Machine perfusion (MP) has been used as the kidney preservation method in our center for over 10 years. The first, small (n = 74) prospective, single-blinded randomized study comparing MP and Cold Storage (CS) showed that the incidence of delayed graft function was higher after CS. There have been no reports in the literature on the effect of storage modality on longterm function of renal allografts. This paper presents an analysis of long-term results of renal transplantation in 415 patients operated on between 1994 and 1999. Of those, 227 kidneys were MP-stored prior to KTx. The control group consisted of 188 CS kidney transplants. Kidneys were not randomized to MP or to CS. Donor demographics, medical and biochemical data, cold ischemia time, HLA match and recipient data were collected. Standard triple-drug immunosuppression was administered to both groups. Mortality, graft survival and incidence of return to hemodialysis treatment were analyzed. Despite longer cold ischemia time and poorer donor hemodynamics in MP group, 5-year Kaplan-Meier graft survival was better in MP-stored than in CS-stored kidneys (68.2% vs. 54.2%, p = 0.02). Conclusion: In this nonrandomized analysis, kidney storage by MP improved graft survival and reduced the number of patients who returned to dialysis.

Background In recent years, the clinical evidence of the controlling nutritional status (CONUT) score has increased in patients with gastrointestinal cancers. The purpose of this systematic review and meta-analysis was to investigate the association between the preoperative CONUT score and outcomes in patients undergoing gastrectomy for gastric cancer (GC). Methods A systematic literature search for studies reporting the prognostic impact of the CONUT score in patients with GC was conducted. Meta-analyses of survival, postoperative outcomes, and postoperative clinico-pathological parameters were conducted. Results Five studies with 2482 patients were found to be eligible and subsequently reviewed and analyzed. The CONUT score was significantly associated with overall survival (HR 1.85, 95%CI 1.38–2.48, P <  0.001), cancer-specific survival (HR 2.56, 95%CI 1.24–5.28, P = 0.01) and recurrence/relapse-free survival (HR 1.43, 95%CI 1.12–1.82, P = 0.004). Moreover, the CONUT score was associated with the incidence of postoperative complications (OR 1.39, P = 0.003) and mortality (OR 6.97, P = 0.04), and clinico-pathological parameters (T factor [OR 1.75, P <  0.001], N factor [OR 1.51, P <  0.001], TNM stage [OR 1.73, P <  0.001], and microvascular invasion [OR 1.50, P = 0.006]), but not with tumor differentiation (OR 0.85, P = 0.13). Conclusions The preoperative CONUT score is an independent prognostic indicator of survival and postoperative complications, and is associated with clinico-pathological parameters in patients with GC. Electronic supplementary material The online version of this article (10.1186/s12893-019-0593-6) contains supplementary material, which is available to authorized users.

BackgroundThe clinical value of the controlling nutritional status (CONUT) score in hepatocellular carcinoma (HCC) has increased. The aim of this meta-analysis was to systematically review the association between the CONUT score and outcomes in patients undergoing hepatectomy for HCC.MethodsEmbase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar were systematically searched. Random effects meta-analyses were conducted to examine the prognostic value of the CONUT score in HCC patients.ResultsA total of five studies including 4679 patients were found to be eligible and analyzed in the meta-analysis. The CONUT score was significantly associated with overall survival (HR 1.78, 95%CI = 1.20–2.64, P = 0.004, I2 = 79%), recurrence-free survival (HR 1.34, 95%CI = 1.17–1.53, P < 0.001, I2 = 16%) and postoperative major complications (OR 1.85, 95%CI: 1.19–2.87, P = 0.006, I2 = 72%) in HCC patients. Moreover, the CONUT score was associated with the Child–Pugh classification, liver cirrhosis, ICGR15, and tumor differentiation. However, it was not associated with tumor size, tumor number, and microvascular invasion.ConclusionsThe CONUT score is an independent prognostic indicator of the prognosis and is associated with postoperative major complications and hepatic functional reserve in HCC patients.

Background: There are many doubts with regards to accepting deceased kidneys with acute kidney injury (AKI) for transplantation. Purpose: The aim of this study was to present the 5-years outcome of kidney transplantation cases where deceased donors developed AKI before organ procurement. Methods: Two hundred twenty-six deceased renal transplants were analyzed. Data regarding donors and recipients were collected. Terminal AKI was defined as terminal serum creatinine concentration higher than 1.99 mg/dL and 66 such cases were diagnosed. All kidney transplant recipients were followed for 60 months. Results: AKI group presented more episodes of delayed graft function (DGF) compared to the non-AKI group (56% vs 35%, p < .05). No differences were observed between the groups in the rate of acute rejection episodes, kidney function as well as patient and graft survival. Conclusions: Transplants with AKI present more often DGF and comparable graft survival to transplants without AKI. Kidneys with AKI can be a valuable source of organs provided attentive selection and appropriate care of deceased donors.

The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower ­CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19–13.2, p < 0.001, I² = 0%), postoperative major complications (RR 1.56, 95% CI 1.05–2.33, p= 0.03, I² = 79%), and overall complications (RR 1.38, 95% CI 1.16–1.63, p < 0.001, I² = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97–23.5, p= 0.05, I² = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

BackgroundDespite universal prophylaxis, late cytomegalovirus (CMV) infection occurs in a high proportion of kidney transplant recipients. We evaluated whether a specific viral T-cell response allows for the better identification of recipients who are at high risk of CMV infection after prophylaxis withdrawal.MethodsWe conducted a prospective study in 19 pretransplant anti-CMV seronegative kidney graft recipients R- (18 from seropositive donors [D+] and one from a seronegative donor [D-]) and 67 seropositive recipients R(+) (59 from seropositive donors and eight from seronegative donors) who received antiviral prophylaxis with valganciclovir. The QuantiFERON-CMV (QF-CMV) assay was performed within the first and third months after transplantation. Blood samples were monitored for CMV DNAemia using a commercial quantitative nucleic acid amplification test (QNAT) that was calibrated to the World Health Organization International Standard.ResultsTwenty-one of the 86 patients (24%) developed CMV viremia after prophylaxis withdrawal within 12 months posttransplantation. In the CMV R(+) group, the QF-CMV assay yielded reactive results (QF-CMV[+]) in 51 of 67 patients (76%) compared with 7 of 19 patients (37%) in the CMV R(−) group (p = 0.001). In the CMV R(+) group, infection occurred in seven of 16 recipients (44%) who were QF-CMV(−) and eight of 51 recipients (16%) who were QF-CMV(+). In the CMV R(−) group, infection evolved in five of 12 recipients (42%) who were QF-CMV(−) and one of 7 recipients (14%) who were QF-CMV(+). No difference was found in the incidence of CMV infection stratified according to the QF-CMV results with regard to the recipients’ pretransplant CMV IgG serology (p = 0.985). Cytomegalovirus infection occurred in 15 of 36 patients (42%) with hypogammaglobulinemia (HGG) 90 days posttransplantation compared with two of 34 patients (6%) without HGG (p = 0.0004). Cytomegalovirus infection occurred in seven of 13 patients (54%) with lymphocytopenia compared with 14 of 70 patients (20%) without lymphocytopenia (p = 0.015). The multivariate analysis revealed that the nonreactive QuantiFERON-CMV assay was an independent risk factor for postprophylaxis CMV infection.ConclusionsIn kidney transplant recipients who received posttransplantation prophylaxis, negative QF-CMV results better defined the risk of CMV infection than initial CMV IgG status after prophylaxis withdrawal. Hypogammaglobulinemia and lymphocytopenia were risk factors for CMV infection.

Background: Many patients with hepatic tumors cannot benefit from resection owing to the difficult anatomic sites of their lesions. Some of these patients might be eligible for ex vivo liver resection and autotransplantation. This procedure consists of complete hepatectomy, extracorporeal liver resection, and autotransplantation of the remnant liver. Methods: Four databases were searched for studies reporting cases of ex vivo liver resection and autotransplantation. Outcomes of this procedure were evaluated by meta-analysis of proportions with random effects model and individual participant data analysis. Results: Fifty-three studies were assessed. Meta-analysis revealed an R0 resection rate of 93.4% (95% confidence interval: 81.0e97.9%, I 2 ¼ 0%), a frequency of major surgical complications of 24.5% (95% confidence interval, 16.9e34.3%, I 2 ¼ 26%), a 30-day mortality of 9.5% (95% confidence interval: 5.9e14.9%, I 2 ¼ 0%), and a 1-year survival of 78.4% (95% confidence interval: 62.2e88.8%, I 2 ¼ 64%). We were able to obtain the individual participant data in 244 patients; R0 resection was achieved in 98.6%, with no obvious difference between analyzed subgroups. The 30-day mortality and 1-year survivals were 7.9% and 82.1%, respectively. For groups with malignant and nonmalignant tumors, the 30-day mortalities were 11.3% vs. 6.3% (P ¼ .181), and 1-year survivals were 65.0% vs. 89.7% (P < .001). When comparing those with malignant versus those with nonmalignant lesions, major surgical complications occurred in 50.0% vs. 21.0%; P < .001). Regression analysis revealed that outcomes of patients with benign tumors were better compared with those with malignant tumors (1-year survival, odds ratio: 4.629; 95% confidence interval: 2.181e10.097, P < .001). Conclusion: Ex vivo liver resection and autotransplantation facilitates radical treatment in selected patients with conventionally unresectable hepatic tumors and normal liver function. The outcomes of treatment of malignant lesions appear to be less satisfactory.

Background Liver retransplantation (re-LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. Methods A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re-LT in the Netherlands. Results Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re-LT. The 5-year patient survival for primary LT, and first, second, and third or fourth re-LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively (P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. Conclusions Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re-LT was good, and comparable to those of primary transplants. Survival after multiple re-LT was not significantly different from the first retransplant group, legitimizing third and fourth re-LT to well-selected patients.