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101. 823 INDETERMINATE CAUSES OF ACUTE LIVER FAILURE: INCIDENCE AND PREDICTIVE FACTORS OF SPONTANEOUS SURVIVAL AND AFTER LIVER TRANSPLANTATION (LT)

Author

Philippe Ichai, Mylène Sebagh, D. Castaing, Eric Levesque, Valérie Delvart, Didier Samuel, Faouzi Saliba, Anne-Marie Roque-Afonso, Jean Charles Duclos-Vallée, and Audrey Coilly

Subjects
Hepatitis, medicine.medical_specialty, Hepatology, business.industry, medicine.medical_treatment, Incidence (epidemiology), Retrospective cohort study, Hepatitis C, Liver transplantation, medicine.disease, Gastroenterology, Acute fatty liver of pregnancy, Liver disease, Internal medicine, medicine, business, Survival rate
Abstract

Methods: A retrospective study of patients with ALF admitted to a tertiary liver centre from 2001 to 2009 was done. We looked at the demographic data, clinical features, prognostic markers – King’s College Hospital (KCH) criteria and Model for End-Stage Liver Disease (MELD) score, and the outcome of these patients. Data was analysed using SPSS. Results: A total of 155 cases were reviewed. 63.9% were females and the mean age was 36.7±15.9 years. The causes of ALF include hepatitis B-related (23.2%), indeterminate (20.0%), nonparacetamol drug-induced liver injury (DILI) (18.7%), autoimmune liver disease (7.7%), acute paracetamol toxicity (7.1%), acute fatty liver of pregnancy (6.5%), dengue-related (5.2%), Wilson’s disease (4.7%), acute hepatitis A (1.3%), hepatitis C (1.9%) and acute Budd Chiari (1.9%). The overall survival rate was 27.1%. Even though 57.2% of the patients satisfied the KCH criteria, only 2 patients were transplanted with one survived. The spontaneous survival rate in patients who satisfied the KCH was 8.3% while in the group who did not satisfy the KCH, the survival rate was 52.9%. In the group where KCH was not applicable, the survival rate was 53.3%. The mean MELD score for patients who died was 30±7, while for patients who survived the score was 22±7. Multivariable logistic regression showed for any one point increase in MELD score, ORadj1.22 (CI 95%: 1.12, 1.32) for mortality. Conclusion: ALF patients with poor prognostic criteria had a high mortality in the absence of liver transplant. The three main causes of ALF in Malaysia were viral hepatitis B, indeterminate and nonparacetamol DILI.

Published
2010

102. 221 OUTCOME OF CIRRHOTIC PATIENTS ADMITTED TO THE LIVER ICU AND PREDICTIVE FACTORS OF MORTALITY: RESULTS OF A RECENT COHORT OF 308 PATIENTS

Author

Bruno Roche, H. Habbouchi, René Adam, Rodolphe Sobesky, Eric Levesque, Faouzi Saliba, Didier Samuel, Teresa Antonini, Daniel Azoulay, Jean Charles Duclos-Vallée, Philippe Ichai, and D. Castaing

Subjects
Inotrope, medicine.medical_specialty, Multivariate analysis, Hepatology, business.industry, medicine.medical_treatment, Albumin, Liver transplantation, Fibrinogen, Gastroenterology, Surgery, Transplantation, Fulminant hepatic failure, Internal medicine, Cohort, medicine, business, medicine.drug
Abstract

(p = 0.006), inotropic support (p = 0.006) and the absence of transplantation (p = 0.002) were significantly predictive of mortality. In the multivariate analysis, MELD score and need for inotropic support were major significant predictors of death while transplant free survival was significantly related to a MELD score

Published
2009

103. P.394 Efficacité de la paracentèse sur les paramètres ventilatoires et les échanges gazeux chez les patients cirrhotiques sous ventilation mécanique

Author

Eric Levesque, Philippe Ichai, A. Coilly, Didier Samuel, Faouzi Saliba, J. Jiabin, and H. Habbouchi

Subjects
Gynecology, medicine.medical_specialty, business.industry, Gastroenterology, Medicine, General Medicine, business
Abstract

Introduction La presence d’ascite, chez les patients cirrhotiques, contribue a une augmentation de la pression-intra-abdominale et a l’existence d’un syndrome du compartiment abdominal. Chez le patient sous assistance ventilatoire, elle participe a la perte d’aeration des volumes pulmonaires. Associee aux alterations du ratio ventilation/perfusion observees chez le cirrhotique, la presence d’ascite peut alterer les echanges gazeux. L’objectif de cette etude est d’evaluer l’influence de la paracentese sur les volumes pulmonaires et sur les echanges gazeux, chez le patient presentant une ascite et requerant une assistance ventilatoire. Patients et Methodes Etude prospective observationnelle incluant tous les patients cirrhotiques admis en reanimation entre mars 2008 et septembre 2008, mis sous assistance ventilatoire (Engstrom, Datex-Ohmeda, GE Healthcare). Les patients etaient sedates, curarises et ventiles en mode controle, avec un volume courant a 6-8 ml/kg, une frequence respiratoire adaptee pour une PaCO 2 entre 35 et 40 mmHg et en Fi0 2 = 1, pendant toute la duree de l’etude. Les echanges gazeux, la capacite residuelle fonctionnelle (CRF), les parametres du respirateur (pression maximale : Pmax, de plateau : Pplat, et la pression expiratoire positive totale : PEPtot) ainsi que la pression vesicale (reflet de la pression intra-abdominale) ont ete mesures avant et en fin d’evacuation de l’ascite. Une surveillance hemodynamique incluant les pressions systolique, diastolique et moyenne, la frequence cardiaque ainsi que la dose des catecholamines a ete realisee tout au long de l’etude. Resultats Seize patients (IGS 63,9 ± 18,3, Meld 32,9 ± 11,0 et Child Pugh 11,4 ± 2,1) ont ete etudies avant et apres paracentese. Le volume moyen d’ascite evacue etait de 4,4 ± 1,8 litres engendrant une diminution significative de la pression intra-vesicale (23,62 ± 11,32 mmHg vs 10,75 ± 6,41 mmHg, p = 0,0004). Apres evacuation de l’ascite, la capacite residuelle fonctionnelle augmentait (814,0 ± 318,2 ml vs 1 386,3 ± 453,7 ml p = 0,01). Il existait parallelement une augmentation du rapport Pa0 2 /FiO 2 (+ 24,74 %) qui est statistiquement significatif dans le sous-groupe des patients (n = 8) presentant un syndrome de detresse respiratoire de l’adulte (SDRA) ou un Acute Lung Injury (ALI) (262,9 ± 90,4 apres vs 135,1 ± 53,7 avant paracentese, p = 0,0074). La PaCO 2 n’etait pas modifiee. Il n’existait pas non plus de modifications des pressions ventilatoires (Pcrete, Pplat et PEPtot) et aucune consequence sur l’etat hemodynamique n’a ete observee suite a la paracentese. Conclusion En plus de l’alteration des echanges gazeux decrits chez le patient cirrhotique, la presence d’ascite entraine une diminution de la CRF qui est peut etre corrigee par la paracentese. Chez le patient cirrhotique, la ponction d’une ascite est un traitement qui permet d’augmenter les volumes pulmonaires et d’ameliorer l’hematose, principalement chez ceux qui presentent un SDRA ou ALI.

Published
2009

104. CO.98 Pronostic des patients atteints d’une insuffisance hépatique aiguë sur une cirrhose admis en réanimation

Author

Didier Samuel, D. Castaing, Bruno Roche, Philippe Ichai, Faouzi Saliba, T.M. Antonini, René Adam, H. Habbouchi, Daniel Azoulay, Jean Charles Duclos-Vallée, and Eric Levesque

Subjects
Gynecology, medicine.medical_specialty, business.industry, Gastroenterology, Medicine, General Medicine, business
Abstract

Introduction La mortalite des patients presentant une insuffisance hepatique aigue sur une cirrhose et admis en reanimation varie de 31 % a 64 %. Recemment, avec le developpement des nouvelles therapeutiques medicamenteuses ou techniques comme la transplantation hepatique, le TIPS et le systeme d’epuration hepatique a l’albumine (MARS®) le pronostic de ces patients dans les unites de reanimation est possiblement modifie. Peu de donnees actuelles ont ete rapportees sur l’evolution et le devenir de ces patients. Patients et Methodes Nous avons etudie une cohorte recente de 301 patients presentant une decompensation aigue de leur cirrhose et admis en reanimation au Centre Hepato-Biliaire de mai 2005 a aout 2008, soit 10,5 % des patients admis en reanimation. L’âge moyen etait de 55,3 ± 11,6 ans (73,4 % de sexe masculin). L’etiologie de la cirrhose etait principalement alcoolique (69 %), virale (15 %) ou mixte (4,3 %). Le motif d’hospitalisation en reanimation etait essentiellement l’hemorragie digestive (44,5 %), le sepsis (15,9 %), l’encephalopathie hepatique (12,3 %) et l’hepatite alcoolique aigue (11,9 %). A l’admission, la valeur moyenne des scores pronostiques de gravite etait de 44,4 ± 20,4 pour l’IGS II, 25,2 ± 12,7 pour le MELD, 10,3 ± 2,3 pour la classification de Child-Pugh et 8,9 ± 4,6 pour le SOFA. Resultats La duree moyenne de sejour en reanimation etait de 9,8 ± 11,6 jours. La mortalite etait de 33,2 % et de 40,2 % respectivement en reanimation et en hospitalisation. 24 % des patients decedes l’ont ete dans les 48 heures de leur admission. Le deces est survenu dans la majorite des cas (73 %) dans un tableau de defaillance multiviscerale suite a un sepsis. L’analyse statistique, comparant les patients decedes et survivants, a montre que les scores pronostiques de gravite, evalues a l’admission, etaient fortement (p Conclusion Le sepsis severe associe a l’insuffisance hepatique severe reste la principale cause de mortalite du cirrhotique admis en reanimation. Parmi les scores de gravite, l’IGS II et le SOFA semblent mieux predire le devenir de ces patients que les scores specifiques hepatiques (MELD, Child Pugh). Ce type d’etude devrait permettre de mieux definir la place des nouvelles therapeutiques specifiques en reanimation.

Published
2009

105. CO.14 Stéatose et transplantation hépatique (TH) : influence du type histologique et du degré d’envahissement sur les résultats à court et à long terme

Author

Jean Charles Duclos-Vallée, Eric Vibert, René Adam, D. Castaing, Mylène Sebagh, V Karam, Eric Levesque, Philippe Ichai, Didier Samuel, Faouzi Saliba, F. Perdigao Cotta, Daniel Azoulay, A. Jimenez, and C. Salloum

Subjects
Gynecology, medicine.medical_specialty, business.industry, Gastroenterology, Medicine, General Medicine, business
Abstract

Introduction La steatose du greffon est un facteur de risque connu de la TH. Neanmoins, aucun consensus n’est clairement etabli pour fixer les limites de l’utilisation des foies steatosiques (FS). L’objectif de cette etude est d’evaluer l’impact du type et de la severite de la steatose sur les resultats de la TH, comparativement aux foies non steatosiques (FNS). Patients et Methodes A partir d’une serie consecutive de 2 054 TH realisees de 1984 a 2008, l’influence (a) du type (microvesiculaire : MIC ou macrovesiculaire : MAC) et (b) du degre (Minime 60 %) de la steatose a ete evaluee sur l’incidence de nonfonction primaire (NFP), de dysfonction (DYF) du greffon (definie par un TP minimum 2 000 UI/L), et sur la survie du greffon. Une analyse multivariee a ete effectuee pour determiner quel type et quell degre de steatose representaient un facteur de risque independant de perte du greffon. Resultats 845 (41 %) TH ont ete realisees avec un FS. Le risque de DYF etait augmente, comparativement aux FNS (17 % vs 11 %, p vs 7 % - p 30 %), la DYF etait plus frequente (19 % vs 11 %) et la survie du greffon significativement inferieure a celle des FNS (80 vs 66 % a 1 an, p 30 % pures et mixtes, les risque de DYF (17 % vs 11 %), de NFP (4 % vs 1,7 %) etaient plus eleves, et la survie du greffon inferieure a celle des FNS, quel que soit le degre de MIC associee. Le risque etait encore majore en cas de MAC > 60 % (n = 30) avec un risque de NFP de 13 %, de DYF de 42 % et une survie a 1 an de 53 %. En analyse multivariee, la steatose MAC > 30 % s’est revelee etre un facteur de risque independant de perte de greffon (p = 0,003, RR : 1,34), conjointement a la retransplantation, l’urgence, le cancer, l’incompatibilite ABO, le nombre de culots transfuses, et l’utilisation du Split ou d’un foie reduit. L’âge jeune du donneur ou une courte duree d’ischemie ne reduisaient pas de facon significative l’effet deletere de la steatose qui etaient en revanche amplifies par l’urgence et l’utilisation d’un foie partiel. Conclusion Plus que la steatose microvesiculaire, la steatose macrovesiculaire est un facteur de risque pour la TH, lorsqu’elle excede 30 %. Le risque devient redhibitoire pour les steatoses de plus de 60 % entrainant la perte de pres d’un greffon sur deux. La diminution du temps d’ischemie ou le jeune âge du donneur ne semblent pas prevenir significativement ce risque.

Published
2009

106. Germline Polymorphisms in the Nuclear Receptors PXR and VDR as Novel Prognostic Markers in Metastatic Colorectal Cancer Patients Treated With FOLFIRI

Author

Elena De Mattia, Jerry Polesel, Rossana Roncato, Adrien Labriet, Alessia Bignucolo, Eva Dreussi, Loredana Romanato, Michela Guardascione, Angela Buonadonna, Mario D'Andrea, Eric Lévesque, Derek Jonker, Félix Couture, Chantal Guillemette, Erika Cecchin, and Giuseppe Toffoli

Subjects
pharmacogenetics, PXR, VDR, survival, FOLFIRI, colorectal cancer, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Nuclear receptors act as mediators of cancer-related inflammation and gene expression. They have a regulatory effect on genes encoding proteins related to drug adsorption, distribution, metabolism, and excretion. The aim of the present study was to highlight novel prognostic markers among polymorphisms in genes encoding for nuclear receptor proteins and inflammation-related cytokines in patients treated with a FOLFIRI regimen. This study included two independent cohorts comprising a total of 337 mCRC patients homogeneously treated with first-line FOLFIRI. Genotyping of 246 haplotype-tagging polymorphisms in 22 genes was performed using bead array technology. The NR1I2 (PXR)-rs1054190 and VDR-rs7299460 polymorphisms were significantly associated with patient overall survival (OS). A detrimental effect of the NR1I2 rs1054190-TT genotype on OS was observed in both the discovery and replication cohorts (HR = 6.84, P = 0.0021, q-value = 0.1278 and HR = 3.56, P = 0.0414, respectively). Patients harboring the NR1I2 rs1054190-TT genotype had a median OS of 9 months vs. 21 months in patients with C-allele (P < 0.0001 log-rank test). VDR rs7299460-T was consistently associated with a longer OS in both cohorts (discovery: HR = 0.61, P = 0.0075, q-value = 0.1535; replication: HR = 0.57, P = 0.0477). Patients with the VDR rs7299460-T allele had a median OS of 23 months compared to 18 months in those with the CC genotype (P = 0.0489, log-rank test). The NR1I2-rs1054190 polymorphism also had an effect on the duration of progression-free survival, consistent with the effect observed on OS. Two novel prognostic markers for mCRC treated with FOLFIRI were described and, if validated by prospective trials, have a potential application in the management of these patients.

Published
2019
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107. Inactivation of Prostaglandin E2 as a Mechanism for UGT2B17-Mediated Adverse Effects in Chronic Lymphocytic Leukemia

Author

Eric P. Allain, Michèle Rouleau, Trang Le, Katrina Vanura, Lyne Villeneuve, Patrick Caron, Véronique Turcotte, Eric Lévesque, and Chantal Guillemette

Subjects
UGT2B17, CLL, prostaglandins, glucuronidation, PGE2, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

High expression of the metabolic enzyme UDP-glucuronosyltransferase UGT2B17 in chronic lymphocytic leukemia (CLL) cells was associated with poor prognosis in two independent studies. However, the underlying mechanism remains unknown. We hypothesized that UGT2B17 impacts intracellular levels of hormone-like signaling molecules involved in the regulation of gene expression in leukemic cells. We initially confirmed in a third cohort of 291 CLL patients that those with high UGT2B17 displayed poor prognosis (hazard ratio of 2.31, P = 0.015). Consistent with the unfavorable prognostic significance of elevated UGT2B17 expression in CLL patients, high UGT2B17 expression was associated with enhanced proliferation of MEC1 and JVM2 malignant B-cell models. Transcriptomic analyses revealed that high UGT2B17 was linked to a significant alteration of genes related to prostaglandin E2 (PGE2) and to its precursor arachidonic acid, both in cell models and a cohort of 448 CLL patients. In functional assays, PGE2 emerged as a negative regulator of apoptosis in CLL patients and proliferation in cells models, whereas its effect was partially abrogated by high UGT2B17 expression in MEC1 and JVM2 cells. Enzymatic assays and mass-spectrometry analyses established that the UGT2B17 enzyme inactivates PGE2 by its conjugation to glucuronic acid (GlcA) leading to the formation of two glucuronide (G) derivatives. High UGT2B17 expression was further associated with a proficient inactivation of PGE2 to PGE2-G in CLL patient cells and cell models. We conclude that UGT2B17-dependent PGE2 glucuronidation impairs anti-oncogenic PGE2 effects in leukemic cells, thereby partially contributing to disease progression in high UGT2B17 CLL patients.

Published
2019
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108. Association of STAT-3 rs1053004 and VDR rs11574077 With FOLFIRI-Related Gastrointestinal Toxicity in Metastatic Colorectal Cancer Patients

Author

Elena De Mattia, Erika Cecchin, Marcella Montico, Adrien Labriet, Chantal Guillemette, Eva Dreussi, Rossana Roncato, Alessia Bignucolo, Angela Buonadonna, Mario D’Andrea, Luigi Coppola, Sara Lonardi, Eric Lévesque, Derek Jonker, Félix Couture, and Giuseppe Toffoli

Subjects
STAT-3, VDR, genetic markers, irinotecan (CPT-11), gastrointestinal toxicity, colorectal cancer, Therapeutics. Pharmacology, RM1-950
Abstract

Pharmacogenomics has largely been applied to the personalization of irinotecan-based treatment, focusing mainly on the study of genetic variants in adsorption, distribution, metabolism, and excretion (ADME) genes. The transcriptional control of ADME gene expression is mediated by a set of nuclear factors responding to cancer-related inflammation, which could have pharmacological implications. The aim of the present study was to uncover novel genetic predictors of neutropenia and gastrointestinal toxicity risk among 246 haplotype-tagging polymorphisms in 22 genes encoding inflammation-related cytokines and transcriptional regulators of ADME genes. The study comprised overall more than 400 metastatic colorectal cancer (mCRC) patients treated with first-line FOLFIRI, grouped in a discovery and a replication cohorts. A concordant protective effect of STAT-3 rs1053004 polymorphism against the risk of grade 3–4 gastrointestinal toxicity was observed in both the cohorts of patients (OR = 0.51, p = 0.045, q = 0.521 and OR = 0.39, p = 0.043, respectively). VDR rs11574077 polymorphism was demonstrated to affect both irinotecan biliary index (BI) and glucuronidation ratio (GR) by a pharmacokinetic analysis. This effect was consistent with an increased risk of grade 3–4 gastrointestinal toxicity in the discovery cohort (OR = 4.46, p = 0.010, q = 0.305). The association was not significant in the replication cohort (OR = 1.44, p = 0.601). These findings suggest an effect of STAT-3 and VDR polymorphisms on FOLFIRI-related gastrointestinal toxicity. If prospectively validated as predictive markers, they could be used to improve the clinical management of mCRC.

Published
2018
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109. Improved Progression-Free Survival in Irinotecan-Treated Metastatic Colorectal Cancer Patients Carrying the HNF1A Coding Variant p.I27L

Author

Adrien Labriet, Elena De Mattia, Erika Cecchin, Éric Lévesque, Derek Jonker, Félix Couture, Angela Buonadonna, Mario D’Andrea, Lyne Villeneuve, Giuseppe Toffoli, and Chantal Guillemette

Subjects
metastatic colorectal cancer, hepatocyte nuclear factor 1-alpha, irinotecan, polymorphism, progression-free survival, Therapeutics. Pharmacology, RM1-950
Abstract

Hepatocyte nuclear factor 1-alpha (HNF1A) is a liver-enriched transcription factor that plays a key role in many aspects of hepatic functions including detoxification processes. We examined whether HNF1A polymorphisms are associated with clinical outcomes in two independent cohorts combining 417 European ancestry patients with metastatic colorectal cancer (mCRC) treated with irinotecan-based chemotherapy. The intronic rs2244608A>G marker was predictive of an improved progression-free survival with a trend in the Canadian cohort and reaching significance in the Italian cohort, with hazard ratios (HR) of 0.74 and 0.72, P = 0.076 and 0.038, respectively. A strong association between rs2244608A>G and improved PFS was found in the combined analysis of both cohorts (HR = 0.72; P = 0.002). Consistent with an altered HNF1A function, mCRC carriers of the rs2244608G minor allele displayed enhanced drug exposure by 45% (P = 0.032) compared to non-carriers. In Caucasians, rs2244608A>G is in strong linkage with the coding variant rs1169288c.79A>C (HNF1A p.I27L). In healthy donors, we observed an altered hepatic (ABCC1, P = 0.009, ABCC2, P = 0.048 and CYP3A5, P = 0.001; n = 89) and intestinal (TOP1, P = 0.004; n = 75) gene expression associated with the rs1169288C allele. In addition, the rs1169288C polymorphism could significantly increase the ABCC1 promoter activity by 27% (P = 0.008) and 15% (P = 0.041) in the human kidney HEK293 and the human liver HepG2 cell lines, respectively. Our findings suggest that the HNF1A rs2244608, or the tightly linked functional coding variant p.I27L, might be a potential prognostic marker with irinotecan-based regimens.

Published
2017
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110. Cyclosporine and methotrexate-related pharmacogenomic predictors of acute graft-versus-host disease

Author

Isabelle Laverdière, Chantal Guillemette, Ryad Tamouza, Pascale Loiseau, Regis Peffault de Latour, Marie Robin, Félix Couture, Alain Filion, Marc Lalancette, Alan Tourancheau, Dominique Charron, Gérard Socié, and Éric Lévesque

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Effective immunosuppression is mandatory to prevent graft-versus-host disease and to achieve a successful clinical outcome of hematopoietic stem cell transplantation. Here we tested whether germline single nucleotide polymorphisms in 20 candidate genes related to methotrexate and cyclosporine metabolism and activity influence the incidence of graft-versus-host disease in patients who undergo stem cell transplantation for hematologic disorders. Recipient genetic status of the adenosine triphosphate-binding cassette sub-family C1 and adenosine triphosphate-binding cassette sub-family C2 transporters, 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase/ inosine monophosphate cyclohydrolase within the methotrexate pathway, and nuclear factor of activated T cells (cytoplasmic 1) loci exhibit a remarkable influence on severe acute graft-versus-host disease prevalence. Indeed, an increased risk of acute graft-versus-host disease was observed in association with single nucleotide polymorphisms located in 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase/inosine monophosphate cyclohydrolase (hazard ratio=3.04; P=0.002), nuclear factor of activated T cells (cytoplasmic 1) (hazard ratio=2.69; P=0.004), adenosine triphosphate-binding cassette sub-family C2 (hazard ratio=3.53; P=0.0018) and adenosine triphosphate-binding cassette sub-family C1 (hazard ratio=3.67; P=0.0005). While donor single nucleotide polymorphisms of dihydrofolate reductase and solute carrier family 19 (member 1) genes are associated with a reduced risk of acute graft-versus-host disease (hazard ratio=0.32–0.41; P=0.0009–0.008), those of nuclear factor of activated T cells (cytoplasmic 2) are found to increase such risk (hazard ratio=3.85; P=0.0004). None of the tested single nucleotide polymorphisms was associated with the occurrence of chronic graft-versus-host disease. In conclusion, by targeting drug-related biologically relevant genes, this work emphasizes the potential role of germline biomarkers in predicting acute graft-versus-host disease. Further investigations are warranted to improve our understanding of these relationships to personalize immunosuppressive therapy and optimize outcomes.

Published
2015
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111. Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis

Author

Delphine, Weil, Eric, Levesque, Marc, McPhail, Rodrigo, Cavallazzi, Eleni, Theocharidou, Evangelos, Cholongitas, Arnaud, Galbois, Heng Chih, Pan, Constantine J, Karvellas, Bertrand, Sauneuf, René, Robert, Jérome, Fichet, Gaël, Piton, Thierry, Thevenot, Gilles, Capellier, Vincent, Di Martino, Ming-Hung, Tsai, Service d'hépatologie, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre hépato-biliaire - CHB [Paul Brousse, Paris], Hôpital Paul Brousse-Université Paris-Sud - Paris 11 (UP11), King‘s College London, University of Louisville, Royal Free Hospital, London, Aristotle University of Thessaloniki, Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Chang Gung Memorial Hospital [Taipei] (CGMH), University of Alberta, Unité de Soins Intensifs [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz-Université de Franche-Comté ( UFC ), Université Paris-Sud - Paris 11 ( UP11 ) -AP-HP Hôpital Paul Brousse, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Université Pierre et Marie Curie - Paris 6 ( UPMC ), Chang Gung Memorial Hospital, University of Alberta [Edmonton], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), CHRU Tours, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse, Royal Free Hospital [London, UK], CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Context (language use), Liver transplantation, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Hepatorenal syndrome, law, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Internal medicine, Intensive care, Anesthesiology, Medicine, Mortality, Prognostic scores, business.industry, CLIF-SOFA, Research, 030208 emergency & critical care medicine, medicine.disease, Intensive care unit, 3. Good health, MELD, Meta-analysis, Organ replacement therapy, Emergency medicine, Extrahepatic organ failure, 030211 gastroenterology & hepatology, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background The best predictors of short- and medium-term mortality of cirrhotic patients receiving intensive care support are unknown. Methods We conducted meta-analyses from 13 studies (2523 cirrhotics) after selection of original articles and response to a standardized questionnaire by the corresponding authors. End-points were in-ICU, in-hospital, and 6-month mortality in ICU survivors. A total of 301 pooled analyses, including 95 analyses restricted to 6-month mortality among ICU survivors, were conducted considering 249 variables (including reason for admission, organ replacement therapy, and composite prognostic scores). Results In-ICU, in-hospital, and 6-month mortality was 42.7, 54.1, and 75.1%, respectively. Forty-eight patients (3.8%) underwent liver transplantation during follow-up. In-ICU mortality was lower in patients admitted for variceal bleeding (OR 0.46; 95% CI 0.36–0.59; p 19 at baseline (OR 8.54; 95% CI 2.09–34.91; p 26 (OR 3.97; 95% CI 1.92–8.22; p

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113. Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study

Author

Dres, Martin, Hajage, David, Lebbah, Said, Kimmoun, Antoine, Pham, Tai, Béduneau, Gaëtan, Combes, Alain, Mercat, Alain, Guidet, Bertrand, Demoule, Alexandre, Schmidt, Matthieu, Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hôpital Bicêtre, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Groupe de Recherche sur le Handicap Ventilatoire et Neurologique (GRHVN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Rouen, Normandie Université (NU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Université d'Angers (UA), CHU Saint-Antoine [AP-HP], COVID-ICU investigators: Alain Mercat, Pierre Asfar, François Beloncle, Julien Demiselle, Tài Pham, Arthur Pavot, Xavier Monnet, Christian Richard, Alexandre Demoule, Martin Dres, Julien Mayaux, Alexandra Beurton, Cédric Daubin, Richard Descamps, Aurélie Joret, Damien Du Cheyron, Frédéric Pene, Jean-Daniel Chiche, Mathieu Jozwiak, Paul Jaubert, Guillaume Voiriot, Muriel Fartoukh, Marion Teulier, Clarisse Blayau, Erwen L'Her, Cécile Aubron, Laetitia Bodenes, Nicolas Ferriere, Johann Auchabie, Anthony Le Meur, Sylvain Pignal, Thierry Mazzoni, Jean-Pierre Quenot, Pascal Andreu, Jean-Baptiste Roudau, Marie Labruyère, Saad Nseir, Sébastien Preau, Julien Poissy, Daniel Mathieu, Sarah Benhamida, Rémi Paulet, Nicolas Roucaud, Martial Thyrault, Florence Daviet, Sami Hraiech, Gabriel Parzy, Aude Sylvestre, Sébastien Jochmans, Anne-Laure Bouilland, Mehran Monchi, Marc Danguy des Déserts, Quentin Mathais, Gwendoline Rager, Pierre Pasquier, Reignier Jean, Seguin Amélie, Garret Charlotte, Canet Emmanuel, Jean Dellamonica, Clément Saccheri, Romain Lombardi, Yanis Kouchit, Sophie Jacquier, Armelle Mathonnet, Mai-AhnNay, Isabelle Runge, Frédéric Martino, Laure Flurin, Amélie Rolle, Michel Carles, Rémi Coudroy, Arnaud W Thille, Jean-Pierre Frat, Maeva Rodriguez, Pascal Beuret, Audrey Tientcheu, Arthur Vincent, Florian Michelin, Marie Anne Melone, Maxime Gauzi, Arnaud Guilbert, Geoffrey Kouadri, Valérie Gissot, Stéphan Ehrmann, Charlotte Salmon Gandonniere, Djlali Elaroussi, Agathe Delbove, Yannick Fedun, Julien Huntzinger, Eddy Lebas, Grâce Kisoka, Céline Grégoire, Stella Marchetta, Bernard Lambermont, Laurent Argaud, Thomas Baudry, Pierre-Jean Bertrand, Auguste Dargent, Christophe Guitton, Nicolas Chudeau, Mickaël Landais, Cédric Darreau, Alexis Ferre, Antoine Gros, Guillaume Lacave, Fabrice Bruneel, Mathilde Neuville, Jérôme Devaquet, Guillaume Tachon, Richard Gallot, Riad Chelha, Arnaud Galbois, Anne Jallot, Ludivine Chalumeau Lemoine, Khaldoun Kuteifan, Valentin Pointurier, Louise-Marie Jandeaux, Joy Mootien, Charles Damoisel, Benjamin Sztrymf, Matthieu Schmidt, Alain Combes, Juliette Chommeloux, Charles Edouard Luyt, Frédérique Schortgen, Leon Rusel, Camille Jung, Florent Gobert, Damien Vimpere, Lionel Lamhaut, Bertrand Sauneuf, Liliane Charrrier, Julien Calus, Isabelle Desmeules, Benoît Painvin, Jean-Marc Tadie, Vincent Castelain, Baptiste Michard, Jean-Etienne Herbrecht, Mathieu Baldacini, Nicolas Weiss, Sophie Demeret, Clémence Marois, Benjamin Rohaut, Pierre-Henri Moury, Anne-Charlotte Savida, Emmanuel Couadau, Mathieu Série, Nica Alexandru, Cédric Bruel, Candice Fontaine, Sonia Garrigou, Juliette Courtiade Mahler, Maxime Leclerc, Michel Ramakers, Pierre Garçon, Nicole Massou, Ly Van Vong, Juliane Sen, Nolwenn Lucas, Franck Chemouni, Annabelle Stoclin, Alexandre Avenel, Henri Faure, Angélie Gentilhomme, Sylvie Ricome, Paul Abraham, Céline Monard, Julien Textoris, Thomas Rimmele, Florent Montini, Gabriel Lejour, Thierry Lazard, Isabelle Etienney, Younes Kerroumi, Claire Dupuis, Marine Bereiziat, Elisabeth Coupez, François Thouy, Clémet Hoffmann, Nicolas Donat, Violaine Muller, Thibault Martinez, Antoine Kimmoun, Audrey Jacquot, Matthieu Mattei, Bruno Levy, Ramin Ravan, Loïc Dopeux, Jean-Mathias Liteaudon, Delphine Roux, Brice Rey, Radu Anghel, Deborah Schenesse, Vincent Gevrey, Jermy Castanera, Philippe Petua, Benjamin Madeux, Otto Hartman, Michael Piagnerelli, Anne Joosten, Cinderella Noel, Patrick Biston, Thibaut Noel, Gurvan L E Bouar, Messabi Boukhanza, Elsa Demarest, Marie-France Bajolet, Nathanaël Charrier, Audrey Quenet, Cécile Zylberfajn, Nicolas Dufour, Buno Mégarbane, SqébastianVoicu, Nicolas Deye, Isabelle Malissin, François Legay, Matthieu Debarre, Nicolas Barbarot, Pierre Fillatre, Bertrand Delord, Thomas Laterrade, Tahar Saghi, Wilfried Pujol, Pierre Julien Cungi, Pierre Esnault, Mickael Cardinale, Vivien Hong Tuan Ha, Grégory Fleury, Marie-Ange Brou, Daniel Zafimahazo, David Tran-Van, Patrick Avargues, Lisa Carenco, Nicolas Robin, Alexandre Ouali, Lucie Houdou, Christophe Le Terrier, Noémie Suh, Steve Primmaz, Jérome Pugin, Emmanuel Weiss, Tobias Gauss, Jean-Denis Moyer, Catherine Paugam Burtz, Béatrice La Combe, Rolland Smonig, Jade Violleau, Pauline Cailliez, Jonathan Chelly, Antoine Marchalot, Cécile Saladin, Christelle Bigot, Pierre-Marie Fayolle, Jules Fatséas, Amr Ibrahim, Dabor Resiere, Rabih Hage, Clémentine Cholet, Marie Cantier, Pierre Trouiler, Philippe Montravers, Brice Lortat-Jacob, Sebastien Tanaka, Alexy Tran Dinh, Jacques Duranteau, Anatole Harrois, Guillaume Dubreuil, Marie Werner, Anne Godier, Sophie Hamada, Diane Zlotnik, Hélène Nougue, Armand Mekontso-Dessap, Guillaume Carteaux, Keyvan Razazi, Nicolas De Prost, Nicolas Mongardon, Olivier Langeron, Eric Levesque, Arié Attias, Charles de Roquetaillade, Benjamin G Chousterman, Alexandre Mebazaa, Etienne Gayat, Marc Garnier, Emmanuel Pardo, Lea Satre-Buisson, Christophe Gutton, Elise Yvin, Clémence Marcault, Elie Azoulay, Michael Darmon, Hafid Ait Oufella, Geoffroy Hariri, Tomas Urbina, Sandie Mazerand, Nicholas Heming, Francesca Santi, Pierre Moine, Djillali Annane, Adrien Bouglé, Edris Omar, Aymeric Lancelot, Emmanuelle Begot, Gaétan Plantefeve, Damien Contou, Hervé Mentec, Olivier Pajot, Stanislas Faguer, Olivier Cointault, Laurence Lavayssiere, Marie-Béatrice Nogier, Matthieu Jamme, Claire Pichereau, Jan Hayon, Hervé Outin, François Dépret, Maxime Coutrot, Maité Chaussard, Lucie Guillemet, Pierre Goffin, Romain Thouny, Julien Guntz, Laurent Jadot, Romain Persichini, Vanessa Jean-Michel, Hugues Georges, Thomas Caulier, Gaël Pradel, Marie-Hélène Hausermann, ThiMy Hue Nguyen-Valat, Michel Boudinaud, Emmanuel Vivier, Sylvène Rosseli, Gaël Bourdin, Christian Pommier, Marc Vinclair, Simon Poignant, Sandrine Mons, Wulfran Bougouin, Franklin Bruna, Quentin Maestraggi, Christian Roth, Laurent Bitker, François Dhelft, Justine Bonnet-Chateau, Mathilde Filippelli, Tristan Morichau-Beauchant, Stéphane Thierry, Charlotte Le Roy, Mélanie Saint Jouan, Bruno Goncalves, Aurélien Mazeraud, Matthieu Daniel, Tarek Sharshar, Cyril Cadoz, RostaneGaci, Sébastien Gette, Guillaune Louis, Sophe-Caroline Sacleux, Marie-Amélie Ordan, Aurélie Cravoisy, Marie Conrad, Guilhem Courte, Sébastien Gibot, Younès Benzidi, Claudia Casella, Laurent Serpin, Jean-Lou Setti, Marie-Catherine Besse, Anna Bourreau, Jérôme Pillot, Caroline Rivera, Camille Vinclair, Marie-Aline Robaux, Chloé Achino, Marie-Charlotte Delignette, Tessa Mazard, Frédéric Aubrun, Bruno Bouchet, Aurélien Frérou, Laura Muller, Charlotte Quentin, Samuel Degoul, Xavier Stihle, Claude Sumian, Nicoletta Bergero, Bernard Lanaspre, Hervé Quintard, Eve Marie Maiziere, Pierre-Yves Egreteau, Guillaume Leloup, Florin Berteau, Marjolaine Cottrel, Marie Bouteloup, Matthieu Jeannot, Quentin Blanc, Julien Saison, Isabelle Geneau, Romaric Grenot, Abdel Ouchike, Pascal Hazera, Anne-Lyse Masse, Suela Demiri, Corinne Vezinet, Elodie Baron, Deborah Benchetrit, Antoine Monsel, Grégoire Trebbia, Emmanuelle Schaack, Raphaël Lepecq, Mathieu Bobet, Christophe Vinsonneau, Thibault Dekeyser, Quentin Delforge, Imen Rahmani, Bérengère Vivet, Jonathan Paillot, Lucie Hierle, Claire Chaignat, Sarah Valette, Benoït Her, Jennifier Brunet, Mathieu Page, Fabienne Boiste, Anthony Collin, Florent Bavozet, Aude Garin, Mohamed Dlala, Kais Mhamdi, Bassem Beilouny, Alexandra Lavalard, Severine Perez, Benoit Veber, Pierre-Gildas Guitard, Philippe Gouin, Anna Lamacz, Fabienne Plouvier, Bertrand P Delaborde, Aïssa Kherchache, Amina Chaalal, Jean-Damien Ricard, Marc Amouretti, Santiago Freita-Ramos, Damien Roux, Jean-Michel Constantin, Mona Assefi, Marine Lecore, Agathe Selves, Florian Prevost, Christian Lamer, Ruiying Shi, Lyes Knani, Sébastien PiliFloury, Lucie Vettoretti, Michael Levy, Lucile Marsac, Stéphane Dauger, Sophie Guilmin-Crépon, Hadrien Winiszewski, Gael Piton, Thibaud Soumagne, Gilles Capellier, Jean-Baptiste Putegnat, Frédérique Bayle, Maya Perrou, Ghyslaine Thao, Guillaume Géri, Cyril Charron, Xavier Repessé, Antoine Vieillard-Baron, Mathieu Guilbart, Pierre-Alexandre Roger, Sébastien Hinard, Pierre-Yves Macq, Kevin Chaulier, Sylvie Goutte, Patrick Chillet, Anaïs Pitta, Barbara Darjent, Amandine Bruneau, Sigismond Lasocki, Maxime Leger, Soizic Gergaud, Pierre Lemarie, Nicolas Terzi, Carole Schwebel, Anaïs Dartevel, Louis-Marie Galerneau, Jean-Luc Diehl, Caroline Hauw-Berlemont, Nicolas Péron, Emmanuel Guérot, Abolfazl Mohebbi Amoli, Michel Benhamou, Jean-Pierre Deyme, Olivier Andremont, Diane Lena, Julien Cady, Arnaud Causeret, Arnaud De La Chapelle, Christophe Cracco, Stéphane Rouleau, David Schnell, Camille Foucault, Cécile Lory, Thibault Chapelle, Vincent Bruckert, Julie Garcia, Abdlazize Sahraoui, Nathalie Abbosh, Caroline Bornstain, Pierre Pernet, Florent Poirson, Ahmed Pasem, Philippe Karoubi, Virginie Poupinel, Caroline Gauthier, François Bouniol, Philippe Feuchere, Florent Bavozet, Anne Heron, Serge Carreira, Malo Emery, Anne Sophie Le Floch, Luana Giovannangeli, Nicolas Herzog, Christophe Giacardi, Thibaut Baudic, Chloé Thill, Said Lebbah, Jessica Palmyre, Florence Tubach, David Hajage, Nicolas Bonnet, Nathan Ebstein, Stéphane Gaudry, Yves Cohen, Julie Noublanche, Olivier Lesieur, Arnaud Sément, Isabel Roca-Cerezo, Michel Pascal, Nesrine Sma, Gwenhaël Colin, Jean-Claude Lacherade, Gauthier Bionz, Natacha Maquigneau, Pierre Bouzat, Michel Durand, Marie-Christine Hérault, Jean-Francois Payen, and dres, martin

Subjects
[SDV] Life Sciences [q-bio], Acute respiratory distress syndrome, Frailty, [SDV]Life Sciences [q-bio], Old patients, COVID-19, Intensive care unit, Mortality, Intubation
Abstract

International audience; Abstract Background The COVID-19 pandemic is a heavy burden in terms of health care resources. Future decision-making policies require consistent data on the management and prognosis of the older patients (> 70 years old) with COVID-19 admitted in the intensive care unit (ICU). Methods Characteristics, management, and prognosis of critically ill old patients (> 70 years) were extracted from the international prospective COVID-ICU database. A propensity score weighted-comparison evaluated the impact of intubation upon admission on Day-90 mortality. Results The analysis included 1199 (28% of the COVID-ICU cohort) patients (median [interquartile] age 74 [72–78] years). Fifty-three percent, 31%, and 16% were 70–74, 75–79, and over 80 years old, respectively. The most frequent comorbidities were chronic hypertension (62%), diabetes (30%), and chronic respiratory disease (25%). Median Clinical Frailty Scale was 3 (2–3). Upon admission, the PaO 2 /FiO 2 ratio was 154 (105–222). 740 (62%) patients were intubated on Day-1 and eventually 938 (78%) during their ICU stay. Overall Day-90 mortality was 46% and reached 67% among the 193 patients over 80 years old. Mortality was higher in older patients, diabetics, and those with a lower PaO 2 /FiO 2 ratio upon admission, cardiovascular dysfunction, and a shorter time between first symptoms and ICU admission. In propensity analysis, early intubation at ICU admission was associated with a significantly higher Day-90 mortality (42% vs 28%; hazard ratio 1.68; 95% CI 1.24–2.27; p

Published
2021

114. Liver transplantation with grafts from donors who die from suicide by hanging: a matched cohort study.

Author

Hoti E, Levesque E, Sebagh M, Heneghan HM, Khalfallah M, Castaing D, and Azoulay D

Subjects
Adult, Alanine Transaminase blood, Aspartate Aminotransferases blood, Biopsy, Brain Death, Cohort Studies, Female, Graft Survival, Humans, Liver Failure mortality, Male, Middle Aged, Treatment Outcome, Liver Failure surgery, Liver Transplantation, Suicide, Tissue Donors, Tissue and Organ Procurement methods
Abstract

Introduction: Hanging is a common method of suicide globally, and the incidence is increasing at an alarming rate. The purpose of this study was to analyze our experience with the use of liver grafts from donors whose cause of death is suicidal hanging and to evaluate the outcome of the graft recipients., Patients and Methods: Twenty-four consecutive patients were transplanted with grafts obtained from suicidal hanging donors. These patients (group A) were case-matched to 24 patients who underwent liver transplantation with a liver graft from a brain-dead donor whose cause of death was not hanging or strangulation (group B). The analysis was focused on postoperative complications, graft, and recipient outcomes., Results: Donors in group A showed a significantly higher mean [±2 standard deviation] serum aspartate aminotransferase and alanine aminotransferase compared to group B (aspartate aminotransferase, 168[166] vs. 57[67] IU/L; P=0.006; alanine aminotransferase, 151[197] vs. 58[103] IU/L; P=0.049); however, there was no difference in graft failure rates between the two groups [8.3% (n=2) in each group]. Overall 30-day postoperative morbidity, 1-year and 5-year survivals were comparable in both groups (P=0.96, P=0.35, P=0.69, respectively)., Conclusion: The use of grafts from suicidal hanging donors (without hemodynamic instability and with downward trend in the donor transaminases) is not associated with higher post-liver transplantation complication rates and does not negatively influence recipient's outcome.

Published
2014
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