References of "Liver Transplantation"
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See detailPreserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: A proof-of-concept study using discarded human livers.
Monbaliu, Diethard; Liu, Qiang; Libbrecht, Louis et al

in Liver Transplantation (2012), 18(12), 1495-507

The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk ... [more ▼]

The wider use of livers from expanded criteria donors and donation after circulatory death donors may help to improve access to liver transplantation. A prerequisite for safely using these higher risk livers is the development of objective criteria for assessing their condition before transplantation. Compared to simple cold storage, hypothermic machine perfusion (HMP) provides a unique window for evaluating liver grafts between procurement and transplantation. In this proof-of-concept study, we tested basic parameters during HMP that may reflect the condition of human liver grafts, and we assessed their morphology after prolonged HMP. Seventeen discarded human livers were machine-perfused. Eleven livers were nontransplantable (major absolute contraindications and severe macrovesicular steatosis in the majority of the cases). Six livers were found in retrospect to be transplantable but could not be allocated and served as controls. Metabolic parameters (pH, lactate, partial pressure of oxygen, and partial pressure of carbon dioxide), enzyme release in the perfusate [aspartate aminotransferase (AST) and lactate dehydrogenase (LDH)], and arterial/portal resistances were monitored during HMP. Nontransplantable livers released more AST and LDH than transplantable livers. In contrast, arterial/portal vascular resistances and metabolic profiles did not differ between the 2 groups. Morphologically, transplantable livers remained well preserved after 24 hours of HMP. In conclusion, HMP preserves the morphology of human livers for prolonged periods. A biochemical analysis of the perfusate provides information reflecting the extent of the injury endured. Liver Transpl, 2012. (c) 2012 AASLD. [less ▲]

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See detailDCD liver transplantation: is donor age an issue?
DETRY, Olivier ULg; Le dinh, Hieu; DE ROOVER, Arnaud ULg et al

in Liver Transplantation (2011, July), 17(6S1), 112

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See detailLiver graft procurement in donors with central nervous system cancers.
Detry, Olivier ULg

in Liver Transplantation (2010), 16(7), 914-5

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See detailLiver transplantation from controlled donation after cardiac death (DCD) donors: a single center experience
Detry, Olivier ULg; Veys, Caroline; Seydel, Benoît ULg et al

in Liver Transplantation (2009, July), 15(7), 180-181

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See detailOutcome of Patients with Hepatocellular Carcinoma Listed for Liver Transplantation Within the Eurotransplant Allocation System
Adler, Michael; De Pauw, Filip; Vereerstraeten, Pierre et al

in Liver Transplantation (2008), 14

Although hepatocellular carcinoma (HCC) has become a recognized indication for liver transplantation, the rules governing priority and access to the waiting list are not well defined. Patient- and tumor ... [more ▼]

Although hepatocellular carcinoma (HCC) has become a recognized indication for liver transplantation, the rules governing priority and access to the waiting list are not well defined. Patient- and tumor-related variables were evaluated in 226 patients listed primarily for HCC in Belgium, a region where the allocation system is patient-driven, priority being given to sicker patients, based on the Child-Turcotte-Pugh (CTP) score. Intention-to-treat and posttransplantation survival rates at 4 years were 56.5 and 66%, respectively, and overall HCC recurrence rate was 10%. The most significant predictors of failure to receive a transplant in due time were baseline CTP score equal to or above 9 (relative risk [RR] 4.1; confidence interval [CI]: 1.7-9.9) and alpha fetoprotein above 100 ng/mL (RR 3.0; CI: 1.2-7.1). Independent predictors of posttransplantation mortality were age equal to or above 50 years (RR 2.5; CI: 1.0-3.7) and United Network for Organ Sharing pathological tumor nodule metastasis above the Milan criteria (RR 2.1; CI: 1.0-5.9). Predictors of recurrence (10%) were _ fetoprotein above 100 ng/mL (RR 3.2; CI:1.1-10) and vascular involvement of the tumor on the explant (RR 3.6; CI: 1.1-11.3). Assessing the value of the pretransplantation staging by imaging compared to explant pathology revealed 34% accuracy, absence of carcinoma in 8.3%, overstaging in 36.2%, and understaging in 10.4%. Allocation rules for HCC should consider not only tumor characteristics but also the degree of liver impairment. Patients older than 50 years with a stage above the Milan criteria at transplantation have a poorer prognosis after transplantation. [less ▲]

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See detailPrimary graft nonfunction and Kupffer cell activation after liver transplantation from non-heart-beating donors in pigs
Monbaliu, D.; van Pelt, J.; De Vos, R. et al

in Liver Transplantation (2007), 13(2), 239-247

More extensive use of non-heart-beating donors (NHBD) could reduce mortality on liver transplantation waiting lists, but this is associated with more primary nonfunction (PNF). We assessed which ... [more ▼]

More extensive use of non-heart-beating donors (NHBD) could reduce mortality on liver transplantation waiting lists, but this is associated with more primary nonfunction (PNF). We assessed which parameters are involved in the development of PNF in livers from NHBD in a previously validated pig liver transplantation model, in which livers were transplanted after exposure to incremental periods of warm ischemia. The risk of PNF was unacceptably high (>50%) when livers were exposed to >30 minutes' warm ischemia before a short cold ischemic period. This study examined how PNF is affected by Kupffer cell activation (beta-galactosidase), the generation of cytokines tumor necrosis factor alpha and interleukin 6, antioxidant mechanisms (ascorbic acid, alpha-tocopherol, reduced glutathione), circulating redox-active iron, and sinusoidal endothelial cell function (hyaluronic acid clearance). Kupffer cells were more activated in PNF recipients, as suggested by higher beta-galactosidase levels (15 minutes after reperfusion), and secondarily, by higher production of tumor necrosis factor alpha and interleukin 6 (180 minutes after reperfusion). In addition, a-tocopherol and reduced glutathione were lower, and ascorbic acid and redox-active iron higher in PNF recipients. Finally, PNF grafts displayed progressively decreasing hyaluronic acid clearance (suggesting sinusoidal endothelial cell dysfunction) and parenchymal edema. Consequently, a reduced-flow phenomenon was documented. In grafts from NHBD that are destined to fail, beta-galactosidase activity (a surrogate of Kupffer cell activation) is higher, proinflammatory cytokines are overproduced, some antioxidant mechanisms fail, and circulating redox-active iron is more rapidly released. A no-flow phenomenon is eventually observed in these failing grafts. [less ▲]

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See detailSelective coil occlusion of a large arterioportal fistula in a liver graft
Detry, Olivier ULg; De Roover, Arnaud ULg; Delwaide, Jean ULg et al

in Liver Transplantation (2006), 12(5), 888-889

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See detailEmergency graft removal after liver transplantation
Detry, Olivier ULg; De Roover, Arnaud ULg; Delwaide, Jean ULg et al

in Liver Transplantation (2006, May), 12(5), 72

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See detailTransmission of an undiagnosed sarcoma to recipients of kidney and liver grafts procured in a non-heart beating donor
Detry, Olivier ULg; De Roover, Arnaud ULg; de Leval, Laurence ULg et al

in Liver Transplantation (2005), 11(6), 696-699

Transmission of an undiagnosed cancer with solid organ transplantation is a rare but dreadful event. In this paper the authors report the transmission of an undiagnosed sarcoma to recipients of kidney and ... [more ▼]

Transmission of an undiagnosed cancer with solid organ transplantation is a rare but dreadful event. In this paper the authors report the transmission of an undiagnosed sarcoma to recipients of kidney and liver grafts procured in a Maastricht category 3 non-heart beating donor. To the authors' knowledge this case is the first report of such a transmission with a liver graft procured in a non-heart beating donor. The cancer transferal was diagnosed I year after transplantation in the recipients of the liver and of one kidney. The liver recipient died from multiple organ failure after a failed attempt of tumor resection. The kidney recipient underwent immunosuppression withdrawal and transplantectomy. Non-heart beating donors should not be particularly at risk for undiagnosed cancer transmission if the procurement is performed according to the same rules of careful inspection of the abdominal and thoracic organs. After diagnosis of donor cancer transmission, kidney recipients should have the graft removed, and immunosuppression should be interrupted. The management of liver graft recipients is very difficult in this setting, and long-term survival was very rarely reported. [less ▲]

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See detailRight Hepatic Lobectomy as a Liver Graft-Saving Procedure
Honore, Pierre ULg; Detry, Olivier ULg; Hamoir, Etienne ULg et al

in Liver Transplantation (2001), 7(3), 269-73

Retransplantation is common after liver transplantation (LT). However, in the present era of organ shortages, every attempt to save the liver graft should be performed before considering retransplantation ... [more ▼]

Retransplantation is common after liver transplantation (LT). However, in the present era of organ shortages, every attempt to save the liver graft should be performed before considering retransplantation. We report our experience with right hepatic lobectomy (RHL) for liver graft salvage. In a retrospective series of 180 adult LTs, 4 patients underwent RHL (Couinaud's segments V, VI, VII, VIII) in the post-LT period. In all cases, the procedure was performed without Pringle's maneuver or mobilization of the left liver lobe to preserve its vascularization. Three liver graft recipients developed intrahepatic biliary strictures, mainly localized to the right lobe of the graft, and RHL was performed 14, 75, and 78 months after LT. These patients were alive at last follow-up without further episodes of cholangitis or retransplantation (mean follow-up, 38 months). The fourth patient developed early post-LT right liver necrosis with a functioning hepatic artery and underwent right lobectomy 48 hours after LT. He later developed cholangitis secondary to late hepatic artery thrombosis, requiring retransplantation after 18 months. We conclude that RHL can be considered a graft-saving option in selected liver transplant recipients with localized biliary strictures, with excellent patient and graft survival. [less ▲]

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