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1. European Society for Organ Transplantation (ESOT) Consensus Statement on Outcome Measures in Liver Transplantation According to Value-Based Health Care

Author

Carbone, M, Neuberger, J, Rowe, I, Polak, W, Forsberg, A, Fondevila, C, Mantovani, L, Nardi, A, Colli, A, Rockell, K, Schick, L, Cristoferi, L, Oniscu, G, Strazzabosco, M, Cillo, U, Carbone M., Neuberger J., Rowe I., Polak W. G., Forsberg A., Fondevila C., Mantovani L., Nardi A., Colli A., Rockell K., Schick L., Cristoferi L., Oniscu G. C., Strazzabosco M., Cillo U., Carbone, M, Neuberger, J, Rowe, I, Polak, W, Forsberg, A, Fondevila, C, Mantovani, L, Nardi, A, Colli, A, Rockell, K, Schick, L, Cristoferi, L, Oniscu, G, Strazzabosco, M, Cillo, U, Carbone M., Neuberger J., Rowe I., Polak W. G., Forsberg A., Fondevila C., Mantovani L., Nardi A., Colli A., Rockell K., Schick L., Cristoferi L., Oniscu G. C., Strazzabosco M., and Cillo U.

Abstract

Liver transplantation is a highly complex, life-saving, treatment for many patients with advanced liver disease. Liver transplantation requires multidisciplinary teams, system-wide adaptations and significant investment, as well as being an expensive treatment. Several metrics have been proposed to monitor processes and outcomes, however these lack patient focus and do not capture all aspects of the process. Most of the reported outcomes do not capture those outcomes that matter to the patients. Adopting the principles of Value-Based Health Care (VBHC), may provide an opportunity to develop those metrics that matter to patients. In this article, we present a Consensus Statement on Outcome Measures in Liver Transplantation following the principles of VBHC, developed by a dedicated panel of experts under the auspices of the European Society of Organ Transplantation (ESOT) Guidelines’ Taskforce. The overarching goal is to provide a framework to facilitate the development of outcome measures as an initial step to apply the VMC paradigm to liver transplantation.

Published
2024

2. 413.11: The Improvement Study: Call for a New International Prospective Non-competitive, Observational Study to Validate And Optimize Kinetic Models to Predict Liver Allograft Failure At 3 and 12 Months After Liver Transplantation

Author

Avolio, A, (PI), Agopian, V, (coPI), Pascale, Marco, Burra, P, Croome, K, de Santibanes, M, Egawa, H, Fondevila, C, Guo, Z, Lai, Q, Martins, P, Oniscu, G, Polak, W, Quintini, C, Rela, M, Sapisochin, G, Wielderkeher, J, Spoletini, G, Agnes, S, Pafundi, P, Pasciuto, T, and Cillo, U

Published
2022
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4. Economic Impact of European Liver and Intestine Transplantation Association (ELITA) Recommendations for Hepatitis B Prophylaxis After Liver Transplantation

Author

Cortesi, P, Vigano, R, Conti, S, Lenci, I, Volpes, R, Martini, S, Angelico, M, Fung, J, Buti, M, Coilly, A, Durand, F, Fondevila, C, Lebray, P, Nevens, F, Polak, W, Rizzetto, M, Zoulim, F, Perricone, G, Berenguer, M, Mantovani, L, Duvoux, C, Belli, L, Cortesi P. A., Vigano R., Conti S., Lenci I., Volpes R., Martini S., Angelico M., Fung J., Buti M., Coilly A., Durand F., Fondevila C., Lebray P., Nevens F., Polak W. G., Rizzetto M., Zoulim F., Perricone G., Berenguer M., Mantovani L. G., Duvoux C., Belli L. S., Cortesi, P, Vigano, R, Conti, S, Lenci, I, Volpes, R, Martini, S, Angelico, M, Fung, J, Buti, M, Coilly, A, Durand, F, Fondevila, C, Lebray, P, Nevens, F, Polak, W, Rizzetto, M, Zoulim, F, Perricone, G, Berenguer, M, Mantovani, L, Duvoux, C, Belli, L, Cortesi P. A., Vigano R., Conti S., Lenci I., Volpes R., Martini S., Angelico M., Fung J., Buti M., Coilly A., Durand F., Fondevila C., Lebray P., Nevens F., Polak W. G., Rizzetto M., Zoulim F., Perricone G., Berenguer M., Mantovani L. G., Duvoux C., and Belli L. S.

Abstract

The European Liver and Intestine Transplant Association, ELITA, promoted a Consensus Conference involving 20 experts across the world which generated updated guidelines on HBV prophylaxis in liver transplant candidates and recipients. This study explores the economic impact associated with the implementation of the new ELITA guidelines. To this aim, a condition-specific cohort simulation model has been developed to compare new and historical prophylaxis, including only pharmaceutical cost and using the European perspective. The target population simulated in the model included both prevalent and incident cases, and consisted of 6,133 patients after the first year, that increased to 7,442 and 8,743 patents after 5 and 10 years from its implementation. The ELITA protocols allowed a cost saving of around € 235.65 million after 5 years and € 540.73 million after 10 years; which was mainly due to early HIBG withdrawal either after the first 4 weeks or after the first year post Liver Transplantation (LT) depending on the virological risk at transplantation. Results were confirmed by sensitivity analyses. The money saved by the implementation of the ELITA guidelines would allow healthcare decision makers and budget holders to understand where costs could be reduced and resources re-allocated to different needs.

Published
2023

6. Prognosis of Children Undergoing Liver Transplantation: A 30-Year European Study

Author

Baumann, U, Karam, V, Adam, R, Fondevila, C, Dhawan, A, Sokal, E, Jacquemin, E, Kelly, D, Grabhorn, E, Pawlowska, J, D'Antiga, L, Vega, P, Debray, D, Polak, W, de Ville de Goyet, J, Verkade, H, Baumann U., Karam V., Adam R., Fondevila C., Dhawan A., Sokal E., Jacquemin E., Kelly D. A., Grabhorn E., Pawlowska J., D'Antiga L., Vega P. J., Debray D., Polak W. G., de Ville de Goyet J., Verkade H. J., Baumann, U, Karam, V, Adam, R, Fondevila, C, Dhawan, A, Sokal, E, Jacquemin, E, Kelly, D, Grabhorn, E, Pawlowska, J, D'Antiga, L, Vega, P, Debray, D, Polak, W, de Ville de Goyet, J, Verkade, H, Baumann U., Karam V., Adam R., Fondevila C., Dhawan A., Sokal E., Jacquemin E., Kelly D. A., Grabhorn E., Pawlowska J., D'Antiga L., Vega P. J., Debray D., Polak W. G., de Ville de Goyet J., and Verkade H. J.

Abstract

OBJECTIVES: The European Liver Transplant Registry has been collecting data on virtually all pediatric liver transplant (PLT) procedures in Europe since 1968. We analyzed patient outcome over time and identified parameters associated with long-term patient outcome. METHODS: Participating centers and European organ-sharing organizations provided retrospective data to the European Liver Transplant Registry. To identify trends, data were grouped into consecutive time spans: era A: before 2000, era B: 2000 to 2009, and the current era, era C: since 2010. RESULTS: From June 1968 until December 2017, 16 641 PLT were performed on 14 515 children by 133 centers. The children <7 years of age represented 58% in era A, and 66% in the current era (P <.01). The main indications for PLT were congenital biliary diseases (44%) and metabolic diseases (18%). Patient survival at 5 years is currently 86% overall and 97% in children who survive the first year after PLT. The survival rate has improved from 74% in era A to 83% in era B and 85% in era C (P <.0001). Low-volume centers (<5 PLT/year) represented 75% of centers but performed only 19% of PLT and were associated with a decreased survival rate. In the current era, however, survival rates has become irrespective of volume. Infection is the leading cause of death (4.1%), followed by primary nonfunction of the graft (1.4%). CONCLUSIONS: PLT has become a highly successful medical treatment that should be considered for all children with end-stage liver disease. The main challenge for further improving the prognosis remains the early postoperative period.

Published
2022

7. Endoscopic Ultrasound with Tissue Acquisition of Lymph Nodes in Patients with Resectable Intrahepatic Cholangiocarcinoma

Author

de Jong, D. M., additional, Van Der Vondervoort, S., additional, Dwarkasing, R. S., additional, Thomeer, M.G. J., additional, Doukas, M. J., additional, Voermans, R. P., additional, Verdonk, R., additional, Polak, W. G., additional, De Jonge, J., additional, Bruno, M. J., additional, Van Driel, L.M.J. W., additional, and Koerkamp, B. Groot, additional

Published
2023
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8. COVID-19 in liver transplant candidates: Pretransplant and post-transplant outcomes - An ELITA/ELTR multicentre cohort study

Author

Belli, L, Duvoux, C, Cortesi, P, Facchetti, R, Iacob, S, Perricone, G, Radenne, S, Conti, S, Patrono, D, Berlakovich, G, Hann, A, Pasulo, L, Castells, L, Faitot, F, Detry, O, Invernizzi, F, Magini, G, De Simone, P, Kounis, I, Morelli, M, Diaz Fontenla, F, Ericzon, B, Loinaz, C, Johnston, C, Gheorghe, L, Lesurtel, M, Romagnoli, R, Kollmann, D, Perera, M, Fagiuoli, S, Mirza, D, Coilly, A, Toso, C, Zieniewicz, K, Elkrief, L, Karam, V, Adam, R, Den Hoed, C, Merli, M, Puoti, M, De Carlis, L, Oniscu, G, Piano, S, Angeli, P, Fondevila, C, Polak, W, Belli L. S., Duvoux C., Cortesi P. A., Facchetti R., Iacob S., Perricone G., Radenne S., Conti S., Patrono D., Berlakovich G., Hann A., Pasulo L., Castells L., Faitot F., Detry O., Invernizzi F., Magini G., De Simone P., Kounis I., Morelli M. C., Diaz Fontenla F., Ericzon B. -G., Loinaz C., Johnston C., Gheorghe L., Lesurtel M., Romagnoli R., Kollmann D., Perera M. T. P. R., Fagiuoli S., Mirza D., Coilly A., Toso C., Zieniewicz K., Elkrief L., Karam V., Adam R., Den Hoed C., Merli M., Puoti M., De Carlis L., Oniscu G. C., Piano S., Angeli P., Fondevila C., Polak W. G., Belli, L, Duvoux, C, Cortesi, P, Facchetti, R, Iacob, S, Perricone, G, Radenne, S, Conti, S, Patrono, D, Berlakovich, G, Hann, A, Pasulo, L, Castells, L, Faitot, F, Detry, O, Invernizzi, F, Magini, G, De Simone, P, Kounis, I, Morelli, M, Diaz Fontenla, F, Ericzon, B, Loinaz, C, Johnston, C, Gheorghe, L, Lesurtel, M, Romagnoli, R, Kollmann, D, Perera, M, Fagiuoli, S, Mirza, D, Coilly, A, Toso, C, Zieniewicz, K, Elkrief, L, Karam, V, Adam, R, Den Hoed, C, Merli, M, Puoti, M, De Carlis, L, Oniscu, G, Piano, S, Angeli, P, Fondevila, C, Polak, W, Belli L. S., Duvoux C., Cortesi P. A., Facchetti R., Iacob S., Perricone G., Radenne S., Conti S., Patrono D., Berlakovich G., Hann A., Pasulo L., Castells L., Faitot F., Detry O., Invernizzi F., Magini G., De Simone P., Kounis I., Morelli M. C., Diaz Fontenla F., Ericzon B. -G., Loinaz C., Johnston C., Gheorghe L., Lesurtel M., Romagnoli R., Kollmann D., Perera M. T. P. R., Fagiuoli S., Mirza D., Coilly A., Toso C., Zieniewicz K., Elkrief L., Karam V., Adam R., Den Hoed C., Merli M., Puoti M., De Carlis L., Oniscu G. C., Piano S., Angeli P., Fondevila C., and Polak W. G.

Abstract

Objective: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. Design: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. Results: From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). Conclusions: Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

Published
2021

9. 2020 position statement and recommendations of the European Liver and Intestine Transplantation Association (ELITA): management of hepatitis B virus-related infection before and after liver transplantation

Author

Duvoux, C, Belli, L, Fung, J, Angelico, M, Buti, M, Coilly, A, Cortesi, P, Durand, F, Feray, C, Fondevila, C, Lebray, P, Martini, S, Nevens, F, Polak, W, Rizzetto, M, Volpes, R, Zoulim, F, Samuel, D, Berenguer, M, Duvoux C., Belli L. S., Fung J., Angelico M., Buti M., Coilly A., Cortesi P., Durand F., Feray C., Fondevila C., Lebray P., Martini S., Nevens F., Polak W. G., Rizzetto M., Volpes R., Zoulim F., Samuel D., Berenguer M., Duvoux, C, Belli, L, Fung, J, Angelico, M, Buti, M, Coilly, A, Cortesi, P, Durand, F, Feray, C, Fondevila, C, Lebray, P, Martini, S, Nevens, F, Polak, W, Rizzetto, M, Volpes, R, Zoulim, F, Samuel, D, Berenguer, M, Duvoux C., Belli L. S., Fung J., Angelico M., Buti M., Coilly A., Cortesi P., Durand F., Feray C., Fondevila C., Lebray P., Martini S., Nevens F., Polak W. G., Rizzetto M., Volpes R., Zoulim F., Samuel D., and Berenguer M.

Abstract

Background: Prophylaxis of HBV recurrence is critical after liver transplantation in HBV patients. Despite new prophylactic schemes, most European LT centres persist on a conservative approach combining hepatitis B immunoglobulin (HBIG) and nucleos(t)ides analogues (NA). Aim: This setting prompted the European Liver Intestine Transplantation Association (ELITA) to look for a consensus on the prevention of HBV recurrence. Methods: Based on a 4-round Delphi process, ELITA investigated 16 research questions and established 50 recommendations. Results: Prophylaxis should be driven according to 3 simplified risk groups: Low and high virological risk patients, with undetectable and detectable HBV DNA pre-LT, respectively, and special populations (HDV, HCC, poorly adherent patients). In low-risk patients, short-term (4 weeks) combination of third-generation NA+ HBIG, or third generation NA monotherapy can be considered as prophylactic options. In high-risk patients, HBIG can be discontinued once HBV DNA undetectable. Combined therapy for 1 year is advised. HBV-HCC patients should be treated according to their virological risk. In HDV/HBV patients, indefinite dual prophylaxis remains the gold standard. Full withdrawal of HBV prophylaxis following or not HBV vaccination should only be attempted in the setting of clinical trials. Organs from HBsAg+ve donors may be considered after assessment of risks, benefits, and patient consent. They should not be used if HDV is present. In poorly adherent patients, dual long-term prophylaxis is recommended. Budget impact analysis should be taken into account to drive prophylactic regimen. Conclusions: These ELITA recommendations should stimulate a more rational and homogeneous approach to HBV prophylaxis across LT programs.

Published
2021

10. Novel benchmark values for redo liver transplantation – does the outcome justify the effort?

Author

Abbassi, F, primary, Gero, D, additional, Muller, X, additional, Bueno, A, additional, Figiel, W, additional, Robin, F, additional, Laroche, S, additional, Picard, B, additional, Shankar, S, additional, Ivanics, T, additional, van Reeven, M, additional, van Leeuwen, O B, additional, Braun, H J, additional, Monbaliu, D, additional, Breton, A, additional, Vachharajani, N, additional, Bonaccorsi Riani, E, additional, Nowak, G, additional, McMillan, R R, additional, Abu-Gazala, S, additional, Nair, A, additional, Bruballa, R, additional, Paterno, F, additional, Weppler Sears, D, additional, Pinna, A D, additional, Guarrera, J V, additional, de Santibañes, E, additional, de Santibañes, M, additional, Hernandez-Aleja, R, additional, Olthoff, K, additional, Ghobrial, R M, additional, Ericzon, B-G, additional, Ciccarelli, O, additional, Chapman, W C, additional, Mabrut, J-Y, additional, Pirenne, J, additional, Müllhaupt, B, additional, Ascher, N L, additional, Porte, R J, additional, de Meier, V E, additional, Polak, W G, additional, Sapisochin, G, additional, Attia, M, additional, Weiss, E, additional, Adam, R A, additional, Cherqui, D, additional, Boudjema, K, additional, Zienewicz, K, additional, Jassem, W, additional, Puhan, M, additional, Dutkowski, P, additional, and Clavien, P-A, additional

Published
2022
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14. Global management of a common, underrated surgical task during the COVID-19 pandemic: Gallstone disease - An international survery

Author

Manzia, T, Angelico, R, Parente, A, Muiesan, P, Tisone, G, Al Alawy, Y, Arif, A, Attia, M, Bhati, C, Battula R, N, Bonney, G, Brooke-Smith, M, Derosas, C, De Liguori Carino, N, Ferretti, S, Fiorani, C, Gherardi, D, Hegab, B, Hussain, Z, Ielpo, B, Iesari, S, Lai, Q, Lainas, P, Lauterio, A, Lazzaro, A, Marudanayagam, R, Nasralla, D, Nicolini, D, Orlando, G, Patrono, D, Pitchaimuthu, M, Polak, W, Quinto, A, Rai, R, Scalera, I, Schlegel, A, Shanmugam, V, Vitale, A, Widmer, J, Yannick, D, Manzia T. M., Angelico R., Parente A., Muiesan P., Tisone G., Al Alawy Y., Arif A. J., Attia M., Bhati C., Battula R N., Bonney G. K., Brooke-Smith M., Derosas C., De Liguori Carino N., Ferretti S., Fiorani C., Gherardi D., Hegab B., Hussain Z., Ielpo B., Iesari S., Lai Q., Lainas P., Lauterio A., Lazzaro A., Marudanayagam R., Nasralla D., Nicolini D., Orlando G., Patrono D., Pitchaimuthu M., Polak W., Quinto A. M., Rai R., Scalera I., Schlegel A., Shanmugam V., Vitale A., Widmer J., Yannick D., Manzia, T, Angelico, R, Parente, A, Muiesan, P, Tisone, G, Al Alawy, Y, Arif, A, Attia, M, Bhati, C, Battula R, N, Bonney, G, Brooke-Smith, M, Derosas, C, De Liguori Carino, N, Ferretti, S, Fiorani, C, Gherardi, D, Hegab, B, Hussain, Z, Ielpo, B, Iesari, S, Lai, Q, Lainas, P, Lauterio, A, Lazzaro, A, Marudanayagam, R, Nasralla, D, Nicolini, D, Orlando, G, Patrono, D, Pitchaimuthu, M, Polak, W, Quinto, A, Rai, R, Scalera, I, Schlegel, A, Shanmugam, V, Vitale, A, Widmer, J, Yannick, D, Manzia T. M., Angelico R., Parente A., Muiesan P., Tisone G., Al Alawy Y., Arif A. J., Attia M., Bhati C., Battula R N., Bonney G. K., Brooke-Smith M., Derosas C., De Liguori Carino N., Ferretti S., Fiorani C., Gherardi D., Hegab B., Hussain Z., Ielpo B., Iesari S., Lai Q., Lainas P., Lauterio A., Lazzaro A., Marudanayagam R., Nasralla D., Nicolini D., Orlando G., Patrono D., Pitchaimuthu M., Polak W., Quinto A. M., Rai R., Scalera I., Schlegel A., Shanmugam V., Vitale A., Widmer J., and Yannick D.

Abstract

Background: Since the Coronavirus disease-19(COVID-19) pandemic, the healthcare systems are reallocating their medical resources, with consequent narrowed access to elective surgery for benign conditions such as gallstone disease(GD). This survey represents an overview of the current policies regarding the surgical management of patients with GD during the COVID-19 pandemic. Methods: A Web-based survey was conducted among 36 Hepato-Prancreato-Biliary surgeons from 14 Countries. Through a 17-item questionnaire, participants were asked about the local management of patients with GD since the start of the COVID-19 pandemic. Results: The majority (n = 26,72.2%) of surgeons reported an alarming decrease in the cholecystectomy rate for GD since the start of the pandemic, regardless of the Country: 19(52.7%) didn't operate any GD, 7(19.4%) reduced their surgical activity by 50–75%, 10(27.8%) by 25–50%, 1(2.8%) maintained regular activity. Currently, only patients with GD complications are operated. Thirty-two (88.9%) participants expect these changes to last for at least 3 months. In 15(41.6%) Centers, patients are currently being screened for SARS-CoV-2 infection before cholecystectomy [in 10(27.8%) Centers only in the presence of suspected infection, in 5(13.9%) routinely]. The majority of surgeons (n = 29,80.6%) have adopted a laparoscopic approach as standard surgery, 5(13.9%) perform open cholecystectomy in patients with known/suspected SARS-CoV-2 infection, and 2(5.6%) in all patients. Conclusion: In the ongoing COVID-19 emergency, the surgical treatment of GD is postponed, resulting in a huge number of untreated patients who could develop severe morbidity. Updated guidelines and dedicated pathways for patients with benign disease awaiting elective surgery are mandatory to prevent further aggravation of the overloaded healthcare systems.

Published
2020

15. Impact of COVID-19 on liver transplantation in Europe: alert from an early survey of European Liver and Intestine Transplantation Association and European Liver Transplant Registry

Author

Polak, W, Fondevila, C, Karam, V, Adam, R, Baumann, U, Germani, G, Nadalin, S, Taimr, P, Toso, C, Troisi, R, Zieniewicz, K, Belli, L, Duvoux, C, Polak W. G., Fondevila C., Karam V., Adam R., Baumann U., Germani G., Nadalin S., Taimr P., Toso C., Troisi R. I., Zieniewicz K., Belli L. S., Duvoux C., Polak, W, Fondevila, C, Karam, V, Adam, R, Baumann, U, Germani, G, Nadalin, S, Taimr, P, Toso, C, Troisi, R, Zieniewicz, K, Belli, L, Duvoux, C, Polak W. G., Fondevila C., Karam V., Adam R., Baumann U., Germani G., Nadalin S., Taimr P., Toso C., Troisi R. I., Zieniewicz K., Belli L. S., and Duvoux C.

Abstract

There are scarce data on the impact of COVID-19 pandemic on liver transplantation (LT) in Europe. The aim of this study was to obtain a preliminary data on incidence, management, and outcome of COVID-19 in liver transplant recipients and candidates in Europe. An Internet-based survey was sent to the centers affiliated with European Liver Transplant Registry (ELTR). One hundred nine out of 149 (73%) of ELTR centers located in 28 European countries (93%) responded. Ninety-four (86%) of the centers tested all donors, and 75 (69%) centers tested all LT recipients for SARS-CoV-2. Seventy-three (67%) centers selected recipients for LT in the COVID-19 pandemic, whereas 33% did not. Eighty-eight centers reported COVID-19 infection in 57 LT candidates and in 272 LT recipients. Overall crude incidence of COVID-19 among LT candidates and recipients was estimated 1.05% (range 0.5–20%) and 0.34% (range 0.1–4.8%), respectively, and it was significantly higher among candidates (P ' 0.001). Crude rate of death was 18% (10/57) among candidates and 15% (36/244) among recipients. This first large-scale European snapshot study clearly shows that both LT candidates and recipients are at a high risk for COVID-19. These results plead for an early and pro-active screening of COVID-19 symptoms in these populations.

Published
2020

16. Novel benchmark values for redo liver transplantation – does the outcome justify the effort?

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Abbassi, F, Gero, D, Muller, X, Bueno, A, Figiel, W, Robin, F, Laroche, S, Picard, B, Shankar, S, Ivanics, T, van Reeven, M, van Leeuwen, O B, Braun, H J, Monbaliu, D, Breton, A, Vachharajani, N, Bonaccorsi Riani, Eliano, Nowak, G, McMillan, R R, Abu-Gazala, S, Nair, A, Bruballa, R, Paterno, F, Weppler Sears, D, Pinna, A D, Guarrera, J V, de Santibañes, E, de Santibañes, M, Hernandez-Aleja, R, Olthoff, K, Ghobrial, R M, Ericzon, B-G, Ciccarelli, Olga, Chapman, W C, Mabrut, J-Y, Pirenne, J, Müllhaupt, B, Ascher, N L, Porte, R J, de Meier, V E, Polak, W G, Sapisochin, G, Attia, M, Weiss, E, Adam, R A, Cherqui, D, Boudjema, K, Zienewicz, K, Jassem, W, Puhan, M, Dutkowski, P, Clavien, P-A, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, Abbassi, F, Gero, D, Muller, X, Bueno, A, Figiel, W, Robin, F, Laroche, S, Picard, B, Shankar, S, Ivanics, T, van Reeven, M, van Leeuwen, O B, Braun, H J, Monbaliu, D, Breton, A, Vachharajani, N, Bonaccorsi Riani, Eliano, Nowak, G, McMillan, R R, Abu-Gazala, S, Nair, A, Bruballa, R, Paterno, F, Weppler Sears, D, Pinna, A D, Guarrera, J V, de Santibañes, E, de Santibañes, M, Hernandez-Aleja, R, Olthoff, K, Ghobrial, R M, Ericzon, B-G, Ciccarelli, Olga, Chapman, W C, Mabrut, J-Y, Pirenne, J, Müllhaupt, B, Ascher, N L, Porte, R J, de Meier, V E, Polak, W G, Sapisochin, G, Attia, M, Weiss, E, Adam, R A, Cherqui, D, Boudjema, K, Zienewicz, K, Jassem, W, Puhan, M, Dutkowski, P, and Clavien, P-A

Published
2022

17. Location and allocation: inequity of access to liver transplantation for patients with severe acute‐on‐chronic liver failure in Europe

Author

Artzner, T, Bernal, W, Belli, L, Conti, S, Cortesi, P, Sacleux, S, Pageaux, G, Radenne, S, Trebicka, J, Fernandez, J, Perricone, G, Piano, S, Nadalin, S, Morelli, M, Martini, S, Polak, W, Zieniewicz, K, Toso, C, Berenguer, M, Iegri, C, Invernizzi, F, Volpes, R, Karam, V, Adam, R, Faitot, F, Rabinowich, L, Saliba, F, Meunier, L, Lesurtel, M, Uschner, F, Michard, B, Coilly, A, Meszaros, M, Poinsot, D, Besch, C, Schnitzbauer, A, De Carlis, L, Fumagalli, R, Angeli, P, Arroyo, V, Fondevila, C, Duvoux, C, Jalan, R, Viganò, R, Mazzarelli, C, Lauterio, A, Giacomoni, A, Donato, F, Lampertico, P, Pasulo, L, Fagiuoli, S, Colledan, M, Cristina Morelli, M, Vitale, G, Ottobrelli, A, Patrono, D, Romagnoli, R, Petridis, I, Cillo, U, Germani, G, Burra, P, Bachellier, P, Schneider, F, Castelain, V, Addeo, P, Deridder, M, Caroline Sacleux Audrey Coilly, S, Faouzi, S, Samuel, D, Guichon, C, Faure, S, Ursic‐bedoya, J, Colmenero, J, Toapanta, D, Hernández‐tejero, M, Vinaixa, C, den Hoed, C, Haan, J, Della Penna, A, Erhard Uschner, F, Welker, M, Zeuzem, S, Bechstein, W, Goossens, N, Raszeja‐wyszomirska, J, Rabinovich, L, Katarey, D, Agarwal, B, Artzner, Thierry, Bernal, William, Belli, Luca S, Conti, Sara, Cortesi, Paolo A, Sacleux, Sophie‐Caroline, Pageaux, George‐Philippe, Radenne, Sylvie, Trebicka, Jonel, Fernandez, Javier, Perricone, Giovanni, Piano, Salvatore, Nadalin, Silvio, Morelli, Maria C, Martini, Silvia, Polak, Wojciech G, Zieniewicz, Krzysztof, Toso, Christian, Berenguer, Marina, Iegri, Claudia, Invernizzi, Federica, Volpes, Riccardo, Karam, Vincent, Adam, René, Faitot, François, Rabinowich, Liane, Saliba, Faouzi, Meunier, Lucy, Lesurtel, Mickael, Uschner, Frank E, Michard, Baptiste, Coilly, Audrey, Meszaros, Magdalena, Poinsot, Domitille, Besch, Camille, Schnitzbauer, Andreas, De Carlis, Luciano G, Fumagalli, Roberto, Angeli, Paolo, Arroyo, Vincente, Fondevila, Constantino, Duvoux, Christophe, Jalan, Rajiv, Viganò, Raffaella, Mazzarelli, Chiara, Lauterio, Andrea, Giacomoni, Alessandro, Donato, Francesca, Lampertico, Pietro, Pasulo, Luisa, Fagiuoli, Stefano, Colledan, Michele, Cristina Morelli, Maria, Vitale, Giovanni, Ottobrelli, Antonio, Patrono, Damiano, Romagnoli, Renato, Petridis, Ioannis, Cillo, Umberto, Germani, Giacomo, Burra, Patrizia, Bachellier, Philippe, Schneider, Francis, Castelain, Vincent, Addeo, Pietro, Deridder, Mathilde, Caroline Sacleux Audrey Coilly, Sophie, Faouzi, Saliba, Adam, Rene, Samuel, Didier, Guichon, Celine, Faure, Stéfanie, Ursic‐Bedoya, Josè, Fondevila, Costantino, Colmenero, Jorde, Toapanta, David, Hernández‐Tejero, María, Vinaixa, Carmen, Polak, Wojciech G., den Hoed, Caroline, Haan, Jubi E., Della Penna, Andrea, Erhard Uschner, Frank, Welker, Martin, Zeuzem, Stefan, Bechstein, Wolf, Goossens, Nicolas, Raszeja‐Wyszomirska, Joanna, Rabinovich, Liane, Katarey, Dev, Agarwal, Banwari, Artzner, T, Bernal, W, Belli, L, Conti, S, Cortesi, P, Sacleux, S, Pageaux, G, Radenne, S, Trebicka, J, Fernandez, J, Perricone, G, Piano, S, Nadalin, S, Morelli, M, Martini, S, Polak, W, Zieniewicz, K, Toso, C, Berenguer, M, Iegri, C, Invernizzi, F, Volpes, R, Karam, V, Adam, R, Faitot, F, Rabinowich, L, Saliba, F, Meunier, L, Lesurtel, M, Uschner, F, Michard, B, Coilly, A, Meszaros, M, Poinsot, D, Besch, C, Schnitzbauer, A, De Carlis, L, Fumagalli, R, Angeli, P, Arroyo, V, Fondevila, C, Duvoux, C, Jalan, R, Viganò, R, Mazzarelli, C, Lauterio, A, Giacomoni, A, Donato, F, Lampertico, P, Pasulo, L, Fagiuoli, S, Colledan, M, Cristina Morelli, M, Vitale, G, Ottobrelli, A, Patrono, D, Romagnoli, R, Petridis, I, Cillo, U, Germani, G, Burra, P, Bachellier, P, Schneider, F, Castelain, V, Addeo, P, Deridder, M, Caroline Sacleux Audrey Coilly, S, Faouzi, S, Samuel, D, Guichon, C, Faure, S, Ursic‐bedoya, J, Colmenero, J, Toapanta, D, Hernández‐tejero, M, Vinaixa, C, den Hoed, C, Haan, J, Della Penna, A, Erhard Uschner, F, Welker, M, Zeuzem, S, Bechstein, W, Goossens, N, Raszeja‐wyszomirska, J, Rabinovich, L, Katarey, D, Agarwal, B, Artzner, Thierry, Bernal, William, Belli, Luca S, Conti, Sara, Cortesi, Paolo A, Sacleux, Sophie‐Caroline, Pageaux, George‐Philippe, Radenne, Sylvie, Trebicka, Jonel, Fernandez, Javier, Perricone, Giovanni, Piano, Salvatore, Nadalin, Silvio, Morelli, Maria C, Martini, Silvia, Polak, Wojciech G, Zieniewicz, Krzysztof, Toso, Christian, Berenguer, Marina, Iegri, Claudia, Invernizzi, Federica, Volpes, Riccardo, Karam, Vincent, Adam, René, Faitot, François, Rabinowich, Liane, Saliba, Faouzi, Meunier, Lucy, Lesurtel, Mickael, Uschner, Frank E, Michard, Baptiste, Coilly, Audrey, Meszaros, Magdalena, Poinsot, Domitille, Besch, Camille, Schnitzbauer, Andreas, De Carlis, Luciano G, Fumagalli, Roberto, Angeli, Paolo, Arroyo, Vincente, Fondevila, Constantino, Duvoux, Christophe, Jalan, Rajiv, Viganò, Raffaella, Mazzarelli, Chiara, Lauterio, Andrea, Giacomoni, Alessandro, Donato, Francesca, Lampertico, Pietro, Pasulo, Luisa, Fagiuoli, Stefano, Colledan, Michele, Cristina Morelli, Maria, Vitale, Giovanni, Ottobrelli, Antonio, Patrono, Damiano, Romagnoli, Renato, Petridis, Ioannis, Cillo, Umberto, Germani, Giacomo, Burra, Patrizia, Bachellier, Philippe, Schneider, Francis, Castelain, Vincent, Addeo, Pietro, Deridder, Mathilde, Caroline Sacleux Audrey Coilly, Sophie, Faouzi, Saliba, Adam, Rene, Samuel, Didier, Guichon, Celine, Faure, Stéfanie, Ursic‐Bedoya, Josè, Fondevila, Costantino, Colmenero, Jorde, Toapanta, David, Hernández‐Tejero, María, Vinaixa, Carmen, Polak, Wojciech G., den Hoed, Caroline, Haan, Jubi E., Della Penna, Andrea, Erhard Uschner, Frank, Welker, Martin, Zeuzem, Stefan, Bechstein, Wolf, Goossens, Nicolas, Raszeja‐Wyszomirska, Joanna, Rabinovich, Liane, Katarey, Dev, and Agarwal, Banwari

Abstract

Background: There is growing evidence that liver transplantation (LT) is the most effective treatment for acute-on-chronic liver failure grade-3 (ACLF-3). This study examines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies and LT activity for ACLF-3 patients across transplant centers in Europe. Methods: Consecutive patients who were admitted to the ICU with ACLF-3, whether or not they were listed and/or transplanted with ACLF-3 between 2018 and 2019 were included across 20 transplantation centers. Results: 351 patients with ACLF-3 were included: 33 had been listed prior to developing ACLF-3 and 318 had not been listed at the time of admission to the ICU. There was no correlation between the number of unlisted ACLF-3 patients admitted to the ICU and the number listed or transplanted whilst in ACLF-3 across centers. In contrast, there was a correlation between the number of patients listed and the number transplanted whilst in ACLF-3. 21% of patients who were listed whilst in ACLF-3 died on the waiting list or were delisted. The percentage of LT for ACLF-3 patients varied from 0%-29% of patients transplanted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% CI: 49%-80%), showing substantial heterogeneity among centers. The one-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more ACLF-3 patients (>10 patients) than in centers that listed and transplanted fewer: respectively 36% vs. 20%, p = 0.012. Conclusion: Patients with ACLF-3 face inequity of access to LT across Europe. Wait-listing strategies for ACLF-3 patients influence their access to LT and, ultimately, their survival.

Published
2022

18. 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

19. European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children

Author

de Ville de Goyet, J, Baumann, U, Karam, V, Adam, R, Nadalin, S, Heaton, N, Reding, R, Branchereau, S, Mirza, D, Klempnauer, J, Fischer, L, Kalicinski, P, Colledan, M, Lopez Santamaria, M, de Kleine, R, Chardot, C, Yilmaz, S, Kilic, M, Boillot, O, di Francesco, F, Polak, W, Verkade, H, de Ville de Goyet, Jean, Baumann, Ulrich, Karam, Vincent, Adam, René, Nadalin, Silvio, Heaton, Nigel, Reding, Raymond, Branchereau, Sophie, Mirza, Darius, Klempnauer, Jürgen L, Fischer, Lutz, Kalicinski, Piotr, Colledan, Michele, Lopez Santamaria, Manuel, de Kleine, Ruben H, Chardot, Christophe, Yilmaz, Sezai, Kilic, Murat, Boillot, Olivier, di Francesco, Fabrizio, Polak, Wojciech G, Verkade, Henkjan J, de Ville de Goyet, J, Baumann, U, Karam, V, Adam, R, Nadalin, S, Heaton, N, Reding, R, Branchereau, S, Mirza, D, Klempnauer, J, Fischer, L, Kalicinski, P, Colledan, M, Lopez Santamaria, M, de Kleine, R, Chardot, C, Yilmaz, S, Kilic, M, Boillot, O, di Francesco, F, Polak, W, Verkade, H, de Ville de Goyet, Jean, Baumann, Ulrich, Karam, Vincent, Adam, René, Nadalin, Silvio, Heaton, Nigel, Reding, Raymond, Branchereau, Sophie, Mirza, Darius, Klempnauer, Jürgen L, Fischer, Lutz, Kalicinski, Piotr, Colledan, Michele, Lopez Santamaria, Manuel, de Kleine, Ruben H, Chardot, Christophe, Yilmaz, Sezai, Kilic, Murat, Boillot, Olivier, di Francesco, Fabrizio, Polak, Wojciech G, and Verkade, Henkjan J

Abstract

Background and Aims: The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968. Approach and Results: Over a 50-year period (1968–2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000–2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found. Conclusions: Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.

Published
2022

20. Prognostic Models predicting allograft failure at 90 and 365 days after liver transplantation. Call for an international Est to West prospective observational study to guide re-transplantation

Author

Avolio, A., primary, Agopian, V., additional, Burra, P., additional, Martins, P., additional, Oniscu, G., additional, Rela, M., additional, Sapisochin, G., additional, Quintini, C., additional, Egawa, H., additional, Polak, W., additional, He, X., additional, Fondevila, C., additional, Lo, C.M., additional, De Santibanes, M., additional, Guo, Z., additional, Lai, Q., additional, Hessheimer, A.J., additional, Spoletini, G., additional, Bianco, G., additional, Moschetta, G., additional, Miele, L., additional, Grieco, A., additional, Agnes, S., additional, Gruttadauria, S., additional, Romagnoli, R., additional, and Cillo, U., additional

Published
2022
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24. CoBra robot for localized cancer treatment and diagnosis under real-time MRI

Author

Dhaliwal, S. S., Wilby, S., Firouzy, S., Boni, K. B., de Vries, M., Navarro, S. E., Belarouci, A., Coelen, V., Lakhal, O., Pasquier, D., Palmer, A. L., Polak, W., Jones, D., Labib, A., Dobbelsteen, J. J., Duriez, C., Merzouki, R., Centre de Recherche en Informatique, Signal et Automatique de Lille - UMR 9189 (CRIStAL), Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS), Portsmouth Hospitals NHS Trust, University of Portsmouth, Cancer Oscar Lambret [Lille], Delft University of Technology (TU Delft), Deformable Robots Simulation Team (DEFROST ), Inria Lille - Nord Europe, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche en Informatique, Signal et Automatique de Lille - UMR 9189 (CRIStAL), Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS), The European Regional Development Fund (ERDF), and European Project: 2S04-022,CoBra

Subjects
[SPI]Engineering Sciences [physics], AUTOMED, Robotized Brachytherapy, Prostate Cancer, [SDV]Life Sciences [q-bio], MRI Robot, Prostate Brachytherapy, IFToMM, Smart Phantom, MESROB, MESROB2021
Abstract

We present the CoBra (Cooperative Brachytherapy) project 2018 - 2022. The CoBra purposes an integrated concept to perform localized cancer treatment and biopsy of soft-tissues under real-time (RT) MRI guidance [1]. The robot executes needle insertion within the MRI-scanner, performing adaptive prostate brachytherapy under RT-imaging. An active steerable-needle under closed-loop control is used to achieve precise positioning of the seeds with the increased reach of the needle to pubic arch and organs-at-risk occluded areas. Dose calculation under RT-MRI is achieved by the generation of synthetic-CT datasets based on a Machine-learning algorithm. Needle trajectory planning based on a steerable needle with minimal entry points is optimized by an algorithm depending upon the target, seed plan, and prostate contours attained from MRI. A bio-inspired active phantom (BIP) is designed for concept validation. The CoBra project is funded by the EU Interreg 2 Seas programme, led by the University of Lille partnering with multiple institutions and industrial observers.

Published
2021

26. Transarterial chemoembolization of hepatocellular carcinoma before liver transplantation and risk of post-transplant vascular complications: a multicentre observational cohort and propensity score-matched analysis

Author

Sneiders, D, primary, Boteon, A P C S, additional, Lerut, J, additional, Iesari, S, additional, Gilbo, N, additional, Blasi, F, additional, Larghi Laureiro, Z, additional, Orlacchio, A, additional, Tisone, G, additional, Lai, Q, additional, Pirenne, J, additional, Polak, W G, additional, Perera, M T P R, additional, Manzia, T M, additional, and Hartog, H, additional

Published
2021
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31. Transarterial chemoembolization of hepatocellular carcinoma before liver transplantation and risk of post-transplant vascular complications: a multicentre observational cohort and propensity score-matched analysis.

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, Sneiders, D, Boteon, A P C S, Lerut, Jan, Iesari, Samuele, Gilbo, N, Blasi, F, Larghi Laureiro, Z, Orlacchio, A, Tisone, G, Lai, Q, Pirenne, J, Polak, W G, Perera, M T P R, Manzia, T M, Hartog, H, 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, Sneiders, D, Boteon, A P C S, Lerut, Jan, Iesari, Samuele, Gilbo, N, Blasi, F, Larghi Laureiro, Z, Orlacchio, A, Tisone, G, Lai, Q, Pirenne, J, Polak, W G, Perera, M T P R, Manzia, T M, and Hartog, H

Abstract

Transarterial chemoembolization (TACE) in patients with hepatocellular cancer (HCC) on the waiting list for liver transplantation may be associated with an increased risk for hepatic artery complications. The present study aims to assess the risk for, primarily, intraoperative technical hepatic artery problems and, secondarily, postoperative hepatic artery complications encountered in patients who received TACE before liver transplantation. Available data from HCC liver transplantation recipients across six European centres from January 2007 to December 2018 were analysed in a 1 : 1 propensity score-matched cohort (TACE versus no TACE). Incidences of intraoperative hepatic artery interventions and postoperative hepatic artery complications were compared. Data on postoperative hepatic artery complications were available in all 876 patients (425 patients with TACE and 451 patients without TACE). Fifty-eight (6.6 per cent) patients experienced postoperative hepatic artery complications. In total 253 patients who had undergone TACE could be matched to controls. In the matched cohort TACE was not associated with a composite of hepatic artery complications (OR 1.73, 95 per cent c.i. 0.82 to 3.63, P = 0.149). Data on intraoperative hepatic artery interventions were available in 825 patients (422 patients with TACE and 403 without TACE). Intraoperative hepatic artery interventions were necessary in 69 (8.4 per cent) patients. In the matched cohort TACE was not associated with an increased incidence of intraoperative hepatic artery interventions (OR 0.94, 95 per cent c.i. 0.49 to 1.83, P = 0.870). In otherwise matched patients with HCC intended for liver transplantation, TACE treatment before transplantation was not associated with higher risk of technical vascular issues or hepatic artery complications.

Published
2021

32. Protective role of tacrolimus, deleterious role of age and comorbidities in liver transplant recipients with Covid-19: results from the ELITA/ELTR multi-center European study

Author

Belli, L, Fondevila, C, Cortesi, P, Conti, S, Karam, V, Adam, R, Coilly, A, Ericzon, B, Loinaz, C, Cuervas-Mons, V, Zambelli, M, Llado, L, Diaz, F, Invernizzi, F, Patrono, D, Faitot, F, Bhooori, S, Pirenne, J, Perricone, G, Magini, G, Castells, L, Detry, O, Cruchaga, P, Colmenero, J, Berrevoet, F, Rodriguez, G, Ysebaert, D, Radenne, S, Metselaar, H, Morelli, C, De Carlis, L, Polak, W, Duvoux, C, Belli, Luca S, Fondevila, Constantino, Cortesi, Paolo A, Conti, Sara, Karam, Vincent, Adam, Rene, Coilly, Audrey, Ericzon, Bo Goran, Loinaz, Carmelo, Cuervas-Mons, Valentin, Zambelli, Marco, Llado, Laura, Diaz, Fernando, Invernizzi, Federica, Patrono, Damiano, Faitot, Francois, Bhooori, Sherrie, Pirenne, Jacques, Perricone, Giovanni, Magini, Giulia, Castells, Lluis, Detry, Oliver, Cruchaga, Pablo Mart, Colmenero, Jordi, Berrevoet, Frederick, Rodriguez, Gonzalo, Ysebaert, Dirk, Radenne, Sylvie, Metselaar, Herold, Morelli, Cristina, De Carlis, Luciano, Polak, Wojciech G, Duvoux, Christophe, Belli, L, Fondevila, C, Cortesi, P, Conti, S, Karam, V, Adam, R, Coilly, A, Ericzon, B, Loinaz, C, Cuervas-Mons, V, Zambelli, M, Llado, L, Diaz, F, Invernizzi, F, Patrono, D, Faitot, F, Bhooori, S, Pirenne, J, Perricone, G, Magini, G, Castells, L, Detry, O, Cruchaga, P, Colmenero, J, Berrevoet, F, Rodriguez, G, Ysebaert, D, Radenne, S, Metselaar, H, Morelli, C, De Carlis, L, Polak, W, Duvoux, C, Belli, Luca S, Fondevila, Constantino, Cortesi, Paolo A, Conti, Sara, Karam, Vincent, Adam, Rene, Coilly, Audrey, Ericzon, Bo Goran, Loinaz, Carmelo, Cuervas-Mons, Valentin, Zambelli, Marco, Llado, Laura, Diaz, Fernando, Invernizzi, Federica, Patrono, Damiano, Faitot, Francois, Bhooori, Sherrie, Pirenne, Jacques, Perricone, Giovanni, Magini, Giulia, Castells, Lluis, Detry, Oliver, Cruchaga, Pablo Mart, Colmenero, Jordi, Berrevoet, Frederick, Rodriguez, Gonzalo, Ysebaert, Dirk, Radenne, Sylvie, Metselaar, Herold, Morelli, Cristina, De Carlis, Luciano, Polak, Wojciech G, and Duvoux, Christophe

Abstract

BACKGROUND AND AIMS: Despite concerns that liver transplant (LT) recipients may be at increased risk of unfavorable outcomes from COVID-19 due the high prevalence of co-morbidities, immunosuppression and ageing, a detailed analysis of their effects in large studies is lacking.METHODS: Data from adult LT recipients with laboratory confirmed SARS-CoV2 infection were collected across Europe. All consecutive patients with symptoms were included in the analysis.RESULTS: Between March 1st and June 27th2020, data from 243 adult symptomatic cases from 36 centers and 9 countries were collected. Thirty-nine (16%) were managed as outpatients while 204 (84%) required hospitalization including admission to the ICU (39/204, 19.1%). Forty-nine (20.2%) patients died after a median of 13.5 (10-23) days, respiratory failure was the major cause. After multivariable Cox regression analysis, age >70 (HR, 4.16; 95% CI, 1.78-9.73) had a negative effect and tacrolimus (TAC) use (HR, 0.55; 95% CI, 0.31-0.99) had a positive independent effect on survival. The role of co-morbidities was strongly influenced by the dominant effect of age where comorbidities increased with the increasing age of the recipients. In a second model excluding age, both diabetes (HR, 1.95; 95% CI, 1.06-3.58) and chronic kidney disease (HR, 1.97; 95% CI, 1.05-3.67) emerged as associated with death CONCLUSIONS: Twenty-five per cent of patients requiring hospitalization for Covid-19 died, the risk being higher in patients older than 70 and with medical co-morbidities, such as impaired renal function and diabetes. Conversely, the use of TAC was associated with a better survival thus encouraging clinicians to keep TAC at the usual dose.

Published
2021

33. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: results of the ELITA/EF-CLIF collaborative study (ECLIS)

Author

Belli, L, Duvoux, C, Artzner, T, Bernal, W, Conti, S, Cortesi, P, Sacleux, S, Pageaux, G, Radenne, S, Trebicka, J, Fernandez, J, Perricone, G, Piano, S, Nadalin, S, Morelli, M, Martini, S, Polak, W, Zieniewicz, K, Toso, C, Berenguer, M, Iegri, C, Invernizzi, F, Volpes, R, Karam, V, Adam, R, Faitot, F, Rabinovich, L, Saliba, F, Meunier, L, Lesurtel, M, Uschner, F, Fondevila, C, Michard, B, Coilly, A, Meszaros, M, Poinsot, D, Schnitzbauer, A, De Carlis, L, Fumagalli, R, Angeli, P, Arroyo, V, Jalan, R, Fagiuoli, S, Belli, Luca S, Duvoux, Christophe, Artzner, Thierry, Bernal, William, Conti, Sara, Cortesi, Paolo A, Sacleux, Sophie-Caroline, Pageaux, George-Philippe, Radenne, Sylvie, Trebicka, Jonel, Fernandez, Javier, Perricone, Giovanni, Piano, Salvatore, Nadalin, Silvio, Morelli, Maria C, Martini, Silvia, Polak, Wojciech G, Zieniewicz, Krzysztof, Toso, Christian, Berenguer, Marina, Iegri, Claudia, Invernizzi, Federica, Volpes, Riccardo, Karam, Vincent, Adam, René, Faitot, Francoise, Rabinovich, Liane, Saliba, Faouzi, Meunier, Lucy, Lesurtel, Mickael, Uschner, Frank E, Fondevila, Costantino, Michard, Baptiste, Coilly, Audrey, Meszaros, Magdalena, Poinsot, Domitille, Schnitzbauer, Andreas, De Carlis, Luciano G, Fumagalli, Roberto, Angeli, Paolo, Arroyo, Vincente, Jalan, Rajiv, FAGIUOLI, STEFANO, Belli, L, Duvoux, C, Artzner, T, Bernal, W, Conti, S, Cortesi, P, Sacleux, S, Pageaux, G, Radenne, S, Trebicka, J, Fernandez, J, Perricone, G, Piano, S, Nadalin, S, Morelli, M, Martini, S, Polak, W, Zieniewicz, K, Toso, C, Berenguer, M, Iegri, C, Invernizzi, F, Volpes, R, Karam, V, Adam, R, Faitot, F, Rabinovich, L, Saliba, F, Meunier, L, Lesurtel, M, Uschner, F, Fondevila, C, Michard, B, Coilly, A, Meszaros, M, Poinsot, D, Schnitzbauer, A, De Carlis, L, Fumagalli, R, Angeli, P, Arroyo, V, Jalan, R, Fagiuoli, S, Belli, Luca S, Duvoux, Christophe, Artzner, Thierry, Bernal, William, Conti, Sara, Cortesi, Paolo A, Sacleux, Sophie-Caroline, Pageaux, George-Philippe, Radenne, Sylvie, Trebicka, Jonel, Fernandez, Javier, Perricone, Giovanni, Piano, Salvatore, Nadalin, Silvio, Morelli, Maria C, Martini, Silvia, Polak, Wojciech G, Zieniewicz, Krzysztof, Toso, Christian, Berenguer, Marina, Iegri, Claudia, Invernizzi, Federica, Volpes, Riccardo, Karam, Vincent, Adam, René, Faitot, Francoise, Rabinovich, Liane, Saliba, Faouzi, Meunier, Lucy, Lesurtel, Mickael, Uschner, Frank E, Fondevila, Costantino, Michard, Baptiste, Coilly, Audrey, Meszaros, Magdalena, Poinsot, Domitille, Schnitzbauer, Andreas, De Carlis, Luciano G, Fumagalli, Roberto, Angeli, Paolo, Arroyo, Vincente, Jalan, Rajiv, and FAGIUOLI, STEFANO

Abstract

Background and aims: Liver transplantation (LT) has been proposed to be an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to address the current clinical practice and outcomes of ACLF patients wait listed (WL) for LT in Europe. Methods: Retrospective study including 308 consecutive ACLF patients, listed in 20 centres across 8 European countries, from January 2018 to June 2019. Results: 2677 patients received a LT, 1216 (45.4%) for decompensated cirrhosis (DC). Of these, 234 (19.2%) had ACLF at LT: ACLF-1, 58 (4.8%); ACLF-2, 78 (6.4%); and ACLF-3, 98 (8.1%). Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and Netherlands had medium rates (9-15%); and United Kingdom and Spain had low rates (3-5%) (p <.0001). One-year probability of survival after LT for patients with ACLF was 81% (95% CI 74-87). Pre-LT arterial lactate levels >4 mmol/L (HR 3.14, 95% CI 1.37-7.19), recent infection from multi-drug resistant organisms (HR 3.67, 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74, 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the WL. In an intention-to-treat analysis, one-year survival of ACLF patients on the LT WL was 73% for ACLF-1 or -2 and 50% for ACLF-3. Conclusion: The results reveal wide variations in listing patients with ACLF in Europe despite favorable post-LT survival. Risk factors for mortality were identified, allowing a more precise prognostic assessment of ACLF patients for potential LT. Lay summary: Acute on chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation is an effective therapeutic option. This study has demonstrated that in Europe, referral and access to liver transplantation (LT) for patients with ACLF needs to be harmonized to avoid inequities.

Published
2021

35. COVID-19 in liver transplant recipients: preliminary data from the ELITA/ELTR registry

Author

Belli, L, Duvoux, C, Karam, V, Adam, R, Cuervas-Mons, V, Pasulo, L, Loinaz, C, Invernizzi, F, Patrono, D, Bhoori, S, Ciccarelli, O, Morelli, M, Castells, L, Lopez-Lopez, V, Conti, S, Fondevila, C, Polak, W, Belli, Luca S, Duvoux, Christophe, Karam, Vincent, Adam, Rene, Cuervas-Mons, Valentin, Pasulo, Luisa, Loinaz, Carmelo, Invernizzi, Federica, Patrono, Damiano, Bhoori, Sherrie, Ciccarelli, Olga, Morelli, Maria Cristina, Castells, Lluis, Lopez-Lopez, Victor, Conti, Sara, Fondevila, Costantino, Polak, Wojchiech, Belli, L, Duvoux, C, Karam, V, Adam, R, Cuervas-Mons, V, Pasulo, L, Loinaz, C, Invernizzi, F, Patrono, D, Bhoori, S, Ciccarelli, O, Morelli, M, Castells, L, Lopez-Lopez, V, Conti, S, Fondevila, C, Polak, W, Belli, Luca S, Duvoux, Christophe, Karam, Vincent, Adam, Rene, Cuervas-Mons, Valentin, Pasulo, Luisa, Loinaz, Carmelo, Invernizzi, Federica, Patrono, Damiano, Bhoori, Sherrie, Ciccarelli, Olga, Morelli, Maria Cristina, Castells, Lluis, Lopez-Lopez, Victor, Conti, Sara, Fondevila, Costantino, and Polak, Wojchiech

Published
2020

43. INDICATIONS AND OUTCOMES OF PEDIATRIC LIVER RETRANSPLANTATION IN EUROPE. ANALYSIS OF A EUROPEAN LIVER REGISTRY-BASED COHORT

Author

Werner, M, Bruggenwirth, I, Adam, R, Polak, W, Karam, V, Branchereau, S, Fischer, L, Colledan, M, Vega, P, Porte, R, de Meijer, V, Werner MJM, Bruggenwirth IMA, Adam R, Polak WG, Karam V, Branchereau S, Fischer L, Colledan M, Vega PJ, Porte RJ, de Meijer VE, Werner, M, Bruggenwirth, I, Adam, R, Polak, W, Karam, V, Branchereau, S, Fischer, L, Colledan, M, Vega, P, Porte, R, de Meijer, V, Werner MJM, Bruggenwirth IMA, Adam R, Polak WG, Karam V, Branchereau S, Fischer L, Colledan M, Vega PJ, Porte RJ, and de Meijer VE

Published
2019

45. HDR Brachytherapy dosimetry: clinical use of micro-silica bead TLD & Gafchromic EBT3 film

Author

Douralis, A., Jafari, S.M., Polak, W., and Palmer, A.L.

Abstract

Purpose or Objective To develop a novel high resolution experimental method for validating Monte Carlo-derived TG-43 brachytherapy source data, and model-based treatment planning systems. Experimental verification is recommended in the “Report of the High Energy Brachytherapy Source Dosimetry (HEBD) Working Group, 2012”, however, the steep dose gradients with a wide dynamic dose range and rapid change in dose rate has been a limitation for the ability of common detectors to obtain accurate measurements. In this study, we tested a micro silica bead TLDs recently developed at University of Surrey for suitability to perform accurate dose measurements around 60Co and 192Ir clinical HDR brachytherapy sources. The micro silica beads proven dosimetric characteristics (independency from dose rate and angle of radiation incidence) accompanied by small ‘donut shape’ physical dimensions (1.2 mm diameter and 0.9 mm thickness (Fig. 1 (a)) along with chemically inert nature, ease of use and reusability were considered as a very promising detectors for this application. Material and Methods Novel dosimeter positioning templates were designed and produced using AutoCAD software. The micro silica bead TLDs were threaded using cotton yarns and stitched onto the template to accurately position the dosimeters within ± 0.1 mm, in a full-scatter water tank (Fig 1(b) and 1(c)). Measurement setup for radial dose distribution and dose linearity is shown on (Fig 1(c)) and (Fig 1(b)). The used dose rates were form 10 to 4000 cGy/min and dose ranged from 0.5 to 40 Gy. The results of dose distribution measurements around the sources were compared to TG- 43 tabulated data and simultaneously irradiated EBT3 Gafchromic film. A TOLADO TL system was employed for read out of the TLDs. Triple-channel dosimetry using FilmQAPro with uncertainty reduction technique was used for film dosimetry Results The novel experimental method suitably addressed the dosimetry challenges. A linear dose response was observed in the investigated range, 0.5–40 Gy, with a correlation coefficient of R2 > 0.999. The ability of detector to assess the high gradient dose distribution with variable dose rate within the range of 10–4000 cGy/min around the sources was compared to the TG-43 data to that of EBT3 film and found to be within experimental uncertainty (Fig 2 (a) and (b)). Conclusion A novel, high spatial resolution experimental method was developed for validating brachytherapy dosimetry using micro silica bead TLDs on high precision templates. The measured radial dose distributions around both of the 60Co and 192Ir sources were comparable within the experimental uncertainty to the relevant TG-43 data and superior to that of EBT3 Gafchromic film measurement in terms of the dynamic dose range evaluated. The experimental method presented is suitable to address the challenge of HDR brachytherapy dosimetry.

Published
2018

50. A nomogram with sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant patients: a competing risk analysis in a national cohort

Author

van Vugt, J., primary, Alferink, L., additional, Buettner, S., additional, Gaspersz, M., additional, Bot, D., additional, Murad, S.D., additional, Feshtali, S., additional, van Ooijen, P., additional, Polak, W., additional, Porte, R., additional, Hoek, B.V., additional, van den Berg, A., additional, Metselaar, H., additional, and Ijzermans, J., additional

Published
2018
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