Publications of Olivier DETRY
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See detailImage in transplantation surgery: median arcuate ligament in liver transplantation
VANDERMEULEN, Morgan ULiege; MOISE, Martin ULiege; MEURISSE, Nicolas ULiege et al

in Acta Chirurgica Belgica (2020), 120

Low inserted median arcuate ligament may cause extrinsic coeliac trunk compression and median arcuate ligament syndrome (association of post-prandial epigastric pain, weight loss and nausea or vomiting ... [more ▼]

Low inserted median arcuate ligament may cause extrinsic coeliac trunk compression and median arcuate ligament syndrome (association of post-prandial epigastric pain, weight loss and nausea or vomiting). In liver transplantation, liver graft arterial supply depends on the recipient's hepatic artery, as the gastro-duodenal artery has generally been ligated. A decreased graft arterial flow caused by coeliac trunk stenosis might induce hepatic artery thrombosis leading to graft loss. In this short report the authors describe a liver transplant procedure during which recipient's hepatic artery pressure was dramatically decreased after ligature of the gastro-duodenal artery. Dissection and division of the median arcuate ligament allowed to restore an excellent blood flow through the hepatic artery. This report reminds how important it is to be able to recognize and how to manage a stenosing median arcuate ligament in liver transplantation. [less ▲]

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See detailCOVID-19 in an international European liver transplant recipient cohort.
Becchetti, Chiara; Zambelli, Marco Fabrizio; Pasulo, Luisa et al

in Gut (2020)

OBJECTIVE: Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this ... [more ▼]

OBJECTIVE: Knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in liver transplant recipients is lacking, particularly in terms of severity of the disease. The aim of this study was to describe the demographic, baseline clinical characteristics and early outcomes of a European cohort of liver transplant recipients with SARS-CoV-2 infection. DESIGN: We conducted an international prospective study across Europe on liver transplant recipients with SARS-CoV-2 infection confirmed by microbiological assay during the first outbreak of COVID-19 pandemic. Baseline characteristics, clinical presentation, management of immunosuppressive therapy and outcomes were collected. RESULTS: 57 patients were included (70% male, median (IQR) age at diagnosis 65 (57-70) years). 21 (37%), 32 (56%) and 21 (37%) patients had one cardiovascular disease, arterial hypertension and diabetes mellitus, respectively. The most common symptoms were fever (79%), cough (55%), dyspnoea (46%), fatigue or myalgia (56%) and GI symptoms (33%). Immunosuppression was reduced in 22 recipients (37%) and discontinued in 4 (7%). With this regard, no impact on outcome was observed. Forty-one (72%) subjects were hospitalised and 11 (19%) developed acute respiratory distress syndrome. Overall, we estimated a case fatality rate of 12% (95% CI 5% to 24%), which increased to 17% (95% CI 7% to 32%) among hospitalised patients. Five out of the seven patients who died had a history of cancer. CONCLUSION: In this European multicentre prospective study of liver transplant recipients, COVID-19 was associated with an overall and in-hospital fatality rate of 12% (95% CI 5% to 24%) and 17% (95% CI 7% to 32%), respectively. A history of cancer was more frequent in patients with poorer outcome. [less ▲]

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See detailMesenchymal Stromal Cells in Solid Organ Transplantation.
VANDERMEULEN, Morgan ULiege; ERPICUM, Pauline ULiege; WEEKERS, Laurent ULiege et al

in Transplantation (2020), 104(5), 923-936

Over the past decade, the clinical application of mesenchymal stromal cells (MSCs) has generated growing enthusiasm as an innovative cell-based approach in solid organ transplantation (SOT). These ... [more ▼]

Over the past decade, the clinical application of mesenchymal stromal cells (MSCs) has generated growing enthusiasm as an innovative cell-based approach in solid organ transplantation (SOT). These expectations arise from a significant number of both transplant- and non-transplant-related experimental studies investigating the complex anti-inflammatory, immunomodulatory and tissue-repair properties of MSCs. Promising preclinical results have prompted clinical trials using MSC-based therapy in SOT. In the present review, the general properties of MSCs are summarized, with a particular emphasis on MSC-mediated impact on the immune system and in the ischemic conditioning strategy. Next, we chronologically detail all clinical trials using MSCs in the field of SOT. Finally, we envision the challenges and perspectives of MSC-based cell therapy in SOT. [less ▲]

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See detailPreoperative risk score for prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma: Report of a collaborative, international-based, external validation study.
Brustia, Raffaele; Langella, Serena; Kawai, Takayuki et al

in European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (2020), 46(4 Pt A), 560-571

PURPOSE: A preoperative risk score (PRS) to predict outcome of patients with intrahepatic cholangiocarcinoma treated by liver surgery could be clinically relevant.To assess accuracy for broadly adoption ... [more ▼]

PURPOSE: A preoperative risk score (PRS) to predict outcome of patients with intrahepatic cholangiocarcinoma treated by liver surgery could be clinically relevant.To assess accuracy for broadly adoption, external validation of predictive models on independent datasets is crucial. The objective of this study was to externally validate the score for prediction of long-term outcomes after liver surgery for intrahepatic cholangiocarcinoma proposed by Sasaki et al. and based on preoperative albumin, neutrophil-to-lymphocytes-ratio, CA19-9 and tumor size. METHODS: Patients treated by liver surgery for intrahepatic cholangiocarcinoma at 11 international HPB centers from 2001 to 2018 were included in the external validation cohort. Harrell's c-index and Hosmer-Lemeshow analyses were used to test PRS discrimination and calibration. Kaplan-Meier curve for risk groups as described in the original study were displayed. RESULTS: A total of 355 patients with 174 deaths during the follow-up period (median=41.7 months, IQR 32.8-50.6) were included. The median PRS value was 14.7 (IQR 10.7-20.6), with normal distribution across the cohort. A Cox regression on PRS covariates found coefficients similar to those of the derivation cohort, except for tumor size. Measures of discrimination estimated by Harrell's c-index was 0.61(95%CI:0.56-0.67) and Hosmer-Lemeshow p=0.175. The Kaplan-Meyer estimation showed reasonable discrimination across risk groups, with 5years survival rate ranging from 20.1% to 0%. CONCLUSION: In this external validation cohort, the PRS had mild discrimination and poor calibration performance, similarly to the original publication. Nevertheless, its ability to identify different classes of risk is clinically useful, for a better tailoring of a therapeutic strategy. [less ▲]

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See detailImpact of mesenchymal stroll cells and/or everolimus on T-reg lymphocyte expansion in rats
Vandermeulen, Morgan ULiege; ERPICUM, Pauline ULiege; POMA, Laurence ULiege et al

Conference (2020, March 11)

Background: Mesenchymal stromal cells (MSC) are a promising cell-therapy in solid-organ transplantation, namely because of their immunomodulatory properties and positive impact on the expansion of T ... [more ▼]

Background: Mesenchymal stromal cells (MSC) are a promising cell-therapy in solid-organ transplantation, namely because of their immunomodulatory properties and positive impact on the expansion of T-regulator lymphocytes (Treg). The “optimal” immunosuppressive regimen to be associated with MSC has not been defined. Here, we aimed to evaluate the effects on Treg expansion of a single injection of MSC combined or not with everolimus in rats. Materials and methods: Twenty-four Lewis rats were randomly assigned to 4 groups (n=6 per group): MSC+Evero group, i.e. everolimus (0,25mg/kg/day, SC) from D0 to D14 and iv MSC (±1x106 cells) at D9; MSC group, i.e. placebo from D0 to D14 and iv MSC at D9; Evero group, i.e. everolimus from D0 to D14 and iv saline at D9; control group, i.e. placebo from D0 to D14 and iv saline at D9. T-reg blood levels were measured at D0-14-28 with flow cytometry analysis using anti-CD4,-CD25 and -FoxP3 antibodies. Results: In the two groups infused with MSC, Treg were significantly expanded at D14 and D28 (p<0.01), in comparison to D0. When compared to controls group, the “Evero” group showed a significant expansion of Treg levels at D14 but not at D28. In control, Treg levels did not significantly change compared to D0. Conclusion: A single iv MSC injection was efficient to expand T-reg blood levels. This effect was not altered by everolimus co-administration. Everolimus exposure alone promotes a transient T-reg expansion. Hence, everolimus may be regarded as a co-drug of choice in MSC-based therapy in solid-organ transplantion. [less ▲]

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See detailAppendiceal neuroendrocrine neoplasms: incidentaloma or something we should worry about?
LOUSBERG, Laurence ULiege; COLLIGNON, Joëlle ULiege; DETRY, Olivier ULiege

in Current opinion in gastroenterology (2020), 36(1), 48-54

PURPOSE OF REVIEW: To synthesize the current knowledge and guidelines on the management of appendiceal neuroendocrine neoplasms (ANENs). RECENT FINDINGS: Most recent guidelines are essentially based on ... [more ▼]

PURPOSE OF REVIEW: To synthesize the current knowledge and guidelines on the management of appendiceal neuroendocrine neoplasms (ANENs). RECENT FINDINGS: Most recent guidelines are essentially based on heterogeneous retrospective series. With the advent of a more precise classification of neuroendocrine neoplasms, this heterogeneity is rightly criticized and many 'grey areas' are now debated in expert literature. The only way to solve these issues is through the conduct of large prospective multicentre studies, but this seems somewhat utopian, given the rarity of this disease. SUMMARY: ANENs are rare tumours with a favourable prognosis, and mainly diagnosed in young patients. They are predominantly localized, and diagnosed incidentally on appendectomy. This procedure is curative for the vast majority of patients but ANENs can relapse even a significant time after the first diagnosis. Identifying the risks for recurrence is challenging, with some factors thought to be predictive of nodal involvement. The presence of one or more of these factors justifies an oncological radicalization of the surgical procedure (right hemicolectomy with lymphadenectomy). However, the beneficial impact of this surgical procedure on survival is still unproven. [less ▲]

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See detailDon d'organes, don de vie
DETRY, Olivier ULiege

Conference (2019, October 22)

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See detailAspect chirurgical du prélèvement et de la transplantation d'organes
DETRY, Olivier ULiege

Conference (2019, October 05)

Detailed reference viewed: 39 (5 ULiège)
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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 detailFirst report of a successful pediatric heart transplantation from donation after circulatory death with distant procurement using normothermic regional perfusion and cold storage.
Tchana-Sato, Vincent ULiege; Ledoux, Didier ULiege; Vandendriessche, Katrien et al

in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (2019), 38(10), 1112-1115

Heart transplantation (HT) from donation after circulatory death (DCD) is a promising alternative to expand the heart donor pool. Cold storage can be used in a strategy to successfully retrieve and ... [more ▼]

Heart transplantation (HT) from donation after circulatory death (DCD) is a promising alternative to expand the heart donor pool. Cold storage can be used in a strategy to successfully retrieve and transplant DCD hearts after reconditioning using normothermic regional perfusion for distant procurement. Herein, we present the first report of a pediatric DCD heart reconditioned with normothermic regional perfusion, preserved using only cold storage while being transported to a neighboring center, and then successfully transplanted after nearly 2 hours of cold static storage. If supported by an appropriate trial, this finding could obviate the need to use expensive perfusion devices for short interhospital distances for DCD heart transportation and stimulate more centers across the world to embrace DCD HT. [less ▲]

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See detailCLINICAL OUTCOMES OF DCD TYPE V LIVER TRANSPLANTATION: DONATION AFTER EUTHANASIA
van Reeven, M; Gilbo, N; Monbaliu, D et al

in Transplant International (2019, October), 32(S2), 029134

Introduction: Due to shortage of donor organs, physicians and surgeons are forced to accept livers from donation after circulatory death (DCD) donors. One special group of DCD organs are those obtained ... [more ▼]

Introduction: Due to shortage of donor organs, physicians and surgeons are forced to accept livers from donation after circulatory death (DCD) donors. One special group of DCD organs are those obtained after euthanasia (DCD type V). To create more awareness on the possibility of organ donation after euthanasia, it is important to evaluate the results of transplantation with this type of graft. The aim of our study was to evaluate the outcome of DCD type V liver transplantation (LT) in the Netherlands and Belgium. Methods: All DCD type V LT performed until 2018 in all three Dutch LT centers and four out of six Belgian LT centers, were included in this study. Grafts that have been preserved with machine perfusion were excluded. Continuous data are expressed as median (IQR), categorical data as number (percentage). Results: Until 2018, 44 DCD type V LT have been performed. Five cases in which the liver was preserved by machine perfusion were excluded. Median age of donor and recipient was 51 years (42–58) and 56 years (48–64), respectively. A neurological disease was the most common underlying disease in donors requesting euthanasia, followed by psychiatric disorders. Median time between administration of the euthanatics and cold perfusion was 19 min (14–25). Peak AST and ALT levels in the recipients were 904 U/l (586–2,478) and 709 U/l (448– 1,841) respectively. One-, three- and five-year patient survival was 90%, 83% and 83%, respectively (figure 1). Five patients (13%) required a retransplantation, due to PNF (n = 1), HAT (n = 1) or post-transplant cholangiopathy (n = 3), the majority within the first year after the prior LT. Conclusion: Liver transplantations with grafts from donors who underwent euthanasia yield satisfying results during the relatively short follow up period that is currently available. Comparison of these results with DCD type III LT and donation after brain death (DBD) LT is currently ongoing. [less ▲]

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See detailDon d'organes à coeur arrêté
DETRY, Olivier ULiege

Conference (2019, September 28)

Dans les années 1960, la définition de la mort cérébrale (« brain death » des anglo-saxons) a permis de développer la transplantation d’organes à partir de donneurs décédés, quoique c’est principalement ... [more ▼]

Dans les années 1960, la définition de la mort cérébrale (« brain death » des anglo-saxons) a permis de développer la transplantation d’organes à partir de donneurs décédés, quoique c’est principalement après la découverte de l’effet immunosuppresseurs de la cyclosporine que les bénéfices de la transplantation ont été significatifs pour les patients. Avant cette définition, la plupart des prélèvements d’organes se réalisaient après l’arrêt du cœur et de la circulation. Ainsi, dans la description de la première transplantation cardiaque en 1967, Barnard décrit l’arrêt du cœur du donneur avant son prélèvement pour la greffe qui allait se dérouler dans une salle d’opération adjacente. Fin des années 1980 et début des années 1990, quasi tous les prélèvements d’organes après décès se réalisaient après démonstration de la mort cérébrale. En 1995, des travaux fondamentaux et cliniques de l’équipe de Maastricht ont relancé le prélèvement de reins après définition de la mort du donneur sur des critères d’arrêt de la fonction cardiaque et de la circulation. Depuis, des programmes de transplantation du foie, du pancréas et des poumons ont été développés dans de nombreux centres mondiaux, dont en Belgique, pour pallier au manque de greffons. En 2018, environ un tiers des prélèvements d’organes après décès ont été réalisés après décès circulatoire en Belgique. Par rapport au prélèvement en état de mort cérébrale, le prélèvement d’organes en état de mort circulatoire impose une souffrance ischémique supplémentaire, appelée l’ischémie chaude de prélèvement. Les résultats des transplantations peuvent s’en ressentir particulièrement si les autres facteurs de risques ne sont pas minimisés. Récemment des programmes de transplantation cardiaque après prélèvement en arrêt circulatoire ont été développés dans quelques centres dans le monde. Ce type de prélèvement cardiaque nécessite la réanimation du cœur sur une machine après prélèvement (perfusion sur machine normothermique) soit dans le donneur même (circulation extra-corporelle de type ECMO). Le prélèvement d’organes après décès circulatoire est une réalité et se développera probablement encore dans le futur. [less ▲]

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See detailSuccessful clinical transplantation of hearts donated after circulatory death using normothermic regional perfusion
TCHANA-SATO, Vincent ULiege; LEDOUX, Didier ULiege; DETRY, Olivier ULiege et al

in Journal of Heart and Lung Transplantation (2019), 38(6), 593-598

BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe ... [more ▼]

BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol. METHODS: Our local abdominal DCD protocol was updated to allow DCD heart procurement, and was accepted by the institutional ethics committee. The main features of the protocol include: pre-mortem insertion of peripheral venoarterial extracorporeal membrane oxygenation cannulas; thoracoabdominal normothermic regional perfusion (NRP) by clamping the 3 aortic arch vessels to exclude cerebral circu- lation; and in-situ heart resuscitation. The retrieved hearts were directly transplanted into recipients located in an adjoining operating room. RESULTS: The procurement warm ischemic time was 25 minutes for the first donor, and 26 minutes for the second donor. The cold ischemic time was 16 minutes for the first recipient and 17 minutes for the second recipient. The suture time was 30 minutes for the first recipient, and 53 minutes for the second recipient. Both recipients were easily weaned off cardiopulmonary bypass in sinus rhythm and inotro- pic support. Post-operative evaluation of cardiac function was excellent and the patients were subse- quently discharged home. CONCLUSIONS: Transplantation of hearts from DCD donors is now a clinical reality.NRP is a useful tool for resuscitation, reperfusion, and preservation of transplanted hearts. It also offers the opportunity to assess the function and viability of organs before transplantation. However,due to ethical issues, some may object to ante-mortem intervention. [less ▲]

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See detailSingle center experience in 157 controlled DCD-liver tranplantation
Schielke, Astrid Anita ULiege; Paolucci, M; MEURISSE, Nicolas ULiege et al

Conference (2019, May 16)

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 detailClinical outcomes of DCD type V liver transplantation: donation after euthanasia
van Reeven, M; Monbaliu, D; van Leeuwen, Olivier et al

Conference (2019, May 16)

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See detailBReLLS, Belgian Prospective Registry on consecutive laparoscopic and open liver surgery: Results of the first 18 months enrollment
Troisi, R; Dhondt, M; DETRY, Olivier ULiege et al

Conference (2019, May 10)

Objectives. The BReLLS (Belgian Registry on Laparoscopic Liver Surgery) project is a prospective, non-compulsory, online registry of laparoscopic (LLS) and open (OLS) liver procedures, endorsed by the ... [more ▼]

Objectives. The BReLLS (Belgian Registry on Laparoscopic Liver Surgery) project is a prospective, non-compulsory, online registry of laparoscopic (LLS) and open (OLS) liver procedures, endorsed by the Belgian Section of Hepato-Biliary and Pancreatic Surgery in 2016. The primary aim is to monitor the evolution and spreading of LLS in Belgium. The secondary aim is to evaluate the cost/benefit ratio of LLS in order to allow appropriate reimbursement. Methods. The BReLLS is accessible through a secured SSL server (www.brells.org). Participating centers prospectively record pre-operative, intra-operative and postoperative (90-day morbidity and follow-up) data of all consecutive LLS and OLS. Statistics are generated real-time and are available to each participating center. An audit is planned after the first 2-years of patients enrollment with early oncological follow-up. Results. From February 2017 to October 2018, 12 centers have joint the BReLLS reporting data of 630 procedures (390 LLS and 240 OLS). Indication for LLS were colorectal metastases (46.4%), hepatocellular-carcinoma (17.2%), benign diseases (17%), other metastases (14.1%) and mixed various pathologies (5.3%). LLS encompassed major hepatectomies (16.5%), sectionectomies (14.1%), mono or bi-segmentectomies (20.3%) and sub-segmentectomies (49.1%). LLS were converted to OLS in 4.1% of cases. Overall morbidity was 9.7% for LLS and 29.7% for OLS (p=.0001). Major morbidity (Clavien-Dindo ≥ IIIb) occurred in 1.5% and 5.8% of LLS and OLS (p=.004). 90-days mortality following LLS was nihil vs 1.6% (n=4) for OLS (p=.027). Conclusions. LLS are wide spreading in Belgium. In selected patients, LLS are safe, advantageous and reproducible in major HPB centers. A low morbidity has been prospectively confirmed. Further (ongoing) evaluation will focus on the selection criteria for patients undergoing LLS eventually defining the limits of the minimally invasive approach for malignant diseases. [less ▲]

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See detailBook review: Hernia Surgery
DETRY, Olivier ULiege

in Acta Chirurgica Belgica (2019), 119(3), 207

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See detailEarly listeriosis after liver transplantation: report of two cases
Piette, E; VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege et al

in Transplant Infectious Disease (2019)

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant recipients. Listeriosis is usually described after kidney or bone marrow transplant, and has been less ... [more ▼]

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant recipients. Listeriosis is usually described after kidney or bone marrow transplant, and has been less frequently reported after liver transplantation. Here, the authors present two cases of severe Listeria infection occurring within four months after complicated liver transplantation in patients still recovering on the ward. The patients were successfully treated by intravenous ampicillin. These cases should remind transplant physicians that listeriosis may develop in liver transplant recipients, that food safety advice should be provided, and that intravenous ampicillin might be an effective treatment for systemic listeriosis in solid organ recipients. It is likely that trimethoprim-sulfamethoxazole prophylaxis might help prevent early listeriosis after solid organ transplantation. [less ▲]

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See detailValidation d’un score pré-opératoire prédisant la survie à long terme du cholangiocarcinome intra-hépatique réséqué : étude de cohorte multicentrique internationale
Brustia, R; Serena, L; Kawai, T et al

Poster (2019, March 23)

IntroductionRécemment, un score pré-opératoire en 5 classes (SCORE_CCIH) capable de prédire le taux de survie à 5 ans après hépatectomie pour cholangiocarcinome intrahépatique (CCIH) et derivé d'une ... [more ▼]

IntroductionRécemment, un score pré-opératoire en 5 classes (SCORE_CCIH) capable de prédire le taux de survie à 5 ans après hépatectomie pour cholangiocarcinome intrahépatique (CCIH) et derivé d'une cohorte internationale de 250 malades, a été proposé (1). Le but de ce travail était de valider ce score sur une cohorte externe afin qu’il soit utilisé en pratique clinique. Patients et Methodes Tous les malades opérés d’un CCIH depuis 2001 dans 9 centres internationaux ont été inclus. Les données minimales du SCORE-CCIH étaient : albumine, leucocytes/neutrophiles, CA19-9 et diamètre tumoral pré-opératoire. Le critère de jugement principal était la précision de discrimination du SCORE_CCIH par l’aire sous la courbe ROC. Une analyse de survie et un modèle de COX ont été réalisés pour déterminer les facteurs prédictifs indépendants de mortalité. Résultats Parmi 330 patients inclus, la survie moyenne était de 64±4 mois. La précision de discrimination du SCORE_CCIH (AUROC) sur la survie était de 0,63 (95%CI:0,57-0,69) (fig.1). Le taux de survie à 5 ans observée était de 35,2%, 29,5%, 15,2%, 15,7% et 0% en fonction des classes (fig.2). Après ajustement dans le modèle de Cox, les variables significativement prédictives de mortalité étaient le taux d’albumine (HR:0,671, IC95%:0,461-0,976 p=0,04), le rapport leucocytes/neutrophiles (HR: 1,091, IC95%:1,012- 1,176 p=0,02) et le taux de CA19-9 (HR :1, IC95%:1-1, p=0,015). Discussion La précision du CCIH_SCORE sur la discrimination de la survie à long terme est modérée. Les prédicteurs indépendants associés à la mortalité étaient albumine, leucocytes/neutrophiles, CA19-9 mais pas le diamètre tumoral. Conclusion Le SCORE_CCIH peut etre consideré en pratique clinique comme aide à la décision en cas de malades complexes. [less ▲]

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See detailEarly listeriosis after liver transplantation: report of 2 cases
PIETTE, E; VANDERMEULEN, Morgan ULiege; MEURISSE, Nicolas ULiege et al

Poster (2019, March 14)

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant patients. Listeriosis is usually described after kidney or bone marrow transplant, and has rarely been ... [more ▼]

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant patients. Listeriosis is usually described after kidney or bone marrow transplant, and has rarely been reported after liver transplantation. Here, the authors present two cases of severe Listeria infection occurring within three months after complicated liver transplantation in patients still recovering on the ward. The patients were successfully treated by intravenous ampicillin. These cases should remind transplant physicians that listeriosis may develop in liver recipients, that food safety advice should be provided, and that intravenous ampicillin might be an effective treatment for systemic listeriosis in solid organ recipients. [less ▲]

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