Le ciblage therapeutique: vers une guerre propre et efficace contre le cancer

Scientific conference (2009, October)

Effect of the transversus abdominis plane block on pain after laparoscopic inguinal hernia repair

in Acta Anaesthesiologica Belgica (2009, September 19), 60(3), 205

Results of liver transplantation (LT) from controlled donation after cardiac death (DCD) donors: a single center experience

in Transplant International (2009, August), 22(S2),

Extended criteria donors: the case for liver procurement in donors with a central nervous system malignancy

in Liver Transplantation (2009), 15

L’étude du mois. Traitement de l’hépatocarcinome au stade palliatif par Sorafenib (Nexavar) :Résultats de l’étude SHARP (Sorafenib Hepatocarcinoma Assessment Randomized Protocol)

in Revue Médicale de Liège (2009), 64(3), 168-170

Curative management of early-stage hepatocarcinoma may include partial hepatic resection, liver transplantation or tumoral necrosis using radiofrequency ablation or alcoholisation. Until recently, no ... [more ▼]

Curative management of early-stage hepatocarcinoma may include partial hepatic resection, liver transplantation or tumoral necrosis using radiofrequency ablation or alcoholisation. Until recently, no efficient therapeutic mean was available for advanced hepatocarcinoma. Sorafenib is a multikinase inhibitor that decreases tumoral proliferation and angiogenesis, and increases apoptosis in many cancer models. The results of a phase 3 randomized, multicentric, study, entitled SHARP, have now demonstrated that Sorafenib increases survival in patients with advanced hepatocarcinoma developed in Child A cirrhosis. Mean survival gain was a little less than 3 months, without any radiologic response or improvement in the delay before symptomatic progression of the disease. The monthly cost of Sorafenib is a little more than 5,000 euros. It is now crucial to evaluate the potential role of Sorafenib in adjuvant therapy after liver resection or radiofrequency ablation of hepatocarcinoma. The CHU of Liège is taking part to a randomized, multicentric study evaluating the use of Sorafenib after liver resection or radiofrequency ablation for hepatocarcinoma. Another future evaluation could be the association of Sorafenib with other antitumoral agents. [less ▲]

Belgium and organ donation: a further increase in organ donation in 2007! Preface to the 15(th) Annual Meeting of the Belgian Transplantation Society.

in Transplantation Proceedings (2009), 41(2), 565

In 2007, the Belgian annual rate of effective cadaveric organ donors further increased to 28.1 per million inhabitants, up from 26.2% in 2006 (http://www.transplant.be/donor/TxCoord.pdf). In numbers, 541 ... [more ▼]

In 2007, the Belgian annual rate of effective cadaveric organ donors further increased to 28.1 per million inhabitants, up from 26.2% in 2006 (http://www.transplant.be/donor/TxCoord.pdf). In numbers, 541 potential cadaveric organ donors were referred to the different transplant centers, resulting in 291 effective organ donors. The main reason for no organ retrieval was medical contraindications (34% of the total referrals). Family refusals dropped to less than 13%. Mean organ yielding was 3.55 per donation after brain death (DBD) donors and 2.28 per donation after cardiac death (DCD) donors, allowing a retrieval of 97.82 transplantable organs per million inhabitants, one of the highest so far to the best of our knowledge. This high rate of organ donation is certainly linked to the opting-out (or presumed consent) Belgian transplantation law, to the high motivation of the different Belgian transplant programs and intensive care units, to the confidence of the Belgian population in the Belgian medicine, and to the federal and regional political incentives to organ donation, as the Beldonor or the GIFT projects. This high rate of donation, in addition to active programs of living donation in kidney and liver transplantation and to MELD allocation, allowed to a significant decrease in the number of patients on the liver and kidney waiting lists( -34% and -18% in two years, respectively). [less ▲]

Liver transplant donation after cardiac death : experience at the University of Liège

in Transplantation Proceedings (2009), 41(2), 582-4

Aim: Donation after cardiac death (DCD) has been proposed to partly overcome the organ donor shortage. In liver transplantation, the additional warm ischemia linked to DCD procurement may promote higher ... [more ▼]

Aim: Donation after cardiac death (DCD) has been proposed to partly overcome the organ donor shortage. In liver transplantation, the additional warm ischemia linked to DCD procurement may promote higher rate of primary non-function and ischemic type biliary lesions. In this study we reviewed the results of DCD liver transplantation at the University of Liège. Patients and Methods: From 2003 to 2007, 13 controlled DCD liver transplantations were consecutively performed. The records of all donors and recipients were retrospectively reviewed, particularly evaluating the outcome and the occurrence of biliary complications. Mean follow-up was 25 months. Results: Mean donor age was 51 years and their mean intensive care stay was 5.4 days. Mean time between ventilation arrest and cardiac arrest was 9.3 min. Mean time between cardiac arrest and arterial flush was 7.7 min. No touch period was 2 to 5 min. Mean graft cold ischemia was 295 min and mean suture warm ischemia was 38 min. Postoperatively there was no primary non-function. Mean peak transaminase was 2,546 UI/ml. Patient and graft survival was 100% at one year. Two patients (15%) developed graft main bile duct stenosis and underwent endoscopic management. No patient developed symptomatic intrahepatic bile duct strictures or needed retransplantation in the follow-up. Conclusions: The experience of the transplantation department of the University of Liege confirms that controlled DCD donors may be a valuable source of transplantable liver grafts, in case of short procurement warm ischemia and short transplant cold ischemia. [less ▲]

Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the 'ReSpECT' study

in American Journal of Transplantation (2009), 9(2), 327-336

We report a multicenter, prospective, randomized, open-label trial investigating the effect of lower levels and delayed introduction of tacrolimus on renal function in liver transplant recipients. Adult ... [more ▼]

We report a multicenter, prospective, randomized, open-label trial investigating the effect of lower levels and delayed introduction of tacrolimus on renal function in liver transplant recipients. Adult patients with good renal function undergoing primary liver transplant were randomized to either: group A (standard-dose tacrolimus [target trough levels >10 ng/mL] and corticosteroids; n = 183); group B (mycophenolate mofetil [MMF] 2g/day, reduced-dose tacrolimus [target trough levels </=8 ng/mL], and corticosteroids; n = 170); group C (daclizumab induction, MMF, reduced-dose tacrolimus delayed until the fifth day posttransplant and corticosteroids, n = 172). The primary endpoint was change from baseline in estimated glomerular filtration rate (eGFR) at 52 weeks. The eGFR decreased by 23.61, 21.22 and 13.63 mL/min in groups A, B and C, respectively (A vs C, p = 0.012; A vs B, p = 0.199). Renal dialysis was required less frequently in group C versus group A (4.2% vs. 9.9%; p = 0.037). Biopsy-proven acute rejection rates were 27.6%, 29.2% and 19.0%, respectively. Patient and graft survival was similar. In conclusion, daclizumab induction, MMF, corticosteroids and delayed reduced-dose tacrolimus was associated with less nephrotoxicity than therapy with standard-dose tacrolimus and corticosteroids without compromising efficacy or tolerability. [less ▲]

Results of liver transplantation from controlled donation after cardiac death (DCD) donors: a single center experience

in Acta Gastro-Enterologica Belgica (2009, January), 72(1), 25

Liver transplantation from donation after cardiac death (DCD) donors: Belgian experience 2002-2007

in Acta Gastro-Enterologica Belgica (2009, January), 72(1), 21