Evaluation of Early Allograft Function Using the Liver Graft Assessment Following Transplantation Risk Score Model

Agopian, Vatche G.; Harlander-Locke, Michael P.; Markovic, Daniela; Dumronggittigule, Wethit; Xia, Victor W.; Kaldas, Fady M.; Zarrinpar, Ali; Yersiz, Hasan; Farmer, Douglas G.; Hiatt, Jonathan R.; Busuttil, Ronald W.

doi:10.1001/jamasurg.2017.5040

Cited by 129 publications

(150 citation statements)

References 33 publications

(76 reference statements)

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“…430,432,433 Neoadjuvant therapies in LT and downstaging within Milan criteria LT candidates with HCC -if not treated -are inherently at risk of cancer progression while waiting, with an incremental risk of tumour progression and post-transplant cancer-related mortality related to HCC presentation and AFP variation over time. 290,404,445,446 Several studies and meta-analyses on locoregional treatment have demonstrated significant advantages of neoadjuvant therapies in reducing the drop-out risk due to tumour progression. 412,422,[447][448][449] Neoadjuvant protocols are very heterogeneous among centres, but hierarchic use of ablation and transarterial therapies in various combinations is almost universal, especially when expected waiting time is above six months.…”

Section: Organ Allocation and Priority For Hccmentioning

confidence: 99%

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Galle¹,

Forner²,

Llovet³

et al. 2018

Journal of Hepatology

6,293

4,351

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Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma represents about 90% of primary liver cancers and constitutes a major global health problem. The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.

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Section: Organ Allocation and Priority For Hccmentioning

confidence: 99%

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Galle¹,

Forner²,

Llovet³

et al. 2018

Journal of Hepatology

6,293

4,351

View full text Add to dashboard Cite

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“…In our cohort, patients with myosteatosis had significantly more major complications over the first 3 months and low muscle density was additionally associated with increased rates of EAD, higher CCI scores, and an increased need for intraoperative blood transfusions. 19,37,38 The association of myosteatosis with the abovementioned parameters of perioperative outcome is further supported by the correlation and quartile analyses, demonstrating that gradually decreasing muscle density leads to more perioperative complications, longer in-hospital stay, and higher estimated costs. The estimated mean procedural costs were more than 20 TEur higher in patients with myosteatosis compared to the rest of our cohort.…”

Section: Major Complications (Cd ≥ 3b) a N = 114mentioning

confidence: 76%

“…35,36 These humoral factors and muscle-to-liver cross-talk, together with the limited functional reserves in myosteatotic patients (eg, reduced KPS score, greater need for intraoperative transfusions) may contribute to an increased oxidative stress and graft injury with a higher incidence of EAD during the perioperative phase. 19,37,38 The association of myosteatosis with the abovementioned parameters of perioperative outcome is further supported by the correlation and quartile analyses, demonstrating that gradually decreasing muscle density leads to more perioperative complications, longer in-hospital stay, and higher estimated costs. Of note, reduced SMM, visceral obesity, and sarcopenic obesity were not associated with increased morbidity in our cohort.…”

Section: Combining Myosteatosis With a Validated Prediction Model: mentioning

confidence: 76%

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Czigány

Kramp

Bednarsch

et al. 2020

American Journal of Transplantation

119

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Abbreviations: AASLD American Association for the Study of Liver Diseases AUC area under the curve AUROC area under the receiver operating characteristics curve BAR balance of risk BC body composition BMI body mass index CCI comprehensive complication index CDC lavien-Dindo classification CT computed tomography EAD early allograft dysfunction EASL European Association for the Study of the Liver ECD extended criteria donor FFP unitsfresh frozen plasma units HU Hounsfield unit ICH International Conference on Harmonisation ICU Intensive Care Unit KPS Karnofsky Performance Score MELD Model of End-stage Liver Disease OLT orthotopic liver transplantation RBC units red blood cell units ROC receiver operating characteristics SM-RA skeletal muscle radiation attenuation SMI skeletal muscle index SMM skeletal muscle mass SOFT survival outcomes following liver transplantation TEur Thousand Euros UH-RWTH University Hospital of the RWTH University VFA visceral fat area1 Muscle wasting and alterations of body composition are linked to clinical outcomes in numerous medical conditions. The role of myosteatosis in posttransplant outcomes remains to be determined. Here we investigated skeletal muscle mass and myosteatosis as prognostic factors in patients undergoing orthotopic liver transplantation (OLT). The data of 225 consecutive OLT recipients from a prospective database were retrospectively analyzed (May 2010-December 2017). Computed tomography-based skeletal-muscleindex (muscle mass), visceral-fat-area (visceral adiposity), and mean skeletal-muscle-radiation-attenuation (myosteatosis) were calculated using a segmentation tool. Cut-off values of myosteatosis resulted in a good stratification of patients into low-and high-risk groups in terms of morbidity (Clavien-Dindo ≥3b). Patients with myosteatosis had significantly higher complication rates (90-day Comprehensive Complication Index 68 ± 32vs 44 ± 30, P < .001) and also displayed significantly longer intensive care (18 ± 25 vs 11 ± 21 days, P < .001) and hospital stay (56 ± 55 vs 33 ± 24 days, P < .001). Estimated costs were 44% higher compared to patients without myosteatosis. Multivariable analysis identified myosteatosis as an independent prognostic factor for major morbidity (odds ratio: 2.772, confidence interval: 1.516-5.066, P = .001). Adding myosteatosis to the well-established Balance-of-Risk-(BAR) score resulted in an increased prognostic value compared to the original BAR score. Myosteatosis may be a useful parameter to predict perioperative outcome in patients undergoing OLT, supporting the role of muscle quality (myosteatosis) over quantity (muscle mass) in this setting. K E Y W O R D Sbody composition, clinical decision-making, clinical research/practice, complication, liver transpla...

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“…It is also very important to choose the right endpoints when designing clinical trials. [76][77][78] The primary endpoint needs to be of significant clinical relevance. A surrogate endpoint has been defined as "a biomarker that is intended to substitute for a clinical endpoint" and generally is considered valid given a more rapid and frequent incidence and strong association with traditional endpoints.…”

Section: Pitfalls In Machine Preservation Studiesmentioning

confidence: 99%

Machine Perfusion: Cold versus Warm, versus Neither. Update on Clinical Trials

et al. 2020

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Machine perfusion (MP) preservation is potentially one of the most significant improvements in the field of liver transplantation in the last 20 years, and it has been considered a promising strategy for improved preservation and ex situ evaluation of extended criteria donor (ECD) organs. However, MP preservation adds significant cost and logistical considerations to liver transplantation. MP protocols are mainly classified according to the perfusion temperature with hypothermic machine perfusion (HMP) and normothermic machine perfusion (NMP) being the two categories most studied so far. After extensive preclinical work, MP entered the clinical setting, and there are now several studies that demonstrated feasibility and safety. However, because of the limited quality of clinical trials, there is no compelling evidence of superiority in preservation quality, and liver MP is still considered experimental in most countries. MP preservation is moving to a more mature phase, where ongoing and future studies will bring new evidence in order to confirm their superiority in terms of clinical outcomes, organ utilization, and cost-effectiveness. Here, we present an overview of all preclinical MP studies using discarded human livers and liver MP clinical trials, and discuss their results. We describe the different perfusion protocols, pitfalls in MP study design, and provide future perspectives. Recent trials in liver MP have revealed unique challenges beyond those seen in most clinical studies. Randomized trials, correct trial design, and interpretation of data are essential to generate the data necessary to prove if MP will be the new gold standard method of liver preservation.

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Evaluation of Early Allograft Function Using the Liver Graft Assessment Following Transplantation Risk Score Model

Cited by 129 publications

References 33 publications

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Machine Perfusion: Cold versus Warm, versus Neither. Update on Clinical Trials

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