion, compared with livers donated after brain death (DBD). METHODS A retrospective single-center analysis of all adult recipients of primary liver transplantation between 2000 and 2019 was performed (total cohort n = 628). Propensity score matching was used to balance baseline characteristics for DCD and DBD liver recipients (propensity score matching cohort n = 218). Intraoperative and postoperative hemostatic variables between DCD and DBD liver recipients were subsequently compared. Additionally, in vitro plasma analyses were performed to compare the intraoperative fibrinolytic state upon reperfusion. RESULTS No significant differences in median (interquartile range) postreperfusion blood loss (1.2 L [0.5-2.2] versus 1.3 L [0.6-2.2]; P = 0.62), red blood cell transfusion (2 units [0-4] versus 1.1 units [0-3]; P = 0.21), or fresh frozen plasma transfusion requirements (0 unit [0-2.2] versus 0 unit [0-0.9]; P = 0.11) were seen in DCD compared with DBD recipients, respectively. Furthermore, plasma fibrinolytic potential was similar in both groups. CONCLUSIONS Transplantation of controlled DCD liver grafts does not result in higher intraoperative blood loss or more transfusion requirements, compared with DBD liver transplantation. In accordance with this, no evidence for increased hyperfibrinolysis upon reperfusion in DCD compared with DBD liver grafts was found.
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Affiliation(s)
- Shanice A Karangwa
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jelle Adelmeijer
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ton Lisman
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincent E de Meijer
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruben H de Kleine
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Koen M E M Reyntjens
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert J Porte
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marieke T de Boer
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, Section of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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9
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van der Heijde N, Lof S, Busch OR, de Hingh I, de Kleine RH, Molenaar IQ, Mungroop TH, Stommel MW, Besselink MG, van Eijck C. Incidence and impact of postoperative pancreatic fistula after minimally invasive and open distal pancreatectomy. Surgery 2021; 171:1658-1664. [PMID: 34906371 DOI: 10.1016/j.surg.2021.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies reported a higher rate of postoperative pancreatic fistula after minimally invasive distal pancreatectomy compared to open distal pancreatectomy. It is unknown whether the clinical impact of postoperative pancreatic fistula after minimally invasive distal pancreatectomy is comparable with that after open distal pancreatectomy. We aimed to compare not only the incidence of postoperative pancreatic fistula, but more importantly, also its clinical impact. METHODS This is a post hoc analysis of a multicenter randomized trial investigating a possible beneficial impact of a fibrin patch on the rate of clinically relevant postoperative pancreatic fistula (International Study Group for Pancreatic Surgery grade B/C) after distal pancreatectomy. Primary outcomes of the current analysis are the incidence and clinical impact of postoperative pancreatic fistula after both minimally invasive distal pancreatectomy and open distal pancreatectomy. RESULTS From October 2010 to August 2017, 252 patients undergoing distal pancreatectomy were randomized, and data of 247 patients were available for analysis: 87 minimally invasive distal pancreatectomy and 160 open distal pancreatectomies. The postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was significantly higher than that after open distal pancreatectomy (28.7% vs 16.9%, P = .029). More patients were discharged with an abdominal surgical drain after minimally invasive distal pancreatectomy compared to open distal pancreatectomy (30/87, 34.5% vs 26/160, 16.5%, P = .001). In patients with postoperative pancreatic fistula, additional percutaneous catheter drainage procedures were performed less often (52% vs 84.6%, P = .012), with fewer drainage procedures (median [range], 2 [1-4] vs 2, [1-7], P = .014) after minimally invasive distal pancreatectomy. CONCLUSION In this post hoc analysis, the postoperative pancreatic fistula rate after minimally invasive distal pancreatectomy was higher than that after open distal pancreatectomy, whereas the clinical impact was less.
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Affiliation(s)
- Nicky van der Heijde
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Sanne Lof
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Ignace de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - I Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht and St Antonius Hospital Nieuwegein, The Netherlands
| | - Timothy H Mungroop
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | | | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Casper van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
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10
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Verhagen MV, Levolger S, Hulshoff JB, Werner MJM, van der Doef HPJ, Viddeleer AR, de Kleine RH, de Haas RJ. Utility of Preoperative Computed Tomography-Based Body Metrics in Relation to Postoperative Complications in Pediatric Liver Transplantation Recipients. Liver Transpl 2021; 27:1779-1787. [PMID: 34118133 PMCID: PMC9291866 DOI: 10.1002/lt.26205] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/13/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 01/13/2023]
Abstract
Computed tomography (CT)-derived body metrics such as skeletal muscle index (SMI), psoas muscle index (PMI), and subcutaneous fat area index (ScFI) are measurable components of sarcopenia, frailty, and nutrition. While these body metrics are advocated in adults for predicting postoperative outcomes after liver transplantation (LT), little is known about their value in pediatric populations. This study assessed the relation between preoperative CT-based body metrics and postoperative short-term outcomes in pediatric LT recipients. Patients aged 0-18 years who underwent a primary LT were retrospectively included (n = 101; median age 0.5 years; range 0.2-17.1). SMI, PMI, and ScFI were derived from preoperative axial CT slices. Postoperative outcomes and complications within 90 days were correlated with the CT-based body metrics. To classify postoperative infections, the Clavien-Dindo (CD) classification was used. Subgroup analyses were performed for age groups (<1, 1-10, and >10 years old). An optimal threshold for test performance was defined using Youden's J-statistic and receiver operating characteristic curve as appropriate. ScFI was significantly (P = 0.001) correlated with moderate to severe postoperative infections (CD grade 3-5) in children aged <1 year, with the optimal ScFI threshold being ≤27.1 cm2 /m2 (sensitivity 80.4% and specificity 77.8%). A weak negative correlation between SMI and the total duration of hospital stay (R = -0.3; P = 0.01) and intensive care unit (ICU) stay (R = -0.3; P = 0.01) was observed in children aged <1 year. No other associations between CT-based body metrics and postoperative outcomes were shown. In children aged <1 year with cirrhotic liver disease undergoing LT, preoperative CT-based body metrics were correlated with moderate to severe postoperative infections (ScFI) and with longer duration of hospital and ICU stay (SMI), and thus can be considered important tools for pre-LT risk assessment.
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Affiliation(s)
- Martijn V. Verhagen
- Department of RadiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Stef Levolger
- Department of RadiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Jan Binne Hulshoff
- Department of RadiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Maureen J. M. Werner
- Department of Hepatobiliary Surgery and Liver TransplantationUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Hubert P. J. van der Doef
- Department of Pediatric GastroenterologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Alain R. Viddeleer
- Department of RadiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Ruben H. de Kleine
- Department of Hepatobiliary Surgery and Liver TransplantationUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Robbert J. de Haas
- Department of RadiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
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11
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Verhagen MV, Dikkers R, de Kleine RH, Kwee TC, van der Doef HPJ, de Haas RJ. Assessment of hepatic artery anatomy in pediatric liver transplant recipients: MR angiography versus CT angiography. Pediatr Transplant 2021; 25:e14002. [PMID: 33729659 DOI: 10.1111/petr.14002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
During LT screening, children undergo CTA to determine hepatic artery anatomy. However, CTA imparts radiation, unlike MRA. The aim was to compare MRA to CTA in assessing hepatic artery anatomy in pediatric LT recipients. Twenty-one children (median age 8.9 years) who underwent both CTA and fl3D-ce MRA before LT were retrospectively included. Interreader variability between 2 radiologists, image quality, movement artifacts, and confidence scores, were used to compare MRA to CTA. Subgroup analyses for ages <6 years and ≥6 years were performed. Interreader variability for MRA and CTA in children <6 years was comparable (k = 0.839 and k = 0.757, respectively), while in children ≥6 years CTA was superior to MRA (k 1.000 and k 0.000, respectively). Overall image quality and confidence scores of CTA were significantly higher compared to MRA at all ages (2.8/3 vs. 2.3/3, p = .001; and 2.9/3 vs. 2.5/3, p = .003, respectively). Movement artifacts were significantly lower in CTA compared to MRA in children ≥6 years (1.0/3 vs. 1.7/3, p = .010, respectively). CTA is preferred over fl3D-ce MRA for the preoperative assessment of hepatic artery anatomy in children receiving LT, both at ages <6 years and ≥6 years.
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Affiliation(s)
- Martijn V Verhagen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riksta Dikkers
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Surgery, Section HPB Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubert P J van der Doef
- Department of Pediatric Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Nomden M, van Wessel DBE, Ioannou S, Verkade HJ, de Kleine RH, Alizadeh BZ, Bruggink JLM, Hulscher JBF. A Higher Incidence of Isolated Biliary Atresia in Rural Areas: Results From an Epidemiological Study in The Netherlands. J Pediatr Gastroenterol Nutr 2021; 72:202-209. [PMID: 32833894 DOI: 10.1097/mpg.0000000000002916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Environmental factors may be involved in the pathogenesis of biliary atresia (BA). This epidemiological study aimed to analyze the relationships between the incidence of BA, the incidence of confirmed viral or bacterial infections and population density, and geographical and temporal clustering of BA in the Netherlands. STUDY DESIGN Correlations between the monthly incidence of BA and the number of confirmed infections were assessed. BA incidence per province was calculated and compared to the province with highest population density. Birthplaces were classified as rural or urban. Temporal clustering of month of birth and month of conception were analyzed. We performed analyses for isolated BA (IBA) and syndromic BA (SBA) separately. Chi2, logistic regression, and Walter and Elwood test were used. RESULTS A total of 262 IBA and 49 SBA patients, born between 1987 and 2018, were included. IBA incidence correlated to the number of confirmed infections of, for example, Chlamydia trachomatis (R = 0.14; P = 0.02) and adenovirus (R = 0.22; P = 0.005). We observed a higher incidence of IBA (0.75/10,000; odds ratio [OR] = 1.86; P = 0.04) and SBA (0.27/10,000; OR = 6.91; P = 0.001) in Groningen and a higher incidence of SBA in Gelderland (0.13/10,000; OR = 3.35; P = 0.03). IBA incidence was 68% higher in rural (0.67/10,000) versus urban areas (0.40/10,000) (P = 0.02). The estimated month of conception of patients with SBA clustered in November (85% increase compared to average SBA incidence [0.09/10,000; P = 0.04]). CONCLUSIONS IBA incidence correlated weakly with national confirmed infections. IBA and SBA incidence varied geographically in the Netherlands. IBA incidence was higher in rural than in urban areas, which may be explained decreased exposure to pathogens. Our results provide support for a role of environmental factors in the pathogenesis of IBA.
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Affiliation(s)
- Mark Nomden
- Section of Paediatric Surgery, Department of Surgery, University Medical Centre Groningen
| | - Daan B E van Wessel
- Section of Paediatric Surgery, Department of Surgery, University Medical Centre Groningen
| | - Solomon Ioannou
- Department of Epidemiology, University Medical Centre Groningen
| | - Henkjan J Verkade
- Section of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen
| | - Ruben H de Kleine
- Section of Hepato-pancreatic-biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Janneke L M Bruggink
- Section of Paediatric Surgery, Department of Surgery, University Medical Centre Groningen
| | - Jan B F Hulscher
- Section of Paediatric Surgery, Department of Surgery, University Medical Centre Groningen
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13
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de Kleine RH, Schreuder AM, ten Hove A, Hulscher JBF, Borel Rinkes IHM, Dejong CHC, de Jonge J, de Reuver P, Erdmann J, Kazemier G, van Gulik TM, Gouw ASH, Porte RJ. Choledochal malformations in adults in the Netherlands: Results from a nationwide retrospective cohort study. Liver Int 2020; 40:2469-2475. [PMID: 32562356 PMCID: PMC7540385 DOI: 10.1111/liv.14568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patients with a choledochal malformation, formerly described as cysts, are at increased risk of developing a cholangiocarcinoma and resection is recommended. Given the low incidence of choledochal malformation (CM) in Western countries, the incidence in these countries is unclear. Our aim was to assess the incidence of malignancy in CM patients and to assess postoperative outcome. METHODS In a nationwide, retrospective study, all adult patients who underwent surgery for CM between 1990 and 2016 were included. Patients were identified through the Dutch Pathology Registry and local patient records and were analysed to determine the incidence of malignancy, as well as postoperative mortality and morbidity. RESULTS A total of 123 patients with a CM were included in the study (Todani Type I, n = 71; Type II, n = 10; Type III, n = 3; Type IV, n = 27; unknown, n = 12). Median age was 40 years (range 18-70) and 81% were female. The majority of patients (99/123) underwent extrahepatic bile duct resection, with additional liver parenchyma resections in eight patients, only exploration in two, and a local cyst resection in eight patients. Postoperative 30-day mortality was 2% (2/123) and limited to patients who underwent liver resection. Severe morbidity occurred in 24%. In 14 of the 123 patients (11%), a malignancy was found in the resected specimen. One patient developed a periampullary malignancy 7 years later. CONCLUSIONS In a large Western series of CM patients, 11% were found to have a malignancy. This justifies resection in these patients, despite the risk of morbidity (24%) and mortality (2%).
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Affiliation(s)
- Ruben H. de Kleine
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - A. Marthe Schreuder
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Anneke ten Hove
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Jan B. F. Hulscher
- Division of Pediatric surgeryDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | | | - Cornelis H. C. Dejong
- Department of SurgeryUniversity Medical Center MaastrichtMaastrichtthe Netherlands,Department of SurgeryRWTH Uniklinikum AachenAachenGermany
| | - Jeroen de Jonge
- Department of SurgeryErasmus Medical CenterRotterdamthe Netherlands
| | - Philip de Reuver
- Department of SurgeryRadboud University Nijmegen Medical CenterNijmegenthe Netherlands
| | - Joris Erdmann
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands,Department of SurgeryUniversity of LeidenLeiden University Medical CenterLeidenthe Netherlands
| | - Geert Kazemier
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCAmsterdamthe Netherlands
| | - the PALGA Foundation
- PALGA Foundation. The nationwide network and registry of histo‐ and cytopathology in the Netherlands
| | - Thomas M. van Gulik
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Annette S. H. Gouw
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Robert J. Porte
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationDepartment of SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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14
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Rodijk LH, Schins EMW, Witvliet MJ, Verkade HJ, de Kleine RH, Hulscher JBF, Bruggink JLM. Health-Related Quality of Life in Biliary Atresia Patients with Native Liver or Transplantation. Eur J Pediatr Surg 2020; 30:261-272. [PMID: 32629498 DOI: 10.1055/s-0040-1712932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We aimed to assess health-related quality of life (HrQoL) in biliary atresia (BA) patients, based on original data and a literature review, and to determine factors associated with their HrQoL. MATERIALS AND METHODS We reviewed available studies describing HrQoL in BA patients. We assessed HrQoL in Dutch BA patients (6-16 years) using the validated Child Health Questionnaire. We compared HrQoL scores in BA patients with healthy peers and with children who had undergone major surgery in infancy or children with chronic conditions. We determined the relationship between specific patient-related factors and HrQoL. RESULTS Literature data indicated that HrQoL in children with BA is lower than in healthy peers. In Dutch BA patients (n = 38; age 10 ± 3 years), parent-proxy physical HrQoL (48 ± 11) was significantly lower compared with two reference groups of healthy peers (59 ± 4 and 56 ± 6, respectively, each p < 0.001), and lower than in children with attention deficit hyperactivity disorder (60 ± 5), asthma (54 ± 6), attending a cardiology clinic (52 ± n/r), congenital diaphragmatic hernia (53 ± 7) or D-transposition of the great arteries (54 ± 6; all p < 0.05). Psychosocial HrQoL (50 ± 9) was lower than in healthy peers (54 ± 6, p = 0.02, and 53 ± 6, p = 0.07) and children with asthma (54 ± 6, p = 0.02), and largely comparable to children with other chronic conditions. Parent-proxy physical HrQoL was adversely related to adverse medical event in the past year, special education, and motor impairments; psychosocial HrQoL was adversely related to behavioral problems. CONCLUSION Children with BA are at risk of impaired HrQoL. Special attention is warranted for children with adverse medical events and special education.
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Affiliation(s)
- Lyan H Rodijk
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Eke M W Schins
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatrics, Section of Gastroenterology/Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan B F Hulscher
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Janneke L M Bruggink
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands
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15
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Abstract
INTRODUCTION Portal hypertension often occurs in biliary atresia (BA). The subsequent development of esophageal varices and bleeding from these varices are a well-known complication. We aim to describe the incidence and severity of variceal bleeding in patients with BA. In addition, we describe the characteristics of patients who experienced variceal bleeds. MATERIALS AND METHODS We included all infants treated for BA at our center between March 1987 and August 2015. Variceal bleeding was defined as hematemesis and/or melena with presence of varices at endoscopy. Findings at endoscopy and ultrasound, laboratory tests, clearance of jaundice, fibrosis-grade at Kasai portoenterostomy, and several varices prediction scores were documented. Routine endoscopies were not performed. RESULTS In this study, 74 patients were included. During follow-up, 18 out of 74 patients (24%) developed variceal bleeding at an age of 9 months (range, 4-111). Twelve patients were listed for liver transplantation at the time of bleeding. Patients who did not clear their jaundice developed variceal bleeds more often and earlier in life. Bleeds were treated with sclerotherapy, banding, or octreotide. Four patients did not receive treatment. No bleeding-related mortality occurred. CONCLUSION One-fourth of the children diagnosed with BA experience variceal bleeds during follow-up. Most of these children are younger than 1 year and often already listed for transplantation. Major complications did not occur after variceal bleeding.
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Affiliation(s)
- Daan B van Wessel
- Department of Pediatric Surgery, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Mauri Witt
- Department of Pediatric Surgery, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Niels Bax
- Department of Pediatric Surgery, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - René Scheenstra
- Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan B Hulscher
- Department of Pediatric Surgery, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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16
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van den Eijnden MHA, de Kleine RH, de Blaauw I, Peeters PMJG, Koot BGP, Oomen MWN, Sloots CEJ, van Gemert WG, van der Zee DC, van Heurn LWE, Verkade HJ, Wilde JCH, Hulscher JBF. The timing of surgery of antenatally diagnosed choledochal malformations: A descriptive analysis of a 26-year nationwide cohort. J Pediatr Surg 2017; 52:1156-1160. [PMID: 28318597 DOI: 10.1016/j.jpedsurg.2017.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 06/27/2016] [Revised: 01/23/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Choledochal malformations (CMs) are increasingly diagnosed antenatally. There is a dilemma between early surgery to prevent CM-related symptoms and postponing surgery to reduce complications. We aimed to identify the optimal timing of surgery in asymptomatic neonates with antenatally diagnosed CM and to identify predictors for development of symptoms. METHODS Using the Netherlands Study group on CHoledochal Cyst/malformation (NeSCHoc) we retrospectively collected demographic, biochemical and surgical data from all Dutch patients with an antenatally detected CM. RESULTS Between 1989 and 2014, antenatally suspected CM was confirmed in 17 patients at a median age of 10days (1day-2months). Four patients developed symptoms directly after birth (24%). Thirteen patients (76%) remained asymptomatic. Two of these progressed to symptoms before surgical intervention at 0.7 and 2.1months resp. Postoperatively, four patients developed short-term complications and three developed long-term complications. Patients <5.6kg (the series median) showed more short-term complications (66%) when compared to patients >5.6kg (0%, p=0.02). CONCLUSION When not symptomatic within the first days of life, the majority of children with antenatally detected CM remains asymptomatic. Surgery might safely be delayed to the age of 6months or a weight of 6kg. Postponing surgery in the clinically and biochemical asymptomatic patient might decrease the complication rate. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
| | - Maria H A van den Eijnden
- Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Paul M J G Peeters
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart G P Koot
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Matthijs W N Oomen
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wim G van Gemert
- Department of Pediatric Surgery, University Medical Center Maastricht, Maastricht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jim C H Wilde
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Jan B F Hulscher
- Department of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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de Rooij T, van Hilst J, Vogel JA, van Santvoort HC, de Boer MT, Boerma D, van den Boezem PB, Bonsing BA, Bosscha K, Coene PP, Daams F, van Dam RM, Dijkgraaf MG, van Eijck CH, Festen S, Gerhards MF, Groot Koerkamp B, Hagendoorn J, van der Harst E, de Hingh IH, Dejong CH, Kazemier G, Klaase J, de Kleine RH, van Laarhoven CJ, Lips DJ, Luyer MD, Molenaar IQ, Nieuwenhuijs VB, Patijn GA, Roos D, Scheepers JJ, van der Schelling GP, Steenvoorde P, Swijnenburg RJ, Wijsman JH, Abu Hilal M, Busch OR, Besselink MG. Minimally invasive versus open distal pancreatectomy (LEOPARD): study protocol for a randomized controlled trial. Trials 2017; 18:166. [PMID: 28388963 PMCID: PMC5385082 DOI: 10.1186/s13063-017-1892-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 12/15/2016] [Accepted: 03/08/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Observational cohort studies have suggested that minimally invasive distal pancreatectomy (MIDP) is associated with better short-term outcomes compared with open distal pancreatectomy (ODP), such as less intraoperative blood loss, lower morbidity, shorter length of hospital stay, and reduced total costs. Confounding by indication has probably influenced these findings, given that case-matched studies failed to confirm the superiority of MIDP. This accentuates the need for multicenter randomized controlled trials, which are currently lacking. We hypothesize that time to functional recovery is shorter after MIDP compared with ODP even in an enhanced recovery setting. METHODS LEOPARD is a randomized controlled, parallel-group, patient-blinded, multicenter, superiority trial in all 17 centers of the Dutch Pancreatic Cancer Group. A total of 102 patients with symptomatic benign, premalignant or malignant disease will be randomly allocated to undergo MIDP or ODP in an enhanced recovery setting. The primary outcome is time (days) to functional recovery, defined as all of the following: independently mobile at the preoperative level, sufficient pain control with oral medication alone, ability to maintain sufficient (i.e. >50%) daily required caloric intake, no intravenous fluid administration and no signs of infection. Secondary outcomes are operative and postoperative outcomes, including clinically relevant complications, mortality, quality of life and costs. DISCUSSION The LEOPARD trial is designed to investigate whether MIDP reduces the time to functional recovery compared with ODP in an enhanced recovery setting. TRIAL REGISTRATION Dutch Trial Register, NTR5188 . Registered on 9 April 2015.
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Affiliation(s)
- Thijs de Rooij
- Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, AZ 1105, The Netherlands
| | - Jony van Hilst
- Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, AZ 1105, The Netherlands
| | - Jantien A Vogel
- Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, AZ 1105, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, PO Box 2500, Nieuwegein, EM 3430, The Netherlands
| | - Marieke T de Boer
- Department of Surgery, University Medical Center Groningen, PO Box 30 001, Groningen, RB 9700, The Netherlands
| | - Djamila Boerma
- Department of Surgery, St Antonius Hospital, PO Box 2500, Nieuwegein, EM 3430, The Netherlands
| | - Peter B van den Boezem
- Department of Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, HB 6500, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, PO Box 9600, Leiden, ZA 2333, The Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, PO Box 90153, Den Bosch, ME 5200, The Netherlands
| | - Peter-Paul Coene
- Department of Surgery, Maasstad Hospital, PO Box 9100, Rotterdam, AC 3007, The Netherlands
| | - Freek Daams
- Department of Surgery, VU University Medical Center, PO Box 7057, Amsterdam, HV 1081, The Netherlands
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical Center, PO Box 5800, Maastricht, AZ 6202, The Netherlands
| | - Marcel G Dijkgraaf
- Clinical Research Unit, Academic Medical Center, PO Box 22660, Amsterdam, DD 1100, The Netherlands
| | - Casper H van Eijck
- Department of Surgery, Erasmus University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Sebastiaan Festen
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, PO Box 95500, Amsterdam, HM 1090, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, PO Box 95500, Amsterdam, HM 1090, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, PO Box 85 500, Utrecht, GA 3508, The Netherlands
| | - Erwin van der Harst
- Department of Surgery, Maasstad Hospital, PO Box 9100, Rotterdam, AC 3007, The Netherlands
| | - Ignace H de Hingh
- Department of Surgery, Catharina Hospital, PO Box 1350, Eindhoven, ZA 5602, The Netherlands
| | - Cees H Dejong
- Department of Surgery, Maastricht University Medical Center, PO Box 5800, Maastricht, AZ 6202, The Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, PO Box 5800, Maastricht, AZ 6202, The Netherlands
| | - Geert Kazemier
- Department of Surgery, VU University Medical Center, PO Box 7057, Amsterdam, HV 1081, The Netherlands
| | - Joost Klaase
- Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, Enschede, KA 7500, The Netherlands
| | - Ruben H de Kleine
- Department of Surgery, University Medical Center Groningen, PO Box 30 001, Groningen, RB 9700, The Netherlands
| | - Cornelis J van Laarhoven
- Department of Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, Nijmegen, HB 6500, The Netherlands
| | - Daan J Lips
- Department of Surgery, Jeroen Bosch Hospital, PO Box 90153, Den Bosch, ME 5200, The Netherlands
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital, PO Box 1350, Eindhoven, ZA 5602, The Netherlands
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht, PO Box 85 500, Utrecht, GA 3508, The Netherlands
| | | | - Gijs A Patijn
- Department of Surgery, Isala Clinics, PO Box 10 400, Zwolle, AB 8025, The Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graag Gasthuis, PO Box 5011, Delft, GA 2600, The Netherlands
| | - Joris J Scheepers
- Department of Surgery, Reinier de Graag Gasthuis, PO Box 5011, Delft, GA 2600, The Netherlands
| | | | - Pascal Steenvoorde
- Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, Enschede, KA 7500, The Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Leiden University Medical Center, PO Box 9600, Leiden, ZA 2333, The Netherlands
| | - Jan H Wijsman
- Department of Surgery, Amphia Hospital, PO Box 90 158, Breda, RK 4800, The Netherlands
| | - Moh'd Abu Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, SO166YD, UK
| | - Olivier R Busch
- Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, DD 1100, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, PO Box 22660, Amsterdam, DD 1100, The Netherlands.
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Wilke MVMB, de Kleine RH, Wietasch JKG, van Amerongen CCA, Blokzijl H, van Spronsen FJ, Schwartz IVD, Derks TGJ. Orthotopic Liver Transplantation in Glycogen Storage Disease Type 1a. Journal of Inborn Errors of Metabolism and Screening 2016. [DOI: 10.1177/2326409816649599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Matheus V. M. B. Wilke
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ruben H. de Kleine
- Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J. K. G. Wietasch
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Cynthia C. A. van Amerongen
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Francjan J. van Spronsen
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ida V. D. Schwartz
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Genetics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Terry G. J. Derks
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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19
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Mantel HTJ, Westerkamp AC, Sieders E, Peeters PMJG, de Jong KP, Boer MT, de Kleine RH, Gouw ASH, Porte RJ. Intraoperative frozen section analysis of the proximal bile ducts in hilar cholangiocarcinoma is of limited value. Cancer Med 2016; 5:1373-80. [PMID: 27062713 PMCID: PMC4944862 DOI: 10.1002/cam4.693] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/13/2016] [Accepted: 02/08/2016] [Indexed: 12/17/2022] Open
Abstract
Frozen section analysis (FS) during cancer surgery is widely used to assess resection margins. However, in hilar cholangiocarcinoma (HCCA), FS may be less reliable because of the specific growth characteristics of the tumor. The aim of this study was to determine the accuracy and consequences of intraoperative FS of the proximal bile duct margins in HCCA. Between 1990 and 2014, 67 patients underwent combined extrahepatic bile duct resection and partial liver resection for HCCA with the use of FS. Sensitivity and specificity of FS was 68% and 97%, respectively. Seventeen of 67 patients (25%) displayed a positive bile duct margin at FS. The false‐negative rate was 16% (eight patients). Ten patients (15%) with a positive bile duct margin underwent an additional resection in an attempt to achieve negative margins, which succeeded in three patients (4%). However, only one of these three patients did not have concomitant lymph node metastases, which are associated with a poor prognosis by itself. The use of FS of the proximal bile duct is of limited clinical value because of the relatively low sensitivity, high risk of false‐negative results, and the low rate of secondary obtained tumor‐free resection margins. Supported by the literature, a new approach to the use of FS in HCCA should be adopted, reserving the technique only for cases in which a substantial additional resection is possible.
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Affiliation(s)
- Hendrik T J Mantel
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrie C Westerkamp
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Egbert Sieders
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M J G Peeters
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koert P de Jong
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke T Boer
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette S H Gouw
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J Porte
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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van den Eijnden MHA, de Kleine RH, Verkade HJ, Wilde JCH, Peeters PMJG, Hulscher JBF. Controversies in Choledochal Malformations: A Survey among Dutch Pediatric Surgeons. Eur J Pediatr Surg 2015; 25:441-8. [PMID: 25344941 DOI: 10.1055/s-0034-1387947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND Choledochal malformation (CM) is a rare medical condition of which 80% are diagnosed in pediatric patients. There are several important controversies regarding diagnostic workup, management, and follow-up in these pediatric patients. To assess preferences and practices of Dutch pediatric surgeons regarding the diagnostic procedures, management, and follow-up of children with CM we conducted an electronic survey. METHODS A questionnaire was sent to all the pediatric surgeons working in the academic centers and the only community hospital with a pediatric surgery service. The questionnaire included, items regarding incidence, diagnostic workup, interval between diagnosis and surgery, surgical techniques, and follow-up. We also assessed whether personal exposure influenced the preferences and practices. RESULTS Overall 22 out of the 31 (71%) Dutch pediatric surgeons returned the questionnaire. Total 15 out of 22 (68%) encountered CM up to 2 times/y, whereas 7 out of 22 (32%) encountered it more than 2 times/y. Indications for surgery were significantly different between surgeons who encountered CM > 2 time/y versus those who did not: 6/6 (100%) of surgeons encountering CM > 2 times/y considered the presence of an asymptomatic CM an indication for surgery versus 5/14 (36%) of the pediatric surgeons who encountered a CM up to 2 times/y (p = 0.01). Overall 12 out of the 22 (55%) respondents preferred surgery between 6 months and 2 years of age. The amount of exposure did not differ in preferred age at surgery or surgical technique. In the symptomatic child 10/22 (45%) of respondents preferred surgery within 3 months. Overall 7/22 (32%) favored laparoscopic resection. Hepaticojejunostomy with Roux-en-Y reconstruction was the preferred reconstruction for all the respondents. One-third stated that they never performed a parenchyma resection. Follow-up was limited to 10 years in almost half of the respondents. CONCLUSION Dutch pediatric surgeons demonstrate a wide variety of opinions regarding diagnostic workup, treatment, and follow-up of CM. While most surgeons encounter CM up to 2 times/y, there is an association between exposure and several of the outcome parameters. Some of the answers are not in line with the expert opinion. This demonstrates that there is a need for evidence-based (inter)national guidelines regarding the diagnostic approach, management, and follow-up.
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Affiliation(s)
| | - Ruben H de Kleine
- Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Henkjan J Verkade
- Department of Paediatrics, University Medical Center Groningen, Groningen, The Netherlands
| | - Jim C H Wilde
- Department of Pediatric Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Paul M J G Peeters
- Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan B F Hulscher
- Department of Pediatric Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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21
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Janssen MCH, de Kleine RH, van den Berg AP, Heijdra Y, van Scherpenzeel M, Lefeber DJ, Morava E. Successful liver transplantation and long-term follow-up in a patient with MPI-CDG. Pediatrics 2014; 134:e279-83. [PMID: 24982104 DOI: 10.1542/peds.2013-2732] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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] [Indexed: 01/30/2023] Open
Abstract
Hepatopathy is the most common feature in the Congenital Disorders of Glycosylation (CDG). More than 70 subtypes have been identified in this growing group of inborn errors. Most defects present as multisystem disease, whereas phosphomannose isomerase deficiency (MPI-CDG) presents with exclusive hepato-intestinal phenotype. MPI-CDG has been considered as one of the very few treatable disorders of glycosylation; several patients showed significant improvement of their life-threatening protein-losing enteropathy and coagulation disorder on oral mannose supplementation therapy. However, patients who have MPI-CDG develop progressive liver insufficiency during a later course of disease. A patient who had MPI-CDG developed progressive liver fibrosis, despite oral mannose supplementation and repeated fractionated heparin therapy. She showed mannose therapy-associated hemolytic jaundice. She developed severe dyspnea and exercise intolerance owing to pulmonary involvement, necessitating liver transplant. After transplantation her physical exercise tolerance, pulmonary functions, and metabolic parameters became fully restored. She is still doing well 2 years after transplantation now. In conclusion, we here report on the first successful liver transplantation in CDG.
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Affiliation(s)
| | | | - Arie P van den Berg
- Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, Netherlands; and
| | | | - Monique van Scherpenzeel
- Neurology, andLaboratory of Genetic, Endocrine, and Metabolic Disease, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Dirk J Lefeber
- Neurology, andLaboratory of Genetic, Endocrine, and Metabolic Disease, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Eva Morava
- Tulane Hayward Genetics Centre, New Orleans, Louisiana
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Bakker AD, Kroeze RJ, Korstjens C, de Kleine RH, Frölke JPM, Klein-Nulend J. Reaming debris as a novel source of autologous bone to enhance healing of bone defects. J Biomed Mater Res A 2011; 97:457-65. [PMID: 21491583 DOI: 10.1002/jbm.a.33080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/11/2011] [Accepted: 01/19/2011] [Indexed: 11/06/2022]
Abstract
Reaming debris is formed when bone defects are stabilized with an intramedullary nail, and contains viable osteoblast-like cells and growth factors, and might thus act as a natural osteoinductive scaffold. The advantage of using reaming debris over stem cells or autologous bone for healing bone defects is that no extra surgery is needed to obtain the material. To assess the clinical feasibility of using reaming debris to enhance bone healing, we investigated whether reaming debris enhances the healing rate of a bone defect in sheep tibia, compared to an empty gap. As golden standard the defect was filled with iliac crest bone. Bones treated with iliac crest bone and reaming debris showed larger callus volume, increased bone volume, and decreased cartilage volume in the fracture gap, and increased torsional toughness compared to the empty gap group at 3 weeks postoperative. In addition, bones treated with reaming debris showed increased torsional stiffness at 6 weeks postoperatively compared to the empty defect group, while bending stiffness was marginally increased. These results indicate that reaming debris could serve as an excellent alternative to iliac crest bone for speeding up the healing process in bone defects that are treated with an intramedullary nail.
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Affiliation(s)
- Astrid D Bakker
- Department of Oral Cell Biology, ACTA-University of Amsterdam and VU University Amsterdam, Research Institute MOVE, Amsterdam, The Netherlands.
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