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Les derniers abstracts de la revue Liver Transplantation :

    Date de mise en ligne : Jeudi 27 avril 2017
    Thoetchai (Bee) Peeraphatdit, Patrick S. Kamath, Vijay H. Shah
    Beta‐Blockers in Advanced Cirrhotics: Red Light, Green Light, Yellow Light…
    n/a

    Date de mise en ligne : Vendredi 21 avril 2017
    Jae Geun Lee, Kwang‐Woong Lee, Choon Hyuck David Kwon, Chong Woo Chu, Bong‐Wan Kim, Dong Lak Choi, Young Kyoung You, Dong‐Sik Kim, Yang Won Nah, Koo Jeong Kang, In Soek Choi, Hee Chul Yu, Geun Hong, Ho‐Seong Han, Shin Hwang, Myoung Soo Kim,
    Donor safety in living donor liver transplantation: The Korean Organ Transplantation Registry (KOTRY) study
    Major concerns about donor safety cause controversy and limit the use of living donor liver transplantation to overcome organ shortages. The Korean Organ Transplantation Registry established a nationwide organ transplantation registration system in 2014. We reviewed the prospectively collected data of all 832 live liver donors who underwent procedures between April 2014 and December 2015. We allocated the donors to a left lobe group (n=59) and a right lobe group (n=773) and analyzed the relations between graft types and remaining liver volumes and complications (graded using the Clavien five‐tier grading system). The median follow‐up was 19 months (range, 10‐31 months). During the study period, 553 men and 279 women donated livers and there were no deaths after live liver donation. The overall, biliary, and major complication (Grade ≥ III) rates were 9.3%, 1.7%, and 1.9%, respectively. The graft types and remaining liver volume were associated with significantly different overall, biliary, and major complication rates. Of the 16 cases with major complications, nine (56.3%) involved biliary complications [two biliary strictures (16.5%) and seven bile leakages (43.8%)]. Among the 832 donors, the mean AST, ALT, and total bilirubin levels were 23.9 ± 8.1 IU/L, 20.9 ± 11.3 IU/L, and 0.8 ± 0.4 mg/dL, respectively, 6 months after liver donation. In conclusion, biliary complications were the most common types of major morbidity in live liver donors. Donor hepatectomy can be performed successfully with minimal and easily controlled complications. . Our study shows that prospective, nationwide cohort data provide an important means of investigating the safety in live liver donation. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 20 avril 2017
    Emily R. Perito, Tabitha Vase, Rageshree Ramachandran, Andrew Phelps, Kuang‐Yu Jen, Robert H. Lustig, Vickie A. Feldstein, Philip Rosenthal
    Hepatic steatosis after pediatric liver transplant
    Rationale: Hepatic steatosis develops after liver transplant in 30% of adults, and non‐alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in non‐transplanted children. However, post‐transplant steatosis has been minimally studied in pediatric liver transplant recipients. We explored the prevalence, persistence, and association with chronic liver damage of hepatic steatosis in these children. Results: In this single‐center study of pediatric patients transplanted 1988‐2015 (n=318), 31% of those with any post‐transplant biopsy (n=271) had ≥1 biopsy with steatosis. Median time from transplant to first biopsy with steatosis was 0.8 months (IQR 0.3‐6.5) and to last biopsy with steatosis was 5.5 months (IQR 1.0‐24.5). 85% of patients with steatosis also had for‐cause biopsies without steatosis. All available for‐cause biopsies were re‐evaluated (n=104); Of 9 biopsies that could be interpreted as NASH/Borderline NASH, with steatosis plus inflammation or ballooning, 8 also had features of cholestasis or rejection. Among 70 patients with surveillance biopsies 3.6‐20.0 years post‐transplant, only 1 overweight adolescent had a biopsy with NAFLD (grade 1 steatosis, mild inflammation, no ballooning or fibrosis)—despite a 30% prevalence of overweight/obesity in the cohort and 27% with steatosis on previous for‐cause biopsy. Steatosis on preceding for‐cause biopsy was not associated with portal (p=0.49) or perivenular fibrosis (p=0.85) on surveillance biopsy. Conclusions: Hepatic steatosis commonly develops early post‐transplant in children and adolescents, but it rarely persists. Biopsies that did have steatosis with NASH characteristics were all for‐cause, mostly in patients with NAFLD risk factors and/or confounding causes of liver damage. Prospective studies that follow children into adulthood will be needed to evaluate if and when hepatic steatosis presents a long‐term risk for pediatric liver transplant recipients. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 20 avril 2017
    Jennie Choe, David C. Mulligan
    Liver retransplantation: Recurrent PSC may provide better outcomes
    n/a

    Date de mise en ligne : Jeudi 20 avril 2017
    Mark Draoua, Nicole Titze, Amar Gupta, Hoylan T. Fernandez, Michael Ramsay, Giovanna Saracino, Gregory McKenna, Giuliano Testa, Goran B. Klintmalm, Peter T.W. Kim
    Significance of Measured Intraoperative Portal Vein Flows After Thrombendvenectomy in Deceased Donor Liver Transplants with Portal Vein Thrombosis
    Background: Adequate portal vein (PV) flow in liver transplantation is essential for a good outcome, and it may be compromised in patients with portal vein thrombosis (PVT). This study evaluated the impact of intraoperatively measured PV flow after PV thrombendvenectomy on outcomes after deceased donor liver transplantation. Study Design: The study included 77 patients over a 16‐year period who underwent PV thrombendvenectomy with complete flow data. Patients were classified into two groups: high PV flow (>1300 mL/min, N = 55) and low PV flow (≤1300 mL/min, N = 22). Postoperative complications and graft survival were analyzed according to the PV flow. Results: The two groups were similar in demographic characteristics. Low PV flow was associated with higher cumulative rates of biliary strictures (P = 0.016) and lower 1‐, 2‐, and 5‐year graft survival (89%, 85%, and 68% vs. 64%, 55%, and 38%, respectively, P = 0.002). There was no difference in the incidence of postoperative PVT between the groups (1.8% vs. 9.2%, P = 0.19). No biliary leaks or hepatic artery thromboses were reported in either group. By multivariate analyses, age >60 years (hazard ratio 3.04, confidence interval 1.36‐6.82; P = 0.007) and low portal flow (HR 2.31 (1.15‐4.65, P=0.02) were associated with worse survival. Conclusion: PV flow <1300 mL/min after PV thrombendvenectomy for PVT during deceased donor liver transplantation was associated with higher rates of biliary strictures and worse graft survival. Consideration should be given to identifying reasons for low flow and performing maneuvers to increase PV flow when intraoperative PV flows are <1300 mL/min. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mercredi 19 avril 2017
    Silvia Martini, Francesco Tandoi, Lodovico Terzi di Bergamo, Silvia Strona, Bruna Lavezzo, Marco Sacco, Francesca Maione, Federica Gonella, Paolo Strignano, Dominic Dell Olio, Mauro Salizzoni, Giorgio Maria Saracco, Renato Romagnoli
    Negativization of viremia prior to liver transplant reduces early allograft dysfunction in hepatitis C recipients
    Although early allograft dysfunction (EAD) negatively impacts on survival from the first months following liver transplantation (LT), direct‐acting antivirals (DAAs) have revolutionized HCV therapy. We investigated the EAD definition best predicting 90‐day graft loss and identified EAD risk factors in HCV positive recipients. From 11‐2002 to 06‐2016, 603 HCV‐positive patients (hepatocellular carcinoma 53.4%) underwent a first LT with HCV‐negative donors. Median recipient MELD score 15, median donor age 63 years. At LT, 77 (12.8%) patients were HCV RNA negative; negativization was achieved and maintained by pre‐LT antiviral therapy (61 patients) or pre‐LT+pre‐emptive post‐LT course (16 patients); 60 (77.9%) patients received DAAs and 17 (22.1%) interferon. We compared three different EAD definitions: a) bilirubin≥10 mg/dL or INR≥1.6 on day 7 post‐LT or AST or ALT>2000 IU/L within 7 days of LT; b) bilirubin>10 mg/dL on days 2 to 7 post‐LT; c) MELD≥19 on day 5 post‐LT. EAD defined by MELD≥19 on day 5 post‐LT had the lowest negative (0.1) and the highest positive (1.9) likelihood ratio to predict 90‐day graft loss. At 90 days post‐LT, 9.2% of recipients with EAD lost their graft as opposed to 0.7% of those without EAD (p<0.001). At multivariate analysis, considering variables available at LT, MELD at LT>25 (OR=7.4) or 15‐25 (OR=3.2), graft macrovesicular steatosis≥30% (OR=6.7), HCV RNA positive at LT (OR=2.7), donor age>70 years (OR=2.0), earlier LT era (OR=1.8), cold ischemia time≥8 hours (OR=1.8) were significant risk factors for EAD. Conclusions. In HCV‐positive patients, MELD≥19 on day 5 post‐LT best predicts 90‐day graft loss. Preventing graft infection by pre/peri‐LT antiviral therapy reduces EAD incidence and could be most beneficial in high MELD patients and recipients of suboptimal grafts. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mercredi 19 avril 2017
    Xiao‐Shun He, Shun‐Jun Fu, Qiang Zhao, Xiao‐Feng Zhu, Dong‐Ping Wang, Ming Han, Wei‐Qiang Ju, Yi Ma, Xing‐Yuan Jiao, Xiao‐Peng Yuan, An‐Bin Hu, Zhi‐Yong Guo
    A Simplified Multivisceral Transplantation Procedure for Patients with Combined End‐Stage Liver Disease and Type 2 Diabetes Mellitus
    In liver transplant patients with type 2 diabetes mellitus (DM), the disease worsens after transplantation because of long‐term use of diabetogenic immunosuppressive drugs, making management of those patients a great challenge. The objective of our study was to evaluate the safety and efficacy of a simplified multivisceral transplantation (SMT) procedure for the treatment of patients with end‐stage liver disease and concurrent type 2 DM. Forty‐four patients who had pretransplant type 2 DM were included. Twenty‐three patients received SMT and 21 patients received orthotopic liver transplantation (OLT). Patient and graft survivals, complications, diabetic control, and quality of life were retrospectively analyzed in both groups. The 1‐, 3‐, and 5‐year cumulative patient and graft survival rates were 91.5%, 75.4%, and 75.4% in the SMT group and were 94.4%, 64.4%, and 64.4% in the OLT group, respectively (P = 0.70). Interestingly, 95.7% (22/23) of patients achieved complete remission from DM after SMT compared to 16.7% (3/18) of patients after OLT. The occurrence of biliary complication was significantly higher in the OLT group than that in the SMT group (23.8% VS 0, P = 0.01). Moreover, better quality of life was observed in the SMT group than that in the OLT group. In conclusion, the SMT procedure we described here is a safe and viable option for patients with end‐stage live disease and concurrent type 2 DM. This SMT procedure offers excellent transplant outcomes and quality of life. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mercredi 19 avril 2017
    Ping‐Chun Li, Ashok Thorat, Long‐Bin Jeng, Horng‐Ren Yang, Ming‐Li Li, Chun‐Chieh Yeh, Te‐Hung Chen, Shih‐Chao Hsu, Kin‐Shing Poon
    Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in consecutive 741 recipients‐ Tips and tricks to overcome the poor hepatic arterial flow
    Background: The reconstruction of hepatic artery (HA) is most complex step in living donor liver transplantation (LDLT) due to smaller diameter of the artery and increased risk of HA related complications. Due to smaller diameter of the HA, many centres use microsurgical technique with interrupted sutures for arterial anastomosis. Aim of our study was to retrospectively investigate the outcomes after HA reconstruction performed under magnifying loupes using “parachute technique”. Materials and Methods: From August 2002 to 31st August 2016, LDLT was performed in 766 recipients. HA reconstruction for initial 25 LDLT surgeries was performed using microsurgery technique (Era I). From May 2007 till date, HA reconstruction was performed in 741 recipients by a “parachute technique” under surgical loupes (Era II). Results: HA reconstruction was performed using surgical loupes in 737 adults (Male:Female, 526:211) and 4 pediatric patients (Male:Female, 3:1). Average diameter of the donor graft HA was 2.8 mm (range,1 to 6.5 mm). The most notable factor in this era was quick HA anastomosis procedure with a mean time of 10 ± 5 minutes (range, 5‐30 minutes). In Era II, nine patients (1.21%) developed hepatic artery thrombosis (HAT) whereas 2 patients developed non‐thrombotic HA related complications. Extra‐anatomic HA reconstruction was performed in 14 patients due to either primary HA anastomosis failure or poor caliber recipient HA. Conclusions: Use of magnifying surgical loupes to perform HA reconstruction is safe, feasible, and yields low incidence of HA related complications. The “Parachute Technique” for HA reconstruction can achieve a speedy reconstruction without increasing risk of HAT. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 13 avril 2017
    Po‐Da Chen, Yao‐Ming Wu
    Re: Living donor liver transplantation: are we ready for full robotic harvesting?
    n/a

    Date de mise en ligne : Jeudi 13 avril 2017
    Hiroaki Haga, Irene K. Yan, David Borelli, Akiko Matsuda, Mansi Parasramka, Neha Shukla, David D. Lee, Tushar Patel
    Extracellular vesicles from bone marrow derived mesenchymal stem cells protect against murine hepatic ischemia‐reperfusion injury
    Hepatic ischemia‐reperfusion injury (IRI) and associated inflammation contributes to liver dysfunction and complications after liver surgery and transplantation. Mesenchymal stem cells (MSC) have been reported to reduce hepatic IRI because of their reparative immunomodulatory effects in injured tissues. Recent studies have highlighted beneficial effects of extracellular vesicles from MSCs (MSC‐EV) on tissue injury. The effects of systemically administered mouse bone marrow derived MSC‐EV were evaluated in an experimental murine model of hepatic IRI induced by cross clamping the hepatic artery and portal vein for 90 minutes followed by reperfusion for periods of upto 6 hours. Compared with controls, intravenous administration of MSC‐EV 30 minutes prior to IRI dramatically reduced the extent of tissue necrosis, decreased caspase‐3 positive and apoptotic cells, and reduced serum aminotransferase levels. MSC‐EV increased hepatic mRNA expression of NACHT, LRR and PYD domains‐containing protein 12 (Nlrp12), and the chemokine (C‐X‐C motif) ligand 1 (CXCL1), and reduced mRNA expression of several inflammatory cytokines such as IL‐6 during IRI. MSC‐EV increased cell viability and suppressed both oxidative injury and NF‐κB activity in AML12 murine hepatocytes in vitro. In conclusion, the administration of EV derived from bone marrow derived MSCs may ameliorate hepatic IRI by reducing hepatic injury through modulation of the inflammatory response. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 13 avril 2017
    Paolo Magistri, Giuseppe Tarantino, Roberto Ballarin, Andrea Coratti, Fabrizio Di Benedetto
    Living donor liver transplantation: Are we ready for full robotic harvesting?
    n/a

    Date de mise en ligne : Jeudi 13 avril 2017
    Hongqun Liu, Saumya Jayakumar, Mouhieddin Traboulsi, Samuel S. Lee
    Cirrhotic cardiomyopathy: Implications for liver transplantation
    The majority of the patients on a waiting list for liver transplantation have end‐stage liver disease. Due to the marked peripheral vasodilatation of end stage cirrhosis that masks a latent myocardial dysfunction, cardiac abnormalities in the resting state are usually subclinical and escape the attention of physicians. However, when challenged, the systolic and diastolic contractile responses are attenuated. In addition to these contractile abnormalities, morphological changes such as enlargement or hypertrophy of cardiac chambers and electrophysiological repolarization changes including a prolonged QT interval can be observed. The constellation of these cardiac abnormalities is termed cirrhotic cardiomyopathy. Liver transplantation induces significant cardiovascular stress. Clamping of the inferior vena cava and portal vein, hemorrhage and blood/volume infusion, and ischemia/reperfusion all cause hemodynamic fluctuation. The changing cardiac preload and afterload increase the cardiac workload and thus the previously subclinical ventricular dysfunction may manifest as overt heart failure during the operative and perioperative periods. Cardiac dysfunction contributes to morbidity and mortality associated with liver transplantation. Cardiovascular events are the third‐leading cause of death in liver recipients. However, as liver transplantation is the only definitive treatment for endstage liver failure and also appears to reverse the cardiac abnormalties, it is important to understand the challenges of the heart in liver transplantation. This review focuses on cardiac status before, during, and after liver transplantation. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 13 avril 2017
    Douglas R. Murken, Allison W. Peng, David D. Aufhauser, Peter L. Abt, David S. Goldberg, Matthew H. Levine
    Same Policy, Different Impact: Center‐Level Effects of Share 35 Liver Allocation
    Early studies of national data suggest that the Share 35 allocation policy increased liver transplants without compromising post‐transplant outcomes. Changes in center‐specific volumes and practice patterns in response to the national policy change are not well characterized. Understanding center‐level responses to Share 35 is crucial for optimizing the policy and constructing effective future policy revisions. Data from the United Network for Organ Sharing were analyzed to compare center‐level volumes of allocation‐MELD ≥35 transplants pre‐ and post‐policy implementation. There was significant center‐level variation in the number and proportion of allocation‐MELD ≥35 transplants performed from the pre‐ to post‐Share 35 period; eight centers accounted for 33.7% of the total national increase in allocation‐MELD ≥35 transplants performed in the 2.5‐year post‐Share 35 period, while 25 centers accounted for 65.0% of the national increase. This trend correlated with increased listing at these centers of patients with MELD ≥35 at the time of initial listing. These centers did not over‐represent the total national volume of liver transplants. Comparison of post‐Share 35 allocation‐MELD to calculated time‐of‐transplant laboratory MELD showed that only 69.6% of patients transplanted with allocation‐MELD ≥35 maintained a calculated laboratory MELD ≥35 at the time‐of‐transplant. Conclusion: Share 35 increased transplantation of allocation‐MELD ≥35 recipients on a national level, but the policy asymmetrically impacted practice patterns and volumes of a subset of centers. Longer‐term data is necessary to assess outcomes at centers with markedly increased volumes of high‐MELD transplants post‐Share 35. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Vendredi 07 avril 2017
    Jasmijn W. Selten, Cornelia J. Verhoeven, Veerle Heedfeld, Henk P. Roest, Jeroen de Jonge, Jacques Pirenne, Jos van Pelt, Jan. N.M. IJzermans, Diethard Monbaliu, Luc J.W. van der Laan
    The Release of MicroRNA‐122 During Liver Preservation is Associated with Early Allograft Dysfunction and Graft Survival After Transplantation
    Introduction: Early allograft dysfunction (EAD) after liver transplantation is associated with inferior graft survival. EAD is more prevalent in grafts from donation after circulatory death (DCD). However, accurate prediction of liver function remains difficult due to the lack of specific biomarkers. Recent experimental and clinical studies highlight the potential of hepatocyte‐derived microRNAs (miRNAs) as sensitive, stable and specific biomarkers of liver injury. The aim of this study was to determine whether miRNAs in graft preservation fluid are predictive for EAD after clinical liver transplantation and in an experimental DCD model. Methods: Graft preservation solutions of 83 liver grafts at the end of cold ischemia were analyzed for miRNAs by RT‐qPCR. Of these grafts 42% developed EAD after transplantation. Results were verified in pig livers (n=36) exposed to different lengths of warm ischemia time. Results: The absolute miR‐122 levels and miR‐122/miR‐222 ratios in preservation fluids were significantly higher in DCD grafts (p=0.001) and grafts developing EAD (p=0.004). In concordance, the miR‐122/miR‐222 ratios in perfusion fluid correlate with serum transaminase levels within the first 24 hours after transplantation. Long‐term graft survival was significantly diminished in grafts with high miR‐122/miR‐222 ratios (p=0.019). In the porcine DCD model, increased warm ischemia lead to higher absolute miR‐122 levels and relative miR‐122/miR‐222 ratios in graft perfusion fluid (p=0.009, and p=0.02, respectively). High miR‐122/miR‐222 ratios in pig livers were also associated with high AST levels after warm oxygenated reperfusion. Conclusion: Both absolute and relative miR‐122 levels in graft preservation solution are associated with DCD, EAD and early graft loss after liver transplantation. As shown in a porcine DCD model, miRNA release correlated with the length of warm ischemia times. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Vendredi 24 mars 2017
    Ghady Haidar, Nina Singh
    Improving the Outcomes of HIV/HCV Coinfected Transplant Recipients: The Answer is Blowin' in the Wind
    n/a

    Date de mise en ligne : Vendredi 24 mars 2017
    Sara M. Lewin, Neil Mehta, R. Kate Kelley, John P. Roberts, Francis Y. Yao, Danielle Brandman
    Liver Transplant (LT) recipients with Nonalcoholic Steatohepatitis (NASH) Have Lower Risk Hepatocellular Carcinoma (HCC)
    Background: Liver transplantation is a well‐established treatment for HCC in carefully selected patients. Risk factors for tumors with poor prognostic features on explant have not been well described in a national cohort. Methods: We performed a retrospective cohort study of adult LT recipients with HCC transplanted from 4/8/12 (when explant pathology in UNOS became available) until 9/30/2014. We evaluated the association between listing diagnosis and other demographic factors with tumor features on explant using logistic regression. High‐risk tumor features included: >3 tumors, largest tumor >5 cm, presence of vascular invasion, presence of metastases, and poor differentiation of tumor. Results: 3733 LT recipients with HCC who had complete explant data in UNOS were included. The median age was 60, 78% were male and 68% were white. 2608 (70%) had hepatitis C (HCV), 271 (7%) had NASH, 246 (7%) had alcoholic cirrhosis, and 189 (5%) had hepatitis B (HBV) as the primary non‐HCC listing diagnosis. 1140 (31%) had evidence of ≥1 high‐risk explant feature(s). The presence of ≥1 high‐risk explant feature(s) was associated with HCC recurrence post‐transplant (OR 5.00; p<0.001). Compared to HCV‐associated HCC transplant recipients, individuals with NASH had lower likelihood of high‐risk explant features (OR 0.71, p=0.02) after adjusting for covariables. Women were more likely to have high‐risk explant features (OR 1.23, p=0.04). Diabetes mellitus was not associated with high‐risk explant features. Conclusion: LT recipients with NASH‐associated HCC had fewer high‐risk tumor features on explant compared to HCV‐associated HCC, despite having higher rates of DM and other potential risk factors for the development of HCC. Women had a higher likelihood of high‐risk tumor features. Further study is warranted whether these differences are due to disease‐specific or gender‐specific influences on tumor biology or due to selection criteria for transplant. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mardi 14 mars 2017
    Andrew P. Wright, Robert J. Fontana, Ryan W. Stidham
    Vedolizumab is Safe and Effective in Moderate to Severe Inflammatory Bowel Disease Following Liver Transplantation
    n/a

    Date de mise en ligne : Mardi 14 mars 2017
    Benjamin Menahem, Jean Lubrano, Christophe Duvoux, Andrea Mulliri, Arnaud Alves, Charlotte Costentin, Ariane Mallat, Guy Launoy, Alexis Laurent
    Liver transplantation versus liver resection for hepatocellular carcinoma in intention to treat: Attempt to perform an ideal meta‐analysis
    Objective This meta‐analysis compared the effects of liver transplantation (LT) and liver resection (LR) on overall survival (OS) and disease‐free survival (DFS) in patients with hepatocellular carcinoma (HCC) small transplantable HCC or within Milan criteria. Methods Articles comparing LR with LT for HCC, based on Milan criteria or small size, published until June 2015 were selected and a meta‐analysis performed. Results No randomized controlled trial (RCT) has been published to date comparing survival outcomes in patients with HCC who underwent LR and LT. Nine studies were identified, including 570 patients who underwent LR and 861 who underwent LT. For HCC within the Milan criteria, the 1‐year OS rates following LR and LT were 84.5% (473/560) and 84.4% (710/841), respectively (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.71‐1.33, p = 0.8) and the 5‐year OS rates were 47.9% (273/570) and 59.3% (509/858), respectively (OR 0.60; 95% CI 0.35‐1.02, p = 0.06). One‐year DFS rates were similar (OR 1.00; 95% CI 0.39‐2.61, p = 1.00), whereas the 3‐year DFS rate was significantly lower in the LR (54.4% [210/386]) than in the LT (74.2% [317/427]) group (OR 0.24, 95% CI 0.07‐0.80, p =0.02) and the 5‐year DFS rate was significantly lower for LR than LT (OR 0.18; 95% CI 0.06‐0.53, p < 0.01). For small HCCs, the 5‐year OS rate was significantly lower for patients who underwent LR than LT (OR 0.30; 95% CI 0.19‐0.48, p < 0.001). Conclusion Relative to LR, LT in patients with HCC meeting the Milan criteria had no benefits before 10 years for OS. For DFS, the benefit is obtain after 3 years. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mardi 14 mars 2017
    Tara A. Russell, Sarah Park, Vatche G. Agopian, Ali Zarrinpar, Douglas G. Farmer, Sean O'Neill, Islam Korayem, Samer Ebaid, Jeffrey Gornbein, Ronald W. Busuttil, Fady M. Kaldas
    Peri‐Transplant Pancreatitis: A Marker of High Mortality and Graft Failure in Liver Transplant Patients
    Perioperative pancreatitis is a significant comorbid condition in surgical patients, however the degree to which pancreatitis affects graft and overall survival in liver transplant recipients has not been evaluated. This study assesses the impact of pancreatitis on graft and patient survival in adult orthotopic liver transplantation (OLT). All patients undergoing OLT at a single academic institution from 2007‐2015 were reviewed. Pancreatitis was classified by method of diagnosis (intra‐operative or radiographic (IO/R) versus isolated serologic (IS)) and timing (pre‐operative versus post‐operative). Twenty‐three patients were identified with peri‐transplant pancreatitis (within 30 days pre‐ or post‐operatively). A control group of patients without pancreatitis undergoing OLT was composed of 775 patients. Graft failure/death rates for patients with versus without pancreatitis were 7.4% vs. 7.4% at 30 days, 33.3% vs. 12.6% at 90 days, and 44.4% vs. 26.9% at 12 months. Four patients with pancreatitis (17.4%) required emergent re‐transplantation, and subsequently died within 90 days of their second transplant. Overall, six patients with pancreatitis (26.1%) died within 90 days of transplantation. Patients with pancreatitis had a hazard ratio (HR) for death or graft failure of 2.28 as compared to controls (p<0.01). The effect of pancreatitis is most pronounced among those diagnosed by intra‐operative or radiographic findings, with an adjusted HR of 2.53 (p<0.01) and those diagnosed in the post‐operative period, adjusted HR 2.57 (p=0.01). Conclusion: Peri‐operative pancreatitis is associated with early graft failure and patient mortality, regardless of method or timing of diagnosis. Given these results, radiographic or intraoperative findings of pancreatitis should induce caution and potentially preclude OLT until resolved. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mardi 14 mars 2017
    Mettu Srinivas Reddy, Ilankumaran Kaliamoorthy, Akila Rajakumar, Selvakumar Malleeshwaran, Ellango Appuswamy, Sukanya Lakshmi, Joy Varghese, Mohamed Rela
    Double Blind Randomized Controlled Trial of the Routine Peri‐operative Use of Terlipressin in Adult Living Donor Liver Transplantation
    Background: Peri‐operative terlipressin (Tp) during living donor liver transplantation (LDLT) has been shown to reduce intra‐operative portal pressures and improve renal function. Its role and safety profile has never been evaluated in a double‐blinded RCT. Aim: To evaluate the haemodynamic effects, clinical benefits and safety of peri‐operative terlipressin infusion in adult LDLT. Methods: This was a single centre double‐blind RCT. Consenting adults with chronic liver disease and low risk of post‐transplant renal dysfunction (PTRD) undergoing their first LDLT were randomized. Study group (TpG) received an initial bolus of Tp during surgery followed by Tp infusion for 72 hours in post‐operative period. Placebo group (PbG) received saline infusion. Primary end point was portal pressure after arterial reperfusion. Multiple intra‐operative and postoperative variables served as secondary endpoints. Results: 41 patients were enrolled in the trial (TpG: 21, PbG:20). There were no significant differences in intra‐operative portal pressures, blood loss, fluid requirement, vasopressor requirement or urine output. Peak intra‐operative and end of surgery lactate levels were significantly higher in the Tp group. There was no difference in post‐operative liver function tests. Incidence of acute kidney injury as assessed by RIFLE criteria was lesser in Tp group (26.5% vs 60%, p=0.043). TpG had less post‐operative ascites, lesser need for percutaneous interventions and shorter hospital stay. Incidence of bradycardia requiring pharmacological intervention and withdrawal from study was significantly higher in Tp group. Conclusion: This study has not demonstrated reduction in post‐reperfusion portal pressure with Tp. However, Tp infusion reduced post‐operative ascitic drain output resulting in less frequent percutaneous interventions and reduced hospital stay. Intra‐operative hyperlactatemia and symptomatic bradycardia are major concerns. Its use should be restricted to patients with high volume ascites and needs close monitoring during drug infusion. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Lundi 27 février 2017
    Sezai Yilmaz, Cuneyt Kayaalp, Burak Isik, Veysel Ersan, Emrah Otan, Sami Akbulut, Abuzer Dirican, Ramazan Kutlu, Aysegul Sagir Kahraman, Cengiz Ara, Mehmet Yilmaz, Bulent Unal, Cemalettin Aydin, Turgut Piskin, Dincer Ozgor, Mustafa Ates, Fatih Ozdemir, Volkan Ince, Cemalettin Koc, Adil Baskiran, Sait Murat Dogan, Bora Barut, Fatih Sumer, Serdar Karakas, Koray Kutluturk, Saim Yologlu, Harika Gozukara
    Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach
    BACKGROUND: Reconstruction of anomalous portal venous branching (APVB) during right lobe living donor liver transplantation (LDLT) can be challenging. OBJECTIVE: To describe our surgical technique, named the Malatya Approach, in case of APVP during right lobe LDLT. The technique includes the unification of the APVB and to obtain a funnel shaped common extension with a circumferential fence by a saphenous vein conduit. METHODS: Total 126 (10.6%) of 1192 right lobe grafts had APVB that were divided into two groups according to the adopted surgical techniques: the Malatya Approach group (n:91) and the previously defined other techniques group (n:35). Both groups were compared regarding portal vein thrombosis (PVT), postoperative 90 day mortality and survival. RESULTS: PVT developed in three cases (3.3%) in the Malatya Approach group, and developed in ten cases (28.6%) for the other group (p<0.001). There were eight (8.8%) 90‐day mortalities in the Malatya Approach group (one PVT related) and 15 patients (nine PVT related) died in the other techniques group (p<0.001). Mean follow‐up time for both groups were similar (999,09 days for the Malatya Approach group vs 1024,69 days for other group, p=0.47), but long term survival in the Malatya Approach group was better than in the other group (84.6% vs. 40%, p<0.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (p<0.001). CONCLUSIONS: This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Lundi 27 février 2017
    Jasmohan S. Bajaj, Andrew Fagan, Masoumeh Sikaroodi, Melanie B. White, Richard K. Sterling, HoChong Gilles, Douglas Heuman, R.T. Stravitz, Scott C. Matherly, Mohammed S. Siddiqui, Puneet Puri, Arun J. Sanyal, Velimir Luketic, Binu John, Michael Fuchs, Vishwadeep Ahluwalia, Patrick M. Gillevet
    Liver Transplant Modulates Gut Microbial Dysbiosis and Cognitive Function in Cirrhosis
    Liver transplant (LT) improves daily function and cognition in cirrhosis but a subset can remain impaired. Unfavorable microbiota or dysbiosis is observed in cirrhosis but the effect of LT on microbial composition; especially with poor post‐LT cognition, is unclear. Aims: (1) determine the effect of LT on gut microbiota and (b) to determine whether gut microbiota are associated with cognitive dysfunction post‐LT. We enrolled outpatient cirrhotics on the LT list and followed them till 6 months post‐LT. Cognition (Psychometric hepatic encephalopathy score, PHES), quality of life (HRQOL) and stool microbiota (multi‐tagged sequencing for diversity and taxa) was performed at both visits. Persistent cognitive impairment was defined as a stable/worsening PHES. Both pre/post‐LT data were compared with age‐matched healthy controls. We enrolled 45 patients (56±7 years, MELD 26±8). They received LT 6±3 months after enrollment and were re‐evaluated 7±2 months post‐LT with a stable course. A significantly improved HRQOL, PHES, with increase in microbial diversity, increase in autochthonous and decrease in potentially pathogenic taxa, were seen post‐LT compared to baseline. However, there was continued dysbiosis and HRQOL/cognitive impairment post‐LT compared to controls in 29% who did not improve PHES post‐LT. In these, Proteobacteria relative abundance was significantly higher and Firmicutes were lower post‐LT while the reverse occurred in the group that improved. Delta PHES was negatively correlated with delta Proteobacteria and positively with delta Firmicutes. Conclusions: LT improves gut microbiota diversity and dysbiosis compared to pre‐LT baseline but residual dysbiosis remains compared to controls. There is cognitive and HRQOL enhancement in general post‐LT but a higher Proteobacteria relative abundance change is associated with post‐transplant cognitive impairment. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Lundi 27 février 2017
    Woo‐Hyoung Kang, Shin Hwang, Gi‐Won Song, Young‐Joo Lee, Ki‐Hun Kim, Chul‐Soo Ahn, Deok‐Bog Moon, Dong‐Hwan Jung, Gil‐Chun Park, Sung‐Gyu Lee
    Prognostic effect of TACE‐induced complete pathological response in patients undergone liver resection and transplantation for hepatocellular carcinoma
    Transcatheter arterial chemoembolization (TACE)‐induced complete pathological response (CPR) is known to improve post‐resection outcomes of hepatocellular carcinoma (HCC). We aimed to assess the prognostic effects of CPR after preoperative TACE for HCC in patients who underwent hepatic resection (HR) or liver transplantation (LT). The clinical outcomes of patients showing CPR after HR (n=110) or LT (n=233) were analyzed. The control groups comprised patients with minimal recurrence risk as naïve single HCC ≤2 cm for HR (n=476), and one or two HCCs ≤2 cm for LT (n=184). Among HR study patients, 1‐, 3‐, and 5‐year tumor recurrence rates were 18.5%, 50.6%, and 58.7% respectively, which were higher than those of controls (p<0.001). The 1‐, 3‐, and 5‐year patient survival rates were 97.8%, 82.0%, and 69.1% respectively, which were lower than those of controls (p<0.001). Among LT study patients, 1‐, 3‐, and 5‐year tumor recurrence rates were 4.1%, 7.9%, and 7.9% respectively, which were higher than those of controls (p=0.019). The 1‐, 3‐, and 5‐year patient survival rates were 92.7%, 89.2%, and 86.9% respectively, which were not different than those of controls (p=0.11). LT recipients had lower recurrence and higher survival rates compared to HR patients (p<0.001). Tumor recurrence site was mainly intrahepatic in HR patients. There was no difference between the incidences of extrahepatic recurrence in HR study group and all‐site recurrence in LT study group (p=0.61). We concluded that the prognostic effect of TACE‐induced CPR for HCC patients appears to be limited to downstaging. LT recipients are benefited more from CPR than HR patients. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Lundi 27 février 2017
    A. Merdrignac, H. Jeddou, P. Houssel‐Debry, E. Flecher, M. Rayar, K. Boudjema
    Venous stent in liver transplant candidates: Dodging the top tip traps
    n/a

    Date de mise en ligne : Mardi 21 février 2017
    Mureo Kasahara, Seisuke Sakamoto, Kengo Sasaki, Hajime Uchida, Toshihiro Kitajima, Takanobu Shigeta, Soichi Narumoto, Yoshihiro Hirata, Akinari Fukuda
    Living donor liver transplantation during the first three months of life
    Background: Living donor liver transplantation is now an established technique for treating children with end‐stage liver disease. Few data exist about liver transplantation for exclusively young infants, especially infants of <3 months of age. We report our single‐center experience with 12 cases in which living donor liver transplantation (LT) was performed during the first 3 months of life and compare the results with those of older infants who underwent LT. All of the patients were treated at the National Center of Child Health and Development, Tokyo, Japan. Patients and Methods: Between November 2005 to November 2016, 436 children underwent LT. Twelve of these patients underwent LT in the first 3 months of life (median age, 41 days; median weight, 4.0 kg). The indications for transplantation were fulminant hepatic failure (n=11) and metabolic liver disease (n=1). All the patients received reducing the left lateral segment in situ to mitigate the problem of graft to recipient size discrepancy. A reduced LLS graft was used in 11 cases and a segment 2 monosegment graft was used in one. We compared the results with those of infants who were 4‐6 months of age (n=67) and 7‐12 months of age (n=110) who were treated in the same study period. Results: There were significant differences in the PELD score and the conversion rate of tacrolimus to cyclosporine in younger infants. Furthermore, the incidence of biliary complications, blood stream infection, and CMV infection tended to be higher, while the incidence of acute cellular rejection tended to be lower in younger infants. The overall cumulative 10‐year patient and graft survival rates in recipients of <3 months of age were both 90.9%. Conclusion: Living donor liver transplantation during the first three months of life appears to be a feasible option with excellent patient and graft survival. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Vendredi 10 février 2017
    Ding Cao, Menghao Wang, Junhua Gong, Sidong Wei, Jianping Gong, Jinzheng Li
    Exogenous VEGF Delivery Prior to Endothelial Precursor Cell Transplantation in Orthotopic Liver Transplant‐Induced Hepatic Ischemia Reperfusion Injury
    Background: Vascular endothelial growth factor (VEGF) promotes angiogenesis in vivo. We hypothesized that exogenous delivery of VEGF prior to bone marrow‐derived endothelial precursor cell (EPC) transplantation may improve orthotopic liver transplantation (OLT)‐induced hepatic ischemia‐reperfusion injury (HIRI). Methods: OLT between Sprague Dawley donor rats and inbred LEW Wistar recipient rats was performed in six experimental groups to comparatively assess the effects of VEGF gene: an untreated normal control group, a surgical control group, a liposomal control group, a VEGF group receiving only the liposome‐encapsulated VEGF plasmid, an EPC group receiving only EPCs, and an EPC+VEGF group receiving the liposome‐encapsulated VEGF plasmid followed by EPCs. VEGF plasmid delivery to liver tissue, endogenous VEGF and VEGF receptor (VEGFR) expression, liver transaminase levels, hepatocellular injury levels, apoptosis, apoptotic biomarkers, hepatotrophic mitogens, angiogenesis, and nitric oxide synthase (NOS) activity were assayed post‐OLT. Results: Exogenous VEGF gene delivery prior to EPC transplantation significantly increased endogenous VEGF and VEGFR expression, significantly reduced liver transaminase levels, significantly reduced hepatocellular injury levels, significantly reduced hepatic apoptosis levels, and significantly reduced several apoptotic biomarkers (i.e., Bax/Bcl‐2 ratio, caspase‐3 activity, and Hsp70 expression) in post‐OLT‐induced HIRI. Moreover, VEGF gene delivery prior to EPC transplantation significantly increased hepatotrophic mitogen expression (i.e., EGF, HB‐EGF, HGF, and TGF‐α), angiogenesis, and NOS activity in post‐OLT‐induced HIRI. Conclusions: Exogenous liposomal delivery of the VEGF gene prior to bone marrow‐derived EPC transplantation may be an effective strategy in decreasing OLT‐induced HIRI. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Vendredi 10 février 2017
    Sang Gyune Kim, Joseph J. Larson, Ji Sung Lee, Therneau M. Terry, W. Ray Kim
    Beneficial and Harmful Effects of Non‐selective Beta Blockade on Acute Kidney Injury in Liver Transplant Candidates
    Non‐selective beta‐blockers have played an important role in the prevention of portal hypertensive bleeding in cirrhotic patients. However, recent studies have suggested that non‐selective beta‐blockers may be harmful in some patients with end‐stage liver disease. To evaluate the association between use of non‐selective beta‐blocker and the incidence of acute kidney injury (AKI). We conducted a nested case‐control study in a cohort of liver transplant waitlist registrants. Each patient with AKI was matched to a control by the model for end‐stage liver disease (MELD)‐Na score, age, serum creatinine, and follow‐up duration. Out of a total of 2,361 waitlist registrants, 205 patients developed AKI after a median follow‐up duration of 18.2 months. When compared to matched controls, ascites (79.0% versus 51.7%) and non‐Caucasian race (16.6% versus 7.8%) were more common among the cases. The frequency of non‐selective beta‐blocker use was higher among the cases than controls, albeit insignificantly (45.9% versus 37.1%, P = .08). In multivariable analyses, the impact of non‐selective beta‐blockade on the development of AKI was dependent upon the presence of ascites: non‐selective beta‐blockade in patients with ascites significantly increased the risk of AKI (hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.57‐6.95), while in patients without ascites, non‐selective beta‐blocker use reduced it (HR, 0.19; 95% CI, 0.06‐0.60). Potential benefits and harms of a non‐selective beta‐blocker in terms of AKI depend on the presence of ascites in liver transplant candidates. Non‐selective beta‐blocker therapy in cirrhotic patients may need to be individualized. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 02 février 2017
    Joon‐Young Ohm, Gi‐Young Ko, Kyu‐Bo Sung, Dong‐Il Gwon, Heung‐Gyu Koh
    Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation1
    Objective: To evaluate and compare the safety and efficacy of endovascular management of the portal vein (PV) via percutaneous transsplenic access versus percutaneous transhepatic access in liver transplant recipients. Methods: Eighteen patients who underwent endovascular management of PV via percutaneous transhepatic (n = 8) and transsplenic (n = 10) access were enrolled. Transsplenic access was chosen if the spleen was located in a normal position, the splenic vein was preserved, and the target lesion did not involve confluence of the superior mesenteric and splenic veins. Accessibility of the percutaneous transsplenic puncture was confirmed via ultrasound in the angiography suite. All procedures were performed under local anesthesia. Percutaneous transhepatic or transsplenic access was performed using a 21‐gauge Chiba needle under ultrasound and fluoroscopic guidance, followed by balloon angioplasty, stent placement, or variceal embolization. The access tract was embolized using coils and a mixture (1:2) of glue and ethiodized oil. Results: Transhepatic or transsplenic access was successfully achieved in all patients. Twelve patients underwent stent placement; 3, balloon angioplasty only; 2, variceal embolization only; and 1, variceal embolization followed by successful stent placement. Regarding major complications, 1 patient experienced a splenic vein tear with extravasation during transsplenic balloon angioplasty, which was successfully managed using temporary balloon inflation, followed by transfusion. Clinical success was achieved in 9 of 11 (82%) patients who exhibited clinical manifestations. The remaining 7 patients who underwent prophylactic endovascular management were healthy. Conclusion: Endovascular management of PV via percutaneous transsplenic access is a relatively safe and effective alternative that does not damage the liver grafts of liver transplant recipients. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 02 février 2017
    Qiang Zhu, Changyong Li, Kunpeng Wang, Shi Yue, Longfeng Jiang, Michael. Ke, Ronald. W. Busuttil, Jerzy.W. Kupiec‐Weglinski, Feng Zhang, Ling Lu, Bibo Ke
    PTEN‐β‐Catenin Signaling Modulates Regulatory T Cells and Inflammatory Responses in Mouse Liver Ischemia and Reperfusion Injury
    The phosphatase and tensin homolog deleted on chromosome 10 (PTEN) plays an important role in regulating T cell activation during inflammatory response. Activation of β‐catenin is crucial for maintaining immune homeostasis. This study investigates the functional roles and molecular mechanisms by which PTEN‐β‐catenin signaling promotes regulatory T cell (Treg) induction in a mouse model of liver ischemia and reperfusion injury (IRI). We found that mice with myeloid specific PTEN knockout (PTENM‐KO) exhibited reduced liver damage as evidenced by decreased levels of serum ALT, intrahepatic macrophage trafficking, and pro‐inflammatory mediators compared to the PTEN‐proficient (PTENFL/FL) controls. Disruption of myeloid PTEN activated β‐catenin, which in turn promoted PPARγ‐mediated Jagged‐1/Notch signaling and induced Foxp3+ Tregs while inhibiting Th17 cells. However, blocking of Notch signaling by inhibiting γ‐secretase reversed myeloid PTEN deficiency‐mediated protection in IR‐triggered liver inflammation with reduced Foxp3+ and increased RORγt‐mediated IL‐17A expression in ischemic livers. Moreover, knockdown of β‐catenin or PPARγ in PTEN‐deficient macrophages inhibited Jagged‐1/Notch activation and reduced Foxp3+ Treg induction, leading to increased proinflammatory mediators in macrophage/T cell co‐cultures. In conclusion, our findings demonstrate that PTEN‐β‐catenin signaling is a novel regulator involved in modulating Treg development and provides a potential therapeutic target in liver IRI. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mardi 10 janvier 2017
    Ping‐Chun Li, Ashok Thorat, Long‐Bin Jeng, Horng‐Ren Yang, Ming‐Li Li, Chun‐Chieh Yeh, Te‐Hung Chen, Shih‐Chao Hsu, Kin‐Shing Poon
    Successful Application Of Supra‐Coeliac Aorto‐Hepatic Conduit Using Saphenous Venous Graft In Right Lobe Living Donor Liver Transplantation
    n/a

    Date de mise en ligne : Mardi 27 décembre 2016
    Kyung‐Suk Suh, Hyo‐Sin Kim, Nam‐Joon Yi, Kwang‐Woong Lee, Suk Kyun Hong, Kyung Chul Yoon, Adianto Nugroho, Hyeyoung Kim
    Living donor liver transplantation using a right anterior section of the liver
    n/a

    Date de mise en ligne : Mardi 27 décembre 2016
    Jacqueline B. Henson, Yuval A. Patel, Lindsay Y. King, Jiayin Zheng, Shein‐Chung Chow, Andrew J. Muir
    Outcomes of Liver Retransplantation in Patients with Primary Sclerosing Cholangitis
    Liver retransplantation in patients with primary sclerosing cholangitis (PSC) has not been well studied. The aims of this study were to characterize patients with PSC listed for and undergoing retransplantation and to describe the outcomes in these patients. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was used to identify all primary liver transplantations and subsequent relistings and first retransplantations in adults with PSC between 1987 and 2015. A total of 5,080 adults underwent primary transplantation for PSC during this period, and of the 1,803 who experienced graft failure, 762 were relisted, and 636 underwent retransplantation. Younger patients and patients with graft failure due to vascular thrombosis or biliary complications were more likely to be relisted, while those with Medicaid insurance or graft failure due to infection were less likely. Both five‐year graft and patient survival after retransplantation were inferior to primary transplantation (p=0.001). Five‐year survival after retransplantation for disease recurrence, however, was similar to primary transplantation (graft survival, p=0.45; patient survival, p=0.09) and superior to other indications for retransplantation (graft and patient survival, p<0.001). On multivariate analysis, mechanical ventilation, creatinine, bilirubin, albumin, advanced donor age, and a living donor were associated with poorer outcomes after retransplantation. Conclusion: While survival after liver retransplantation in patients with PSC was overall inferior to primary transplantation, outcomes after retransplantation for PSC recurrence were similar to primary transplantation at five years. Retransplantation may therefore represent a treatment option with the potential for excellent outcomes in patients with recurrence of PSC in the appropriate clinical circumstances. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Jeudi 22 décembre 2016
    Jin‐Young Huh, Danbi Lee, Jihyun Ahn, Ju Hyun Shim, Young‐Suk Lim, Gil‐Chun Park, Gi‐Won Song, Ki‐Hun Kim, Dong‐Hwan Jung, Deok‐Bog Moon, Shin Hwang, Sung Gyu Lee, Sei Won Lee, Jin‐Woo Song, Yeon‐Mok Oh, Tae Sun Shim, Kyung‐Wook Jo
    The Impact of Emergency Adult Living‐Donor Liver Transplantation on the Survival of Patients with Antituberculosis Therapy‐Induced Acute Liver Failure
    n/a

    Date de mise en ligne : Jeudi 22 décembre 2016
    B. Revilla‐Nuin, A. de Bejar, L. Martínez‐Alarcón, J.I. Herrero, C.M. Martínez‐Cáceres, P. Ramírez, A. Baroja‐Mazo, J.A. Pons
    Differential profile of activated regulatory T cell subsets and microRNAs in tolerant liver transplant recipients
    Regulatory T cells (Tregs) play a potential role in operational tolerance in liver transplant patients, and microRNAs (miRNAs) are known to be involved in immunological responses and tolerance. Thus, we analyzed the implication of different peripheral blood Treg subsets and miRNAs on liver transplantation tolerance in 24 tolerant (Tol) and 23 non‐tolerant (non‐Tol) liver transplant recipients by cellular, genetic and epigenetic approximation. Non‐Tol patients had a lower demethylation rate of the FOXP3 Treg‐specific demethylated region (TSDR) than Tol patients that correlated with the frequency of circulating Tregs. Tol patients presented a different signature of Treg subset markers compared with non‐Tol patients with increased expression of HELIOS and FOXP3 and a higher proportion of LAP+ Tregs and CD45RA‐HLA‐DR+ activated effector‐memory Tregs. The expression of miR95, miR24, miR31, miR146a and miR155 was higher in Tol than in non‐Tol patients and was positively correlated with activated Treg markers. Conclusions: These data suggest that activated effector‐memory Tregs and a TSDR‐demethylation state of Tregs may play a role in the complex system of regulation of liver transplantation tolerance. In addition, we describe a set of miRNAs differentially expressed in human liver transplant tolerant patients providing suggestive evidence that miRNAs are implied in the preservation of self‐tolerance as mediated by Tregs. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Vendredi 09 décembre 2016
    Kojiro Taura, Toshimi Kaido, Takayuki Anazawa, Shintaro Yagi, Hideaki Okajima, Shinji Uemoto
    Living donor liver transplantation with a left trisegmental graft from a donor with anomalous branching of the portal vein
    n/a

    Date de mise en ligne : Vendredi 09 décembre 2016
    Suk Kyun Hong, Kwang‐Woong Lee, Hyo‐Sin Kim, Kyung Chul Yoon, Sung‐Woo Ahn, Jin Yong Choi, Hyeyoung Kim, Nam‐Joon Yi, Kyung‐Suk Suh
    Optimal bile duct division using real‐time indocyanine green near‐infrared fluorescence cholangiography during laparoscopic donor hepatectomy
    n/a

    Date de mise en ligne : Vendredi 09 décembre 2016
    Margaret V. Ragni, Abhinav Humar, Peter G. Stock, Emily A. Blumberg, Bijan Eghtesad, John J. Fung, Valentina Stosor, Nicholas Nissen, Michael T. Wong, Kenneth E. Sherman, Donald M. Stablein, Burc Barin
    Hemophilia Liver Transplantation Observational Study (HOTS)
    Hepatitis C (HCV) infection is the leading cause of liver disease in hemophilia. In those with HIV/HCV co‐infection, the rate of liver disease progression is greater than in HCV mono‐infected individuals. Despite antiretroviral therapy which slows HCV liver disease progression, some require transplantation. Whether transplant outcomes are worse in hemophilic (H) than non‐hemophilic (NH) candidates is unknown. In order to determine rates and predictors of pre‐ and post‐transplant survival, we conducted a retrospective observational study utilizing United Network for Organ Sharing (UNOS) national transplant registry data, comparing HCV+ H and NH candidates. We identified 2,502 HCV+ liver transplant candidates from eight U.S. university‐based transplant centers, between January 1, 2004 to December 31, 2010, including 144 HIV+ (6%) and 2,358 HIV‐; 36 H (1%) and 2,466 NH; 1,213 (48%) transplanted and 1,289 not transplanted. Other than male predominance and younger age, each p<0.001, baseline data were comparable between H and NH. In univariate analysis, 90‐day pre‐transplant mortality was associated with higher baseline MELD, HR=1.15, p<0.001, lower baseline platelet count, HR=1.11 per 25k/µL, p=0.04, and having HIV/HCV+ hemophilia, p=0.003. In multivariate analysis, pre‐transplant mortality was associated with higher MELD (p<0.001) and was significantly greater in HIV+ than HIV‐ groups (p=0.001), but did not differ between HIV+ H and NH, HR=1.7, p=0.36. Among HIV/HCV+, post‐transplant mortality was similar between H and NH, despite lower CD4 in H, p=0.04. Conclusions: This observational study confirms that hemophilia per se does not have a specific influence on transplant outcomes, and that HIV infection increases the risk of mortality in both H and NH patients. This article is protected by copyright. All rights reserved.

    Date de mise en ligne : Mercredi 01 avril 2015
    Erratum
    Erratum
    n/a

    Date de mise en ligne : Lundi 24 avril 2017
    Issue Information
    Issue Information
    578

    Date de mise en ligne : Lundi 24 avril 2017
    Vatche G. Agopian
    Liver transplantation with donation after cardiac death donors as a strategy for recipients with model for end‐stage liver disease score >15: Has the die been cast?
    580

    Date de mise en ligne : Lundi 24 avril 2017
    Andrew P. Keaveny, C. Burcin Taner
    Prioritization for liver transplantation: Reconsidering survival benefit
    582

    Date de mise en ligne : Lundi 24 avril 2017
    Elsa Solà, Santiago Sanchez‐Cabús, Ezequiel Rodriguez, Chiara Elia, Raquel Cela, Rebeca Moreira, Elisa Pose, Jordi Sánchez‐Delgado, Nuria Cañete, Manuel Morales‐Ruiz, Francisco Campos, Jaume Balust, Mónica Guevara, Juan Carlos García‐Valdecasas, Pere Ginès
    Effects of alfapumpâ„¢ system on kidney and circulatory function in patients with cirrhosis and refractory ascites
    The alfapump system has been proposed as a new treatment for the management of refractory ascites. The system removes ascites from the peritoneal cavity to urinary bladder, producing a continuous low‐volume paracentesis. The aim of the study is to investigate the effects of treatment with the alfapump™ system on kidney and circulatory function in patients with cirrhosis and refractory ascites. This was a prospective study including 10 patients with cirrhosis and refractory ascites. Primary outcomes were changes in glomerular filtration rate (GFR), as assessed by isotopic techniques, and changes in circulatory function assessed by arterial pressure, cardiac output, and activity of vasoconstrictor systems. Secondary outcomes were the need for large‐volume paracentesis and adverse events. Follow‐up was 1 year. GFR decreased significantly from 67 mL/minute/1.73 m2 (41‐90 mL/minute/1.73 m2) at baseline to 45 mL/minute/1.73 m2 (36‐74 mL/minute/1.73 m2) at month 6 (P = 0.04). Mean arterial pressure and cardiac output did not change significantly; however, there was a marked increase in plasma renin activity and norepinephrine concentration (median percent increase with respect to baseline +191% and 59%, respectively). There were 68 episodes of complications of cirrhosis in 8 patients during follow‐up, the most frequent being acute kidney injury. In conclusion, treatment with alfapump™ system was associated with marked activation of endogenous vasoconstrictor systems and impairment of kidney function. The chronological relationship observed between kidney impairment and vasoconstrictor systems activation after device insertion suggests a cause‐effect relationship, raising the possibility that treatment with alfapump impairs effective arterial blood volume mimicking a postparacentesis circulatory dysfunction syndrome. In this context, the potential role of albumin in counteracting these effects should be investigated in future studies. Liver Transplantation 23 583–593 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    Kenneth A. McLean, Julian Camilleri‐Brennan, Stephen R. Knight, Thomas M. Drake, Riinu Ots, Catherine A. Shaw, Stephen J. Wigmore, Ewen M. Harrison
    Decision modeling in donation after circulatory death liver transplantation
    Donation after circulatory death (DCD) liver allografts are increasingly used for transplantation. However, the posttransplantation clinical and quality of life outcomes of DCD recipients are traditionally considered to be inferior compared with donation after brain death (DBD) allograft recipients. Decision making for such marginal organs can be difficult. This study investigated the optimal decision to accept or decline a DCD liver allograft for a patient based on their current health. A Markov decision process model was constructed to predict the 5‐year clinical course of patients on the liver transplant waiting list. Clinical outcomes were determined from the UK transplant registry or appropriate literature. Quality‐adjusted life years (QALYs) were determined using the condition‐specific short form of liver disease quality of life (SF‐LDQoL) questionnaire. There were 293/374 (78.3%) eligible patients who completed the SF‐LDQoL questionnaire. A total of 73 respondents (24.9%) were before transplant and 220 were after transplant (DBD recipient, 56.3%; DCD recipient, 8.5%; ischemic cholangiopathy patient, 2.4%; retransplant recipient, 7.9%). Predictive modeling indicated that QALYs gained at 5 years were significantly higher in DCD recipients (3.77; 95% confidence interval [CI], 3.44‐4.10) compared with those who remained on the waiting list for a DBD transplant with Model for End‐Stage Liver Disease (MELD) scores of 15‐20 (3.36; 95% CI, 3.28‐3.43), or >20 (3.07; 95% CI, 3.00‐3.14). There was no significant advantage for individuals with MELD scores <15 (3.55; 95% CI, 3.47‐3.63). In conclusion, this model predicts that patients on the UK liver transplant waiting list with MELD scores >15 should receive an offered DCD allograft based on the QALYs gained at 5 years. This analysis only accounts for donor‐recipient risk pairings seen in current practice. The optimal decision for patients with MELD scores <15 remains unclear. However, a survival benefit was observed when a DCD organ was accepted. Liver Transplantation 23 594–603 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    David S. Goldberg, Matthew Levine, Seth Karp, Richard Gilroy, Peter L. Abt
    Share 35 changes in center‐level liver acceptance practices
    Share 35 was implemented to provide improved access to organs for patients with Model for End‐Stage Liver Disease (MELD) scores ≥ 35. However, little is known about the impact of Share 35 on organ offer acceptance rates. We evaluated all liver offers to adult patients who were ultimately transplanted between January 1, 2011 and December 31, 2015. The analyses focused on patients ranked in the top 5 positions of a given match run and used multilevel mixed‐effects models, clustering on individual wait‐list candidate and transplant center. There was a significant interaction between Share 35 era and MELD category (P < 0.001). Comparing offers to MELD score ≥ 35 patients, offers after Share 35 were 36% less likely to be accepted compared with offers to MELD score ≥ 35 patients before Share 35 (adjusted odds ratio, 0.64). There was no clinically meaningful difference in the donor risk index of livers that were declined for patients with an allocation MELD score ≥35 in the pre– versus post–Share 35 era. Organ offer acceptance rates for patients with an allocation MELD ≥ 35 decreased in every region after Share 35; the magnitude of these changes was bigger in regions 2, 3, 4, 5, 6, 7, and 11, compared with regions 8 and 9 that had regional sharing in place before Share 35. There were significant changes in organ offer acceptance rates at the center level before versus after Share 35, and these changes varied across centers (P < 0.001). In conclusion, in liver transplantation candidates achieving a MELD score ≥ 35, liver acceptance of offers declined significantly after implementation of Share 35. The alterations in behavior at the center level suggest that practice patterns changed as a direct result of Share 35. Changes in organ acceptance under even broader organ sharing (redistricting) would likely be even greater, posing major logistical and operational challenges, while potentially increasing discard rates, thus decreasing the total number of transplants nationally. Liver Transplantation 23 604–613 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    Adianto Nugroho, Ok‐Kyung Kim, Kwang‐Woong Lee, Sanghee Song, Hyeyoung Kim, Suk Kyun Hong, Kyung Chul Yoon, Hyo‐Sin Kim, YoungRok Choi, Hae Won Lee, Nam‐Joon Yi, Kyung‐Suk Suh
    Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation
    The process of evaluating potential donors in liver transplantation is important to ensure donor safety and provide optimal recipient outcomes. However, there has been no report about donor exclusion rates and reasons for such exclusion in Korea. In this study, we aimed to elucidate the outcomes of potential living liver donor evaluation in a major living donor liver transplantation center. From July 2011 to June 2015, prospectively collected data of 726 potential donors for 588 matched recipients were subsequently evaluated. Among 726 potential donors, 374 potential donors (51.5%) finally reached donation; 352 potential donors (48.5%) were excluded for various reasons. Donor reasons were 29.8%, including medical problems, withdrawal of consent, graft volume issues, and identification of a better suitable donor. Recipient reasons were 20.7%, including recipient death or recovery, allocation to deceased donor, and progressions of hepatocellular carcinoma. A total of 38 (5.2%) potential donors had a fatty liver. Among them, 15 (39.5%) potential donors tried short‐term weight reduction and eventually were able to donate. In conclusion, the main reasons for donor exclusion were medical problems and withdrawal of consent. Therefore, thorough medical screening and careful examination for donor voluntarism are important in the donor evaluation process. Liver Transplantation 23 614–624 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    Elizabeth J. Carey, Jennifer C. Lai, Connie W. Wang, Srinivasan Dasarathy, Iryna Lobach, Aldo J. Montano‐Loza, Michael A. Dunn,
    A multicenter study to define sarcopenia in patients with end‐stage liver disease
    Sarcopenia is associated with increased wait‐list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end‐stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98%. Using image analysis software, the total cross‐sectional area (cm2) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait‐list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex‐specific potential cutoff values to define sarcopenia were determined with a grid search guided by log‐rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6 cm2/m2: 50.0 in men and 42.0 in women. At a median of 8.8 months follow‐up, mortality was 25% in men and 36% in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5 cm2/m2; P < 0.001), and SMI was associated with wait‐list mortality (hazard ratio, 0.95; P < 0.001). Optimal search method yielded SMI cutoffs of 50 cm2/m2 for men and 39 cm2/m2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI < 50 cm2/m2 for men and < 39 cm2/m2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625–633 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    Ina Jochmans, Nicolas Meurisse, Arne Neyrinck, Marleen Verhaegen, Diethard Monbaliu, Jacques Pirenne
    Hepatic ischemia/reperfusion injury associates with acute kidney injury in liver transplantation: Prospective cohort study
    Solid clinical prospective studies investigating the association between hepatic ischemia/reperfusion injury (HIRI) and acute kidney injury (AKI) after liver transplantation are missing. HIRI, reflected by transaminase release, induces AKI in rodents, and retrospective studies suggest a similar association in humans. This prospective cohort study determined risk factors for AKI in 80 adult liver‐only recipients. AKI defined by Risk, Injury, Failure, Loss, and End‐Stage Kidney Disease (RIFLE) criteria developed in 21 (26%) recipients at 12 hours after reperfusion (interquartile range, 6 hours to postoperative day [POD] 1); 13 progressed from “risk” to “injury”; 5 progressed to “failure.” In AKI patients, creatinine (Cr) increased during liver transplantation and was higher versus baseline at 6 hours to POD 4, whereas perioperative Cr remained stable in those without AKI. Plasma heart‐type fatty acid–binding protein was higher 12 hours after reperfusion in AKI patients, though urinary kidney injury molecule 1 and neutrophil gelatinase–associated lipocalin were similar between those with or without AKI. Peak aspartate aminotransferase (AST), occurring at 6 hours, was the only independent risk factor for AKI (adjusted odds ratio, 2.42; 95% confidence interval, 1.24‐4.91). Early allograft dysfunction occurred more frequently in AKI patients, and intensive care and hospital stays were longer. Patient survival at 1 year was 90% in those with AKI versus 98% in those without AKI. Chronic kidney disease stage ≥ 2 at 1 year was more frequent in patients who had had AKI (89% versus 58%, respectively). In conclusion, AKI is initiated early after liver reperfusion and its association with peak AST suggests HIRI as a determinant. Identifying operating mechanisms is critical to target interventions and to reduce associated morbidity. Liver Transplantation 23 634–644 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    Fernando Agüero, Alejandro Forner, Andrés Valdivieso, Marino Blanes, Rafael Barcena, Christian Manzardo, Antoni Rafecas, Lluis Castells, Manuel Abradelo, Pilar Barrera‐Baena, Luisa González‐Diéguez, Magdalena Salcedo, Trinidad Serrano, Miguel Jiménez‐Pérez, José Ignacio Herrero, Mikel Gastaca, Victoria Aguilera, Juan Fabregat, Santos del Campo, Itxarone Bilbao, Carlos Jiménez Romero, Asunción Moreno, Antoni Rimola, José M. Miro,
    Human immunodeficiency virus–infected liver transplant recipients with incidental hepatocellular carcinoma: A prospective multicenter nationwide cohort study
    There is a lack of data on incidental hepatocellular carcinoma (iHCC) in the setting of liver transplantation (LT) in human immunodeficiency virus (HIV)–infected patients. This study aims to describe the frequency, histopathological characteristics, and outcomes of HIV+ LT recipients with iHCC from a Spanish multicenter cohort in comparison with a matched cohort of LT patients without HIV infection. A total of 15 (6%) out of 271 patients with HIV infection who received LT in Spain from 2002 to 2012 and 38 (5%) out of the 811 HIV– counterparts presented iHCC in liver explants (P = 0.58). Patients with iHCC constitute the present study population. All patients also had hepatitis C virus (HCV)–related cirrhosis. There were no significant differences in histopathological features of iHCC between the 2 groups. Most patients showed a small number and size of tumoral nodules, and few patients had satellite nodules, microvascular invasion, or poorly differentiated tumors. After a median follow‐up of 49 months, no patient developed hepatocellular carcinoma (HCC) recurrence after LT. HIV+ LT recipients tended to have lower survival than their HIV– counterparts at 1 (73% versus 92%), 3 (67% versus 84%), and 5 years (50% versus 80%; P = 0.06). There was also a trend to a higher frequency of HCV recurrence as a cause of death in the former (33% versus 10%; P = 0.097). In conclusion, among LT recipients for HCV‐related cirrhosis, the incidence and histopathological features of iHCC in HIV+ and HIV– patients were similar. However, post‐LT survival was lower in HIV+ patients probably because of a more aggressive HCV recurrence. Liver Transplantation 23 645–651 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    George N. Ioannou
    Transplant‐related survival benefit should influence prioritization for liver transplantation especially in patients with hepatocellular carcinoma
    Transplant‐related survival benefit is calculated as the difference between life expectancy with transplantation and life expectancy without transplantation. Determining eligibility and prioritization for liver transplantation based on the highest survival benefit is a superior strategy to prioritization based on the highest urgency (ie, the highest wait‐list mortality) or the highest utility (ie, the highest posttransplant survival) because prioritization based on the highest survival benefit maximizes the overall life expectancy of all patients in need of liver transplantation. Although the Model for End‐Stage Liver Disease (MELD)–based prioritization system was designed as an urgency‐based system, in practice it functions to a large extent as a survival benefit–based system, when the natural MELD score is used without exceptions. Survival benefit considerations should be used to determine the consequences of deviating from prioritization based on the natural MELD score, such as when exception points are awarded to patients with hepatocellular carcinoma (HCC) that are independent of MELD score or tumor burden, or the appropriateness of expanding eligibility for transplantation. The most promising application of survival benefit–based prioritization would be to replace the current system of prioritization of patients with HCC by one that uses their natural MELD score and tumor characteristics such as HCC tumor burden, serum alpha fetoprotein level, and response to locoregional therapies to predict the impact on survival benefit caused by the presence of HCC and adjust the natural MELD score for prioritization accordingly. Liver Transplantation 23 652–662, 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    Amy Tan, Sander S. Florman, Thomas D. Schiano
    Genetic, hematological, and immunological disorders transmissible with liver transplantation
    It is well recognized that solid organ transplantation can transmit bacterial infection and chronic viral hepatitis as well as certain cancers. As indications for liver transplantation (LT) have expanded, it has been used to treat and even cure certain genetic cholestatic disorders, urea cycle defects, and coagulation abnormalities; many of these conditions are potentially transmissible with LT as well. It is important for clinicians and transplant patients to be aware of these potentially transmissible conditions as unexplained post‐LT complications can sometimes be related to donor transmission of disease and thus should prompt a thorough exploration of the donor allograft history. Herein, we will review the reported genetic, metabolic, hematologic, and immunological disorders that are transmissible with LT and describe clinical scenarios in which these cases have occurred, such as in inadvertent or recognized transplantation of a diseased organ, domino transplantation, and with living related liver donation. Liver Transplantation 23 663–678 2017 AASLD.

    Date de mise en ligne : Lundi 24 avril 2017
    Hazel Marecki, Adel Bozorgzadeh, Robert J. Porte, Henri G. Leuvenink, Korkut Uygun, Paulo N. Martins
    Liver ex situ machine perfusion preservation: A review of the methodology and results of large animal studies and clinical trials
    Ex vivo machine perfusion (MP) is a promising way to better preserve livers prior to transplantation. Currently, no methodology has a verified benefit over simple cold storage. Before becoming clinically feasible, MP requires validation in models that reliably predict human performance. Such a model has been found in porcine liver, whose physiological, anatomical, and immunological characteristics closely resemble the human liver. Since the 1930s, researchers have explored MP as preservation, but only recently have clinical trials been performed. Making this technology clinically available holds the promise of expanding the donor pool through more effective preservation of extended criteria donor (ECD) livers. MP promises to decrease delayed graft function, primary nonfunction, and biliary strictures, which are all common failure modes of transplanted ECD livers. Although hypothermic machine perfusion (HMP) has become the standard for kidney ex vivo preservation, the precise settings and clinical role for liver MP have not yet been established. In research, there are 2 schools of thought: normothermic machine perfusion, closely mimicking physiologic conditions, and HMP, to maximize preservation. Here, we review the literature for porcine ex vivo MP, with an aim to summarize perfusion settings and outcomes pertinent to the clinical establishment of MP. Liver Transplantation 23 679‐695 2017 AASLD.

    Date de mise en ligne : Mardi 11 avril 2017
    Francesco Esposito, Chetana Lim, Chady Salloum, Michael Osseis, Laurence Baranes, Aurelien Amiot, Philippe Compagnon, Daniel Azoulay
    Intragastric migration of a mesentericoportal polytetrafluoroethylene jump graft after liver transplantation
    697

    Date de mise en ligne : Lundi 24 avril 2017
    Matthew Goss, Jeffrey Reese, Michael Kueht, John M. Vierling, Ayse L. Mindikoglu, Norman L Sussman, Bruce Kaplan, R. Patrick Wood, Abbas A. Rana
    A Surge in cadaveric liver donors and a national narcotic epidemic: Is there an association?
    700

    Date de mise en ligne : Lundi 24 avril 2017
    Jens G. Brockmann, Thomas Vogel, Constantin Coussios, Peter J. Friend
    Liver splitting during normothermic organ preservation
    706

    Date de mise en ligne : Lundi 24 avril 2017
    Davide Ghinolfi, Laura Caponi, Lorella Marselli, Daniele Pezzati, Maria Franzini, Paolo De Simone, Vanna Fierabracci, Piero Marchett, Aldo Paolicchi, Franco Filipponi
    Anti‐inflammatory signaling during ex vivo liver perfusion improves the preservation of pig liver grafts before transplantation
    708

    Date de mise en ligne : Mercredi 05 avril 2017
    Nicolas Goldaracena, Juan Echeverri, Markus Selzner
    Reply
    709

    Date de mise en ligne : Mercredi 05 avril 2017
    Henri Bismuth
    Current status of auxiliary partial orthotopic liver transplantation for acute liver failure
    710

    Date de mise en ligne : Lundi 24 avril 2017
    Issue Information
    Issue Information
    718