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2. A multicenter randomized-controlled trial of hypothermic oxygenated perfusion (HOPE) for human liver grafts before transplantation

Author

Schlegel, Andrea, Mueller, Matteo, Muller, Xavier, Eden, Janina, Panconesi, Rebecca, von Felten, Stefanie, Steigmiller, Klaus, Sousa Da Silva, Richard X., de Rougemont, Olivier, Mabrut, Jean-Yves, Lesurtel, Mickaël, Cerisuelo, Miriam Cortes, Heaton, Nigel D., Allard, Marc Antoine, Adam, Rene, Monbaliu, Diethard, Jochmans, Ina, Haring, Martijn P.D., Porte, Robert J., Parente, Alessandro, Muiesan, Paolo, Kron, Philipp, Attia, Magdy, Kollmann, Dagmar, Berlakovich, Gabriela, Rogiers, Xavier, Petterson, Karin, Kranich, Anne L., Amberg, Stefanie, Müllhaupt, Beat, Clavien, Pierre-Alain, and Dutkowski, Philipp

Published
2023
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5. Novel Benchmark Values for Redo Liver Transplantation: Does the Outcome Justify the Effort?

Author

Abbassi, Fariba, Gero, Daniel, Muller, Xavier, Bueno, Alba, Figiel, Wojciech, Robin, Fabien, Laroche, Sophie, Picard, Benjamin, Shankar, Sadhana, Ivanics, Tommy, van Reeven, Marjolein, van Leeuwen, Otto B., Braun, Hillary J., Monbaliu, Diethard, Breton, Antoine, Vachharajani, Neeta, Bonaccorsi Riani, Eliano, Nowak, Greg, McMillan, Robert R., Abu-Gazala, Samir, Nair, Amit, Bruballa, Rocio, Paterno, Flavio, Weppler Sears, Deborah, Pinna, Antonio D., Guarrera, James V., de Santibañes, Eduardo, de Santibañes, Martin, Hernandez-Alejandro, Roberto, Olthoff, Kim, Ghobrial, R Mark, Ericzon, Bo-Göran, Ciccarelli, Olga, Chapman, William C., Mabrut, Jean-Yves, Pirenne, Jacques, Müllhaupt, Beat, Ascher, Nancy L., Porte, Robert J., de Meijer, Vincent E., Polak, Wojciech G., Sapisochin, Gonzalo, Attia, Magdy, Soubrane, Olivier, Weiss, Emmanuel, Adam, René A., Cherqui, Daniel, Boudjema, Karim, Zieniewicz, Krzysztof, Jassem, Wayel, Dutkowski, Philipp, and Clavien, Pierre-Alain

Published
2022
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6. Predictive value of early postoperative lactate (<6 h) during normothermic machine perfusion and outcome after liver transplantation: results from a multicentre study.

Author

Hofmann, Julia, Meszaros, Andras T, Butler, Andrew, Hann, Angus, Hartog, Hermien, Kneifel, Felicia, Iype, Satheesh, Crick, Keziah, Cardini, Benno, Fiore, Barbara, Attia, Magdy, Pollok, Joerg-Matthias, Pascher, Andreas, Vogel, Thomas, Perera, Thamara, Watson, Christopher J E, and Schneeberger, Stefan

Subjects
LIVER transplantation, LACTATES, LACTATION, TREATMENT effectiveness, PERFUSION, HOMOGRAFTS, MYOCARDIAL perfusion imaging
Abstract

Background: Biomarkers with strong predictive capacity towards transplantation outcome for livers undergoing normothermic machine perfusion (NMP) are needed. We investigated lactate clearing capacity as a basic function of liver viability during the first 6 h of NMP. Methods: A trial conducted in 6 high-volume transplant centres in Europe. All centres applied a back-to-base NMP approach with the OrganOx metra system. Perfusate lactate levels at start, 1, 2, 4 and 6 h of NMP were assessed individually and as area under the curve (AUC) and correlated with EAD (early allograft dysfunction), MEAF (model for early allograft function) and modified L-GrAFT (liver graft assessment following transplantation) scores. Results: A total of 509 livers underwent ≥6 h of NMP before transplantation in 6 centres in the UK, Germany and Austria. The donor age was 53 (40–63) years (median, i.q.r.). The total NMP time was 10.8 (7.9–15.7) h. EAD occurred in 26%, MEAF was 4.72 (3.54–6.05) and L-GrAFT10 −0.96 (−1.52–−0.32). Lactate at 1, 2 and 6 h correlated with increasing robustness with MEAF. Rather than a binary assessment with a cut-off value at 2 h, the actual 2 h lactate level correlated with the MEAF (P = 0.0306 versus P = 0.0002, Pearson r = 0.01087 versus r = 0.1734). The absolute lactate concentration at 6 h, the AUC of 0–6 h and 1–6 h (P < 0.0001, r = 0.3176) were the strongest predictors of MEAF. Conclusion: Lactate measured 1–6 h and lactate levels at 6 h correlate strongly with risk of liver allograft dysfunction upon transplantation. The robustness of predicting MEAF by lactate increases with perfusion duration. Monitoring lactate levels should be extended to at least 6 h of NMP routinely to improve clinical outcome. Biomarkers with strong predictive capacity towards transplantation outcome for livers undergoing normothermic machine perfusion are needed. We investigated lactate clearing capacity as a basic function of liver viability during the first 6 hours of NMP in a multicentre trial in 509 livers and found the absolute lactate concentration at 6h, the AUC of 0-6h and 1-6h were the strongest predictors of clinical outcome. Monitoring lactate levels should be extended to at least 6h of NMP routinely to improve clinical outcome. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Author

Al Alawy, Yousef, Arif, Abdul Jabba, Attia, Magdy, Bhati, Chandra, Battula R, Narendra, Bonney, Glenn Kunnath, Brooke-Smith, Mark, Derosas, Carlos, De Liguori Carino, Nicola, Ferretti, Stefano, Fiorani, Cristina, Gherardi, Dario, Hegab, Bassem, Hussain, Zaki, Ielpo, Benedetto, Iesari, Samuele, Lai, Quirino, Lainas, Panagiotis, Lauterio, Andrea, Lazzaro, Alessandra, Marudanayagam, Ravi, Nasralla, David, Nicolini, Daniele, Orlando, Giuseppe, Patrono, Damiano, Pitchaimuthu, Maheswaran, Polak, Wojciech, Quinto, Alberto Marcacuzco, Rai, Rakesh, Scalera, Irene, Schlegel, Andrea, Shanmugam, Vivek, Vitale, Alessandro, Widmer, Jeannette, Yannick, Deswysen, Manzia, Tommaso Maria, Angelico, Roberta, Parente, Alessandro, Muiesan, Paolo, and Tisone, Giuseppe

Published
2020
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11. The impact of center volume on the utilization and outcomes of machine perfusion technology in liver transplantation: An international survey.

Author

Angelico, Roberta, Sensi, Bruno, Quaranta, Claudia, Orsi, Michela, Parente, Alessandro, Schlegel, Andrea, Tisone, Giuseppe, Manzia, Tommaso M., Abradelo De Usera, Manuel, Addeo, Pietro, Agnes, Bonadona, Attia, Magdy, Bechstein, Wolf, Berardi, Giammauro, Berlakovich, Gabriela, Berrevoet, Frederik, Boteon, Yuri, Carraro, Amedeo, Conte, Grazia, and De Meijer, Vincent E.

Subjects
LIVER transplantation, PERFUSION, PERCEIVED benefit, MACHINERY, CLINICAL trials, TECHNOLOGY transfer
Abstract

Introduction: Machine perfusion (MP) was developed to expand the donor pool and improve liver transplantation (LT) outcomes. Despite optimal results in clinical trials, the real‐world MP benefit in centers with low‐/mid‐volume activity (LVCs) is still being determined. Methods: Online survey on MP for LT, distributed to worldwide LT‐centers representatives. Variables of interest included logistics, technicalities, and outcomes. Responders were grouped into high‐volume centers (HVCs) (>60 LTs/year) and LVCs and results compared. Results: Sixty‐seven centers were included, 36 HVCs and 31 LVCs. Significant differences in MP regarded: (I) existence of an established program (80.6% vs. 41.9%; p = 0.02), (II) presence of a dedicated perfusionist (58.3% vs. 22.6%; p = 0.006), (III) duration (>4 h: 47.2% vs. 16.1%; p = 0.01), (IV) routine use (20%–40% vs. 5%–20%; p = 0.002), (V) graft utilization (>50%: 75% vs. 51.6%; p = 0.009), (VI) 90‐day patient‐survival (90%–100% vs. 50%–90%; p = 0.001) and (VII) subjectively perceived benefit (always vs. only in selected ECD; p = 0.009). Concordance was found for indications, type, viability tests, graft‐salvage, 90‐day graft‐loss, and major‐complications. Conclusions: This study captured a picture of MP in real‐world LT‐practice. Significant disparities have surfaced between LVCs and HVCs regarding logistics, utilization, and results. To close this gap, efforts should be made to more efficiently deliver dedicated support, training and mentoring to LVC teams adopting MP technology. [ABSTRACT FROM AUTHOR]

Published
2023
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14. Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease: A retrospective observational study

Author

Alnagar, Amr M, primary, Hakeem, Abdul R, additional, Daradka, Khaled, additional, Kyrana, Eirini, additional, Methga, Marumbo, additional, Palaniswamy, Karthikeyan, additional, Rajwal, Sanjay, additional, Mulla, Jamila, additional, O'meara, Moira, additional, Upasani, Vivek, additional, Vijayanand, Dhakshinamoorthy, additional, Prasad, Raj, additional, and Attia, Magdy S, additional

Published
2023
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16. A multicenter randomized-controlled trial of hypothermic oxygenated perfusion (HOPE) for human liver grafts before transplantation

Author

Schlegel, Andrea; https://orcid.org/0000-0002-9385-9847, Mueller, Matteo; https://orcid.org/0000-0002-1118-156X, Muller, Xavier, Eden, Janina, Panconesi, Rebecca, von Felten, Stefanie; https://orcid.org/0000-0002-5264-6394, Steigmiller, Klaus; https://orcid.org/0000-0002-2527-9234, Sousa Da Silva, Richard X; https://orcid.org/0000-0001-8970-7077, de Rougemont, Olivier, Mabrut, Jean-Yves, Lesurtel, Mickaël, Cerisuelo, Miriam Cortes, Heaton, Nigel D, Allard, Marc Antoine, Adam, Rene, Monbaliu, Diethard, Jochmans, Ina; https://orcid.org/0000-0003-4592-2810, Haring, Martijn P D, Porte, Robert J, Parente, Alessandro; https://orcid.org/0000-0001-5506-224X, Muiesan, Paolo; https://orcid.org/0000-0002-7389-6691, Kron, Philipp, Attia, Magdy, Kollmann, Dagmar, Berlakovich, Gabriela; https://orcid.org/0000-0001-8850-7874, Rogiers, Xavier, Petterson, Karin, Kranich, Anne L, Amberg, Stefanie, Müllhaupt, Beat; https://orcid.org/0000-0002-9020-8192, et al, Schlegel, Andrea; https://orcid.org/0000-0002-9385-9847, Mueller, Matteo; https://orcid.org/0000-0002-1118-156X, Muller, Xavier, Eden, Janina, Panconesi, Rebecca, von Felten, Stefanie; https://orcid.org/0000-0002-5264-6394, Steigmiller, Klaus; https://orcid.org/0000-0002-2527-9234, Sousa Da Silva, Richard X; https://orcid.org/0000-0001-8970-7077, de Rougemont, Olivier, Mabrut, Jean-Yves, Lesurtel, Mickaël, Cerisuelo, Miriam Cortes, Heaton, Nigel D, Allard, Marc Antoine, Adam, Rene, Monbaliu, Diethard, Jochmans, Ina; https://orcid.org/0000-0003-4592-2810, Haring, Martijn P D, Porte, Robert J, Parente, Alessandro; https://orcid.org/0000-0001-5506-224X, Muiesan, Paolo; https://orcid.org/0000-0002-7389-6691, Kron, Philipp, Attia, Magdy, Kollmann, Dagmar, Berlakovich, Gabriela; https://orcid.org/0000-0001-8850-7874, Rogiers, Xavier, Petterson, Karin, Kranich, Anne L, Amberg, Stefanie, Müllhaupt, Beat; https://orcid.org/0000-0002-9020-8192, and et al

Abstract

BACKGROUND & AIMS Machine perfusion is a novel method intended to optimize livers before transplantation. However, its effect on morbidity within a 1-year period after transplantation has remained unclear. METHODS In this multicenter controlled trial, we randomly assigned livers donated after brain death (DBD) for liver transplantation (LT). Livers were either conventionally cold stored (control group), or cold stored and subsequently treated by 1-2 h hypothermic oxygenated perfusion (HOPE) before implantation (HOPE group). The primary endpoint was the occurrence of at least one post-transplant complication per patient, graded by the Clavien score of ≥III, within 1-year after LT. The comprehensive complication index (CCI), laboratory parameters, as well as duration of hospital and intensive care unit stay, graft survival, patient survival, and biliary complications served as secondary endpoints. RESULTS Between April 2015 and August 2019, we randomized 177 livers, resulting in 170 liver transplantations (85 in the HOPE group and 85 in the control group). The number of patients with at least one Clavien ≥III complication was 46/85 (54.1%) in the control group and 44/85 (51.8%) in the HOPE group (odds ratio 0.91; 95% CI 0.50-1.66; p = 0.76). Secondary endpoints were also not significantly different between groups. A post hoc analysis revealed that liver-related Clavien ≥IIIb complications occurred less frequently in the HOPE group compared to the control group (risk ratio 0.26; 95% CI 0.07-0.77; p = 0.027). Likewise, graft failure due to liver-related complications did not occur in the HOPE group, but occurred in 7% (6 of 85) of the control group (log-rank test, p = 0.004, Gray test, p = 0.015). CONCLUSIONS HOPE after cold storage of DBD livers resulted in similar proportions of patients with at least one Clavien ≥III complication compared to controls. Exploratory findings suggest that HOPE decreases the risk of severe liver graft-related events. IMPACT AND IMPLICATIO

Published
2023

20. Novel Benchmark Values for Redo Liver Transplantation. Does the Outcome Justify the Effort?

Author

UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Abbassi, Fariba, Gero, Daniel, Muller, Xavier, Bueno, Alba, Figiel, Wojciech, Robin, Fabien, Laroche, Sophie, Picard, Benjamin, Shankar, Sadhana, Ivanics, Tommy, van Reeven, Marjolein, van Leeuwen, Otto B, Braun, Hillary J, Monbaliu, Diethard, Breton, Antoine, Vachharajani, Neeta, Bonaccorsi Riani, Eliano, Nowak, Greg, McMillan, Robert R, Abu-Gazala, Samir, Nair, Amit, Bruballa, Rocio, Paterno, Flavio, Weppler Sears, Deborah, Pinna, Antonio D, Guarrera, James V, de Santibañes, Eduardo, de Santibañes, Martin, Hernandez-Alejandro, Roberto, Olthoff, Kim, Ghobrial, R Mark, Ericzon, Bo-Göran, Ciccarelli, Olga, Chapman, William C, Mabrut, Jean-Yves, Pirenne, Jacques, Müllhaupt, Beat, Ascher, Nancy L, Porte, Robert J, de Meijer, Vincent E, Polak, Wojciech G, Sapisochin, Gonzalo, Attia, Magdy, Weiss, Emmanuel, Adam, René A, Cherqui, Daniel, Boudjema, Karim, Zienewicz, Krzysztof, Jassem, Wayel, Dutkowski, Philipp, Clavien, Pierre-Alain, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Abbassi, Fariba, Gero, Daniel, Muller, Xavier, Bueno, Alba, Figiel, Wojciech, Robin, Fabien, Laroche, Sophie, Picard, Benjamin, Shankar, Sadhana, Ivanics, Tommy, van Reeven, Marjolein, van Leeuwen, Otto B, Braun, Hillary J, Monbaliu, Diethard, Breton, Antoine, Vachharajani, Neeta, Bonaccorsi Riani, Eliano, Nowak, Greg, McMillan, Robert R, Abu-Gazala, Samir, Nair, Amit, Bruballa, Rocio, Paterno, Flavio, Weppler Sears, Deborah, Pinna, Antonio D, Guarrera, James V, de Santibañes, Eduardo, de Santibañes, Martin, Hernandez-Alejandro, Roberto, Olthoff, Kim, Ghobrial, R Mark, Ericzon, Bo-Göran, Ciccarelli, Olga, Chapman, William C, Mabrut, Jean-Yves, Pirenne, Jacques, Müllhaupt, Beat, Ascher, Nancy L, Porte, Robert J, de Meijer, Vincent E, Polak, Wojciech G, Sapisochin, Gonzalo, Attia, Magdy, Weiss, Emmanuel, Adam, René A, Cherqui, Daniel, Boudjema, Karim, Zienewicz, Krzysztof, Jassem, Wayel, Dutkowski, Philipp, and Clavien, Pierre-Alain

Abstract

To define benchmark cutoffs for redo liver transplantation (redo-LT). In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT. We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with MELD score ≤25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary non-function (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers. Out of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index (CCI®) at 1-year of ≤72, and in-hospital and 1-year mortality rates of ≤13% and ≤15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redo-LT benchmarks. This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This major analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.

Published
2022

21. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author

Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B., Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Carvalho, Mauricio Flores, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M., van Hoek, Bart, Attia, Magdy, Lodge, Peter, IJzermans, Jan N.M., Polak, Wojciech G., Claasen, Marco, de Meijer, Vincent E., Metselaar, Herold J., Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B., Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Carvalho, Mauricio Flores, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M., van Hoek, Bart, Attia, Magdy, Lodge, Peter, IJzermans, Jan N.M., Polak, Wojciech G., Claasen, Marco, de Meijer, Vincent E., and Metselaar, Herold J.

Abstract

Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in hi

Published
2022

22. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author

Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, Muiesan, Paolo, Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, and Muiesan, Paolo

Abstract

Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk grou

Published
2022

23. 011 Outcome of children on the UK national prioritised paediatric registration tier

Author

Dixit, Shweta, primary, Taylor, Rhiannon, additional, Whitney, Julie, additional, Hartley, Jane, additional, Attia, Magdy, additional, Mirza, Darius, additional, Rajwal, Sanjay, additional, Watson, Sarah, additional, Isaac, John, additional, Manas, Derek, additional, Heaton, Nigel, additional, Dhawan, Anil, additional, Forsythe, John, additional, Thorburn, Douglas, additional, and Grammatikopoulos, Tassos, additional

Published
2022
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24. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author

Schlegel, Andrea, primary, van Reeven, Marjolein, additional, Croome, Kristopher, additional, Parente, Alessandro, additional, Dolcet, Annalisa, additional, Widmer, Jeannette, additional, Meurisse, Nicolas, additional, De Carlis, Riccardo, additional, Hessheimer, Amelia, additional, Jochmans, Ina, additional, Mueller, Matteo, additional, van Leeuwen, Otto B., additional, Nair, Amit, additional, Tomiyama, Koji, additional, Sherif, Ahmed, additional, Elsharif, Mohamed, additional, Kron, Philipp, additional, van der Helm, Danny, additional, Borja-Cacho, Daniel, additional, Bohorquez, Humberto, additional, Germanova, Desislava, additional, Dondossola, Daniele, additional, Olivieri, Tiziana, additional, Camagni, Stefania, additional, Gorgen, Andre, additional, Patrono, Damiano, additional, Cescon, Matteo, additional, Croome, Sarah, additional, Panconesi, Rebecca, additional, Carvalho, Mauricio Flores, additional, Ravaioli, Matteo, additional, Caicedo, Juan Carlos, additional, Loss, George, additional, Lucidi, Valerio, additional, Sapisochin, Gonzalo, additional, Romagnoli, Renato, additional, Jassem, Wayel, additional, Colledan, Michele, additional, De Carlis, Luciano, additional, Rossi, Giorgio, additional, Di Benedetto, Fabrizio, additional, Miller, Charles M., additional, van Hoek, Bart, additional, Attia, Magdy, additional, Lodge, Peter, additional, Hernandez-Alejandro, Roberto, additional, Detry, Olivier, additional, Quintini, Cristiano, additional, Oniscu, Gabriel C., additional, Fondevila, Constantino, additional, Malagó, Massimo, additional, Pirenne, Jacques, additional, IJzermans, Jan N.M., additional, Porte, Robert J., additional, Dutkowski, Philipp, additional, Taner, C. Burcin, additional, Heaton, Nigel, additional, Clavien, Pierre-Alain, additional, Polak, Wojciech G., additional, Muiesan, Paolo, additional, Alwayn, Ian P.J., additional, van der Berg, Aad P., additional, Carbonaro, Margherita, additional, Claasen, Marco, additional, Daud, Amna, additional, de Meijer, Vincent E., additional, Metselaar, Herold J., additional, Monbaliu, Diethard, additional, Paolucci, Maite, additional, Vets, Sofie, additional, and Winter, Erin, additional

Published
2022
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25. A coordinated national UK liver transplant program response, prioritizing waitlist recipients with the highest need, provided excellent outcomes during the first wave of the COVID‐19 pandemic

Author

Masson, Steven, primary, Taylor, Rhiannon, additional, Whitney, Julie, additional, Adair, Anya, additional, Attia, Magdy, additional, Gibbs, Paul, additional, Grammatikopoulos, Tassos, additional, Isaac, John, additional, Marshall, Aileen, additional, Mirza, Darius, additional, Prachalias, Andreas, additional, Watson, Sarah, additional, Manas, Derek, additional, Forsythe, John, additional, and Thorburn, Douglas, additional

Published
2022
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28. P091 A coordinated national response maintained a safe and effective UK liver transplant program during the first year of the COVID-19 pandemic

Author

Masson, Steven, primary, Taylor, Rhiannon, additional, Adair, Anya, additional, Allison, Michael, additional, Attia, Magdy, additional, Gibbs, Paul, additional, Grammatikopoulos, Tassos, additional, Isaac, John, additional, Marshall, Aileen, additional, Mirza, Darius, additional, Prachalis, Andreas, additional, Prasad, Raj, additional, Tapp, Maxine, additional, Watson, Sarah, additional, Whitney, Julie, additional, Manas, Derek, additional, Forsythe, John, additional, and Thorburn, Douglas, additional

Published
2021
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36. P42 Predictors of patient and graft survival following pediatric liver transplantation: Long-term analysis of more than 300 cases from single centre

Author

Alnagar, Amr, primary, Daradka, Khaled, additional, Kyrana, Eirini, additional, Methga, Marumbo, additional, Palaniswamy, Karthikeyan, additional, Davison, Suzanne, additional, Mcclean, Patricia, additional, Rajwal, Sanjay, additional, Upasani, Vivek, additional, Dhakshinamoorthy, Vijayanand, additional, Prasad, Raj, additional, and Attia, Magdy, additional

Published
2021
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37. P36 Outcomes of pediatric liver transplantation, comparison between acute and chronic liver failure settings

Author

Alnagar, Amr, primary, Daradka, Khaled, additional, Kyrana, Eirini, additional, Methga, Marumbo, additional, Palaniswamy, Karthikeyan, additional, Davison, Suzanne, additional, Mcclean, Patricia, additional, Rajwal, Sanjay, additional, Upasani, Vivek, additional, Dhakshinamoorthy, Vijayanand, additional, Prasad, Raj, additional, and Attia, Magdy, additional

Published
2021
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38. O3 The UK paediatric liver transplant programme during the COVID-19 pandemic

Author

Grammatikopoulos, Tassos, primary, Taylor, Rhiannon, additional, Whitney, Julie, additional, Hartley, Jane, additional, Attia, Magdy, additional, Mirza, Darius, additional, Rajwal, Sanjay, additional, Watson, Sarah, additional, Isaac, John, additional, Manas, Derek, additional, Heaton, Nigel, additional, Dhawan, Anil, additional, Forsythe, John, additional, and Thorburn, Douglas, additional

Published
2021
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42. Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Author

Manzia, Tommaso Maria, Angelico, Roberta, Parente, Alessandro, Muiesan, Paolo, Tisone, Giuseppe, Al Alawy, Yousef, Arif, Abdul Jabba, Attia, Magdy, Bhati, Chandra, Battula R, Narendra, Bonney, Glenn Kunnath, Brooke-Smith, Mark, Derosas, Carlos, De Liguori Carino, Nicola, Ferretti, Stefano, Fiorani, Cristina, Gherardi, Dario, Hegab, Bassem, Hussain, Zaki, Ielpo, Benedetto, Iesari, Samuele, Lai, Quirino, Lainas, Panagiotis, Lauterio, Andrea, Lazzaro, Alessandra, Marudanayagam, Ravi, Nasralla, David, Nicolini, Daniele, Orlando, Giuseppe, Patrono, Damiano, et al, University of Zurich, and Angelico, Roberta

Subjects
610 Medicine & health, 10217 Clinic for Visceral and Transplantation Surgery, 2746 Surgery, COVID
Published
2020

43. Resuming liver transplantation amid the COVID-19 pandemic

Author

Thorburn, Douglas, primary, Taylor, Rhiannon, additional, Whitney, Julie, additional, Adair, Anya, additional, Attia, Magdy, additional, Gibbs, Paul, additional, Grammatikopoulos, Tassos, additional, Isaac, John R, additional, Masson, Steven, additional, Marshall, Aileen, additional, Mirza, Darius F, additional, Prachalias, Andreas, additional, Watson, Sarah, additional, Manas, Derek M, additional, and Forsythe, John, additional

Published
2021
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47. Predictors of patient and graft survival following pediatric liver transplantation: Long‐term analysis of more than 300 cases from single centre.

Author

Alnagar, Amr, Daradka, Khaled, Kyrana, Eirini, Mtegha, Marumbo, Palaniswamy, Karthikeyan, Rajwal, Sanjay, Mulla, Jamila, O'meara, Moira, Karam, Mohamed, Shawky, Ahmed, Hakeem, Abdul Rahman, Upasani, Vivek, Dhakshinamoorthy, Vijayanand, Prasad, Raj, and Attia, Magdy

Subjects
OVERALL survival, GRAFT survival, LIVER transplantation, HEPATIC artery, MULTIVARIATE analysis
Abstract

Background: Pediatric liver transplant (PLT) activity has flourished over time although with limited expansion in the graft pool. The study aims to identify pre‐transplant factors that predict post‐transplant patient and graft survival in the PLT population. Methods: Retrospective review of PLTs at a single tertiary transplant unit from 2000 to 2019. Univariate and multivariate analyses of pre‐transplant factors were performed to identify predictors of patient and graft survival. Results: Two hundred and seventy‐six patients received 320 PLTs. The most common cause of graft loss was hepatic artery thrombosis (n = 13, 29.6%). The most common cause of mortality was sepsis (n = 11, 29.7%). Univariate analysis showed that the following variables had a significant (p <.05) impact on patient survival: recipient age, weight, height, graft type (technical variant graft), transplant category (acute liver failure), the era of transplant, and invasive ventilation. The following variables had a significant (p <.05) impact on graft survival: recipient age, weight, height, transplant category (acute liver failure), and the era of transplant. Multivariate analysis precluded the era of transplant as the only significant factor for patient survival; patients transplanted after 2005 had significantly higher patient survival. No independent factor predicting graft survival was identified. For children transplanted after 2005, the only factor that predicted patient survival was pre‐transplant invasive ventilation. Conclusions: Our study suggests that the learning curve and pre‐transplant invasive ventilation in the recipient have a significant impact on patient survival. The traditional view of worse outcomes of smaller PLT candidates should be changed. [ABSTRACT FROM AUTHOR]

Published
2022
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49. C-reactive protein in febrile children 1 to 36 months of age with clinically undetectable serious bacterial infection

Author

Pulliam, Patrick N., Attia, Magdy W., and Cronan, Kathleen M.

Subjects
C-reactive protein, Bacterial infections -- Diagnosis
Abstract

Objective. To determine the diagnostic properties of quantitative C-reactive protein (CRP) associated with clinically undetectable serious bacterial infection (SBI) in febrile children 1 to 36 months of age. Methods. Febrile children presenting to a pediatric emergency department (ED) with ages ranging from 1 to 36 months, temperatures [greater than or equal to] 39 [degrees] C, and clinically undetectable source of fever were enrolled in this prospective cohort study. Demographic information, ED temperature, duration of fever, and clinical evaluation using the Yale observation scale were recorded at the time of the initial evaluation. The white blood cell count (WBC), band count, absolute neutrophil count (ANC), and CRP concentration were measured at the same time. All patients received blood cultures and either a screening urinalysis or urine culture. A chest radiograph was obtained at the discretion of the ED physician. Patients with history of using antibiotics within 1 week of their presentation to the ED were excluded. The main outcome result was the presence of laboratory or radiographically proven SBI (bacteremia, meningitis, urinary tract infection, pneumonia, septic arthritis, and osteomyelitis). Results. Seventy-seven patients were enrolled in the study. Fourteen (18%) had a SBI (6 urinary tract infection; 4 pneumonia, including 1 patient with Streptococcus pneumoniae bacteremia; and 4 occult S pneumoniae bacteremia), and 63 had no SBI. The 2 groups were indistinguishable in age, sex, ED temperature, duration of fever, and Yale observation scale. CRP concentration, WBC, and ANC were significantly different between the 2 groups. In a multivariate logistic regression analysis, only CRP remained as a predictor of SBI (Beta = 0.76, 95% confidence interval [CI]: 0.64, 0.89). Receiver-operating characteristic analysis demonstrated CRP (area under curve [AUC] 0.905, standard error [SE] 0.05, 95% CI: 0.808, 1.002) to be superior to ANC (AUC 0.805, SE 0.051, 95% CI: 0.705, 0.905) and to WBC (AUC 0.761, SE 0.068, 95% CI: 0.628, 0.895). A CRP cutoff point of 7 was determined to maximize both sensitivity and specificity (sensitivity 79%, specificity 91%, likelihood ratio 8.3, 95% CI: 3.8, 27.3). Multilevel likelihood ratios and posttest probabilities were calculated for a variety of CRP levels. A CRP concentration of Conclusions. Quantitative CRP concentration is a valuable laboratory test in the evaluation of febrile young children who are at risk for occult bacteremia and SBI, with a better predictive value than the WBC or ANC. Pediatrics 2001;108:1275-1279; C-reactive protein, fever, serious bacterial infection, bacteremia, urinary tract infection., ABBREVIATIONS. SBI, serious bacterial infection; OB, occult bacteremia; UTI, urinary tract infection; WBC, white blood cell count; ANC, absolute neutrophil count; CRP, C-reactive protein; ED, emergency department; YOS, Yale Observational [...]

Published
2001

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