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Background: The frequency with which patients with high Model for End-Stage Liver Disease (MELD) scores undergo liver transplantation has been increasing. Canadian literature regarding the outcomes of liver transplantation in recipients with high MELD scores is limited. The primary objective of this study was to assess patient and graft survival among recipients with high (> 35) and low ([less than or equal to] 35) MELD scores. Secondary objectives were to potentially identify independent predictors of graft failure and patient mortality. Methods: We conducted a retrospective chart review of patients undergoing liver transplantation at a single Canadian centre from 2012 to 2017. Results: A total of 332 patients were included in the study: 280 patients had a MELD score of 35 or lower, and 52 had a MELD score above 35. Patients with high MELD scores had higher rates of pretransplant acute kidney injury and dialysis (p < 0.001), admission to the intensive care unit (ICU) or intubation (p < 0.001), intraoperative blood product transfusions (p < 0.001) and posttransplantation acute kidney injury and dialysis (p < 0.001), as well as longer ICU (p < 0.001) and hospital stays (p = 0.002). One- and 3-year patient survival in recipients with MELD scores of 35 or lower was 93.1% and 84.9% versus 85.0% and 80.0% in recipients with MELD scores above 35 (p = 0.37). One- and 3-year graft survival in recipients with MELD scores of 35 or lower was 91.7% and 90.9% versus 77.2% and 72.8% in recipients with MELD scores above 35 (p < 0.001). Prior liver transplant was an independent predictor of patient mortality, and no independent predictors of graft failure were identified. When MELD was replaced with D-MELD (donor age * recipient MELD), it predicted graft failure but not patient survival. Conclusion: No difference in patient mortality was found between MELD groups. Graft survival was significantly lower in recipients with MELD scores above 35. D-MELD may potentially be used as an adjunct in determining risk of graft failure in recipients with high MELD scores. Contexte : Les greffes de foie chez les patients ayant un score MELD (Model for End-Stage Liver Disease) eleve sont de plus en plus frequentes, mais le corpus de publications canadiennes concernant les resultats de ces greffes est limite. Cette etude visait principalement a mesurer le taux de survie des receveurs ayant un score MELD eleve (> 35) et faible ([less than or equal to] 35) ainsi que le taux de survie du greffon pour chaque categorie. Les objectifs secondaires consistaient a possiblement determiner des predicteurs independants de defaillance du greffon et de mortalite du patient. Methodes : Nous avons mene un examen retrospectif des dossiers de patients ayant subi une greffe de foie dans le meme etablissement canadien entre 2012 et 2017. Resultats : L'etude portait sur 332 patients : 280 avaient un score MELD de 35 ou moins, et 52 avaient un score MELD superieur a 35. Ces derniers presentaient des taux plus eleves d'insuffisance renale aigue avec dialyse avant la transplantation (p < 0,001), d'admission en soins intensifs ou d'intubation (p < 0,001), de transfusions peroperatoires de produits sanguins (p < 0,001) et d'insuffisance renale aigue avec dia lyse apres la transplantation (p < 0,001); ils sejournaient aussi plus longtemps aux soins intensifs (p < 0,001) et a l'hopital (p = 0,002). Le taux de survie a 1 et a 3 ans des receveurs ayant un score MELD inferieur ou egal a 35 etait respectivement de 93,1 % et de 84,9 %, contre 85,0 % et 80,0 % chez ceux dont le score MELD etait superieur a 35 (p = 0,37). Le taux de survie du greffon a 1 et a 3 ans chez les receveurs ayant un score MELD inferieur ou egal a 35 etait respectivement de 91,7 % et de 90,9 %, contre 77,2 % et 72,8 % chez ceux ayant un score MELD superieur a 35 (p < 0,001). Les antecedents de greffe de foie etaient un predicteur independant de mortalite, tandis qu'aucun predicteur independant de defaillance du greffon n'a ete trouve. L'utilisation du score D-MELD (age du donneur * score MELD du receveur) au lieu du score MELD permettait de predire la defaillance du greffon, mais non la survie du patient. Conclusion : Concernant la mortalite, aucune difference n'a ete constatee entre les categories de scores MELD. Le taux de survie du greffon s'est avere considerablement plus faible chez les receveurs ayant un score MELD superieur a 35. Le score D-MELD pourrait possiblement servir d'indice complementaire pour determiner le risque de defaillance du greffon chez les receveurs ayant un score MELD eleve., In 2002, the United States introduced the Model for End-Stage Liver Disease (MELD) score as an organ allocation tool to help prioritize liver transplant (LT) candidates on LT wait lists. [...]

Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 3, we discuss the management of choledochal cysts, thus completing our comprehensive review. Dans une large mesure, l'etiologie, la pathophysiologie, le cours naturel et le traitement optimal de la maladie kystique de l'arbre biliaire continuent de faire l'objet de debats. Les gastroenterologues, les chirurgiens et les radiologues cherchent toujours a optimiser leur role respectif dans la prise en charge des kystes du choledoque. C'est pourquoi les chercheurs ont beaucoup ecrit a propos de cette entite morbide, et le present examen en trois parties a pour objet d'organiser les etudes publiees et de presenter les diverses theories que font actuellement valoir les experts. Dans la troisieme partie, nous discutons de la prise en charge des kystes du choledoque, ce qui complete notre examen detaille., Choledochal cysts (CCs) are single or multiple dilatations of the intrahepatic or extrahepatic biliary tree. If left untreated, they can cause morbidity and mortality from recurrent cholangitis, pancreatitis, sepsis, liver [...]

Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 2, we explore the details surrounding diagnosis, describing the presentation and imaging of the disease. Dans une large mesure, l'etiologie, la pathophysiologie, le cours naturel et le traitement optimal de la maladie kystique de l'arbre biliaire continuent de faire l'objet de debats. Les gastroenterologues, les chirurgiens et les radiologues cherchent toujours a optimiser leur role respectif dans la prise en charge des kystes du choledoque. C'est pourquoi les chercheurs ont beaucoup ecrit a propos de cette entite morbide, et le present examen en 3 parties a pour objet d'organiser les etudes publiees et de presenter les diverses theories que font actuellement valoir les experts. Dans la deuxieme partie, nous examinons les details entourant le diagnostic, en decrivant la presentation et l'imagerie de la maladie., Choledochal cysts (CCs), which are cysts that can occur anywhere along the biliary tree, can cause clinically important mortality and morbidity unless diagnosed early. They can mimic many other conditions [...]

Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their [...]

Abstract Background Pancreatic ductal adenocarcinoma is a lethal disease with a 5-year survival rate of 4% and typically presents in an advanced stage. In this setting, prognostic markers identifying the more agrressive tumors could aid in managment decisions. Insulin-like growth factor 2 mRNA binding protein 3 (IGF2BP3, also known as IMP3 or KOC) is an oncofetal RNA-binding protein that regulates targets such as insulin-like growth factor-2 (IGF-2) and ACTB (beta-actin). Methods We evaluated the expression of IGF2BP3 by immunohistochemistry using a tissue microarray of 127 pancreatic ductal adenocarcinomas with tumor grade 1, 2 and 3 according to WHO criteria, and the prognostic value of IGF2BP3 expression. Results IGF2BP3 was found to be selectively overexpressed in pancreatic ductal adenocarcinoma tissues but not in benign pancreatic tissues. Nine (38%) patient samples of tumor grade 1 (n = 24) and 27 (44%) of tumor grade 2 (n = 61) showed expression of IGF2BP3. The highest rate of expression was seen in poorly differentiated specimen (grade 3, n = 42) with 26 (62%) positive samples. Overall survival was found to be significantly shorter in patients with IGF2BP3 expressing tumors (P = 0.024; RR 2.3, 95% CI 1.2-4.8). Conclusions Our data suggest that IGF2BP3 overexpression identifies a subset of pancreatic ductal adenocarcinomas with an extremely poor outcome and supports the rationale for developing therapies to target the IGF pathway in this cancer.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis, particularly for patients with metastatic disease. Treatment for oligometastatic presentation has been reported in recent literature, but the role of intraperitoneal chemotherapy for patients with peritoneal metastases (PM) remains unclear. We performed a systematic literature search of the PubMed, Cochrane and Embase databases in order to identify clinical trials and case-series reporting on the safety and efficacy of intraperitoneal chemotherapy in patients with PDAC-derived PM. Eight publications reporting on 85 patients were identified, using three different therapeutic strategies. First, 37 patients received cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for PDAC with PM. Grade 3 and 4 complications occurred in 37.8% of patients, without perioperative mortality. Median disease-free survival and overall survival (OS) rates varied from 4 to 36 months and 4 to 62 months, respectively. Secondly, 40 patients with resectable PDAC without PM received prophylactic HIPEC following pancreatic resection, with postoperative morbidity and mortality rates of 30% and 5%, and 5-year OS rates of 23–24%. Finally, eight patients with PDAC-derived peritoneal disease were converted to resectable disease after receiving neoadjuvant intraperitoneal chemotherapy and operated on with curative intent, achieving a median OS of 27.8 months. In conclusion, CRS with HIPEC for PDAC-derived PM appears to be safe, conferring the same postoperative morbidity and mortality as reported on non-pancreatic malignancies. In highly selected patients, it could be considered for short-term disease control. However, long-term survival remains poor. The addition of prophylactic HIPEC for resectable PDAC cannot be recommended. [ABSTRACT FROM AUTHOR]