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1. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

Author

Mayr, Andreas, Dominguez, Beatriz, Muller, Elmi, Rando, Karina, Enoch, Mary Anne, Tamir, Noam, Healy, Pamela, Manser, Tanja, Briggs, Tim, Chaudhary, Abhideep, Humar, Abhinav, Jafarian, Ali, Soin, Arvinder Singh, Eghtesad, Bijan, Miller, Charles, Cherqui, Daniel, Samuel, Didier, Broering, Dieter, Pomfret, Elizabeth, Villamil, Federico, Durand, Francois, Berlakovich, Gabriela, McCaughan, Geoffrey, Auzinger, Georg, Testa, Giuliano, Klintmalm, Goran, Belghiti, Jacques, Findlay, James, Lai, Jennifer, Fung, John, Klinck, John, Roberts, John, Liu, Linda, Cattral, Mark, Ghobrial, Mark, Selzner, Markus, Ramsay, Michael, Rela, Mohamed, Ascher, Nancy, Man, Nancy Kwan, Selzner, Nazia, Burra, Patrizia, Friend, Peter, Busuttil, Ronald, Hwang, Shin, McCluskey, Stuart, Mas, Valeria, Vohra, Vijay, Vij, Vivek, Merritt, William, Tokat, Yaman, Kang, Yoogoo, Chan, Albert, Mazzola, Alessandra, Hessheimer, Amelia, Rammohan, Ashwin, Hogan, Brian, Vinaixa, Carmen, Nasralla, David, Victor, David, De Martin, Eleonora, Alconchel, Felipe, Roll, Garrett, Kabacam, Gokhan, Sapisochin, Gonzalo, Campos-Varela, Isabel, Liu, Jiang, Patel, Madhukar S., Izzy, Manhal, Kalisvaart, Marit, Adams, Megan, Goldaracena, Nicholas, Tinguely, Pascale, Hernandez-Alejandro, Roberto, Chadha, Ryan, Shaker, Tamer Mahmoud, Klair, Tarunjeet S., Pan, Terry, Tanaka, Tomohiro, Yoon, Uzung, Kirchner, Varvara, Hannon, Vivienne, Cheah, Yee Lee, Frola, Carlo, Morkane, Clare, Milliken, Don, Lurje, Georg, Potts, Jonathan, Fernandez, Thomas, Badenoch, Adam, Mukhtar, Ahmed, Zanetto, Alberto, Montano-Loza, Aldo, Chieh, Alfred Kow Wei, Shetty, Amol, DeWolf, Andre, Olmos, Andrea, Mrzljak, Anna, Blasi, Annabel, Berzigotti, Annalisa, Malik, Ashish, Rajakumar, Akila, Davidson, Brian, O'Farrell, Bryan, Kotton, Camille, Imber, Charles, Kwon, Choon Hyuck David, Wray, Christopher, Ahn, Chul-Soo, Krenn, Claus, Quintini, Cristiano, Maluf, Daniel, Mina, Daniel Santa, Sellers, Daniel, Balci, Deniz, Patel, Dhupal, Rudow, Dianne LaPointe, Monbaliu, Diethard, Bezinover, Dmitri, Krzanicki, Dominik, Kim, Dong-Sik, Brombosz, Elizabeth, Blumberg, Emily, Weiss, Emmanuel, Wey, Emmanuel, Kaldas, Fady, Saliba, Faouzi, Pittau, Gabriella, Wagener, Gebhard, Song, Gi-Won, Biancofiore, Gianni, Crespo, Gonzalo, Rodríguez, Gonzalo, Palli, Graciela Martinez, McKenna, Gregory, Petrowsky, Henrik, Egawa, Hiroto, Montasser, Iman, Pirenne, Jacques, Eason, James, Guarrera, James, Pomposelli, James, Lerut, Jan, Emond, Jean, Boehly, Jennifer, Towey, Jennifer, Hillingsø, Jens G, de Jonge, Jeroen, Caicedo, Juan, Heimbach, Julie, Emamaullee, Juliet Ann, Bartoszko, Justyna, Ma, Ka Wing, Kronish, Kate, Forkin, Katherine T., Chok, Kenneth Siu Ho, Olthoff, Kim, Reyntjens, Koen, Lee, Kwang-Woong, Suh, Kyung-Suk, Denehy, Linda, van der Laan, Luc J.W., McCormack, Lucas, Gorvin, Lucy, Ruffolo, Luis, Bhat, Mamatha, Ramírez, María Amalia Matamoros, Londoño, Maria-Carlota, Gitman, Marina, Levstik, Mark, de Santibañes, Martin, Lindsay, Martine, Parotto, Matteo, Armstrong, Matthew, Kasahara, Mureo, Schofield, Nick, Rizkalla, Nicole, Akamatsu, Nobuhisa, Scatton, Olivier, Keskin, Onur, Imventarza, Oscar, Andacoglu, Oya, Muiesan, Paolo, Giorgio, Patricia, Northup, Patrick, Matins, Paulo, Abt, Peter, Newsome, Philip N, Dutkowski, Philipp, Bhangui, Pooja, Bhangui, Prashant, Tandon, Puneeta, Brustia, Raffaele, Planinsic, Raymond, Brown, Robert, Porte, Robert, Barth, Rolf, Ciria, Rubén, Florman, Sander, Dharancy, Sebastien, Pai, Sher-Lu, Yagi, Shintaro, Nadalin, Silvio, Chinnakotla, Srinath, Forbes, Stuart J, Rahman, Suehana, Hong, Suk Kyun, Liying, Sun, Orloff, Susan, Rubman, Susan, Eguchi, Susumu, Ikegami, Toru, Reichman, Trevor, Settmacher, Utz, Aluvihare, Varuna, Xia, Victor, Yoon, Young-In, Soejima, Yuji, Genyk, Yuri, Jalal, Arif, Borakati, Aditya, Gustar, Adrian, Mohamed, Ahmed, Ramirez, Alejandro, Rothnie, Alex, Scott, Aneya, Sharma, Anika, Munro, Annalise, Mahay, Arun, Liew, Belle, Hidalgo, Camila, Crouch, Cara, Yan, Cheung Tsz, Tschuor, Christoph, Shaw, Conrad, Schizas, Dimitrios, Fritche, Dominic, Huda, Fabia Ferdousi, Wells, Gemma, Farrer, Giselle, Kwok, Hiu Tat, Kostakis, Ioannis, Mestre-Costa, Joao, Fan, Ka Hay, Fan, Ka Siu, Fraser, Kyra, Jeilani, Lelia, Pang, Li, Lenti, Lorenzo, Kathirvel, Manikandan, Zachiotis, Marinos, Vailas, Michail, Milan, Michele Mazza, Elnagar, Mohamed, Alradhawi, Mohammad, Dimitrokallis, Nikolaos, Machairas, Nikolaos, Morare, Nolitha, Yeung, Oscar, Khanal, Pragalva, Satish, Pranav, Ghani, Shahi Abdul, Makhdoom, Shahroo, Arulrajan, Sithhipratha, Bogan, Stephanie, Pericleous, Stephanos, Blakemore, Timon, Otti, Vanessa, Lam, Walter, Jackson, Whitney, Abdi, Zakee, Pollok, Joerg M, Berenguer, Marina, Niemann, Claus U, Raptis, Dimitri A, and Spiro, Michael

Published
2023
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3. Can we reduce ischemic cholangiopathy rates in donation after cardiac death liver transplantation after 10 years of practice? Canadian single-centre experience

Author

Tun-Abraham, Mauro Enrique, Wanis, Kerollos N., Garcia-Ochoa, Carlos, Sela, Nathalie, Sharma, Hemant, Hasan, Ibrahim Al, Quan, Douglas, Judaibi, Bandar Al-, Levstik, Mark, and Hernandez-Alejandro, Roberto

Subjects
International Business Machines Corp., Computer industry -- Analysis, Liver transplantation -- Analysis, Gifts -- Evaluation -- Analysis, Heart -- Analysis, Tissue donation -- Analysis, Organ transplant recipients -- Analysis, Purchasing, Death, Organ transplantation, Jewelry, Surgery, Ischemia, Brain death, Computer industry, Microcomputer industry, Health, Health care industry
Abstract

Background: Outcomes in liver transplantation with organs obtained via donation after cardiocirculatory death (DCD) have been suboptimal compared to donation after brain death, attributed mainly to the high incidence of ischemic cholangiopathy (IC). We evaluated the effect of a 10-year learning curve on IC rates among DCD liver graft recipients at a single centre.Methods: We analyzed all DCD liver transplantation procedures from July 2006 to July 2016. Patients were grouped into early (July 2006 to June 2011) and late (July 2011 to July 2016) eras. Those with less than 6 months of follow-up were excluded. Primary outcomes were IC incidence and IC-free survival rate.Results: Among the 73 DCD liver transplantation procedures performed, 70 recipients fulfilled the selection criteria, 32 in the early era and 38 in the late era. Biliary complications were diagnosed in 19 recipients (27%). Ischemic cholangiopathy was observed in 8 patients (25%) in the early era and 1 patient (3%) in the late era (p = 0.005). The IC-free survival rate was higher in the late era than the early era (98% v. 79%, p = 0.01). The warm ischemia time (27 v. 24 min, p = 0.049) and functional warm ischemia time (21 v. 17 min, p = 0.002) were significantly lower in the late era than the early era.Conclusion: We found a significant reduction in IC rates and improvement in IC-free survival among DCD liver transplantation recipients after a learning curve period that was marked by more judicious donor selection with shorter procurement times.Contexte : L'issue des greffes de foie suite a un don d'organe apres deces cardiocirculatoire (DDC) a ete sous-optimale comparativement aux dons suivant la mort cerebrale. Cela serait surtout attribuable a une forte incidence de cholangiopathie ischemique (CI). Nous avons evalue l'effet d'une courbe d'apprentissage echelonnee sur 10 ans sur les taux de CI chez des receveurs de greffe de foie apres DDC dans un seul centre.Methodes : Nous avons analyse toutes les greffes de foie consecutives a des DDC entre juillet 2006 et juillet 2016. Les patients ont ete regroupes en 2 epoques, la premiere, de juillet 2006 a juin 2011, et la seconde, de juillet 2011 a juillet 2016. Ceux pour lesquels on disposait de moins de 6 mois de suivi ont ete exclus. Les parametres principaux etaient l'incidence de CI et le taux de survie sans CI.Resultats : Parmi les 73 greffes de foie par suite de DDC, 70 receveurs repondaient aux criteres de selection, 32 pour la premiere epoque et 38 pour la seconde epoque. Des complications biliaires ont ete diagnostiquees chez 19 receveurs (27%). La cholangiopathie ischemique a ete observee chez 8 patients (25%) de la premiere epoque et 1 patient (3%) de la seconde (p = 0,005). Le taux de survie sans CI a ete plus eleve pendant la seconde epoque que pendant la premiere (98% c. 79%, p = 0,01). Le temps d'ischemie chaude (27 minutes c. 24, p = 0,049) et le temps d'ischemie chaude fonctionnelle (21 minutes c. 17, p = 0,002) ont ete significativement plus courts durant la seconde epoque que durant la premiere.Conclusion : Nous avons observe une reduction significative des taux de CI et une amelioration de la survie sans CI chez les receveurs de greffes de foie par DDC apres une courbe d'apprentissage qui a ete marquee par une selection plus judicieuse des donneurs et des delais d'obtention plus courts., Recommended strategies to expand the donor pool in liver transplantation and decrease waiting list mortality include using extended-criteria donors and living donation. Encompassed among extended-criteria donors is donation after cardiocirculatory [...]

Published
2019
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4. Optimizing associated liver partition and portal vein ligation for staged hepatectomy outcomes: Surgical experience or appropriate patient selection?

Author

Al Hasan, Ibrahim, Tun-Abraham, Mauro Enrique, Wanis, Kerollos N., Garcia-Ochoa, Carlos, Levstik, Mark A., Al-Judaibi, Bandar, and Hernandez-Alejandro, Roberto

Subjects
Digestive system surgery -- Patient outcomes, Liver diseases -- Care and treatment, Health, Health care industry
Abstract

Background: Early reports of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) outcomes have been suboptimal. The literature has confirmed that learning curves influence surgical outcomes. We [...]

Published
2017
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5. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

Author

Pollok, Joerg M, primary, Tinguely, Pascale, additional, Berenguer, Marina, additional, Niemann, Claus U, additional, Raptis, Dimitri A, additional, Spiro, Michael, additional, Mayr, Andreas, additional, Dominguez, Beatriz, additional, Muller, Elmi, additional, Rando, Karina, additional, Enoch, Mary Anne, additional, Tamir, Noam, additional, Healy, Pamela, additional, Manser, Tanja, additional, Briggs, Tim, additional, Chaudhary, Abhideep, additional, Humar, Abhinav, additional, Jafarian, Ali, additional, Soin, Arvinder Singh, additional, Eghtesad, Bijan, additional, Miller, Charles, additional, Cherqui, Daniel, additional, Samuel, Didier, additional, Broering, Dieter, additional, Pomfret, Elizabeth, additional, Villamil, Federico, additional, Durand, Francois, additional, Berlakovich, Gabriela, additional, McCaughan, Geoffrey, additional, Auzinger, Georg, additional, Testa, Giuliano, additional, Klintmalm, Goran, additional, Belghiti, Jacques, additional, Findlay, James, additional, Lai, Jennifer, additional, Fung, John, additional, Klinck, John, additional, Roberts, John, additional, Liu, Linda, additional, Cattral, Mark, additional, Ghobrial, Mark, additional, Selzner, Markus, additional, Ramsay, Michael, additional, Rela, Mohamed, additional, Ascher, Nancy, additional, Man, Nancy Kwan, additional, Selzner, Nazia, additional, Burra, Patrizia, additional, Friend, Peter, additional, Busuttil, Ronald, additional, Hwang, Shin, additional, McCluskey, Stuart, additional, Mas, Valeria, additional, Vohra, Vijay, additional, Vij, Vivek, additional, Merritt, William, additional, Tokat, Yaman, additional, Kang, Yoogoo, additional, Chan, Albert, additional, Mazzola, Alessandra, additional, Hessheimer, Amelia, additional, Rammohan, Ashwin, additional, Hogan, Brian, additional, Vinaixa, Carmen, additional, Nasralla, David, additional, Victor, David, additional, De Martin, Eleonora, additional, Alconchel, Felipe, additional, Roll, Garrett, additional, Kabacam, Gokhan, additional, Sapisochin, Gonzalo, additional, Campos-Varela, Isabel, additional, Liu, Jiang, additional, Patel, Madhukar S., additional, Izzy, Manhal, additional, Kalisvaart, Marit, additional, Adams, Megan, additional, Goldaracena, Nicholas, additional, Hernandez-Alejandro, Roberto, additional, Chadha, Ryan, additional, Shaker, Tamer Mahmoud, additional, Klair, Tarunjeet S., additional, Pan, Terry, additional, Tanaka, Tomohiro, additional, Yoon, Uzung, additional, Kirchner, Varvara, additional, Hannon, Vivienne, additional, Cheah, Yee Lee, additional, Frola, Carlo, additional, Morkane, Clare, additional, Milliken, Don, additional, Lurje, Georg, additional, Potts, Jonathan, additional, Fernandez, Thomas, additional, Badenoch, Adam, additional, Mukhtar, Ahmed, additional, Zanetto, Alberto, additional, Montano-Loza, Aldo, additional, Chieh, Alfred Kow Wei, additional, Shetty, Amol, additional, DeWolf, Andre, additional, Olmos, Andrea, additional, Mrzljak, Anna, additional, Blasi, Annabel, additional, Berzigotti, Annalisa, additional, Malik, Ashish, additional, Rajakumar, Akila, additional, Davidson, Brian, additional, O'Farrell, Bryan, additional, Kotton, Camille, additional, Imber, Charles, additional, Kwon, Choon Hyuck David, additional, Wray, Christopher, additional, Ahn, Chul-Soo, additional, Krenn, Claus, additional, Quintini, Cristiano, additional, Maluf, Daniel, additional, Mina, Daniel Santa, additional, Sellers, Daniel, additional, Balci, Deniz, additional, Patel, Dhupal, additional, Rudow, Dianne LaPointe, additional, Monbaliu, Diethard, additional, Bezinover, Dmitri, additional, Krzanicki, Dominik, additional, Kim, Dong-Sik, additional, Brombosz, Elizabeth, additional, Blumberg, Emily, additional, Weiss, Emmanuel, additional, Wey, Emmanuel, additional, Kaldas, Fady, additional, Saliba, Faouzi, additional, Pittau, Gabriella, additional, Wagener, Gebhard, additional, Song, Gi-Won, additional, Biancofiore, Gianni, additional, Crespo, Gonzalo, additional, Rodríguez, Gonzalo, additional, Palli, Graciela Martinez, additional, McKenna, Gregory, additional, Petrowsky, Henrik, additional, Egawa, Hiroto, additional, Montasser, Iman, additional, Pirenne, Jacques, additional, Eason, James, additional, Guarrera, James, additional, Pomposelli, James, additional, Lerut, Jan, additional, Emond, Jean, additional, Boehly, Jennifer, additional, Towey, Jennifer, additional, Hillingsø, Jens G, additional, de Jonge, Jeroen, additional, Caicedo, Juan, additional, Heimbach, Julie, additional, Emamaullee, Juliet Ann, additional, Bartoszko, Justyna, additional, Ma, Ka Wing, additional, Kronish, Kate, additional, Forkin, Katherine T., additional, Chok, Kenneth Siu Ho, additional, Olthoff, Kim, additional, Reyntjens, Koen, additional, Lee, Kwang-Woong, additional, Suh, Kyung-Suk, additional, Denehy, Linda, additional, van der Laan, Luc J.W., additional, McCormack, Lucas, additional, Gorvin, Lucy, additional, Ruffolo, Luis, additional, Bhat, Mamatha, additional, Ramírez, María Amalia Matamoros, additional, Londoño, Maria-Carlota, additional, Gitman, Marina, additional, Levstik, Mark, additional, de Santibañes, Martin, additional, Lindsay, Martine, additional, Parotto, Matteo, additional, Armstrong, Matthew, additional, Kasahara, Mureo, additional, Schofield, Nick, additional, Rizkalla, Nicole, additional, Akamatsu, Nobuhisa, additional, Scatton, Olivier, additional, Keskin, Onur, additional, Imventarza, Oscar, additional, Andacoglu, Oya, additional, Muiesan, Paolo, additional, Giorgio, Patricia, additional, Northup, Patrick, additional, Matins, Paulo, additional, Abt, Peter, additional, Newsome, Philip N, additional, Dutkowski, Philipp, additional, Bhangui, Pooja, additional, Bhangui, Prashant, additional, Tandon, Puneeta, additional, Brustia, Raffaele, additional, Planinsic, Raymond, additional, Brown, Robert, additional, Porte, Robert, additional, Barth, Rolf, additional, Ciria, Rubén, additional, Florman, Sander, additional, Dharancy, Sebastien, additional, Pai, Sher-Lu, additional, Yagi, Shintaro, additional, Nadalin, Silvio, additional, Chinnakotla, Srinath, additional, Forbes, Stuart J, additional, Rahman, Suehana, additional, Hong, Suk Kyun, additional, Liying, Sun, additional, Orloff, Susan, additional, Rubman, Susan, additional, Eguchi, Susumu, additional, Ikegami, Toru, additional, Reichman, Trevor, additional, Settmacher, Utz, additional, Aluvihare, Varuna, additional, Xia, Victor, additional, Yoon, Young-In, additional, Soejima, Yuji, additional, Genyk, Yuri, additional, Jalal, Arif, additional, Borakati, Aditya, additional, Gustar, Adrian, additional, Mohamed, Ahmed, additional, Ramirez, Alejandro, additional, Rothnie, Alex, additional, Scott, Aneya, additional, Sharma, Anika, additional, Munro, Annalise, additional, Mahay, Arun, additional, Liew, Belle, additional, Hidalgo, Camila, additional, Crouch, Cara, additional, Yan, Cheung Tsz, additional, Tschuor, Christoph, additional, Shaw, Conrad, additional, Schizas, Dimitrios, additional, Fritche, Dominic, additional, Huda, Fabia Ferdousi, additional, Wells, Gemma, additional, Farrer, Giselle, additional, Kwok, Hiu Tat, additional, Kostakis, Ioannis, additional, Mestre-Costa, Joao, additional, Fan, Ka Hay, additional, Fan, Ka Siu, additional, Fraser, Kyra, additional, Jeilani, Lelia, additional, Pang, Li, additional, Lenti, Lorenzo, additional, Kathirvel, Manikandan, additional, Zachiotis, Marinos, additional, Vailas, Michail, additional, Milan, Michele Mazza, additional, Elnagar, Mohamed, additional, Alradhawi, Mohammad, additional, Dimitrokallis, Nikolaos, additional, Machairas, Nikolaos, additional, Morare, Nolitha, additional, Yeung, Oscar, additional, Khanal, Pragalva, additional, Satish, Pranav, additional, Ghani, Shahi Abdul, additional, Makhdoom, Shahroo, additional, Arulrajan, Sithhipratha, additional, Bogan, Stephanie, additional, Pericleous, Stephanos, additional, Blakemore, Timon, additional, Otti, Vanessa, additional, Lam, Walter, additional, Jackson, Whitney, additional, and Abdi, Zakee, additional

Published
2023
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11. What is the optimal prophylaxis against postoperative deep vein thrombosis in the living donor to avoid complications and enhance recovery? – A systematic review of the literature and expert panel recommendations.

Author

Ruffolo, Luis I., Levstik, Mark, Boehly, Jen, Spiro, Michael, Raptis, Dimitri A., Liu, Linda, and Hernandez‐Alejandro, Roberto

Subjects
*VENOUS thrombosis, *LOW-molecular-weight heparin, *PREVENTIVE medicine, *LIVER transplantation
Abstract

Background: Deep venous thrombosis (DVT) prophylaxis is often employed to prevent the potentially serious complication of pulmonary embolism (PE). However, little data exist regarding the optimal DVT prophylaxis strategy for living donors undergoing hepatectomy for living donor liver transplantation. Here we present our consensus statement on DVT prophylaxis for living donors undergoing hepatectomy. Objectives: To identify the optimal DVT prophylaxis strategy, which reduces, risk of complications in living liver donors, and enhances recovery. Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Of interest was the impact of DVT prophylaxis or lack of prophylaxis on living donors undergoing hepatectomy and subsequent rates of DVT, PE, and hemorrhagic complications. PROSPERO ID: CRD42021260720 Results: The review of the literature identified three studies, which directly addressed thrombogenesis following living donor hepatectomy. All studies were observational in nature without randomization into treatments. The rate of DVT‐PE in unscreened living donors with chemoprophylaxis was 5%. Furthermore, thromboelastography of living donors demonstrated sustained hypercoagulability for 50% of donors 10 days postoperatively. In line with CHEST (The American College of Chest Physicians) guidelines of chemoprophylaxis for surgical procedures with 3% or greater risk of DVT‐PE, we conclude that a minimum of 10 days of postoperative chemoprophylaxis with unfractionated heparin or low‐molecular weight heparin is recommended for patients undergoing living donor hepatectomy. The quality of evidence (QOE) for these recommendations based on the GRADE criteria is low, with a Grade of Recommendation of Strong. Conclusions: Chemoprophylaxis for DVT following living donor hepatectomy is associated with reduced adverse thrombotic events, (Quality of Evidence; Low | Grade of Recommendation; Strong). [ABSTRACT FROM AUTHOR]

Published
2022
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13. Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre

Author

Hernandez-Alejandro, Roberto, Caumartin, Yves, Marotta, Paul J., Ghent, Cameron, Levstik, Mark A., Quan, Douglas, Muirhead, Norman, House, Andrew A., McAlister, Vivian, Jevnikar, Anthony M., Luke, Patrick P.W., and Wall, William

Subjects
Kidneys -- Transplantation, Liver -- Transplantation, Liver diseases -- Care and treatment -- Research, Kidney diseases -- Care and treatment -- Research, Health, Health care industry
Abstract

Background: The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs. Methods: We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors. Results: The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) µmol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%. Conclusion: Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged. Contexte : L'ecart entre le nombre de patients en attente de transplantation d'organe et la disponibilite d'organes de donneurs se creuse chaque annee au Canada. Le don apres la mort cardiaque (DMC) suivant le retrait du maintien des fonctions vitales chez les patients dont le pronostic est sans espoir permet de lutter contre la penurie et pourrait augmenter le nombre d'organes transplantables. Methodes : Nous avons effectue une etude retrospective unicentrique de dossiers portant sur des organes donnes apres la mort cardiaque par le Programme de transplantation d'organes multiples au Centre des sciences de la sante de London entre juillet 2006 et decembre 2007. Au total, on a preleve 34 organes pleins (24 reins et 10 foies) de 12 donneurs en etat de mort cardiaque. Resultats : Les donneurs avaient en moyenne 38 (intervalle de 18 a 59) ans. Les deces avaient ete causes par un traumatisme craniocerebral (n = 7), un accident vasculaire cerebral (n = 4) et une hypoxie cerebrale (n = 1). Les 10 foies ont ete transplantes a notre centre, ainsi que 14 des 24 reins. Les 10 autres reins ont ete transplantes a d'autres centres. L'ischemie froide du rein a dure en moyenne 6 (intervalle de 3 a 9,5) heures. Chez 12 des 14 receveurs d'un rein (86 %), le greffon a commence a fonctionner tardivement, mais tous les reins ont recommence a fonctionner. Au suivi a 1 an, la fonction renale etait bonne, la concentration moyenne de creatinine serique s'etablissait a 145 (intervalle de 107 a 220) µmol/L et la clairance glomerulaire estimative moyenne, a 64 (intervalle de 41 a 96) mL/min. L'ischemie froide du rein a dure en moyenne 5,8 (plage de 5,5 a 8) heures. Il y a eu un cas de non-fonctionnement primitif qui a oblige a proceder a une autre transplantation. Les 9 autres foies ont bien fonctionne. Un patient a presente une stenose anastomotique biliaire qui est disparue apres la pose d'un stent par endoscopie. Tous les receveurs d'un foie etaient vivants apres un suivi moyen de 11 (intervalle de 3 a 20) mois. Depuis le debut de ce programme de don apres la mort cardiaque, le nombre de donneurs diriges a notre centre a augmente de 14 %. Conclusion : Nos premiers resultats se comparent favorablement a ceux de la transplantation d'organes preleves chez des donneurs apres la mort cerebrale. Le don apres la mort cardiaque peut etre un moyen important d'accroitre le nombre d'organes disponibles pour la transplantation. Il faudrait en encourager la generalisation au Canada., The disparity between the number of patients on transplant waiting lists and the number of organs donated from deceased individuals increases each year in Canada. This organ shortage has prompted [...]

Published
2010

28. Interpreting Outcomes in DCDD Liver Transplantation

Author

Goldberg, David S., primary, Karp, Seth J., additional, McCauley, Maureen E., additional, Markmann, James F., additional, Croome, Kristopher P., additional, Taner, C. Burcin, additional, Heimbach, Julie K., additional, Leise, Michael D., additional, Fryer, Jonathan P., additional, Bohorquez, Humberto E., additional, Cohen, Ari J., additional, Gilroy, Richard K., additional, Kumer, Sean C., additional, Foley, David P., additional, Karim, Aos S., additional, Hernandez-Alejandro, Roberto, additional, Levstik, Mark A., additional, and Abt, Peter L., additional

Published
2017
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29. Reuse of liver grafts following brain death of the initial recipient

Author

Tanaka, Hideaki, McAlister, Vivian C., Levstik, Mark, Ghent, Cameron, Marotta, Paul, Quan, Douglas, and Wall, William

Subjects
Transplantation, surgical procedures, operative, Medicine and Health Sciences, Surgery, Reuse, Liver graft, Brain death, Liver transplantation
Abstract

AIM: To determine if there is a reasonable prospect of success of a re-use liver transplantation. METHODS: We systematically searched for reports of liver graft re-use using electronic searches of PubMed and Web of Knowledge. We performed hand searches of references lists of articles reporting re-use of grafts. RESULTS:A systematic review of the literature reveals 28 liver transplantations using previously transplanted grafts. First and second recipients ranged in age from 4 to 72 years and 29 to 62 years respectively. Liver disease in the first recipient was varied including 5 (18%) patients with fulminant liver failure who died subsequently of cerebral edema. The second transplantation was performed after a median interval of 5 d (one day-13 years). Viral hepatitis was present in 3 (11%) of the initial recipients and in 8 (29%) of final recipients. hepatocellular carcinoma was present in 6 (21%) of the final recipients. Early survival after the final transplantation was 93%, whereas long-term survival was 78% with a mean follow-up of 23.3 (3-120) mo. CONCLUSION: Outcomes of transplantation using previously transplanted grafts in this select population are similar to those seen with conventional grafts.

Published
2014

39. Clinical Recommendations for the Use of Recombinant Human Erythropoietin in Patients with Hepatitis C Virus Being Treated with Ribavirin

Author

Sherman, Morris, primary, Cohen, Lawrence, additional, Anne Cooper, Mary, additional, Elkashab, Magdy, additional, Feinman, Victor, additional, Fletcher, David, additional, Girgrah, Nigel, additional, Heathcote, Jenny, additional, Levstik, Mark, additional, McNaull, William B, additional, Wong, David, additional, Wong, Florence, additional, and Yim, Colina, additional

Published
2006
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41. Etiology of ascites after liver transplant

Author

Tombazzi, Claudio R., primary, Deshmukh, Suhas L., additional, Waters, Bradford, additional, Shokouh-Amiri, M. Hosein, additional, Fleckenstein, Jacqueline F., additional, Levstik, Mark A., additional, Davila, Rene, additional, Vera, Santiago R., additional, Grewal, Hani P., additional, Gaber, Osama, additional, Payne, Tanci, additional, and Riely, Caroline A., additional

Published
2001
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42. Outcome of TIPS in candidates and non-candidates for liver transplantation

Author

Tombazzi, Claudio R., primary, Deshmukh, Suhas L., additional, Waters, Bardford, additional, Shokouh-Amiri, M Hosein, additional, Fleckenstein, Jaquelyn F., additional, Davila, Rene, additional, Levstik, Mark A., additional, Vera, Santiago R., additional, Grewal, Hani P., additional, Gaber, A. Osama, additional, and Riely, Caroline A., additional

Published
2001
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46. Ranking in Canadian Gastroenterology Residency Match: What Do Residents and Program Directors Want?

Author

J Khan, Khurram and A Levstik, Mark

Abstract

BACKGROUND: Matching to a gastroenterology (GI) fellowship position in Canada is increasingly competitive.OBJECTIVE: To identify factors that determine how residents rank programs across the country, and how program directors rank their applicants.METHODS: Using input from several current GI trainees and former program directors, two separate surveys were developed. An online survey was sent one month after the match to every resident matched to an adult GI program in the 2007 match. A separate online survey was simultaneously sent to all program directors of 14 accredited GI programs in Canada. Two subsequent cohorts (2008 and 2009) of matched residents were surveyed during the annual GI fellow endoscopy course at McMaster University (Hamilton, Ontario).RESULTS: The overall response rate was 64 of 91 (70%) for residents and 11 of 15 (73%) for program directors (one program had codirectors). Using a five-point Likert scale for rating the importance of various factors influencing their decision, residents from three years ranked the following factor as most important: suitable location for spouse/partner/family (median score = 5). The overall least important factor was an opportunity for pediatric elective (median score = 2). Using the same scale, program directors ranked the following factors as most important (median score = 5) in ranking residents to their program: the ability to get along with others, outstanding reference letters, exceptional curriculum vitae and applying to only one specialty.CONCLUSIONS: Several factors important for GI applicants and program directors were identified, as well as a few less-important factors. Based on these results, GI training programs can more effectively market their programs to applicants in the future, and residents applying to GI programs can strengthen their applications in the ever competitive match process.

Published
2010
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47. Is Serum Hepcidin Causative in Hemochromatosis? Novel Analysis from a Liver Transplant with Hemochromatosis

Author

C Adams, Paul, McAlister, Vivian, Chakrabarti, Subrata, Levstik, Mark, and Marotta, Paul

Abstract

BACKGROUND: Hepcidin is a circulating hepatic hormone that regulates iron balance. It has been speculated that hepcidin insufficiency or dysregulation may be the primary defect in genetic hemochromatosis.METHODS: A 62-year-old woman underwent elective liver transplantation for chronic hepatitis C cirrhosis. Genetic testing for hemochromatosis was subsequently performed on the donor and recipient. Liver iron concentration was measured in the donated liver at the time of transplantation, and at day 2 and day 652 post-transplant. Serum hepcidin was measured at day 935 in the recipient and in three other liver transplant recipients.RESULTS: The donor was discovered to have significant iron overload without fibrosis, with a liver iron concentration of 326 μmol/g (normal is 0 μmol/g to 35 μmol/g). Genetic testing confirmed that the 89-year-old female donor was a typical C282Y homozygote for hemochromatosis. The recipient did not carry either the C282Y or the H63D mutation of the HFE gene for hemochromatosis. Liver biopsy was performed on the recipient on day 2 and day 652 post-transplant; the liver iron concentrations were 333 μmol/g and 253 μmol/g, respectively. Serum hepcidin in the recipient was elevated at 111 ng/mL compared with that of the three other ambulatory liver transplant recipients (66 ng/mL, 76 ng/mL and 81 ng/mL).CONCLUSION: The liver transplant recipient described in the present report demonstrated a slight decrease in liver iron concentration over a 1.8-year follow-up period without specific therapy. Hepcidin insufficiency as a primary cause of genetic hemochromatosis seems unlikely based on the clinical profile of the present patient and the hepcidin measurements.

Published
2008
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48. Reuse of liver grafts following the brain death of the initial recipient.

Author

Tanaka H, McAlister VC, Levstik MA, Ghent CN, Marotta PJ, Quan D, and Wall WJ

Abstract

Aim: To determine if there is a reasonable prospect of success of a re-use liver transplantation., Methods: We systematically searched for reports of liver graft re-use using electronic searches of PubMed and Web of Knowledge. We performed hand searches of references lists of articles reporting re-use of grafts., Results: A systematic review of the literature reveals 28 liver transplantations using previously transplanted grafts. First and second recipients ranged in age from 4 to 72 years and 29 to 62 years respectively. Liver disease in the first recipient was varied including 5 (18%) patients with fulminant liver failure who died subsequently of cerebral edema. The second transplantation was performed after a median interval of 5 d (one day-13 years). Viral hepatitis was present in 3 (11%) of the initial recipients and in 8 (29%) of final recipients. Hepatocellular carcinoma was present in 6 (21%) of the final recipients. Early survival after the final transplantation was 93%, whereas long-term survival was 78% with a mean follow-up of 23.3 (3-120) mo., Conclusion: Outcomes of transplantation using previously transplanted grafts in this select population are similar to those seen with conventional grafts.

Published
2014
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