Publications of Jean DELWAIDE
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See detailHepatitis E virus genotype 3 subtype dependent clinical outcomes in Belgium 2010-2018
De Somer, T; Peeters, M; Klamer, S et al

in Acta Gastro-Enterologica Belgica (2020, March), 83(1), 12

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See detailIndirect diagnosis of HCV viremia in Malian women: relevance of a cost-effective algorithm.
Bouare, Nouhoum; DELWAIDE, Jean ULiege; BONTEMS, Sébastien ULiege et al

in African Journal of Virology Research (2020), 14(1), 1-11

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See detailA SINGLE CENTER EXPERIENCE WITH 157 CONTROLED DCD-LIVER TRANSPLANTATIONS
Schielke, Astrid Anita ULiege; Paolucci, Maité ULiege; MEURISSE, Nicolas ULiege et al

in Transplant International (2019, October), 32(S2), 029165

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and ... [more ▼]

Introduction: Donation after circulatory death (DCD) have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of graft loss and retransplantation. The authors retrospectively reviewed a single centre experience with controlled DCD-LT in a 15-year period. Patients and Methods: 157 DCD-LT were consecutively performed between 2003 and 2017. All donation and procurement procedures were performed as controlled DCD in the operating theatre. Data are presented as median (ranges). Median donor age was 57 years (16–83). Median DRI was 2.242 (1.322–3.554). Allocation was centre-based. Median recipient MELD score at LT was 15 (6–40). Mean follow-up was 37 months. No patient was lost to follow-up. Results: Median total DCD warm ischemia was 19 min (7–39). Median total ischemia was 313 min (181–586). Patient survivals were 89.8%, 75.5% and 73.1% at 1,3 and 5 years, respectively. Graft survivals were 89%, 73.8% and 69.8% at 1,3 and 5 years, respectively. Biliary complications included mainly anastomotic strictures, that were managed either by endoscopy or hepatico- jejunostomy. Two patients were retransplanted due to intrahepatic ischemic lesions. Conclusion: In this series, DCD LT provides results similar to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]

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See detailA multicentre, observational study on demographic and disease characteristics of patients seeking care for chronic hepatitis C in Belgium in 2016
Bourgeois, S; Mulkay, JP; Lasser, L et al

in Acta Gastro-Enterologica Belgica (2019), 82(1), 43-52

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See detailNew concepts in liver regeneration mechanisms in human severe alcoholic steatohepatitis.
Lejeune, A; Starkel, P; Louvet, A et al

in Acta Gastro-Enterologica Belgica (2019, March), 82(1), 12

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See detailOutcome of liver transplantation for hepatopulmonary syndrome: a Eurotransplant experience.
Raevens, Sarah; Rogiers, Xavier; Geerts, Anja et al

in European Respiratory Journal (2019), 53(pii: 1801096), 1-4

Hepatopulmonary syndrome (HPS) is a pulmonary vascular complication of liver disease that affects up to 30% of patients with cirrhosis [1]. Intrapulmonary vascular dilatations and shunts result in gas ... [more ▼]

Hepatopulmonary syndrome (HPS) is a pulmonary vascular complication of liver disease that affects up to 30% of patients with cirrhosis [1]. Intrapulmonary vascular dilatations and shunts result in gas exchange abnormalities, ranging from elevated alveolar–arterial oxygen gradients with no hypoxaemia to very severe hypoxaemia [1, 2]. Currently, liver transplantation (LT) is the only treatment option [3]. The Model for End-Stage Liver Disease (MELD) is a scoring system for assessing liver disease severity that has been validated to predict the 3-month waiting list mortality and is used by Eurotransplant for prioritising allocation of liver transplants [4]. However, this score poorly predicts overall and post-transplant survival, and does not take into account complications that affect outcomes independent of liver disease severity Copyright ©ERS 2019 https://doi.org/10.1183/13993003.01096-2018 Eur Respir J 2019; 53: 1801096 [5]. Hypoxaemia in HPS is generally progressive and mortality is highest in advanced stages [6, 7]. In this sense, a standard exception (SE) policy has been established to prioritise patients with severe HPS (arterial oxygen tension (PaO2) <60 mmHg), as their severity of illness is not properly reflected by the MELD score. In the pre-SE MELD era, FALLON et al. [1] reported that HPS is associated with a doubled risk of mortality compared to patients without HPS. In 2014, GOLDBERG et al. [5] reviewed SE LT outcomes in HPS patients in the USA and found that LT candidates with SE for HPS had decreased pre-transplantation mortality and superior overall survival compared to non-HPS patients. The European outcomes for patients with SE for HPS have never been explored. In this retrospective study, we analysed overall, pre-transplant and post-transplant survival in LT candidates with SE for HPS within Eurotransplant, and determined whether the intent of the exception policy is being met. [less ▲]

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See detailDiagnostic différentiel de l’anémie dans la cirrhose éthylique
Delmotte, Valentine ULiege; Foidart, Pierre ULiege; DE VOEGHT, Adrien ULiege et al

in Revue Médicale de Liège (2019), 74(10), 527-534

We report here the case of a 62-year-old patient with Child-Pugh stage C ethylic cirrhosis associated with severe macrocytic anaemia, refractory to iterative transfusions and withdrawal. After a ... [more ▼]

We report here the case of a 62-year-old patient with Child-Pugh stage C ethylic cirrhosis associated with severe macrocytic anaemia, refractory to iterative transfusions and withdrawal. After a haemorrhagic, deficiency-related, or sideroblastic etiology was ruled out, haemolytic anaemia was suspected. A blood smear allowed diagnosis of haemolytic anaemia with acanthocytes. This offers the opportunity to discuss anaemia in patients with alcoholic cirrhosis, a frequent complication spanning a broad severity range and having the potential to be life-threatening. Its origin can be multifactorial : acute haemorrhage, dilution, haemolysis (here due to acanthocytosis), marrow insufficiency caused by direct alcohol toxicity, malnutrition, iron deficiency, vitamin B9 or B12 deficiency, chronic inflammation, splenic sequestration induced by portal hypertension...Nous rapportons le cas d’une patiente de 62 ans atteinte d’une cirrhose éthylique de stade Child-Pugh C associée à une anémie macrocytaire sévère, réfractaire aux transfusions itératives et au sevrage. Après avoir exclu les étiologies hémorragiques, carentielles et sidéroblastiques, une anémie hémolytique (AH) est suspectée. La réalisation d’un frottis sanguin a permis le diagnostic d’une anémie hémolytique à acanthocytes. L’opportunité nous est donnée de discuter de l’anémie chez le patient cirrhotique alcoolique, complication fréquente recouvrant un large spectre de gravité et pouvant menacer la survie. Elle peut être multifactorielle : hémorragie aiguë, dilution, hémolyse (dans le cas particulier, liée à une acanthocytose), insuffisance médullaire par toxicité directe de l’alcool, malnutrition, carence martiale, déficit en vitamine B9 ou B12, inflammation chronique, séquestration splénique induite par l’hypertension portale…. [less ▲]

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See detailL'hepatite alcoolique aigue.
WARLING, Odile ULiege; Oger, AF; LAMPROYE, Anne ULiege et al

in Revue medicale de Liege (2019), 74(5-6), 326-331

Alcoholic hepatitis is a syndrome defined primarily by the clinical onset of jaundice in patients with a concomitant heavy consumption of alcoholic beverages. This pathology is managed by alcohol ... [more ▼]

Alcoholic hepatitis is a syndrome defined primarily by the clinical onset of jaundice in patients with a concomitant heavy consumption of alcoholic beverages. This pathology is managed by alcohol withdrawal with a 30-day survival rate of 90 %. For patients with severe alcoholic hepatitis, with a Maddrey score greater than 32 (taking into account bilirubin and prothrombin time), treatment with corticosteroids is discussed provided that a possible infection can be sufficiently excluded or adequately managed. The administration of corticosteroids is continued for 28 days if the Lille score, calculated after 7 days of treatment, is favourable (inferior to 0.45), leading to a survival rate of 80-90 %. However, if the Lille score is unfavourable (superior to 0.45), the prognosis is bad, with a survival of only 25-30 % at 6 months. Special attention needs to be paid to assure a sufficient caloric intake during the treatment period for a successful management. Liver transplantation, previously prohibited for this indication, can be discussed under certain circumstances. However, the success of treatment is contingent upon the alcohol withdrawal. Innovative drugs are currently under investigation to improve the prognosis of this condition. [less ▲]

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See detailProblematique de la transplantation hepatique chez le patient alcoolique.
DETRY, Olivier ULiege; MEURISSE, Nicolas ULiege; LAMPROYE, Anne ULiege et al

in Revue medicale de Liege (2019), 74(5-6), 332-335

En Belgique, comme dans beaucoup d’autres pays, la maladie alcoolique constitue une des causes les plus fréquentes menant à la transplantation hépatique chez l’adulte. Or la transplantation hépatique chez ... [more ▼]

En Belgique, comme dans beaucoup d’autres pays, la maladie alcoolique constitue une des causes les plus fréquentes menant à la transplantation hépatique chez l’adulte. Or la transplantation hépatique chez des patients alcooliques pose de claires questions éthiques concernant l’utilisation de greffons pour soigner des patients souffrant d’une maladie trop souvent considérée comme étant auto- infligée. La maladie alcoolique du foie est une des meil- leures indications de greffe hépatique, avec d’excellents résultats en termes de durée de survie et de qualité de vie après transplantation. Le pré-requis est que cette trans- plantation soit proposée par une équipe multidisciplinaire, chez un patient capable de se prendre en charge et sou- tenu par un environnement familial et social favorable. [less ▲]

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See detailHepatic alveolar echinococcosis.
DETRY, Olivier ULiege; MEURISSE, Nicolas ULiege; Delwaide, Jean ULiege et al

in Acta Chirurgica Belgica (2018), 118(3), 200-201

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See detailA SINGLE CENTER EXPERIENCE WITH 157 CONTROLED DCD-LIVER TRANSPLANTATIONS
Schielke, Astrid Anita ULiege; Paolucci, Maite; MEURISSE, Nicolas ULiege et al

Conference (2018, November 29)

But du travail: Rapporter une expérience monocentrique de 14 ans de transplantation hépatique (TH) à partir de donneurs en mort circulatoire de type III (DMC III) de Maastricht. Méthodes : 157 TH DMC III ... [more ▼]

But du travail: Rapporter une expérience monocentrique de 14 ans de transplantation hépatique (TH) à partir de donneurs en mort circulatoire de type III (DMC III) de Maastricht. Méthodes : 157 TH DMC III ont été réalisées entre 2003 et 2017. Tous les prélèvements ont été réalisés sur des DMC III dont les soins ont été interrompus en salle d’opération. Aucune perfusion normothermique n’a été utilisée dans cette série. Les données sont présentées en médiane et extrêmes. L’âge des donneurs étaient de 57 ans (16-84). L’âge des receveurs était de 60 ans (21-74), avec un score MELD de 15 (6-40). Le suivi était de 37 mois (6-180). Résultats : L’ischémie chaude totale de prélèvement (de l’arrêt du support respiratoire à la perfusion aortique) était de 19 min (7-39). L’ischémie froide était de 237 min (105-576). Le pic d’ASAT était de 978 U/L (67-21.510). La survie des patients et de greffons étaient de 89,8%, 75,5% and 73,1 % et 89%, 73,8% and 69,8%, à 1, 3 et 5 ans, respectivement. La plupart des complications biliaires ont été des sténoses anastomotiques traitées par voie endoscopique, et 2 patients ont été re-transplantés pour des lésions ischémiques intra-hépatiques diffuses. La majorité des décès étaient dus à des causes néoplasiques (récidive de carcinome hépatocellulaire ou tumeur de novo). Conclusions : cette expérience nous encourage à continuer l’utilisation des DMC III pour la TH. Une ischémie froide courte et une sélection des patients avec des MELD peu élevé peut en partie expliquer ces bons résultats. [less ▲]

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See detailNew concepts in liver regeneration mechanisms in human severe alcoholic steatohepatitis.
Lejeune, A; Starkel, P; Louvet, A et al

in Hepatology (2018, October 18), 68(S1), 1378

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See detailAlveolar echinococcosis in southern Belgium: retrospective experience of a tertiary center.
Cambier, Audrey ULiege; LEONARD, Philippe ULiege; Losson, Bertrand ULiege et al

in European Journal of Clinical Microbiology and Infectious Diseases (2018), 37(6), 1195-1196

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See detailLiver transplantation in Jehovah’s Witnesses: a single center-experience
VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege; DAMAS, Pierre ULiege et al

Conference (2018, March 15)

For religious reasons most of the Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma. However, they may ... [more ▼]

For religious reasons most of the Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma. However, they may accept solid organ transplantation. The authors report their experience of liver transplantation (LT) in JW over a 20-year period. [less ▲]

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See detailPrise en charge multidisciplinaire de l'echinococcose alveolaire : le groupe Echino-Liege.
Cambier, Audrey; GIOT, Jean-Baptiste ULiege; LEONARD, Philippe ULiege et al

in Revue Médicale de Liège (2018), 73(3), 135-142

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for ... [more ▼]

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis. However, recent studies carried out in southern Belgium have revealed, through post-mortem examination, high prevalences (up to 62 %) in foxes. Cats and dogs can act as definitive hosts. Human are accidentally infected by ingestion of food contaminated by the feces. After a long incubation period, invasive hepatic lesions may appear, as well as extra-hepatic lesions. The disease may be fatal. The diagnosis is based on imaging techniques, serology and nucleic acid detection in tissues. Early diagnosis may allow surgical removal of the lesion associated with at least 2 years of albendazole postoperative treatment. In case of contraindication to surgery, a long term treatment with albendazole is necessary. Liver transplantation is sometimes necessary. This article presents the epidemiologic, clinical, diagnostic and therapeutics features of this zoonotic disease. [less ▲]

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See detailIs it too early to expand beyond the Milan criteria for liver transplantation? A retrospective, multicentric study in Belgium.
Degroote, H; Callebout, E; De Kervel, J et al

in Acta Gastro-Enterologica Belgica (2018, March)

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See detailStopping nucleos(t)ide analogue treatment in Caucasian hepatitis B patients after HBeAg serovconversion is associated with high relapse rates and fatal outcomes
Van Hees, S; Bourgeois, S; Van Vlierberghe, H et al

in Alimentary Pharmacology and Therapeutics (2018), 47(8), 1170-1180

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See detailPrise en charge multidisciplinaire d'une volumineuse hydatidose hepatique.
HALLEUX, Danaé ULiege; Juriens, I.; Delwaide, Jean ULiege et al

in Revue Médicale de Liège (2018), 73(2), 65-71

Cystic echinococcosis or hydatidosis, is a zoonosis caused by larval stages of Echinococcus granulosus that can be encountered in Belgium in patients originating from endemic countries. The liver is the ... [more ▼]

Cystic echinococcosis or hydatidosis, is a zoonosis caused by larval stages of Echinococcus granulosus that can be encountered in Belgium in patients originating from endemic countries. The liver is the most commonly affected organ. In this paper, the authors describe the multidisciplinary management of this pathology based on the clinical case of a patient suffering from a 28 cm cystic echinococcosis treated by combination of albendazole and liver resection. Several treatment options are described in the literature although there is currently no clear consensus on the management of this condition. [less ▲]

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See detailLiver transplantation in Jehovah's witnesses
VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege; DAMAS, Pierre ULiege et al

in Acta Gastro-Enterologica Belgica (2018, January), 81(1), 30

Introduction: Liver transplantation (LT) is a major surgical procedure with large dissections and sutures of large vessels in patients with high portal hypertension and low levels of platelets and ... [more ▼]

Introduction: Liver transplantation (LT) is a major surgical procedure with large dissections and sutures of large vessels in patients with high portal hypertension and low levels of platelets and coagulation factors. In consequence, LT often requires large amounts of blood products. For religious reasons, most Jehovah's witnesses (JW) refuse infusions of any blood product, including autologous or homologous pre-donated blood, platelets, fresh frozen plasma, coagulation factor concentrates, or human albumin. However, they may accept solid organ transplantation, including LT. Aim: The authors developed experience in abdominal and oncological surgery in JW and present here their results with LT in JW patients. Methods: Over a 20-year period, 22 LT (16 DBD, 2DCD, and 4 LRLT with JW living donors) were performed in 21 JW patients and were analyzed retrospectively. All patients received perioperative iron supplementation and erythropoietin. Two patients had percutaneous spleen embolization to increase platelet level. Anti-fibrinolytic (aprotinin or tranexamic acid) was administrated during LT and meticulous surgical hemostasis was achieved, helped by argon beam coagulation. Continuous circuit cell salvage and reinfusion whereby scavenged blood was maintained in continuity with the patient's circulation, was used in all patients. Veno-venous bypass was avoided during LT to minimize the coagulation disorders. Results: There were 10 male and 11 female patients whose mean age was 48 years (ranges: 6-70). Indications for LT were HCV with (3) or without (1) HCC, PBC (2), PSC (1), HBV (2), autoimmune hepatitis (1), antitrypsin deficiency (1), sarcoidosis (2), amyloidosis (3), polycystic liver disease (1), alcoholic cirrhosis with HCC (1), cryptogenic (3), hepatic artery thrombosis (1). At transplant, mean pre-operative hematocrit was 41% (ranges: 22-50), mean platelet level was 140x103/mm3 (ranges: 33-355), and mean INR was 1.25 (ranges: 0.84- 2.18).One LRLT recipient died at day 11 from aspergillosis and anemia, and another DBD recipient at day 28 due to complications after hepatic artery thrombosis. One patient finally accepted to be transfused for severe anemia. The mean hospital stay was 31 days (10-137). Kaplan-Maier patient survival was 85%, 72%, 72% at 5, 10 and 15 years, respectively Conclusions: According to the authors' experience, LT may be successful in selected and prepared JW patients who should not be a priori excluded from this life saving procedure. The indications for LT in JW were quite different from the common indications for LT, with a low rate of alcoholic cirrhosis. The experience with this particular group of patients helped the team to reduce transfusion needs in the non-JW patients. [less ▲]

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