Longterm results of liver transplantation from donation after circulatory death.
; DETRY, Olivier ; et al
in Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (2016), 22(8), 1107-14
Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type ... [more ▼]
Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P < 0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD. [less ▲]Detailed reference viewed: 13 (2 ULg)
Belgian multicenter experience with intestinal transplantation.
; ; DE ROOVER, Arnaud et al
in Transplant international : official journal of the European Society for Organ Transplantation (2015), 28
Intestinal transplantation (ITx) has evolved from an experimental procedure towards a clinical reality but remains a challenging procedure. The aim of this survey was to analyze the multicenter Belgian ... [more ▼]
Intestinal transplantation (ITx) has evolved from an experimental procedure towards a clinical reality but remains a challenging procedure. The aim of this survey was to analyze the multicenter Belgian ITx-experience. From 1999-2014, 24 ITx in 23 patients were performed in Belgium, divided over 5 centers. Median recipient age was 38 years (8 months-57 years); male/female ratio was 13/10; 6 were children and 17 adults. Intestinal failure was related to intestinal ischemia(n=5), volvulus(n=5), splanchnic thrombosis(n=4), Crohn(n=2), pseudo-obstruction(n=2), microvillus inclusion(n=2), Churg-Strauss(n=1), necrotizing enterocolitis(n=1), intestinal atresia(n=1) and chronic rejection(n=1). Graft-type was isolated ITx(n=9), combined liver-ITx(n=11) and multivisceralTx(n=4). One was a living donor-related transplantation and five patients received simultaneously a kidney graft. Early acute rejection occurred in 8; late acute rejection in 4 and chronic rejection in 2. Two patients developed a post-transplant lymphoproliferative disease. Nine patients have died. Among 14 survivors at last follow-up, 11 have been transplanted for more than 1 year. None of the latter has developed renal failure and all were nutritionally independent with a Karnofsky score >90%. 1-/5-year patient and graft survivals were 71.1%/62.8% and 58.7%/53.1%, respectively. Based on this experience, ITx has come of age in Belgium as a life-saving and potentially quality of life restoring therapy. This article is protected by copyright. All rights reserved. [less ▲]Detailed reference viewed: 16 (2 ULg)
MULTICENTER BELGIAN SURVEY ON DONOR MORBIDITY AND MORTALITY IN ADULT-TO-ADULT LIVING DONOR LIVER TRANSPLANTATION
; ; et al
in Transplant International (2011, September), 24(2), 13-13Detailed reference viewed: 18 (1 ULg)