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The Institut Georges Lopez 1 (IGL-1) solution was developed to improve the outcomes of solid organ transplantation. Nevertheless, follow-up of liver transplants using IGL-1-preserved organs is still scarce.To compare morbidity, postoperative complications, and early survival between liver grafts perfused with IGL-1 and those perfused with histidine-tryptophan-ketoglutarate (HTK) solutions.Prospective liver grafts perfused with IGL-1 (n = 65) were paired with a historical control group of recipients whose grafts were preserved with HTK solution (n = 130). The primary endpoint was the sum of the incidence of primary graft dysfunction (PGD) and primary graft nonfunction (PGNF). Secondary endpoints included resource utilization, complications, and survival analysis.In the HTK group, 52 patients (40%) exhibited either PGD or PGNF, compared to 20 patients (31%) in the IGL-1 group (P = .208). Patients from the HTK group had higher mean values for cryoprecipitate transfusion (P = .0064), first day serum lactate (P = .0099), higher incidence of vascular complications (11% vs 2% in the IGL-1 group; P = .0226), but a lower incidence of infection (7% vs 28% in the IGL-1 group; P .0001). The IGL-1 group presented a lower mean aspartate aminotransferase and alanine aminotransferase (ALT) on the first and second postoperative day and a lower ALT on the seventh day. Recipients of grafts perfused with IGL-1 had a better early survival than those whose grafts were perfused with HTK.Both solutions are safe and present good results. Grafts perfused with IGL-1 showed decreased enzymatic peaks and better short-term survival rates than the HTK group. The use of the IGL-1 solution might be preferable.

Prolonged time on the waiting list affects post-transplant survival of patients with hepatocellular carcinoma (HCC). However, it is not yet known which patients will be at higher risk for early dropout from the list. We investigate specific risk factors for early waiting list dropout in patients with HCC.This was a single-center, intention-to-treat analysis of adults with HCC, within the Milan criteria, from July 2006 through September 2013. Patients were divided into groups according to waiting list time. The main end point was dropout from the list.The dropout rates of the study cohort at 3, 6, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Patients who dropped out from the list tended to be older, with blood types A and O, and with higher Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. They also had larger nodules, responded poorly to trans-arterial chemo-embolization (TACE), and had a higher alpha-fetoprotein. Those with blood types B and AB appeared to be protected for dropout (odds ratio [OR] = 0.21, P = .02). Patients who responded to TACE were also protected (OR = 0.22, P .001). When we looked into time to dropout, the only baseline characteristic that stood out was a higher MELD score (13 for those dropping out up to 90 days vs 10 for those dropping out after 180 days, P = .0025).We conclude that patients who drop out early from the list are primarily driven by the severity of liver disease. Patients who had progressive HCC had a high tumor load and poor response to loco-regional therapies, dropping out from the list after 180 days of inclusion.

Background Transplant surgeons have one the riskiest jobs in medicine. Multiple reports have described fatalities involving transplant team members who were traveling to recover organs for transplantation. There are few initiatives to use allografts recovered by local teams. We tested the impact of local organ procurement on posttransplantation survival. Methods This single-center retrospective study included primary deceased-donor liver grafts transplanted under the Model for End-stage Liver Disease system. Multivariate analysis was performed to evaluate whether liver allografts procured outside of the organ procurement organization (OPO) region were related to allograft loss. We also studied posttransplantation survival according to local procurement. Results There were 271 transplantations performed with local donors, 19 from other states, and 54 from within our state but outside of our OPO. Recipient demographic data were similar among the groups. There were more male ( P = .007), slim ( P = .01), and younger ( P = .008) donors among allografts from other states (national group). Local or regional donors had brain death more often related to cerebrovascular accidents. National donors had brain death related to trauma ( P = .01). Multivariate analysis confirmed that local organ retrieval was not related to posttransplantation survival. Kaplan-Meier curves showed no difference in patient and graft survivals among the groups. Conclusions Local procurement did not affect posttransplantation survival. Liver allografts procured by other teams showed equivalent posttransplantation outcomes. Policies that stimulate the training of local teams to procure liver allografts for distant transplant centers should be launched to increase job safety for transplant surgeons.

Early allograft dysfunction (EAD) had been related to poor transplant outcomes during the early years of liver transplantation. We sought to determine the incidence of EAD at our unit and to evaluate its impact on posttransplant outcomes.This single-center retrospective study included primary deceased donor liver grafts transplanted under the model for end-stage liver disease system. EAD was defined as a peak values of aminotransferase2000 IU/mL during the first week or an international normalized ratio of ≥1.6 and/or bilirubin ≥10 mg/dL at day 7. The main endpoints were patient and graft survivals.Patients with versus without EAD showed similar recipient characteristics. Donors who experienced EAD who comprises 56% of recipients were heavier with larger body mass indices. EAD was an independent risk factor for allograft loss. Most retransplants were performed early due to nonfunction. The primary nonfunction rate among subjects with versus without EAD were 7% and 12% respectively (P.05). Patient survival among those with EAD was 87.4%, while without EAD it was 90% (P = NS) with graft survivals of 81.4% and 88.7% respectively (P.05).Patients with EAD show a significantly higher risk for allograft loss, but with a comparable survival after transplantation. Despite their worse outcomes, it seems that not all of these recipients behave equally.

Purpose To evaluate morphologic and pathologic features affecting therapy response in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization with doxorubicin drug eluting beads (DEB-TACE) prior to liver transplant. Materials and Methods This prospective study included 27 HCCs in 23 patients treated with DEB-TACE (DcBeads®, Biocompatibles, UK) followed by liver transplant. Imaging response was assessed with the mRECIST criteria with areas of non-enhancement used as a surrogate for necrosis. Pathology evaluation of the treated HCCs from the explanted liver was utilized to categorize the magnitude of response to the therapy: Group I, >50% necrosis, Group II, ≤50% necrosis. Pathology data included percent of necrosis after therapy, lesion size, presence of tumor capsule and presence of macro/micro-vascular invasion. Additional variables recorded included: days between DEB-TACE and transplant; number of sessions per nodule; cumulative doxorubicin dose administered to each nodule; and percentage reduction in size of each nodule after therapy. Results The mean percentage of histological necrosis identified overall was 67.8% (95% CI: 56.5%-79.4%). Group I included 18 nodules with a mean percentage of necrosis of 86.2% (60% to 100%). Group II was comprised of 9 nodules with a mean percentage of necrosis of 31.1% (15% to 40%). The mean pre-treatment lesion size by imaging was significantly larger (p=0.030) for Group I [3.2 cm (range 1.5-5.2cm)] when compared to Group II [2.1cm (range 1.5-2.5cm)]. Group I also demonstrated a significantly higher frequency of lesions having a tumor capsule compared to the Group II (p=0.0027) with a tumor capsule present in 78% and 22%, respectively. There was no significant difference between the two groups with respect to vascular invasion, time to transplantation, treatment sessions, and cumulative Doxorubicin dose and percentage reduction in size of the tumors. Conclusion Lesion size and presence of capsule around the tumor are associated with a higher percentage of necrosis after DEB-TACE.