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See detailLiver transplant donation after cardiac death : experience at the University of Liège
Detry, Olivier ULg; Seydel, Benoît ULg; Delbouille, Marie-Hélène ULg et al

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 ▲]

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See detailBelgium and organ donation: a further increase in organ donation in 2007! Preface to the 15(th) Annual Meeting of the Belgian Transplantation Society.
Detry, Olivier ULg; Donckier, Vincent

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 ▲]

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See detailOrgan Procurement After Euthanasia: Belgian Experience
Ysebaert, dirk; Van Beeumen, G.; De Greef, K. et al

in Transplantation Proceedings (2009), 41

Euthanasia was legalized in Belgium in 2002 for adults under strict conditions. The patient must be in a medically futile condition and of constant and unbearable physical or mental suffering that cannot ... [more ▼]

Euthanasia was legalized in Belgium in 2002 for adults under strict conditions. The patient must be in a medically futile condition and of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident. Between 2005 and 2007, 4 patients (3 in Antwerp and 1 in Liège) expressed their will for organ donation after their request for euthanasia was granted. Patients were aged 43 to 50 years and had a debilitating neurologic disease, either after severe cerebrovascular accident or primary progressive multiple sclerosis. Ethical boards requested complete written scenario with informed consent of donor and relatives, clear separation between euthanasia and organ procurement procedure, and all procedures to be performed by senior staff members and nursing staff on a voluntary basis. The euthanasia procedure was performed by three independent physicians in the operating room. After clinical diagnosis of cardiac death, organ procurement was performed by femoral vessel cannulation or quick laparotomy. In 2 patients, the liver, both kidneys, and pancreatic islets (one case) were procured and transplanted; in the other 2 patients, there was additional lung procurement and transplantation. Transplant centers were informed of the nature of the case and the elements of organ procurement. There was primary function of all organs. The involved physicians and transplant teams had the well-discussed opinion that this strong request for organ donation after euthanasia could not be waived. A clear separation between the euthanasia request, the euthanasia procedure, and the organ procurement procedure is necessary. [less ▲]

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See detailAn 11 - Year Overview of the belgian donor and transplant statistics bsed on a consecutive yearly data follow-up and comparing two periods : 1997 to 2005 versus 2006 to 2007
Van Gelder, F.; Delbouille, Marie-Hélène ULg; Vandervennet, M. et al

in Transplantation Proceedings (2009), 41

Background. The Belgian Transplant Coordinators Section is responsible for the yearly data follow-up concerning donor and transplantation statistics in Belgium and presents herein a 10-year overview ... [more ▼]

Background. The Belgian Transplant Coordinators Section is responsible for the yearly data follow-up concerning donor and transplantation statistics in Belgium and presents herein a 10-year overview. Methods. The procurement and transplant statistics were compared between 2 periods: Period 1 (P1, 1997–2005) versus Period 2 (P2, 2006–2007). Results. The kidney and liver waiting lists (P1 vs P2) showed an overall decrease for a period of 2 consecutive years in P2; kidney ( 170 patients; 18%), and liver ( 83 patients; 34%). All other waiting lists (heart, lung, pancreas) remained stable. Mean ED further increased (P1 vs P2); 229 (P1) versus 280 (P2, 22.27%). Non–heart-beating donors were significantly ( 288%) more often procured in P2. Mean donor age was 37.9 17.8 years (P1) versus 46.5 19.9 years (P2), and mean organ yield per donor was 3.48 1.7 (P1) versus 3.38 1.8 (P2). Overall transplant activity per million inhabitants increased 21.1%. Conclusion. For 2 consecutive years, the Belgian statistics showed significantly increased donor activity with an impact on waiting list dynamics and transplantation. The mean organ yield per donor was not influenced despite an increased average age and change in reason for death. [less ▲]

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See detailPreface.
Donckier, V.; Colenbie, L.; Delbouille, Michèle ULg et al

in Transplantation Proceedings (2009), 41(8), 3379

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See detailFulminant Hepatic Failure Induced by Venlafaxine and Trazodone Therapy: A Case Report.
Detry, Olivier ULg; Delwaide, Jean ULg; De Roover, Arnaud ULg et al

in Transplantation Proceedings (2009), 41(8), 3435-3436

Although acute hepatitis may be a side effect of many medications, most cases are reversible after treatment interruption, and fulminant hepatic failure (FHF) is rare. Venlafaxine and trazodone are 2 ... [more ▼]

Although acute hepatitis may be a side effect of many medications, most cases are reversible after treatment interruption, and fulminant hepatic failure (FHF) is rare. Venlafaxine and trazodone are 2 popular antidepressant agents. Alteration of liver enzyme levels has been reported as a side effect of these drugs at normal doses. Herein we have reported the case of a 48-year-old woman without any previous history of liver disease, who developed fulminant liver failure after 4 months of venlafaxine and trazodone therapy. She required liver transplantation, a procedure that was successful with full patient recovery. The first 5 years of follow-up were uneventful. This case documented that venlafaxine and trazodone at normal doses can produce severe liver toxicity. Liver tests should be monitored regularly in patients who receive this therapy. [less ▲]

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See detailBudd-Chiari Syndrome Complicating Hepatic Sarcoidosis: Definitive Treatment by Liver Transplantation: A Case Report.
Delfosse, Vincent ULg; De Leval, Laurence ULg; De Roover, Arnaud ULg et al

in Transplantation Proceedings (2009), 41(8), 3432-3434

Sarcoidotic involvement of the liver is frequent, albeit uncommonly symptomatic. Severe complications are rare, but may seldom require liver transplantation. Budd-Chiari syndrome has been described in a ... [more ▼]

Sarcoidotic involvement of the liver is frequent, albeit uncommonly symptomatic. Severe complications are rare, but may seldom require liver transplantation. Budd-Chiari syndrome has been described in a few patients with hepatic sarcoidosis. Herein we have reported the case of a young woman suffering from hepatic sarcoidosis who developed severe cholestasis and chronic Budd-Chiari syndrome. She successfully underwent orthotopic liver transplantation (OLT) and is asymptomatic with normal liver function at 3 years follow-up. Histopathological assessment of the liver explant demonstrated a florid granulomatous process, with involvement of the large intrahepatic veins, providing an anatomical basis for the vascular flow disturbances. This case adds further evidence that liver transplantation may be the curative treatment for complicated sarcoidotic liver disease. [less ▲]

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See detailLiver Transplantation Is Feasible in Super-Obese Patients: A Case Report.
Detry, Olivier ULg; Seydel, Benoît ULg; Kohnen, Laurent ULg et al

in Transplantation Proceedings (2009), 41(8), 3430-3431

Short- and long-term results of liver transplantation in morbidly obese patients may be impaired compared with the general transplant population. As a consequence, severe obesity has been considered to be ... [more ▼]

Short- and long-term results of liver transplantation in morbidly obese patients may be impaired compared with the general transplant population. As a consequence, severe obesity has been considered to be a relative contraindication to liver transplantation in many centers. Surgically, liver transplantation in severe obesity may be challenging. Moreover, obesity may lead to an increased rate of early and late medical complications. Herein we have reported successful liver transplantation in a super-obese patient (body mass index, 55.1 kg/m(2)) who had developed terminal acute-on-chronic liver disease. In the first 6 months of follow-up, the patient underwent a severe diet that led to a significant weight loss reduction to a body mass index of 39 kg/m(2). This report of successful liver transplantation in a super-obese patient suggests that severe obesity should not be considered to be an absolute contraindication to liver transplantation. [less ▲]

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See detailA Retrospective Monocenter Review of Simultaneous Pancreas-Kidney Transplantation.
Decker, Emmanuel ULg; Coimbra, C.; Weekers, Laurent ULg et al

in Transplantation Proceedings (2009), 41(8), 3389-3392

OBJECTIVE: Herein we have reviewed a consecutive series of simultaneous pancreas-kidney (SPK) transplantations performed at our institution over a 6-year period. PATIENTS AND METHODS: The study population ... [more ▼]

OBJECTIVE: Herein we have reviewed a consecutive series of simultaneous pancreas-kidney (SPK) transplantations performed at our institution over a 6-year period. PATIENTS AND METHODS: The study population included 22 patients (15 males and 7 females) who underwent SPK transplantation between 2001 and 2007. The mean recipient age was 47 years (range, 26-63 years). Eighteen patients suffered type 1 and 4 type 2 diabetes mellitus. The mean donor age was 33 years (range, 14-56 years). The mean HLA match was 2.1 (range, 1-5). Immunosuppressive treatment consisted of basiliximab induction followed by tacrolimus, mycophenolate mofetil, and prednisone. RESULTS: The mean hospital stay was 20 days (range, 11-52 days). After a mean follow-up of 44 months (range, 17-88 months), patient, kidney, and pancreas graft survivals were 86%, 82%, and 73%, respectively. Two patients died in the immediate postoperative period due to, respectively, disseminated intravascular coagulation and pulmonary embolism. A kidney graft was lost due to early hyperacute rejection. Other early complications associated with the pancreas graft included 2 cases of immediate reperfusion defects that led to early vascular thrombosis in 1 patient and a duodenal graft fistula in the other patient; a third patient developed type 2 diabetes mellitus. Beyond the postoperative period, graft loss was limited to 1 case of noncompliance to the immunosuppressive medications and 1 death secondary to pulmonary infection with a functional allograft after 4 years. CONCLUSIONS: SPK transplantation is a valid therapeutic option for patients with insulin-dependent diabetes mellitus and renal failure due to diabetic nephropathy. The main complications of SPK transplantation occur in the immediate postoperative period consequent to vascular or rejection processes. [less ▲]

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See detail14th Annual meeting of the Belgian Transplantation Society - March 27, 2007, Brussels, Belgium - Preface
Detry, Olivier ULg; Donckier, Vincent

in Transplantation Proceedings (2007), 39(8), 2633-2633

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See detailOverview of the Belgian Donor and Transplant Statistics 2006: Results of Consecutive Yearly Data Follow-up by the Belgian Section of Transplant Coordinators
Van Gelder, F.; Delbouille, Marie-Hélène ULg; Vandervennet, M. et al

in Transplantation Proceedings (2007), 39

Background. The Belgian Section of Transplant Coordinators, created in 1997 under the auspices of the Belgian Transplant Society, is in charge of the collection of the national data about donor ... [more ▼]

Background. The Belgian Section of Transplant Coordinators, created in 1997 under the auspices of the Belgian Transplant Society, is in charge of the collection of the national data about donor/procurement activities. Methods. Data are collected in all Belgian transplant centers. An annual report is finalized by combining these data with data from the Eurotransplant database. Results. An increase of both potential donors (n 501, 14.4%) and effective donors (n 273, 16.7%) was observed in 2006 versus 2005. Among effective donors, 28 were non–heart-beating donors (10.25%). Overall donor ratio was 26.26 donors per million inhabitants. Within potential donors, absence of organ harvesting was due to medical contraindications (28%), family refusal (13%), or legal refusal (2%). Donor mean age was 46.4 years and mean organs/donor was 3.21 1.7. An overall reduction of Belgian waiting lists was observed in 2006 as compared with 2005 ( 5.7% for kidney, 25.7% for liver, 9.4% for heart, 6.7% for lung, and 11.7% for pancreas), while waiting list mortality was 18% for liver, 11% for heart, and 7% for lung. As compared with 2005, transplant activities increased for kidney (n 485, 24.3%), heart lungs (n 73, 7.3%), and lungs (n 83, 39.4%) but decreased for liver (n 236, 2.1%). Living donation represented 8.45% for kidney ( 28.1% vs 2005) and 8% for liver transplantation ( 29.6%). Conclusion. Globally, a marked increase of procurement and transplant activities was observed in 2006, allowing to limit waiting list and waiting list mortality. Further increase of living donor activity and non–heart-beating donation remains necessary to extend the donor pool. [less ▲]

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See detailAvoiding blood products during liver transplantation
Detry, Olivier ULg; De Roover, Arnaud ULg; Delwaide, Jean ULg et al

in Transplantation Proceedings (2005), 37(6, Jul-Aug), 2869-2870

Liver transplantation is a major surgical procedure usually requiring large amount of blood products (red cells, platelets, fresh-frozen plasma). We developed a multidisciplinary transfusion-free protocol ... [more ▼]

Liver transplantation is a major surgical procedure usually requiring large amount of blood products (red cells, platelets, fresh-frozen plasma). We developed a multidisciplinary transfusion-free protocol for liver transplantation in Jehovah's witnesses who refuse the use of blood products but accept organ transplantation. Between September 1998 and November 2004, 9 of 29 Jehovah's witnesses evaluated for liver transplantation were transplanted after medical preparation. None of these patients received any blood product during the surgical procedure. This experience may be beneficial for the entire liver transplantation population, as excessive transfusion has been linked to increased morbidity and mortality in liver transplantation. [less ▲]

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See detailRight lobe living related liver transplantation in adults without venous drainage of the paramedian sector
Detry, Olivier ULg; De Roover, Arnaud ULg; Coimbra Marques, Carla ULg et al

in Transplantation Proceedings (2005), 37(6, Jul-Aug), 2865-2868

Introduction. There is some controversy on the necessity of venous reconstruction of the right paramedian sector (segments V and VIII) during right lobe living related liver transplantation. In this ... [more ▼]

Introduction. There is some controversy on the necessity of venous reconstruction of the right paramedian sector (segments V and VIII) during right lobe living related liver transplantation. In this report we describe the evolution of posttransplant graft function in five consecutive right lobe recipients without specific drainage of the right paramedian sector. Material and methods. The technique of common right hepatectomy for right lobe graft harvesting and transplantation did not include the middle hepatic vein in the graft. The mean total ischemic time was 51 minutes (ranges: 35 to 64 minutes). The mean graft to recipient weight ratio was 1.35% +/- 0.15%. No patient developed small-for-size syndrome. Results. All patients showed a rise in transaminases with a maximum at postoperative day 2 (mean aspartate aminotransferase: 1067 +/- 432 IU/mL). Liver function improved rapidly, with coagulation normalized at postoperative day 5. Bilirubin decreased progressively to normalize in three patients at postoperative day 14. Ultrasonography and computed tomography demonstrated that the paramedian sector of the right liver was congested, a state that was temporary with normalization of the liver tests and congestion disappeared at follow-up. No complication was linked to congestion. Discussion. This series showed that in right lobe liver transplantation with a relatively large-size graft, reconstruction of the hepatic veins of the paramedian sector may not be necessary despite the induction of some degree of venous congestion. In smaller grafts, this congestion might be avoided by reconstruction of the large veins draining segments V and VIII. [less ▲]

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See detailOxidative stress in the liver and the brain of rats in fulminant hepatic failure
Detry, Olivier ULg; Gaspar, Yves; Cheramy-Bien, Jean-Paul ULg et al

in Transplantation Proceedings (2005), 37(6, Jul-Aug), 2883-2885

The etiological mechanisms of brain edema in fulminant hepatic failure are incompletely understood. In a surgical model of fulminant hepatic failure in the rat, we tested whether oxidative stress may be ... [more ▼]

The etiological mechanisms of brain edema in fulminant hepatic failure are incompletely understood. In a surgical model of fulminant hepatic failure in the rat, we tested whether oxidative stress may be involved in the early steps of brain edema. Moreover, we took advantage of this model to determine if oxidative stress may be involved in the hepatocyte dysfunction observed in the setting of fulminant hepatic failure. Oxidative stress was evaluated by measurement of tissue ascorbic acid in the brain and liver of rats at 6 hours after induction of fulminant hepatic failure versus in control or partially hepatectomized rats. After 6 hours, the level of ascorbic acid was not different in the brain tissue of the various groups, indicating no oxidative stress. The liver showed a significant decrease in ascorbic acid levels, both in ischemic and nonischemic liver tissue, suggesting that oxidative stress might be involved in the failure of liver regeneration in fulminant hepatic failure. In this rat model no oxidative stress was demonstrated in the brain during the early phase of fulminant liver failure. [less ▲]

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See detailA new model for human intestinal preservation: Comparison of University of Wisconsin and Celsior preservation solutions
De Roover, Arnaud ULg; de Leval, Laurence ULg; Gilmaire, Julie ULg et al

in Transplantation Proceedings (2004), 36(2), 270-272

AIM: We compared University of Wisconsin (UW) and Celsior preservation solutions using a new model of human intestinal preservation that mimics the clinical conditions of small bowel procurement. METHODS ... [more ▼]

AIM: We compared University of Wisconsin (UW) and Celsior preservation solutions using a new model of human intestinal preservation that mimics the clinical conditions of small bowel procurement. METHODS: Intestinal grafts were harvested from four multiorgan donors. After classic warm dissection for organ procurement, an ileal segment of 50 cm was immediately flushed with Celsior. After the perfusion of the abdominal organs with UW, a second segment of adjacent ileum was harvested. The two intestinal grafts were then divided into segments by stapling, before immersion into the corresponding preservation solution (Celsior or UW) for 0-, 6-, 12-, or 24-hour incubation at 4 degrees C. A histological score was graded after blinded examination of three random specimens within each ileal graft for each duration of preservation. RESULTS: Control specimens showed normal histology. After 6 hours of preservation, most villi showed complete epithelial detachment although the crypts appeared intact. After 12 hours of preservation, a larger proportion of the villi showed extensive epithelial sloughing. After 24 hours, the damage involved the entire mucosa with the crypt epithelium largely detached from the basal membrane. No statistical difference in histological score was observed between the two preservation solutions. CONCLUSION: This study showed severe histological alterations of graft mucosa after short periods of preservation by UW or Celsior solutions. This model may be useful to evaluate improvements in the quality of preservation of human intestinal transplants. [less ▲]

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See detailLuminal contact with University of Wisconsin solution improves human small bowel preservation
De Roover, Arnaud ULg; de Leval, Laurence ULg; Gilmaire, Julie ULg et al

in Transplantation Proceedings (2004), 36(2), 273-275

AIM: Under clinical conditions small bowel mucosa is stored without any contact between the mucosa and the preservation solution. We evaluated the impact of luminal contact with University of Wisconsin ... [more ▼]

AIM: Under clinical conditions small bowel mucosa is stored without any contact between the mucosa and the preservation solution. We evaluated the impact of luminal contact with University of Wisconsin solution (UW) on the structural quality of small bowel preservation. METHODS: Segments of ileum harvested from stable multi-organ donors were flushed with UW. For each donor, ileal segments were placed in UW without any contact between the mucosa and the preservation solution (group A), as is practiced in clinical conditions. Adjacent segments were cut on their antimesenteric side and placed in UW so that their mucosa was widely in contact with the solution (group B). The grafts preserved in ice were removed from the preservation fluid at different times (0, 3, 6, or 12 hours). Tissues were studied by optical microscopy after H [less ▲]

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See detailMycophenolate mofetil monotherapy in stable liver transplant recipients with progressive renal failure
Detry, Olivier ULg; De Roover, Arnaud ULg; Honore, Pierre ULg et al

in Transplantation Proceedings (2002), 34(3), 782-783

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See detailEffect of perioperative infusion of antioxidants on neutrophil activation during liver transplantation in humans
Biasi, F.; Poli, G.; Salizzoni, M. et al

in Transplantation Proceedings (2002), 34(3), 755-758

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See detailIntracellular free iron content of rat liver tissue after cold ischemia
Pincemail, Joël ULg; Sergent, O.; Detry, Olivier ULg et al

in Transplantation Proceedings (2002), 34(3), 759-761

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See detailAntioxidant Status after Cold Ischemia of Rabbit Lung
Pincemail, Joël ULg; Kolh, Philippe ULg; Detry, Olivier ULg et al

in Transplantation Proceedings (2000), 32(2), 484-5

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