Does comfort therapy during controlled donation after circulatory death shorten the life of potential donors?
LEDOUX, Didier ; DELBOUILLE, Marie-Hélène ; DE ROOVER, Arnaud et al
in Clinical transplantation (2014), 28(1), 47-51
INTRODUCTION: Controlled donation after circulatory death (DCD) remains ethically controversial. The authors developed a controlled DCD protocol in which comfort therapy is regularly used. The aim of this ... [more ▼]
INTRODUCTION: Controlled donation after circulatory death (DCD) remains ethically controversial. The authors developed a controlled DCD protocol in which comfort therapy is regularly used. The aim of this study was to determine whether this policy shortens the DCD donors' life. METHODS: The authors retrospectively analyzed prospectively collected data on patients proposed for DCD at the University Hospital of Liege, Belgium, over a 56-month period. The survival duration of these patients, defined as duration between the time of proposal for DCD and the time of circulatory arrest, was compared between patients who actually donated organs and those who did not. RESULTS: About 128 patients were considered for controlled DCD and 54 (43%) became donors. Among the 74 non-donor patients, 34 (46%) objected to organ donation, 38 patients (51%) were denied by the transplant team for various medical reasons, and two potential DCD donors did not undergo procurement due to logistical and organizational reasons. The survival durations were similar in the DCD donor and non-donor groups. No non-donor patient survived. CONCLUSIONS: Survival of DCD donors is not shortened when compared with non-donor patients. These data support the ethical and respectful approach to potential DCD donors in the authors' center, including regular comfort therapy. [less ▲]Detailed reference viewed: 30 (6 ULg)
Prognostic value of 18f-fdg PET - CT in liver transplantation for hepatocarcinoma
MEURISSE, Nicolas ; DETRY, Olivier ; et al
Poster (2014)Detailed reference viewed: 13 (7 ULg)
Alcoholic liver disease: when to consider liver transplantation?
Scientific conference (2013, December 07)Detailed reference viewed: 21 (2 ULg)
DONATION AFTER CIRCULATORY DEATH INCREASES THE CADAVERIC DONOR POOL
; DE ROOVER, Arnaud ; SQUIFFLET, Jean-Paul et al
in Transplant International (2013, December), 26(S2), 54-101
Background: There is a controversy on the possibility to increase the organ donor pool by donation-after-circulatory-death (DCD) and the possible decrease in donation-after-brain-death (DBD) by DCD ... [more ▼]
Background: There is a controversy on the possibility to increase the organ donor pool by donation-after-circulatory-death (DCD) and the possible decrease in donation-after-brain-death (DBD) by DCD programs. Our aim is to report the DCD experience at the University Hospital of Liege, Belgium, from 2002 through 2012, in a donor region of about 1 million inhabitants. Methods: The prospective organ donor and recipient databases were retrospectively reviewed. Results: 94 and 331 procurements were performed from controlled DCD and DBD donors in the time period, respectively. DCD donors contributed to 22.1% of the deceased donor (DD) organ procurement activity from Jan 2002 to Dec 2012, and up to one-third annually since 2009. DCD liver and kidneys contributed 23.7% and 24.2% of the DD liver and kidney transplantation activity, respectively. There was no decrease of the DBD procurement in the study period. In 2012, overall 54 DD were procured in the Liege region, reaching a high procurement activity.Conclusions: Controlled DCD donors are a valuable source of transplantable liver and kidney grafts, and in our experience do not adversely affect DBD organ procurement activity. [less ▲]Detailed reference viewed: 67 (6 ULg)
DONATION AFTER CIRCULATORY DEATH LIVER TRANSPLANTATION: IS DONOR AGE AN ISSUE?
DETRY, Olivier ; ; HONORE, Pierre et al
in Transplant International (2013, December), 26(s2), 112-228
Background: Donation after circulatory death (DCD) donors > 55 years are usually not considered suitable for liver transplantation (LT). At our institute, age is not an absolute exclusion criterion to ... [more ▼]
Background: Donation after circulatory death (DCD) donors > 55 years are usually not considered suitable for liver transplantation (LT). At our institute, age is not an absolute exclusion criterion to refuse DCD liver grafts. We retrospectively compared the transplant outcome of patients receiving older DCD liver grafts to the younger ones. Methods: 70 DCD liver transplants have been performed from 2003 to 2012, which includes 32 liver grafts from younger donors <55y (group A), 20 between 56 and 69 years (group B), and 18 from older donors ≥70 years (group C). The three groups were compared in terms of donor and recipient demographics, procurement and transplantation conditions, peak laboratory values during the first post-transplant week and results at one and three years. Results are expressed as median IQR. Results: No difference other than age in donor and recipient characteristics as well as procurement conditions was noted between both groups. Median donor age of the group A was 44 (38-45) years, in group B 62 (60-64) years and 73 (71-75) in group C. Median primary warm ischemia time (WIT) were 20 (17-22), 21 (19-25) and 19 (16-23) min, respectively (NS). Median cold ischemia time (CIT) was 236 (229-294), 245 (227-290) and 210 (195-277) min, respectively (NS). Peak AST (UI/ml) was 1162 (1072-3971), 1416 (1006-2752), and 1067 (902-4037), respectively (NS). There was no primary nonfunction and one patient needed retransplantation for artery thrombosis. Biliary complications occurred similarly in both groups, without graft loss secondary to ischemic cholangiopathy. Graft and patient survivals were not different at one and three years. Conclusion: This study shows comparable results between DCD liver transplants from younger and older donors. Therefore donor age >55 years should not be a contraindication to DCD liver transplantation if other donor risk factors (such as WIT, CIT) are minimized. [less ▲]Detailed reference viewed: 34 (6 ULg)
IS ULTRA-SHORT COLD ISCHEMIA THE KEY TO ISCHEMIC CHOLANGIOPATHY AVOIDANCE IN DCD- LT?
DETRY, Olivier ; DE ROOVER, Arnaud ; et al
in Transplant International (2013, December), 26(S2), 53-98
Introduction: Donation after circulatory death (DCD) donors have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of ischemic ... [more ▼]
Introduction: Donation after circulatory death (DCD) donors have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of ischemic cholangiopathy leading to graft loss. The authors retrospectively reviewed a single centre experience with DCD-LT in a 9-year period. Patients and Methods: 70 DCD-LT were performed from 2003 to November 2012. All DCD procedures were performed in operative rooms. Median donor age was 59 years. Most grafts were flushed with HTK solution. Allocation was centre-based. Median total DCD warm ischemia was 19.5 min. Mean follow-up was 36 months. No patient was lost to follow-up. Results: Median MELD score at LT was 15. Median cold ischemia was 235 min. Median peak AST was 1,162 U/L. Median peak bilirubin was 31.2 mg/dL. Patient and graft survivals were 92.8% and 91.3% at one year and 79% and 77.7% at 3 years, respectively. One graft was lost due to hepatic artery thrombosis. No PNF or graft loss due to ischemic cholangiopathy was observed in this series. Causes of death were malignancies in 8 cases. Discussion: In this series, DCD LT appears to provide results equal to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]Detailed reference viewed: 25 (5 ULg)
Effects of Parecoxib on The Prevention of Postoperative Peritoneal Adhesions in Rats.
; ; et al
in Journal of Investigative Surgery : The Official Journal of the Academy of Surgical Research (2013), 26(6), 340-346
ABSTRACT Background: No systemic preventive therapy has been successful in inhibiting the development of postoperative peritoneal adhesions (PPAs). Objective: The aim of this study was to evaluate the ... [more ▼]
ABSTRACT Background: No systemic preventive therapy has been successful in inhibiting the development of postoperative peritoneal adhesions (PPAs). Objective: The aim of this study was to evaluate the potential effects of 5 day administration of parecoxib, on PPA prevention and on suture or wound healing in rats. Methods: In a model of PPAs induced by peritoneal electrical burn, 30 rats were randomized into 3 groups according to parecoxib administration route (control; intraperitoneal (IP); intramuscular (IM)). Plasma and peritoneal levels of PAI-1 and tPA were measured at T0, after 90 min of surgery (T90), and on postoperative day 10 (D10). In a cecum resection model, 20 rats were randomized into two groups (control and IP parecoxib), and abdominal wound healing and suture leakage were assessed at D10. In both models, PPAs were evaluated quantitatively and qualitatively on D10. Results: Administration of parecoxib significantly decreased the quantity (p < .05) and the severity (p < .01) of PPAs in both models. In addition, parecoxib administration did not cause healing defects or infectious complications in the two models. In the peritoneal burn model, IP or IM parecoxib administration inhibited the increase of postoperative plasma and peritoneum PAI-1 levels, an increase that was observed in the control group (p < .01). No anastomosis leakage could be demonstrated in both groups in the cecum resection model. Conclusion: This study showed that, in these rat models, parecoxib might reduce PPA formation. Confirmation of the safety of parecoxib on intestinal anastomoses is required and should be investigated in further animal models. [less ▲]Detailed reference viewed: 30 (5 ULg)
The key to success of the ULG DCD organ procurement program : the points of view of the intensivist, the anaesthesiologist and the surgeon
LEDOUX, Didier ; JORIS, Jean ; DETRY, Olivier
Scientific conference (2013, September 23)Detailed reference viewed: 37 (5 ULg)
How to perform the most minimal invasive cholecystectomy?
Conference (2013, September 20)
Twenty years ago, laparoscopy has totally transformed the surgical approach of the gallbladder. For those who were not in surgery at that time, it has to be reminded that most open cholecystectomies ... [more ▼]
Twenty years ago, laparoscopy has totally transformed the surgical approach of the gallbladder. For those who were not in surgery at that time, it has to be reminded that most open cholecystectomies performed in the 80’s required nasogastric tube for several days, surgical drain, and 5 to 8 days of hospitalisation. For these obvious advantages, laparoscopic cholecystectomy has become the “Gold Standard” without evidence by a randomised controlled study comparing open and laparoscopic techniques. These last years, some groups proposed variations of laparoscopic cholecystectomies that they presented as less invasive. In robotic surgery, the Da-Vinci device has been proposed without significant improvement since more than 10 years. To date, no interest of this Da-Vinci robot has been demonstrated in abdominal surgery. Its cost for acquisition, its yearly fee and the cost for each use render its use without proof of results totally inappropriate. Single-Incision Laparoscopic Surgery (SILS) has also been described to perform cholecystectomy with only one larger umbilical incision. Until now, no superiority of SILS on classical cholecystectomy has been demonstrated. The Natural Orifice Transluminal Endoscopic Surgery (NOTES) proposes to use the vagina, the stomach or the colon to remove the gallbladder. No prospective controlled comparison has proved the superiority of these approaches that sometimes do not reach common sense or usual surgical principles. What is a minimal invasive cholecystectomy? A safe and un expensive cholecystectomy, with a good anatomical exposure, a cholangiography, and a good surgical comfort allowing to perform several procedures in the same day; a cholecystectomy that can be performed as a day-case without complications; a cholecystectomy that can be performed laparoscopically in acute settings; a cholecystectomy without the risk of postoperative incisional hernia. In necessary, in young and thin woman, laparoscopic cholecystectomy may be performed using 2 mm trocars that allow a good triangulation but with minimal scars. [less ▲]Detailed reference viewed: 21 (2 ULg)
Mesenchymal Stem Cells in Solid Organ Transplantation (MiSOT) Fourth Meeting: Lessons Learned from First Clinical Trials.
; ; et al
in Transplantation (2013), 96(3), 234-238
The Fourth Expert Meeting of the Mesenchymal Stem Cells in Solid Organ Transplantation (MiSOT) Consortium took place in Barcelona on October 19 and 20, 2012. This meeting focused on the translation of ... [more ▼]
The Fourth Expert Meeting of the Mesenchymal Stem Cells in Solid Organ Transplantation (MiSOT) Consortium took place in Barcelona on October 19 and 20, 2012. This meeting focused on the translation of preclinical data into early clinical settings. This position paper highlights the main topics explored on the safety and efficacy of mesenchymal stem cells as a therapeutic agent in solid organ transplantation and emphasizes the issues (proper timing, concomitant immunossupression, source and immunogenicity of mesenchymal stem cells, and oncogenicity) that have been addressed and will be followed up by the MiSOT Consortium in future studies. [less ▲]Detailed reference viewed: 34 (3 ULg)
Mosquito net for abdominal wall repair: a comparison of their chemical, physical, morphological and mechanical properties to commercial meshes
Sevrin, Chantal ; ; et al
in Biomedica proceedings (2013, June 23)
Meshes are the actual standard in abdominal wall repair. Commercial medical meshes are however either unavailable or unaffordable too expensive for developing countries. Therefore in most resource-poor ... [more ▼]
Meshes are the actual standard in abdominal wall repair. Commercial medical meshes are however either unavailable or unaffordable too expensive for developing countries. Therefore in most resource-poor developing countries a traditional sutured repair is still commonplace although with significantly inferior results. Sterilized mosquito nets have been recently roposed by several authors to replace medical meshes in low-income countries . However in the perspective of their clinical use a better understanding of this mosquito net is obviously requested both in terms of material properties and of in vivo biocompatibility. [less ▲]Detailed reference viewed: 39 (7 ULg)
INFUSION OF THIRD-PARTY MESENCHYMAL STEM CELLS (MSC) AFTER KIDNEY AND LIVER TRANSPLANTATION: A PHASE I-II, OPEN-LABEL, CLINICAL STUDY (EudraCT 2011-001822-81 & NCT01429038)
DETRY, Olivier ; DELBOUILLE, Marie-Hélène ; LECHANTEUR, Chantal et al
Poster (2013, May 30)
MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC ... [more ▼]
MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC infusion after cadaveric kidney and liver transplantation in a prospective phase I-II study, taking advantage of our centre expertise and experience in MSC use in graft-versus-host disease (GVHD) after bone marrow transplantation and using an already functioning GMP-compliant laboratory producing clinical-grade MSC. Secondary end-points will help to evaluate the immunosuppressive potential of MSC after organ transplantation, and the opportunity to develop larger randomised, controlled, phase III trials. After successful transplantation, 10 liver and 10 kidney transplant recipients under standard immunosuppression (tacrolimus, MMF, steroids) will receive an intravenous infusion of 1.5-3x106/kg of third-party MSC on post-operative day 3±2. These patients will be prospectively compared to 10 liver and 10 kidney recipients who meet the inclusion criteria but deny MSC infusion. Safety will be assessed by recording side effects, including opportunistic infections and cancers. Immunosuppressive potential will be evaluated by rejection episode rates, by graft/patient survivals, by immunohistology of 3-months kidney and 6-month liver graft biopsies and by in vitro evaluation of the immunity profile of the recipients. In a second step, reduction (kidney) and progressive weaning (liver) of immunosuppression will be attempted in recipients who received MSC. This ongoing study is supported by research grants from the CHU of Liège, University of Liège, and by the Senior Clinical Research Grant from ESOT. The first patients were included and treated in early 2012, and final results expected in late 2013. [less ▲]Detailed reference viewed: 72 (13 ULg)
The prognostic value of preoperative FDG PET-CT in hepatocellular carcinoma treated by liver transplantation.
; DETRY, Olivier ; BLETARD, Noëlla et al
in PROCEEDINGS OF THE XVIth SYMPOSIUM OF THE BELGIAN SOCIETY OF NUCLEAR MEDICINE (2013, May)Detailed reference viewed: 2 (0 ULg)
Is ultra-short cold ischemia the key to ischemic cholangiopathy avoidance in DCD-LT?
DETRY, Olivier ; DE ROOVER, Arnaud ; et al
in Acta Chirurgica Belgica (2013, May), Supplement 113(3), 6729Detailed reference viewed: 43 (12 ULg)
A modified surgical model of fulminant hepatic failure in the rat.
DETRY, Olivier ; ; CHERAMY-BIEN, Jean-Paul et al
in Journal of Surgical Research (2013), 181
BACKGROUND: There is a need for better animal models of fulminant liver failure (FHF). Eguchi et al described an interesting surgical model of FHF in the rat. This model includes 68% partial hepatectomy ... [more ▼]
BACKGROUND: There is a need for better animal models of fulminant liver failure (FHF). Eguchi et al described an interesting surgical model of FHF in the rat. This model includes 68% partial hepatectomy, ischemia of 24% of the liver mass, and 8% of remnant liver left intact. In the original description by Eguchi et al, rats were administered subcutaneous glucose. However, the authors found that normothermic FHF rats with subcutaneous glucose died from deep hypoglycemia. In this report, we describe a modification of that model, and show that administration of intravenous glucose allows better survival and development of intracranial hypertension. METHODS: We operated on FHF rats using the procedure described by Eguchi et al, kept them normothermic, and maintained normoglycemia by continuous intravenous glucose injection (glucose 10%, 1 mL/h). At 24 h, we monitored liver blood tests (n = 5), intracranial pressure (n = 5), clinical encephalopathy, and survival (n = 10), and compared them with sham and 68% hepatectomy rats. RESULTS: The FHF rats developed acute cytolysis, cholestasis, and liver failure, as demonstrated by the liver blood tests. They experienced progressive encephalopathy and intracranial hypertension leading to death. Mean survival was 45.9 h. Of 10 FHF rats from the survival evaluation cohort, one survived 7 d. Laparotomy showed necrosis of lateral liver lobes and enlargement of omental lobes with a normal hepatic aspect, suggesting liver recovery. CONCLUSIONS: This surgical rat model mimics the features of human FHF and seems interesting for further research into the pathophysiology and therapeutic management of the disease. [less ▲]Detailed reference viewed: 42 (8 ULg)
Superior Renal Function Sustained for 24 Months through Early Everolimus-Facilitated Reduction of Tacrolimus Versus Standard Tacrolimus in De Novo Liver Transplant Recipients: Results of a Randomized Trial.
; DETRY, Olivier ; et al
in American Journal of Transplantation (2013, April), 13(S5), 169450
mTOR inhibitors have the potential to reduce calcineurin inhibitor nephrotoxicity by minimizing or eliminating the need for their use. The 12 month (M) results of H2304 (NCT00622869) study demonstrated ... [more ▼]
mTOR inhibitors have the potential to reduce calcineurin inhibitor nephrotoxicity by minimizing or eliminating the need for their use. The 12 month (M) results of H2304 (NCT00622869) study demonstrated superior renal function with everolimus (EVR) plus reduced tacrolimus (rTAC) vs. standard TAC (TAC-C) in de novo liver transplant recipients (LTxR). Presented here are 24M renal function results. For this 24M, multicenter, open-label study 719 de novo LTxR were randomized (1:1:1) after a 30-day (±5 days) run-in period with TAC (±mycophenolate mofetil), to receive either EVR (C0 3-8 ng/mL) with rTAC (C0 3-5 ng/mL; EVR+rTAC, N=245) or EVR (C0 6-10 ng/mL) with TAC withdrawal (TAC-WD; N=231) at M4 or TAC-C (C0 6-10 ng/mL; TAC-C, N=243); all patients received corticosteroids. Enrollment in TAC-WD arm was stopped early due to higher rejection rates. Main endpoints at M24 included composite efcacy failure rate of treated biopsy proven acute rejection, graft loss or death, and evolution of renal function from randomization (RND) to M24 measured as eGFR by MDRD4. At M24, composite efcacy failure rate in EVR+rTAC arm was comparable to TAC-C (10.3% vs. 12.5%, p=0.452). Evolution of renal function from RND to M24 was superior for EVR+rTAC vs. TAC-C with an adjusted mean difference in eGFR change of 6.66 mL/min/1.73m2 (p=0.0018; ITT population). Signicantly higher eGFR with EVR+rTAC was achieved at M2 post-LTx and was maintained until M24. On-treatment data showed a decrease in mean eGFR from RND to M24 of 6.6 mL/min/1.73m2 with EVR+rTAC vs. 13 mL/min/1.73m2 with TAC-C and 2.5 mL/ min/1.73m2 gain with TAC-WD. Urinary protein:creatinine ratio (mg/g) at M24 was higher with EVR+rTAC vs. TAC-C (Mean±SD: 194±280 vs. 159±284, p=0.006). Early introduction of EVR at 1M post-LTx with rTAC showed superior renal function sustained for 24M compared to TAC-C, without compromising efcacy in de novo LTxR. [less ▲]Detailed reference viewed: 50 (2 ULg)
Retrospective analysis of Belgian experience with intestinal transplantation
; DE ROOVER, Arnaud ; DETRY, Olivier et al
Conference (2013, March 21)
Aim: The only alternative to Total Parenteral Nutrition (TPN) for complicated intestinal failure is Intesti- nal Transplantation (ITx) which is perceived as a high-risk procedure with inferior results ... [more ▼]
Aim: The only alternative to Total Parenteral Nutrition (TPN) for complicated intestinal failure is Intesti- nal Transplantation (ITx) which is perceived as a high-risk procedure with inferior results compared to other organ Tx. Therefore ITx has been rarely applied in Belgium. In a multicenter retrospective review, we analyzed the overall Belgian experience with ITx. Methods: The Belgium Liver Intestine Committee organized a survey among all Belgian Tx centers, based on the patient-specific data form of the international ITx registry. Overall activity and indications were reviewed. Patient/graft survival was calculated (Kaplan-Meier). Nutritional (TPN) independence and Quality of Life (QoL) (Karnofsky score) were analyzed. Results: 21 ITx were performed in 20 patients (03/99-11/12), distributed among 5 centers: KUL (12), ULg (5), UZG (2), UCL (1), UZA (1). Median age was 38y(8mo-56y). Male/female ratio was 10/10. 5 were pediatrics (<18y) and 15 adults. Indications were anatomical or functional short bowel syndrome: intestinal ischemia(5), volvulus(5), Crohn(2), chronic intestinal pseudo-obstruction(2), splanchnic thrombosis(2), Churg-Strauss(1), necrotizing enterocolitis(1), microvillus inclusion(1), intestinal atresia(1) and chronic rejection of a first ITx(1). Most patients also suffered from TPN-associated com- plications (infection/shortage of venous access or liver failure). An isolated small bowel was trans- planted in 9 patients (plus kidney Tx in 2; plus pancreas Tx in 1); 10 received a combined liver and ITx; 2 received a multivisceral Tx. At time of Tx, 11 patients were hospitalized and 10 at home. 20 grafts were procured from deceased donors; one segmental intestinal graft was procured from a living donor. ABO blood group was identical in 63%, compatible in 37%. Median cold ischemia time was 5h30 ́(3h17 ́-9h31 ́). All patients received tacrolimus-based immunosuppression. Basiliximab (anti-IL2 receptor antibody) induction was administered in 16 patients. In 11 patients donor specific blood was transfused as part of an immunomodulatory protocol. 5-year patient and graft survival is 59% and 55.6%, respectively. 8 patients died: 6 to sepsis, 1 to intracerebral hemorrhage; 1 sudden death re- mained unexplained. 1 patient developed postTx lymphoma. 2 chronic rejections occured for which one reTx was performed. Of 12 survivors (median follow-up 1870 days), 11 are nutritionally independent (TPN-free) and 10 have a Karnofsky score >90%. Conclusions: ITx has come of age in Belgium. During the last 13 years, 21 ITx were performed in 5 centers. A 5-year patient/graft survival of 59%/55.6% is achieved, which is similar to results reported by the International ITx registry. In Belgium, awareness should grow that ITx represents a life-saving (and QoL improving) treatment in selected patients with reduced life expectancy due to significant complica- tions from TPN and intestinal failure. [less ▲]Detailed reference viewed: 30 (5 ULg)