122 results on '"Rayar Michel"'
Search Results
102. An update on liver surgery for cholangiocarcinoma
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Boudjema, Karim, primary, Levi Sandri, Giovanni Battista, additional, Boucher, Eveline, additional, Rohou, Tanguy, additional, Rayar, Michel, additional, and Sulpice, Laurent, additional
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- 2013
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103. Intrahepatic cholangiocarcinoma: impact of genetic hemochromatosis on outcome and overall survival after surgical resection
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Sulpice, Laurent, primary, Rayar, Michel, additional, Boucher, Eveline, additional, Pele, Fabienne, additional, Pracht, Marc, additional, Meunier, Bernard, additional, and Boudjema, Karim, additional
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- 2013
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104. Disposable bipolar irrigated sealer (Aquamantys®) for liver resection: use with caution.
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Patrizi, Andrea, Jezequel, Caroline, Sulpice, Laurent, Meunier, Bernard, Rayar, Michel, and Boudjema, Karim
- Abstract
The disposable bipolar irrigated sealer has been demonstrated to reduce perioperative bleeding, but its role in preventing postoperative cut-surface complications has not been evaluated to date. A prospective observational study was performed between January and September 2013 to evaluate a disposable bipolar irrigated sealed (Aquamantys
® ) on a continuous series of 51 first liver resections without biliary reconstruction. Primary end-point was the occurrence of cut-surface complications during the postoperative period. Secondary endpoints were postoperative complications and the 1-year overall survival rate. The results were compared to a propensity score matched group of 153 liver resections performed with conventional monopolar cautery. A cut-surface complication occurred in 13/51 (25.5 %) resected patients. Bleeding, bile leakage and subphrenic abscess occurred in 7.8, 11.8 and 11.8 % patients, respectively. Compared to the matched group, the resected group had a higher rate of cut-surface complications (25.5 vs. 14.7 %, p < 0.01) and a higher rate of Clavien–Dindo type ≥3 postoperative complications (29.5 vs. 17.2 %, p < 0.01). In the multivariate analysis, preoperative chemotherapy (p = 0.03, 95 % CI 1.09–5.9, OR 2.53), blood transfusion (p = 0.02, 95 % CI 1.78–6.55, OR 2.78) and Aquamantys® use (p = 0.02, 95 % CI 1.21–6.7, OR 2.85) were independent of cut-surface complications within the first 90 postoperative days. The overall 1-year survival rates were not different between the two groups (p = 0.078). Aquamantys® use is associated with an increased rate of postoperative complications compared to classical monopolar cautery, and we recommend that it should be used with caution in this type of surgery. [ABSTRACT FROM AUTHOR]- Published
- 2016
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105. Glass Microspheres 90Y Selective Internal Radiation Therapy and Chemotherapy as First-Line Treatment of Intrahepatic Cholangiocarcinoma.
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Edeline, Julien, Le Du, Fanny, Rayar, Michel, Rolland, Yan, Beuzit, Luc, Boudjema, Karim, Rohou, Tanguy, Latournerie, Marianne, Campillo-Gimenez, Boris, Garin, Etienne, and Boucher, Eveline
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- 2015
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106. Long Term Survival after Resection of a Small Bowel Metastasis of Lung Adenocarcinoma: A Case Report
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Sulpice, Laurent, primary, D’Errico, Emanuele, additional, Arnaud, Alexis, additional, Rayar, Michel, additional, Boudjema, Karim, additional, and Meunier, Bernard, additional
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- 2011
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107. A Preliminary Clinical Experience Using Hypothermic Oxygenated Machine Perfusion for Rapid Recovery of Octogenarian Liver Grafts.
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Rayar, Michel, Maillot, Betty, Bergeat, Damien, Camus, Christophe, Houssel-Debry, Pauline, Sulpice, Laurent, Meunier, Bernard, and Boudjema, Karim
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OXYGEN metabolism ,ALCOHOLIC liver diseases ,HYPOTHERMIA ,CIRRHOSIS of the liver ,LIVER transplantation ,LIVER tumors ,LIVER function tests ,ORGAN donors ,PERFUSION ,REPERFUSION injury ,RESEARCH funding ,TRANSPLANTATION of organs, tissues, etc. ,TREATMENT effectiveness ,REVASCULARIZATION (Surgery) ,DISEASE complications - Abstract
The article describes the two cases of end-ischemic hypothermic oxygenated machine perfusion, or HOPE, using the LiverAssist device via the portal vein only for octogenarian liver graft leading to rapid graft function recovery and early hospital discharge, with topics mentioned such as cerebral hemorrhage, alcohol cirrhosis, and reperfusion syndrome.
- Published
- 2019
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108. Recurrence of Primary Biliary Cholangitis After Liver Transplantation: Is Tacrolimus Really Worse Than Other Drugs?
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Bardou-Jacquet, Edouard and Rayar, Michel
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- 2019
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109. Area under the curve of tacrolimus using microsampling devices: towards precision medicine in solid organ transplantation?
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Couette, Aurélien, Tron, Camille, Golbin, Léonard, Franck, Bénédicte, Houssel-Debry, Pauline, Frouget, Thierry, Morin, Marie-Pascale, Brenier, Henri, Rayar, Michel, Verdier, Marie-Clémence, Vigneau, Cécile, Chemouny, Jonathan, and Lemaitre, Florian
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DRUG efficacy , *RELATIVE medical risk , *STATISTICS , *LIQUID chromatography , *PATIENTS , *KIDNEY transplantation , *REGRESSION analysis , *DRUG monitoring , *MASS spectrometry , *DESCRIPTIVE statistics , *RESEARCH funding , *LIVER transplantation , *STATISTICAL correlation , *DATA analysis software , *DATA analysis , *TRANSPLANTATION of organs, tissues, etc. , *TACROLIMUS - Abstract
Purpose: Therapeutic drug monitoring of tacrolimus using trough concentration (Cmin) is mandatory to ensure drug efficacy and safety in solid organ transplantation. However, Cmin is just a proxy for the area under the curve of drug concentrations (AUC) which is the best pharmacokinetic parameter for exposure evaluation. Some studies suggest that patients may present discrepancies between these two parameters. AUC is now easily available through mini-invasive microsampling approach. The aim of this study is to evaluate the relationship between AUC and Cmin in patients benefiting from a complete pharmacokinetic profile using a microsampling approach. Methods: Fifty-one transplant recipients benefited from a complete pharmacokinetic profile using a microsampling approach, and their 24-h AUC were calculated using the trapezoidal method. The correlation with Cmin was then explored. In parallel, we estimated AUC using the sole Cmin and regression equations according to the post-transplantation days and the galenic form. Results: Weak correlations were found between 24-h AUC observed and the corresponding Cmin (R2 = 0.60) and between AUC observed and expected using the sole Cmin (R2 = 0.62). Therapeutic drug monitoring of tacrolimus using Cmin leads to over- or under-estimate drug exposure in 40.3% of patients. Conclusion: Tacrolimus Cmin appears to be an imperfect reflection of drug exposure. Evaluating AUC using a microsampling approach offers a mini-invasive strategy to monitor tacrolimus treatment in transplant recipients. [ABSTRACT FROM AUTHOR]
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- 2023
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110. End-ischemic hypothermic oxygenated perfusion for extended criteria donors in liver transplantation: a multicenter, randomized controlled trial—HOPExt.
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Pradat, Pierre, Pantel, Solene, Maynard, Marianne, Lalande, Laure, Thevenon, Sylvie, Adam, Rene, Allard, Marc-Antoine, Robin, Fabien, Rayar, Michel, Boleslawski, Emmanuel, Scatton, Olivier, Chirica, Mircea, Faitot, François, Bachellier, Philippe, Soubrane, Olivier, Mohkam, Kayvan, Mabrut, Jean-Yves, and Lesurtel, Mickaël
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REPERFUSION , *LIVER transplantation , *ORGAN transplant waiting lists , *PERFUSION , *LIVER failure - Abstract
Background: Given the scarce donor supply, an increasing number of so-called marginal or extended criteria donor (ECD) organs are used for liver transplantation. These ECD liver grafts are however known to be associated with a higher rate of early allograft dysfunction and primary non-function because of a greater vulnerability to ischemia–reperfusion injury. The end-ischemic hypothermic oxygenated machine perfusion (HOPE) technique may improve outcomes of liver transplantation with ECD grafts by decreasing reperfusion injury. Methods: HOPExt trial is a comparative open-label, multicenter, national, prospective, randomized, controlled study, in two parallel groups, using static cold storage, the gold standard procedure, as control. The trial will enroll adult patients on the transplant waiting list for liver failure or liver cirrhosis and/or liver malignancy requiring liver transplantation and receiving an ECD liver graft from a brain-dead donor. In the experimental group, ECD liver grafts will first undergo a classical static cold (4 °C) storage followed by a hypothermic oxygenated perfusion (HOPE) for a period of 1 to 4 h. The control group will consist of the classic static cold storage which is the gold standard procedure in liver transplantation. The primary objective of this trial is to study the efficacy of HOPE used before transplantation of ECD liver grafts from brain-dead donors in reducing postoperative early allograft dysfunction within the first 7 postoperative days compared to simple cold static storage. Discussion: We present in this protocol all study procedures in regard to the achievement of the HOPExt trial, to prevent biased analysis of trial outcomes and improve the transparency of the trial results. Enrollment of patients in the HOPExt trial has started on September 10, 2019, and is ongoing. Trial registration: ClinicalTrials.gov NCT03929523. Registered on April 29, 2019, before the start of inclusion. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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111. Correction: End-ischemic hypothermic oxygenated perfusion for extended criteria donors in liver transplantation: a multicenter, randomized controlled trial—HOPExt.
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Pradat, Pierre, Pantel, Solene, Maynard, Marianne, Lalande, Laure, Thevenon, Sylvie, Adam, Rene, Allard, Marc-Antoine, Robin, Fabien, Rayar, Michel, Boleslawski, Emmanuel, Scatton, Olivier, Chirica, Mircea, Faitot, François, Bachellier, Philippe, Soubrane, Olivier, Mohkam, Kayvan, Mabrut, Jean-Yves, and Lesurtel, Mickaël
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CONTRAST-enhanced magnetic resonance imaging , *LIVER transplantation , *LIVER surgery , *LIVER biopsy , *LIBRARY users , *PERFUSION , *LIBRARY resources - Abstract
This correction notice addresses a misalignment in Table 1 of an article titled "End-ischemic hypothermic oxygenated perfusion for extended criteria donors in liver transplantation: a multicenter, randomized controlled trial—HOPExt." The corrected table and additional information about the trial are provided, including inclusion criteria, informed consent, medical history, randomization, clinical examination, biological analyses, donor characteristics, HOPE perfusion parameters, bacteriological and fungal analyses, intra-operative data, liver biopsy, machine perfusate sample, ICU and hospital stay, morbidity, concomitant medication, adverse events, and abdominal contrast-enhanced MRI/MRCP. [Extracted from the article]
- Published
- 2023
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112. How to Handle Arterial Conduits in Liver Transplantation? Evidence From the First Multicenter Risk Analysis
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Henrik Petrowsky, Timothy Owen, Kayvan Mohkam, Roberto Hernandez-Alejandro, Manuel Maglione, Mauro E Tun Abraham, Elias Khajeh, Philip C. Müller, Christian E. Oberkofler, Alejandro Pita, Karim Boudjema, Joseph DiNorcia, Paolo Muiesan, Michel Rayar, Antonio Daniele Pinna, Ronald W. Busuttil, Dimitri A. Raptis, Matteo Ravaioli, J. Peter A. Lodge, M. Lesurtel, Yuri Genyk, Jens Mittler, Philipp Dutkowski, Hannah Esser, Arianeb Mehrabi, Pierre-Alain Clavien, Dhakshina Vijayanand, Katherine M. Dokus, Hauke Lang, Fady M. Kaldas, Massimo Malagó, Andrea Schlegel, Oberkofler, Christian E, Raptis, Dimitri A, DiNorcia, Joseph, Kaldas, Fady M, Müller, Philip C, Pita, Alejandro, Genyk, Yuri, Schlegel, Andrea, Muiesan, Paolo, Tun Abraham, Mauro E, Dokus, Katherine, Hernandez-Alejandro, Roberto, Rayar, Michel, Boudjema, Karim, Mohkam, Kayvan, Lesurtel, Mickaël, Esser, Hannah, Maglione, Manuel, Vijayanand, Dhakshina, Lodge, J Peter A, Owen, Timothy, Malagó, Massimo, Mittler, Jen, Lang, Hauke, Khajeh, Elia, Mehrabi, Arianeb, Ravaioli, Matteo, Pinna, Antonio D, Dutkowski, Philipp, Clavien, Pierre-Alain, Busuttil, Ronald W, and Petrowsky, Henrik
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Liver transplantation ,Revascularization ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,LT ,Occlusion ,medicine ,Clinical endpoint ,Humans ,Aorta, Abdominal ,Vascular Patency ,business.industry ,Anastomosis, Surgical ,Graft Survival ,Anticoagulants ,Thrombosis ,Perioperative ,Middle Aged ,Arterial occlusion ,Surgery ,Liver Transplantation ,Regimen ,Liver ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Vascular Surgical Procedures ,Cohort study - Abstract
OBJECTIVE: The aims of the present study were to identify independent risk factors for conduit occlusion, compare outcomes of different AC placement sites, and investigate whether postoperative platelet antiaggregation is protective. BACKGROUND: Arterial conduits (AC) in liver transplantation (LT) offer an effective rescue option when regular arterial graft revascularization is not feasible. However, the role of the conduit placement site and postoperative antiaggregation is insufficiently answered in the literature. STUDY DESIGN: This is an international, multicenter cohort study of adult deceased donor LT requiring AC. The study included 14 LT centers and covered the period from January 2007 to December 2016. Primary endpoint was arterial occlusion/patency. Secondary endpoints included intra- and perioperative outcomes and graft and patient survival. RESULTS: The cohort was composed of 565 LT. Infrarenal aortic placement was performed in 77% of ACs whereas supraceliac placement in 20%. Early occlusion (≤30 days) occurred in 8% of cases. Primary patency was equivalent for supraceliac, infrarenal, and iliac conduits. Multivariate analysis identified donor age >40 years, coronary artery bypass, and no aspirin after LT as independent risk factors for early occlusion. Postoperative antiaggregation regimen differed among centers and was given in 49% of cases. Graft survival was significantly superior for patients receiving aggregation inhibitors after LT. CONCLUSION: When AC is required for rescue graft revascularization, the conduit placement site seems to be negligible and should follow the surgeon's preference. In this high-risk group, the study supports the concept of postoperative antiaggregation in LT requiring AC.
- Published
- 2021
113. Defining Benchmarks in Liver Transplantation
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Magali Chahdi Beltrame, Eduardo de Santibañes, Greg Nowak, Kyle Jacskon, Milo A. Puhan, Majella B. Doyle, Roxane D Staiger, Samuele Iesari, Ina Jochmans, Jan Lerut, Michelle L. de Oliveira, Jun Li, Marc Antoine Allard, Dimitri A. Raptis, Paolo Muiesan, Antonio Daniele Pinna, Bo Göran Ericzon, Roberto Hernandez-Alejandro, Marjolein van Reeven, Jacques Pirenne, Kim M. Olthoff, Lauren Callans, Pierre-Alain Clavien, Catherine Paugam-Burtz, Amanda Carvalheiro, Michel Rayar, Wojciech G. Polak, Bjoern Nashan, Federica Dondero, F. Marcon, Paul D. Greig, Xavier Muller, Martin de Santibañes, René Adam, Avi Shaked, Daniel Cherqui, Philipp Dutkowski, Max Marquez, Alessandro Cucchetti, William C. Chapman, Olivier Soubrane, Karim Boudjema, Henrik Petrowsky, David R. Grant, Hemant Sharma, Andrew M. Cameron, Gonzalo Sapisochin, Muller, Xavier, Marcon, Francesca, Sapisochin, Gonzalo, Marquez, Max, Dondero, Federica, Rayar, Michel, Doyle, Majella M.B., Callans, Lauren, Li, Jun, Nowak, Greg, Allard, Marc-Antoine, Jochmans, Ina, Jacskon, Kyle, Beltrame, Magali Chahdi, Van Reeven, Marjolein, Iesari, Samuele, Cucchetti, Alessandro, Sharma, Hemant, Staiger, Roxane D., Raptis, Dimitri A., Petrowsky, Henrik, De Oliveira, Michelle, Hernandez-Alejandro, Roberto, Pinna, Antonio D., Lerut, Jan, Polak, Wojciech G., De Santibañes, Eduardo, De Santibañes, Martín, Cameron, Andrew M., Pirenne, Jacque, Cherqui, Daniel, Adam, René A., Ericzon, Bö-Göran, Nashan, Bjoern, Olthoff, Kim, Shaked, Avi, Chapman, William C., Boudjema, Karim, Soubrane, Olivier, Paugam-Burtz, Catherine, Greig, Paul D., Grant, David R., Carvalheiro, Amanda, Muiesan, Paolo, Dutkowski, Philipp, Puhan, Milo, Clavien, Pierre-Alain, and Surgery
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Outcome analysis ,complication ,morbidity ,030230 surgery ,Liver transplantation ,Outcome (game theory) ,03 medical and health sciences ,benchmark ,Postoperative Complications ,0302 clinical medicine ,Health care ,Humans ,Medicine ,Intensive care medicine ,Survival analysis ,business.industry ,Benchmarking ,Survival Analysis ,Liver Transplantation ,Outcome and Process Assessment, Health Care ,outcome ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Complication - Abstract
This multicentric study of 17 high-volume centers presents 12 benchmark values for liver transplantation. Those values, mostly targeting markers of morbidity, were gathered from 2024 "low risk" cases, and may serve as reference to assess outcome of single or any groups of patients.To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups.Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative.Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff.Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values.Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.
- Published
- 2018
114. Long-term outcomes after hypothermic oxygenated machine perfusion and transplantation of 1,202 donor livers in a real-world setting (HOPE-REAL study).
- Author
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Eden J, Brüggenwirth IMA, Berlakovich G, Buchholz BM, Botea F, Camagni S, Cescon M, Cillo U, Colli F, Compagnon P, De Carlis LG, De Carlis R, Di Benedetto F, Dingfelder J, Diogo D, Dondossola D, Drefs M, Fronek J, Germinario G, Gringeri E, Györi G, Kocik M, Küçükerbil EH, Koliogiannis D, Lam HD, Lurje G, Magistri P, Monbaliu D, Moumni ME, Patrono D, Polak WG, Ravaioli M, Rayar M, Romagnoli R, Sörensen G, Uluk D, Schlegel A, Porte RJ, Dutkowski P, and de Meijer VE
- Abstract
Background & Aims: Despite strong evidence for improved preservation of donor livers by machine perfusion, longer post-transplant follow-up data are urgently needed in an unselected patient population. We aimed to assess long-term outcomes after transplantation of hypothermic oxygenated machine perfusion (HOPE)-treated donor livers based on real-world data (i.e., IDEAL-D stage 4)., Methods: In this international, multicentre, observational cohort study, we collected data from adult recipients of HOPE-treated livers transplanted between January 2012 and December 2021. Analyses were stratified by donation after brain death (DBD) and donation after circulatory death (DCD), sub-divided by their respective risk categories. The primary outcome was death-censored graft survival. Secondary outcomes included the incidence of primary non-function (PNF) and ischaemic cholangiopathy (IC)., Results: We report on 1,202 liver transplantations (64% DBD) performed at 22 European centres. For DBD, a total number of 99 benchmark (8%), 176 standard (15%), and 493 extended-criteria (41%) cases were included. For DCD, 117 transplants were classified as low risk (10%), 186 as high risk (16%), and 131 as futile (11%), with significant risk profile variations among centres. Actuarial 1-, 3-, and 5-year death-censored graft survival rates for DBD and DCD livers were 95%, 92%, and 91%, vs. 92%, 87%, and 81%, respectively (log-rank p = 0.003). Within DBD and DCD strata, death-censored graft survival was similar among risk groups (log-rank p = 0.26, p = 0.99). Graft loss due to PNF or IC was 2.3% and 0.4% (DBD), and 5% and 4.1% (DCD)., Conclusions: This study shows excellent 5-year survival after transplantation of HOPE-treated DBD and DCD livers with low rates of graft loss due to PNF or IC, irrespective of their individual risk profile. HOPE treatment has now reached IDEAL-D stage 4, which further supports its implementation in routine clinical practice., Trial Registration: ClinicalTrials.gov Identifier: NCT05520320., Impact and Implications: This study demonstrates the excellent long-term performance of hypothermic oxygenated machine perfusion (HOPE) treatment of donation after circulatory and donation after brain death liver grafts irrespective of their individual risk profile in a real-world setting, outside the evaluation of randomised-controlled trials. While previous studies have established safety, feasibility, and efficacy against the current standard, according to the IDEAL-D evaluation framework, HOPE treatment has now reached the final IDEAL-D stage 4, which further supports its implementation in routine clinical practice., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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115. The importance of preoperative imaging in living-donor hepatectomy.
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Rayar M and Levi Sandri GB
- Abstract
Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-24-29/coif). G.B.L.S. serves as an unpaid editorial board member of Hepatobiliary Surgery and Nutrition. The other author has no conflicts of interest to declare.
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- 2024
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116. Adverse Events and Outcomes of High-volume Plasma Exchange in 50 Acute Liver Failure Patients: A Monocentric Retrospective Real-world Study.
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Coirier V, Quelven Q, Guillot P, Delamaire F, Houssel-Debry P, Maamar A, Painvin B, Gacouin A, Lesouhaitier M, Rayar M, Grulois I, Terzi N, Tadié JM, and Camus C
- Abstract
Background and Aims: Acute liver failure (ALF) is a condition that mostly requires Intensive Care Unit (ICU) admission and sometimes necessitates emergency liver transplantation. High-volume plasma exchange (HVPE) may improve transplant-free survival (TFS) in ALF. Our study assessed complications of HVPE therapy and outcome in ALF patients., Methods: We conducted a single-center retrospective study of all patients admitted to the ICU for ALF and who underwent HVPE between June 2016 and June 2021. The plasmapheresis technique used was centrifugation, and the volume exchanged was calculated as 15% of the ideal body weight. Dedicated staff prospectively collected clinical adverse effects, while biological data were retrospectively collected. The primary outcome was the rate of severe adverse effects (SAE, defined as severe manifestations of hypotension, allergy, metabolic disturbances or other life-threatening event) that occurred during HVPE sessions. Factors influencing day-21 TFS were also studied., Results: One hundred twenty sessions were performed in 50 patients. The main etiology for ALF was paracetamol (52% of the patients). During the session, hemoglobin, platelet, transaminases, ammonia and bilirubin decreased, coagulation factors increased, and creatinine and lactate remained unchanged. At least one SAE was reported for 32 out of 120 sessions (26.7% [19%-35.5%], mostly severe alkalosis [24/117], hypotension [4/120] and hypocalcemia [4/119]). Arterial pH ≤ 7.43 following HVPE and paracetamol etiology were negatively and positively associated with day-21 TFS, respectively., Conclusion: Severe adverse effects were frequent during HVPE performed for ALF, mainly severe alkalosis, hypotension and hypocalcemia. Post-HVPE, pH and paracetamol etiology were prognosis markers., (© 2024 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)
- Published
- 2025
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117. [Surgical aspects of multi-organ harvesting for transplantation].
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Rayar M, Allain G, and Kerforne T
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The aim of multi-organ harvesting is to remove and condition organs so that they can be transplanted. It is an extremely well codified surgical procedure, performed in a precise order. It is unique in that it involves different teams, each with its own specialization., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)
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- 2023
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118. Comparison of reconstruction methods used during liver transplantation in case of a graft with replaced or accessory right hepatic artery: A retrospective study.
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Wouters D, Blondeau M, Bos I, Camus C, Jezequel C, Bardou-Jacquet E, van der Plas WS, Nieuwenhuis LM, de Meijer VE, Porte RJ, and Rayar M
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- Humans, Hepatic Artery surgery, Retrospective Studies, Liver, Liver Transplantation methods, Thrombosis etiology, Thrombosis surgery
- Abstract
Variations in graft arterial anatomy can increase the risk of postoperative hepatic arterial thrombosis (HAT), especially in presence of a replaced or accessory right hepatic artery (RHA). We retrospectively analyzed 223 cases of liver transplantations with the presence of an RHA on the graft. Patient outcomes were compared according to the four different reconstruction methods used: (i) the re-implantation of the RHA into the splenic or gastroduodenal artery (n = 106); (ii) the interposition of the superior mesenteric artery (SMA) (n = 83); (iii) dual anastomosis (n = 24); (iv) use of an aortic patch including the origins of both the SMA and the coeliac trunk (n = 10). A competing risk analysis and Inverse Probability Weighting (IPW) were used. We found that the interposition of the SMA method was associated with a significantly lower incidence of HAT, at 4.8% compared to the re-implantation method at 17.9%, dual anastomosis at 12.5%, and aortic patch at 20%, p = .03. In the competing risk analysis with IPW, the only risk factor for RHA thrombosis was the type of reconstruction. Taking the SMA interposition group as the reference, the sub-hazard ratio (sHR) was 5.05 (CI 95 [1.72; 14.78], p < .01) for the re-implantation group, sHR = 2.37 (CI 95 [0.51; 11.09], p = .27) for the dual anastomosis group and sHR = 2.24 (CI 95 [0.35; 14.33], p = .40) for the aortic patch group. There were no differences for intraoperative transfusion, hospitalization duration (p = .37) or incidence of severe complications (p = .1). The long-term graft (p = .69) and patient (p = .52) survival was not different. In conclusion, the SMA interposition method was associated with a lower incidence of RHA thrombosis., (© 2022 The Authors. Journal of Hepato-Biliary-Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato-Biliary-Pancreatic Surgery.)
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- 2023
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119. Liver transplantation and hepatocellular carcinoma: is TIPS deleterious? A multicentric retrospective study of the ARCHET research group with propensity score matching.
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Laurent C, Rayar M, Maulat C, Muscari F, Marichez A, Gregoire E, Chopinet S, Mabrut JY, Boudjema K, Lesurtel M, Adam JP, Mohkam K, and Chiche L
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- Humans, Retrospective Studies, Propensity Score, Neoplasm Recurrence, Local epidemiology, Carcinoma, Hepatocellular surgery, Liver Transplantation adverse effects, Liver Neoplasms surgery
- Abstract
Purpose: A transjugular intrahepatic portosystemic shunt (TIPS) before the liver transplantation (LT) has been considered a contraindication in cases of hepatocellular carcinoma (HCC) because of the risk of tumour growth. We aimed to assess the impact of TIPS on incidental HCC and oncological outcomes in transplanted patients with pre-existing HCC., Methods: All consecutive transplanted patients for cirrhosis who had a previous TIPS with or without HCC were included. Between 2007 and 2014, 1912 patients were transplanted. We included 122 (6.3%) patients having TIPS before LT. A 1:3 matched cohort of 366 patients (18.9%) having LT without previous TIPS was selected using a propensity score. Incidental HCC rate and risk factor of HCC recurrence were evaluated using multivariate analysis with a competing risk model., Results: Before LT, in the TIPS group, 27 (22.1%) had an HCC vs. 81 (22.1%) in the control group (p = 1). The incidental HCC rate was similar: 10.5% (10/95) in the TIPS group vs. 6.3% (18/285) in the control group (p = 0.17). Recurrence occurred in 1/27 (3.7%) patient in the TIPS group and in 7/81 (8.6%) patients in the control group, without significant difference (p = 0.51). After multivariate regression, patient's gender (p < 0.01) was significantly associated with HCC recurrence while a tumour within Milan criteria (p = 0.01, sHR: 0.17 [0.04; 0.7]) and an incidental HCC (p<0.01) were found to be protector factors against HCC recurrence., Conclusion: TIPS did not worsen the prognosis of transplanted patients for HCC. TIPS should no longer be contraindicated for oncological reasons in patients with HCC waiting for an LT., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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120. Liver transplant for patients outside Milan criteria.
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Levi Sandri GB, Rayar M, Qi X, and Lucatelli P
- Abstract
Hepatocellular carcinoma (HCC) is one of the most indication to Liver Transplantation (LT). Milan criteria are worldwide accepted as the gold standard for LT indication for HCC. Nevertheless, expanded criteria are often used to transplant patient outside Milan. We described the most important proposed criteria outside Milan criteria. From the University of California San Francisco, to the Toronto criteria. From East to Western, and for living donor liver transplantation. In order to achieve similar results the downstaging strategy is more frequently used and for patients with locally advanced HCC. Carefully selected patients beyond the traditional criteria for transplantation may achieve excellent LT outcomes through a planned, multidisciplinary approach to treatment., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2018
- Full Text
- View/download PDF
121. Disease-Free Survival after Simultaneous or Delayed Resection of Synchronous Colorectal Liver Metastasis and Primary Cancer.
- Author
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Bigourdan JM, Faber B, Rayar M, Chirpaz E, Boucher E, and Boudjema K
- Subjects
- Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Colorectal Neoplasms mortality, Disease-Free Survival, Female, France, Humans, Kaplan-Meier Estimate, Liver Neoplasms mortality, Male, Middle Aged, Multivariate Analysis, Postoperative Complications etiology, Proportional Hazards Models, Retrospective Studies, Risk Factors, Tertiary Care Centers, Time Factors, Treatment Outcome, Colectomy adverse effects, Colectomy mortality, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Hepatectomy adverse effects, Hepatectomy mortality, Liver Neoplasms pathology, Liver Neoplasms surgery, Time-to-Treatment
- Abstract
Background/aims: The purpose of our study was to compare disease-free survival in patients with synchronous colorectal liver metastasis who underwent delayed hepatic resection or simultaneous resection., Methodology: All patients who underwent a curative resection of synchronous colorectal liver metastasis between 2000 and 2006 in our tertiary care referral centre were retrospectively included in our study. Patients who underwent the first stage of a two-stage hepatectomy during the primary resection were included in the delayed resection group. Disease-free survival was studied using a Kaplan-Meier method. Prognostic factors for disease-free and overall survival were determined by multivariate analysis using Cox models., Results: One hundred and five patients underwent 85 delayed resections and 20 simultaneous resections. Three and five-year disease-free survival did not differ significantly between simultaneous (50% and 40%) and delayed (65% and 34%) resection groups (P = 0.47). Preoperative carcinoembryonic antigen (HR = 2.05, 95% CI, 1.07-3.92) and presence of extra-hepatic metastasis (HR = 2.85, 95% CI, 1.08-7.54) were independent prognostic factors for disease-free survival. Three and five-year overall survival did not differ either (23% and 23%; 24% and 20%, P = 0.13)., Conclusions: Simultaneous resection of synchronous colorectal liver metastasis and primitive cancer does not appear to impair long-term disease-free survival.
- Published
- 2014
122. Does an aberrant right hepatic artery really influence the short- and long-term results of a pancreaticoduodenectomy for malignant disease? A matched case-controlled study.
- Author
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Sulpice L, Rayar M, Paquet C, Bergeat D, Merdrignac A, Cunin D, Meunier B, and Boudjema K
- Subjects
- Adenocarcinoma surgery, Aged, Bile Duct Neoplasms mortality, Bile Duct Neoplasms surgery, Bile Ducts, Intrahepatic surgery, Case-Control Studies, Cholangiocarcinoma mortality, Cholangiocarcinoma surgery, Disease-Free Survival, Female, Hepatic Artery surgery, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Pancreatic Neoplasms surgery, Retrospective Studies, Risk Factors, Adenocarcinoma mortality, Hepatic Artery abnormalities, Pancreatic Neoplasms mortality, Pancreaticoduodenectomy mortality, Postoperative Complications mortality
- Abstract
Background: An aberrant right hepatic artery (ARHA) is a common anatomic variation. The risk associated with ARHA during pancreaticoduodenectomy (PD) continues to be debated. The aim of this study was to compare the clinical outcomes and survival after PD with ARHA against a matched cohort of patients without ARHA., Methods: PD with an ARHA performed between January 2000 and September 2009 were retrospectively analyzed. Patients with an ARHA (group 1) were matched (1:2) to patients without an ARHA (group 2) according to gender, age, body mass index, type of tumor, and lymph node status. Peri- and postoperative outcomes were compared between the two groups. Overall survival and disease-free survival were estimated by Kaplan-Meier method and compared with log-rank test., Results: A total of 29 patients (group 1) and 55 patients (group 2) were compared. In group 1, an ARHA entered the tumor in six cases (20.7%), was sacrificed in four cases, and repaired in two cases. There was no difference regarding the rate of intraoperative and postoperative variables between the two groups. The oncological clearance (P = 0.731) and survival (overall survival, P = 0.843; disease-free survival, P = 0.832) were also similar., Conclusions: Our study showed that the presence of an ARHA during PD was not associated with worse postoperative outcomes or survival., (Copyright © 2013. Published by Elsevier Inc.)
- Published
- 2013
- Full Text
- View/download PDF
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