Search

Purpose A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. Methods An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. Results A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score >= 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. Conclusion Patients with a Shin score

Primary graft dysfunction is a common postoperative complication, lacking consensus regarding diagnostic criteria. Olthoff criteria are the most used, based on blood parameters in the first 7 postoperative days. This lack of consensus and late diagnosis evidence the need of early parameters. This study proposes factor V (FV) as a marker in the first 3 postoperative days for primary graft dysfunction.Within a 500-patient database, 27 patients with graft loss in the first 90 days were chosen and compared with a group of 54 patients composed of the immediately preceding and following transplant to each case. Through receiver operating characteristic curves, FV and maximum glutamic pyruvic transaminase (GPT) predictive value on the first 3 postoperative days were assessed. The best threshold value was selected according to the Youden index.FV was significantly higher in the control group, with second postoperative day as the highest discriminative one (area under the curve = 0.893). In addition, a cutoff point of FV 37.50 exhibited a specificity of 92% and sensibility of 69% in predicting allograft failure in the first 3 months. GPT showed a lower validity with area under the curve = 0.77, and a GPT of 1539 presented a specificity of 82% and sensibility of 67%. Combining FV37.5 and GPT1539, a specificity of 98% and sensibility of 55% was reached.FV could postulate as an early marker of primary graft dysfunction because of its high specificity despite having a lower sensibility. With de association of FV and GPT the maximum specificity for predicting graft loss in the first 3 months was reached, becoming a promising parameter for further analysis.

The so-called grafts or donors with extended criteria are a risk factor for the development of liver transplant activity. One source comes from controlled donation after circulatory death (cDCD). The hypothesis was to verify the improvement in results by comparing DCD liver transplants performed with postmortem normothermic regional perfusion (NRP) vs super-rapid recovery (SRR), the current standard for cDCD. A prospective study comparing both techniques was carried out.A total of 42 transplants were performed with cDCD, 22 of which were with SRR and 23 with NRP from April 2014 to September 2019.Differences were found in early allograft dysfunction (68.1% in the SRR group vs 25% in the NRP group; P .01) and biliary complications (22.7% vs 5%, respectively; P = .04). Differences were also found, although not statistically significant, in ischemic cholangiopathy (13.6% in the SRR group vs 5% in the NRP group; P = .09), and retransplant rate (9.1% vs 0%, respectively; P = .3).With the use of NRP machines, results are similar to the standard donation with donors in brain death in terms of rate of early allograft dysfunction and survival of the patient and graft attempted, reducing the rate of ischemic cholangiopathy compared with SRR.

Background Sarcopenia (SP) and preoperative muscle mass are independent predictive factors for short- and long-term outcome of liver transplantation. Objective To assess the influence of muscle mass index (MMI) and preoperative SP on the prognosis of patients who underwent liver transplantation in our hospital. Methods Ninety-seven patients who underwent liver transplantation in the Regional University Hospital of Malaga from September 2013 to March 2016 were analyzed. SP was determined based on the MMI, as assessed by psoas muscle area at the L4 level measured by computed tomography (CT), with adjustment for patient sex. Two cohorts were differentiated: 54 patients without SP and 42 patients with SP. Postoperative complications, graft survival, and patient survival were assessed. A 3-year follow-up was carried out. Results Recipient characteristics were similar in both cohorts, except for MMI ± SD (group without SP: 94.03 ± 15.43 cm2/m2 vs group with SP: 56.99 ± 13.59 cm2/m2; P = .001). The incidence of postoperative complications (Clavien ≥ 3) in patients with and without SP was 39.5% and 24.1%, respectively (P = .08). SP was not associated with poorer long-term graft or patient survival. Conclusions SP, determined by preoperative measurement of MMI, was identified as a predictive factor associated with a higher incidence of postoperative complications. Since MMI can be easily determined by CT, it should be assessed in all candidates for liver transplantation.