Pub Date : 2023-08-01DOI: 10.1016/j.liver.2023.100165
Sophia EL Boukili, Laurent Reydellet, Valery Blasco, Karim Harti, Jacques Albanese, Cyril Nafati
Purpose
Cirrhotic cardiomyopathy (CCM) is a major comorbidity of cirrhosis. The diagnostic performance of conventional echocardiography is poor. Two-dimensional-strain echo-cardiography (2D-strain) detects myocardial dysfunction earlier than conventional echocardiography, with a significant prognostic value. The aim of our study is to assess whether the 2D-strain will allow a more relevant assessment of CCM in cirrhotic patients than conventional echocardiography. The secondary objective is to determine if altered strain or strain rate are associated with cirrhotic patient's outcome in intensive care unit (ICU).
Methods
Conventional echocardiography and 2D-strain were performed on 44 consecutive patients within 24 hours of admission to the ICU. Using 2D-strain, the global-longitudinal-strain (GLS) was assessed.
Results
GLS was impaired in 64% of patients. GLS was significantly higher in the patients who died compared with those who survived, using 28-day mortality rate (-17 vs -14 p < 0.039). Regarding conventional echocardiography, no factor was associated with increased mortality.
Conclusion
GLS is correlated to cirrhotic patient's prognosis in intensive care, while conventional echocardiography shows no dysfunction.
目的肝硬化性心肌病(CCM)是肝硬化的主要合并症。常规超声心动图的诊断性能较差。二维应变超声心动图(2D-strain)比常规超声心动图更早发现心肌功能障碍，具有重要的预后价值。我们研究的目的是评估2D-strain是否能够比传统超声心动图更相关地评估肝硬化患者的CCM。次要目的是确定应变或应变率的改变是否与肝硬化患者在重症监护病房(ICU)的预后有关。方法对44例连续入院24小时的患者行常规超声心动图和二维应变检查。采用2d -应变法对全局-纵向-应变(GLS)进行评估。结果64%的患者gls功能受损。使用28天死亡率计算，死亡患者的GLS明显高于存活患者(-17 vs -14 p <0.039)。对于常规超声心动图，没有任何因素与死亡率增加相关。结论ls与肝硬化重症监护患者预后相关，而常规超声心动图显示无功能障碍。
{"title":"Prognostic value of two-dimensional strain-echocardiography in patients with liver cirrhosis in Intensive care Unit. A prospective, observational Study","authors":"Sophia EL Boukili, Laurent Reydellet, Valery Blasco, Karim Harti, Jacques Albanese, Cyril Nafati","doi":"10.1016/j.liver.2023.100165","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100165","url":null,"abstract":"<div><h3>Purpose</h3><p>Cirrhotic cardiomyopathy (CCM) is a major comorbidity of cirrhosis. The diagnostic performance of conventional echocardiography is poor. Two-dimensional-strain echo-cardiography (2D-strain) detects myocardial dysfunction earlier than conventional echocardiography, with a significant prognostic value. The aim of our study is to assess whether the 2D-strain will allow a more relevant assessment of CCM in cirrhotic patients than conventional echocardiography. The secondary objective is to determine if altered strain or strain rate are associated with cirrhotic patient's outcome in intensive care unit (ICU).</p></div><div><h3>Methods</h3><p>Conventional echocardiography and 2D-strain were performed on 44 consecutive patients within 24 hours of admission to the ICU. Using 2D-strain, the global-longitudinal-strain (GLS) was assessed.</p></div><div><h3>Results</h3><p>GLS was impaired in 64% of patients. GLS was significantly higher in the patients who died compared with those who survived, using 28-day mortality rate (-17 vs -14 <em>p <</em> 0.039). Regarding conventional echocardiography, no factor was associated with increased mortality.</p></div><div><h3>Conclusion</h3><p>GLS is correlated to cirrhotic patient's prognosis in intensive care, while conventional echocardiography shows no dysfunction.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"11 ","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49881979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1016/j.liver.2023.100157
Z. Tremblay , A. Kawaguchi , A. Calderone , M. Beaunoyer , F. Alvarez , M. Lallier , P. Jouvet
Background
Pediatric liver transplantation is performed with either whole, reduced, split livers depending on the technical aspects of the surgery and the discrepancy between donor and recipient body dimensions. The optimal method of partial hepatectomy for pediatric transplants remains debated to this day: either in situ (i.e. occurring before liver removal from the donor) or ex situ (i.e. taking place after liver removal). In 2007, our tertiary academic center changed its surgical protocol from ex situ to in situ partial hepatectomy in deceased donor mainly to decrease bleeding complication risk among other amendments. Our study aimed to evaluate the clinical impact of this major modification on the post-operative blood products volume transfusion.
Methods
A retrospective analysis of 104 patients who underwent liver transplantation at our pediatric center between 1998 and 2016 was performed. Patients receiving multiple organ transplantations or re-transplantation were excluded from the study. Differences in blood products transfusion volume, post-operative complications and mortality rates were compared between two periods implementing different surgical transplantation protocols: ex situ partial hepatectomy from 1998 to 2006 and in situ partial hepatectomy from 2007 to 2016.
Results
42 children from the original ex situ protocol group and 62 children from the modified in situ protocol group were included in the study. The median age and weight were 1.5 years (0.7–4.8 kg) and 11.1 kg (7.9–18.2), respectively. There were no significant differences in demographic data between groups. A significant decrease in liver transplant cold ischemia time was observed in the in situ group compared to the ex situ group (p < 0.001). A significant increase in vasopressor use was observed for the in situ group (64% (IS) vs. 24% ex situ group (p < 0.001)), as part of the protocol modifications. Median perioperative blood products transfusion volume was not significantly different between both groups: 275 ml/kg (76–497) ex situ group vs. 229 ml/kg (76–499) in situ group (p = 0.82). We observed a 28-day and 90-day mortality rate of 14.3% and 16.6%, respectively, for the ex situ group and 6.5% and 8.1%, respectively, for the in situ group. Hepatic artery thrombosis was found in the first 7 days in 7% of the ex situ group patients and 6% of the in situ group patients. There were no significant differences in post-operative mortality and morbidity rates observed between groups (p value of 0.29 and 0.28 for 28-days and 90-days mortality rates, respectively).
Conclusions
Although the median amount of transfusion was higher in the ex-situ group, our stud
{"title":"Impacts of in situ donor partial hepatectomy in pediatric liver transplantation","authors":"Z. Tremblay , A. Kawaguchi , A. Calderone , M. Beaunoyer , F. Alvarez , M. Lallier , P. Jouvet","doi":"10.1016/j.liver.2023.100157","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100157","url":null,"abstract":"<div><h3>Background</h3><p>Pediatric liver transplantation is performed with either whole, reduced, split livers depending on the technical aspects of the surgery and the discrepancy between donor and recipient body dimensions. The optimal method of partial hepatectomy for pediatric transplants remains debated to this day: either <em>in situ</em> (<em>i.e.</em> occurring before liver removal from the donor) or <em>ex situ</em> (<em>i.e.</em> taking place after liver removal). In 2007, our tertiary academic center changed its surgical protocol from <em>ex situ</em> to <em>in situ</em> partial hepatectomy in deceased donor mainly to decrease bleeding complication risk among other amendments. Our study aimed to evaluate the clinical impact of this major modification on the post-operative blood products volume transfusion.</p></div><div><h3>Methods</h3><p>A retrospective analysis of 104 patients who underwent liver transplantation at our pediatric center between 1998 and 2016 was performed. Patients receiving multiple organ transplantations or re-transplantation were excluded from the study. Differences in blood products transfusion volume, post-operative complications and mortality rates were compared between two periods implementing different surgical transplantation protocols: <em>ex situ</em> partial hepatectomy from 1998 to 2006 and <em>in situ</em> partial hepatectomy from 2007 to 2016.</p></div><div><h3>Results</h3><p>42 children from the original <em>ex situ</em> protocol group and 62 children from the modified <em>in situ</em> protocol group were included in the study. The median age and weight were 1.5 years (0.7–4.8 kg) and 11.1 kg (7.9–18.2), respectively. There were no significant differences in demographic data between groups. A significant decrease in liver transplant cold ischemia time was observed in the <em>in situ</em> group compared to the <em>ex situ</em> group (<em>p</em> < 0.001). A significant increase in vasopressor use was observed for the <em>in situ</em> group (64% (IS) <em>vs</em>. 24% <em>ex situ</em> group (<em>p</em> < 0.001)), as part of the protocol modifications. Median perioperative blood products transfusion volume was not significantly different between both groups: 275 ml/kg (76–497) <em>ex situ</em> group <em>vs</em>. 229 ml/kg (76–499) <em>in situ</em> group (<em>p</em> = 0.82). We observed a 28-day and 90-day mortality rate of 14.3% and 16.6%, respectively, for the <em>ex situ</em> group and 6.5% and 8.1%, respectively, for the <em>in situ</em> group. Hepatic artery thrombosis was found in the first 7 days in 7% of the <em>ex situ</em> group patients and 6% of the <em>in situ</em> group patients. There were no significant differences in post-operative mortality and morbidity rates observed between groups (p value of 0.29 and 0.28 for 28-days and 90-days mortality rates, respectively).</p></div><div><h3>Conclusions</h3><p>Although the median amount of transfusion was higher in the ex-situ group, our stud","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"11 ","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49882497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1016/j.liver.2023.100160
James Neuberger
{"title":"Liver transplant registries: Need, benefits and risks","authors":"James Neuberger","doi":"10.1016/j.liver.2023.100160","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100160","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"11 ","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49882501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1016/j.liver.2023.100167
Julie Gaudefroy , Paul Brunet , Baptiste Lordier , Benjamin Lebas , Julien Pottecher
Acute on Chronic Liver Failure (ACLF) is a severe condition that can be seen in all patients with liver disease and is associated with high short-term mortality. Decompensated cirrhosis and organ failures resulting can lead to an admission in Intensive Care Unit (ICU) where only few tools can be used to evaluate the safety or futility of care, including liver transplantation. High short-term mortality for patients with ACLF admitted in ICU is a reason to ethically propose a liver transplantation as a curative treatment despite the existence of multi-organ failures. However, caution is advised for patients with grade-3 ACLF as they have to be attentively selected by a multidisciplinary approach, carefully evaluated and may benefit from an early transplant with a low-risk donor graft. Recent use of perfusion machine to increase outcomes after liver transplant in these urgent situations still needs to be evaluated. This review summarizes the ACLF entity and presents some recommendations about liver transplantation (LT) candidates in terms of selection, evaluation and timing of LT.
{"title":"Assessment of liver transplantation eligibility for ACLF patients","authors":"Julie Gaudefroy , Paul Brunet , Baptiste Lordier , Benjamin Lebas , Julien Pottecher","doi":"10.1016/j.liver.2023.100167","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100167","url":null,"abstract":"<div><p>Acute on Chronic Liver Failure (ACLF) is a severe condition that can be seen in all patients with liver disease and is associated with high short-term mortality. Decompensated cirrhosis and organ failures resulting can lead to an admission in Intensive Care Unit (ICU) where only few tools can be used to evaluate the safety or futility of care, including liver transplantation. High short-term mortality for patients with ACLF admitted in ICU is a reason to ethically propose a liver transplantation as a curative treatment despite the existence of multi-organ failures. However, caution is advised for patients with grade-3 ACLF as they have to be attentively selected by a multidisciplinary approach, carefully evaluated and may benefit from an early transplant with a low-risk donor graft. Recent use of perfusion machine to increase outcomes after liver transplant in these urgent situations still needs to be evaluated. This review summarizes the ACLF entity and presents some recommendations about liver transplantation (LT) candidates in terms of selection, evaluation and timing of LT.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"11 ","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49882504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.1016/j.liver.2023.100169
Gabriel Wisenfeld Paine , Michael Toolan , Jeremy S Nayagam , Deepak Joshi , Brian J Hogan , Colm McCabe , Philip Marino , Sameer Patel
Portopulmonary hypertension (PoPH) is defined as the presence of otherwise unexplained pre-capillary pulmonary hypertension in patients with portal hypertension of cirrhotic or non-cirrhotic aetiology. PoPH occurs in at least 5–8.5% of patients being worked up for a liver transplant (LT) and its prevalence is thought to be increasing. Uncontrolled PoPH prior to LT is associated with high perioperative morbidity and mortality, with severe PoPH being considered a contraindication to LT. Early recognition and appropriate management of PoPH in patients being considered for LT is therefore imperative to achieve optimal outcomes. This review provides a detailed overview of: the epidemiology, prognosis and pathophysiology of PoPH; clinical assessment, screening and diagnostic approach; and pre-, peri‑ and post-transplant management of PoPH in patients undergoing LT. The current evidence base in this area is limited. This review particularly focuses on the evidence both supporting and challenging current practices and highlights areas for future research.
{"title":"Assessment and management of patients with portopulmonary hypertension undergoing liver transplantation","authors":"Gabriel Wisenfeld Paine , Michael Toolan , Jeremy S Nayagam , Deepak Joshi , Brian J Hogan , Colm McCabe , Philip Marino , Sameer Patel","doi":"10.1016/j.liver.2023.100169","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100169","url":null,"abstract":"<div><p>Portopulmonary hypertension (PoPH) is defined as the presence of otherwise unexplained pre-capillary pulmonary hypertension in patients with portal hypertension of cirrhotic or non-cirrhotic aetiology. PoPH occurs in at least 5–8.5% of patients being worked up for a liver transplant (LT) and its prevalence is thought to be increasing. Uncontrolled PoPH prior to LT is associated with high perioperative morbidity and mortality, with severe PoPH being considered a contraindication to LT. Early recognition and appropriate management of PoPH in patients being considered for LT is therefore imperative to achieve optimal outcomes. This review provides a detailed overview of: the epidemiology, prognosis and pathophysiology of PoPH; clinical assessment, screening and diagnostic approach; and pre-, peri‑ and post-transplant management of PoPH in patients undergoing LT. The current evidence base in this area is limited. This review particularly focuses on the evidence both supporting and challenging current practices and highlights areas for future research.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"12 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50203521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1016/j.liver.2023.100153
Manuel Lozano , Miguel Molina , Jesús Zarauza , Federico Castillo , Roberto Fernández-Santiago , Edward J. Anderson , Emilio Fábrega , Juan C. Rodríguez-Sanjuán
Cardiovascular events are the most important cause of morbidity and mortality after liver transplant (LT), since many recipients are older with cardiovascular risk factors and pathophysiology particular to end stage liver disease. Moreover, the LT procedure is associated with a unique cardiac risk. Detection of cardiovascular disease and stratification of risk have, therefore, an important impact on the prognosis of these patients.
{"title":"Cardiovascular assessment of candidates for liver transplant","authors":"Manuel Lozano , Miguel Molina , Jesús Zarauza , Federico Castillo , Roberto Fernández-Santiago , Edward J. Anderson , Emilio Fábrega , Juan C. Rodríguez-Sanjuán","doi":"10.1016/j.liver.2023.100153","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100153","url":null,"abstract":"<div><p>Cardiovascular events are the most important cause of morbidity and mortality after liver transplant (LT), since many recipients are older with cardiovascular risk factors and pathophysiology particular to end stage liver disease. Moreover, the LT procedure is associated with a unique cardiac risk. Detection of cardiovascular disease and stratification of risk have, therefore, an important impact on the prognosis of these patients.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"10 ","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49880130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1016/j.liver.2023.100152
A. Timms , P. Bras , D. Green , S. Cottam , S.E. Khorsandi , R. Broomhead , A. Sheikh , C.D.A. Goonasekera
Liver transplantation has evolved from an initial experimental procedure to a successful treatment for end-stage liver disease. This study explored milestones in liver transplantation anaesthetic care that contributed to improved outcomes in a single centre.
An analysis of transplant mortality outcomes was performed on adults and children who underwent liver transplantation between 1988 and 2019. A qualitative enquiry involved a thematic analysis of the opinions of retired and current anaesthetists.
Four overarching themes were identified:
•
The evolving status of liver transplantation service
•
The importance of multi-disciplinary teams
•
The surgical process
•
The experimental nature of liver transplantation
Of 5398 liver transplants performed, 23% were paediatric. Kaplan-Meier survival curves for adult and paediatric recipients showed a 1-year survival probability of over 90%. The 25-year survival was 42% and 80%, respectively.
Improved management of (a) intraoperative blood loss through the use of techniques such as preoperative coagulation screening, intraoperative blood salvage, and the use of blood transfusions (b) enhanced intraoperative monitoring through the use of techniques such as continuous echocardiography, transesophageal echocardiography, and pulmonary artery catheters and (c) the establishment of dedicated theatre space and staff for liver transplantation achieved through the construction of new dedicated liver transplantation units and the hiring of specialized staff were the key anaesthetic milestones that contributed to improved patient outcome following liver transplantation.
{"title":"Exploring the milestones in anaesthesia that made liver transplantation a realistic therapeutic option for fatal liver failure: A story of 4 decades in a single centre","authors":"A. Timms , P. Bras , D. Green , S. Cottam , S.E. Khorsandi , R. Broomhead , A. Sheikh , C.D.A. Goonasekera","doi":"10.1016/j.liver.2023.100152","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100152","url":null,"abstract":"<div><p>Liver transplantation has evolved from an initial experimental procedure to a successful treatment for end-stage liver disease. This study explored milestones in liver transplantation anaesthetic care that contributed to improved outcomes in a single centre.</p><p>An analysis of transplant mortality outcomes was performed on adults and children who underwent liver transplantation between 1988 and 2019. A qualitative enquiry involved a thematic analysis of the opinions of retired and current anaesthetists.</p><p>Four overarching themes were identified:</p><ul><li><span>•</span><span><p>The evolving status of liver transplantation service</p></span></li><li><span>•</span><span><p>The importance of multi-disciplinary teams</p></span></li><li><span>•</span><span><p>The surgical process</p></span></li><li><span>•</span><span><p>The experimental nature of liver transplantation</p></span></li></ul>Of 5398 liver transplants performed, 23% were paediatric. Kaplan-Meier survival curves for adult and paediatric recipients showed a 1-year survival probability of over 90%. The 25-year survival was 42% and 80%, respectively.<p>Improved management of (a) intraoperative blood loss through the use of techniques such as preoperative coagulation screening, intraoperative blood salvage, and the use of blood transfusions (b) enhanced intraoperative monitoring through the use of techniques such as continuous echocardiography, transesophageal echocardiography, and pulmonary artery catheters and (c) the establishment of dedicated theatre space and staff for liver transplantation achieved through the construction of new dedicated liver transplantation units and the hiring of specialized staff were the key anaesthetic milestones that contributed to improved patient outcome following liver transplantation.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"10 ","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49880029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1016/j.liver.2023.100147
Aman Kumar , Sorabh Kapoor , Chirag S Desai
{"title":"Early AMR in a ABOi - A2 to O liver transplantation: A reason for caution","authors":"Aman Kumar , Sorabh Kapoor , Chirag S Desai","doi":"10.1016/j.liver.2023.100147","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100147","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"10 ","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49880037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1016/j.liver.2023.100150
Mika S. Buijk , Marcel Dijkshoorn , Roy S. Dwarkasing , Alicia C. Chorley , Robert C. Minnee , Markus U. Boehnert
Background
Liver volume measurement plays a critical role in the clinical success of living donor liver transplantation (LDLT). CT liver volumetry is used for volumetric assessment of the donor hepatectomy. However, the degree of accuracy of the preoperative predicted volumetric measurements remains unclear.
Purpose
This systematic review will assess the accuracy of CT liver volumetry.
Materials and Methods
A systematic literature search was conducted to evaluate the accuracy of the CT based liver volumetry. To assess the difference between the left and right liver lobe the ratio between preoperative estimated graft volume (EGV) and actual graft weight (AGW) was calculated. A meta-analysis was performed to compare the EGV to the AGW of the left and right lobe with automated and manual CT volume prediction.
Results
Thirty-one studies met the inclusion criteria and 1336 patients were included in the meta-analysis. The EGV of the right liver is overestimated with a mean of 4.01% and 2.99% for automated and manual volumetry respectively. The left lobe is overestimated with 6.28% and 14.41% for automated and manual volumetry respectively. For a right lobe liver graft automated volume prediction showed a mean difference of 43.9 g (95% confidence interval (CI): 21.21–66.54, p<0.001) between EGV and AGW. For manual volume prediction this was 34.0 g (95% CI: 11.85–56.11, p = 0.003). For a left lobe with automated volume prediction the mean difference was 46.0 g (95% CI: 20.91–71.09, p<0.001) between EGV and AGW. For manual volume prediction this was 39.6 g (95% CI: 8.40–70.74, p = 0.01).
Conclusion
The volumes of the right and left liver lobe seem to be overestimated with automated and manual CT volume prediction. Considering the larger estimation error in the prediction of the left liver lobe, special attention should be paid to the volume when performing a LDLT with a left liver lobe to prevent small for size syndrome.
肝体积测量在活体肝移植(LDLT)的临床成功中起着至关重要的作用。CT肝体积测量用于供体肝切除术的体积评估。然而，术前预测体积测量的准确度仍不清楚。目的评价CT肝容量测量的准确性。材料与方法通过系统的文献检索，评价基于CT的肝脏体积测量的准确性。计算术前估计移植物体积(EGV)与实际移植物重量(AGW)之比，以评估左右肝叶的差异。进行meta分析，比较自动和手动CT容积预测的左右叶EGV和AGW。结果31项研究符合纳入标准，1336例患者被纳入meta分析。自动容积法和手动容积法对右肝EGV的平均高估分别为4.01%和2.99%。自动容积法和手动容积法分别高估了左叶的6.28%和14.41%。对于右肝叶移植物，自动体积预测显示EGV和AGW之间的平均差异为43.9 g(95%可信区间(CI): 21.21-66.54, p<0.001)。人工体积预测为34.0 g (95% CI: 11.85-56.11, p = 0.003)。对于自动容积预测的左叶，EGV和AGW之间的平均差异为46.0 g (95% CI: 20.91-71.09, p<0.001)。人工体积预测为39.6 g (95% CI: 8.40-70.74, p = 0.01)。结论CT自动和人工预测的肝左、右叶容积存在高估的现象。考虑到左肝叶预测的估计误差较大，左肝叶行LDLT时应特别注意容积，防止小体积综合征。
{"title":"Accuracy of preoperative liver volumetry in living donor liver transplantation—A systematic review and meta-analysis","authors":"Mika S. Buijk , Marcel Dijkshoorn , Roy S. Dwarkasing , Alicia C. Chorley , Robert C. Minnee , Markus U. Boehnert","doi":"10.1016/j.liver.2023.100150","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100150","url":null,"abstract":"<div><h3>Background</h3><p>Liver volume measurement plays a critical role in the clinical success of living donor liver transplantation (LDLT). CT liver volumetry is used for volumetric assessment of the donor hepatectomy. However, the degree of accuracy of the preoperative predicted volumetric measurements remains unclear.</p></div><div><h3>Purpose</h3><p>This systematic review will assess the accuracy of CT liver volumetry.</p></div><div><h3>Materials and Methods</h3><p>A systematic literature search was conducted to evaluate the accuracy of the CT based liver volumetry. To assess the difference between the left and right liver lobe the ratio between preoperative estimated graft volume (EGV) and actual graft weight (AGW) was calculated. A meta-analysis was performed to compare the EGV to the AGW of the left and right lobe with automated and manual CT volume prediction.</p></div><div><h3>Results</h3><p>Thirty-one studies met the inclusion criteria and 1336 patients were included in the meta-analysis. The EGV of the right liver is overestimated with a mean of 4.01% and 2.99% for automated and manual volumetry respectively. The left lobe is overestimated with 6.28% and 14.41% for automated and manual volumetry respectively. For a right lobe liver graft automated volume prediction showed a mean difference of 43.9 g (95% confidence interval (CI): 21.21–66.54, <em>p</em><0.001) between EGV and AGW. For manual volume prediction this was 34.0 g (95% CI: 11.85–56.11, <em>p</em> = 0.003). For a left lobe with automated volume prediction the mean difference was 46.0 g (95% CI: 20.91–71.09, <em>p</em><0.001) between EGV and AGW. For manual volume prediction this was 39.6 g (95% CI: 8.40–70.74, <em>p</em> = 0.01).</p></div><div><h3>Conclusion</h3><p>The volumes of the right and left liver lobe seem to be overestimated with automated and manual CT volume prediction. Considering the larger estimation error in the prediction of the left liver lobe, special attention should be paid to the volume when performing a LDLT with a left liver lobe to prevent small for size syndrome.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"10 ","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49880030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1016/j.liver.2023.100151
GP Rodríguez Laiz , P Melgar Requena , C Alcázar López , M Franco Campello , C Villodre Tudela , P Bellot García , M Rodríguez Soler , C Miralles Maciá , I Herrera Marante , MT Pomares Mas , P Mas Serrano , L Gómez Salinas , F Jaime Sánchez , M Perdiguero Gil , JM Ramia Ángel , S Pascual Bartolomé
Fast Tracking in Liver Transplantation has been around for the past 25 years, although no substantial advancement, in the form of a comprehensive protocol, had been readily available. Few centers had embraced this goal, so before we started our program, a little over a decade ago, we adopted most of these ideas into a comprehensive pathway that would swiftly carry our patients from the preoperative stage through a safe home discharge. From day one, we have used this Fast Track pathway and applied it prospectively to every single patient undergoing liver transplantation at our institution, monitoring the results periodically. We now report our results after 10 years.
Patients and Methods
All liver transplants performed at our center for the first 10 years since the start of the program (September 2012–September 2022) were included. Our standard protocol included balanced general anesthesia, fluid restriction, avoidance of transfusions, inferior vena cava preservation with temporary porto-caval shunt and thromboelastography. Standard immunosuppression administered included steroids, tacrolimus (delayed in the setting of renal impairment, with basiliximab induction added) and mycophenolate mofetil. Tacrolimus dosing was adjusted using a Bayesian estimation methodology. Oral intake and ambulation were started early.
Results
385 transplants were performed in 367 patients (287♂/80♀) over 120 months, mean age 57.4±9.5 years, raw MELD score 15.4±8.1. Predominant etiologies were alcohol (n=217) and HCV (n=108), with hepatocellular carcinoma present in 197 (53.7%). Eighteen patients underwent combined liver-and-kidney transplants. Mean operating time was 313±66 min with cold ischemia times of 281±85 min. Fifty-nine patients (15.3%) were transfused in the OR (2.3±1.1 units of PRBC). Extubation was immediate (< 30 min) in 365 cases (94.8%). Median ICU length of stay was 12.6 h, and median post-transplant hospital stay was 4 days (2–97) with 55 patients (15.8%) discharged home by the 2nd day, 141 (40.5%) by the 3rd day and 203 (58.3%) by the 4th day, which defined our Fast-Track group. The overall thirty-day-readmission rate was (34.5%), which became significantly lower (27.6% vs 44.1%, p=0.0014) in the Fast-Track group when compared to the regular discharge group. Patient survival was 87.6% at 1 year and 79.7% at 5 years.
Conclusion
Fast-Tracking of Liver Transplant patients is very feasible and can be applied as the standard of care.
{"title":"Fast Track Liver Transplantation: Lessons learned after 10 years running a prospective cohort study with an ERAS-like protocol","authors":"GP Rodríguez Laiz , P Melgar Requena , C Alcázar López , M Franco Campello , C Villodre Tudela , P Bellot García , M Rodríguez Soler , C Miralles Maciá , I Herrera Marante , MT Pomares Mas , P Mas Serrano , L Gómez Salinas , F Jaime Sánchez , M Perdiguero Gil , JM Ramia Ángel , S Pascual Bartolomé","doi":"10.1016/j.liver.2023.100151","DOIUrl":"https://doi.org/10.1016/j.liver.2023.100151","url":null,"abstract":"<div><p>Fast Tracking in Liver Transplantation has been around for the past 25 years, although no substantial advancement, in the form of a comprehensive protocol, had been readily available. Few centers had embraced this goal, so before we started our program, a little over a decade ago, we adopted most of these ideas into a comprehensive pathway that would swiftly carry our patients from the preoperative stage through a safe home discharge. From day one, we have used this Fast Track pathway and applied it prospectively to every single patient undergoing liver transplantation at our institution, monitoring the results periodically. We now report our results after 10 years.</p></div><div><h3>Patients and Methods</h3><p>All liver transplants performed at our center for the first 10 years since the start of the program (September 2012–September 2022) were included. Our standard protocol included balanced general anesthesia, fluid restriction, avoidance of transfusions, inferior vena cava preservation with temporary porto-caval shunt and thromboelastography. Standard immunosuppression administered included steroids, tacrolimus (delayed in the setting of renal impairment, with basiliximab induction added) and mycophenolate mofetil. Tacrolimus dosing was adjusted using a Bayesian estimation methodology. Oral intake and ambulation were started early.</p></div><div><h3>Results</h3><p>385 transplants were performed in 367 patients (287♂/80♀) over 120 months, mean age 57.4±9.5 years, raw MELD score 15.4±8.1. Predominant etiologies were alcohol (n=217) and HCV (n=108), with hepatocellular carcinoma present in 197 (53.7%). Eighteen patients underwent combined liver-and-kidney transplants. Mean operating time was 313±66 min with cold ischemia times of 281±85 min. Fifty-nine patients (15.3%) were transfused in the OR (2.3±1.1 units of PRBC). Extubation was immediate (< 30 min) in 365 cases (94.8%). Median ICU length of stay was 12.6 h, and median post-transplant hospital stay was 4 days (2–97) with 55 patients (15.8%) discharged home by the 2nd day, 141 (40.5%) by the 3rd day and 203 (58.3%) by the 4th day, which defined our Fast-Track group. The overall thirty-day-readmission rate was (34.5%), which became significantly lower (27.6% vs 44.1%, p=0.0014) in the Fast-Track group when compared to the regular discharge group. Patient survival was 87.6% at 1 year and 79.7% at 5 years.</p></div><div><h3>Conclusion</h3><p>Fast-Tracking of Liver Transplant patients is very feasible and can be applied as the standard of care.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"10 ","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49880034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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