The development of Transplant Oncology may worsen the liver gap and needs new technical options in liver transplantation

Soubrane, Olivier; Scatton, Olivier

doi:10.1097/sla.0000000000006086

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Graft evaluation [ 32 ] and specific scenarios that might benefit the most from HOPE still need to be explored to safely increase the donor pool for pediatric recipients through tailored preservation strategies [ 14 ]. In addition to PLT, HOPE may also facilitate the access to partial grafts for adult recipients with oncological indications in the context of the RAPID procedure (Resection And Partial Liver Segment 2/3 Transplantation with Delayed Total Hepatectomy) [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation

Rossignol,

Muller,

Ruiz

et al. 2024

Transpl Int

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Optimizing graft preservation is key for ex-situ split grafts in pediatric liver transplantation (PSLT). Hypothermic Oxygenated Perfusion (HOPE) improves ischemia-reperfusion injury (IRI) and post-operative outcomes in adult LT. This study compares the use of HOPE in ex-situ partial grafts to static cold storage ex-situ partial grafts (SCS-Split) and to the gold standard living donor liver transplantation (LDLT). All consecutive HOPE-Split, SCS-Split and LDLT performed between 2018–2023 for pediatric recipients were included. Post‐reperfusion syndrome (PRS, drop ≥30% in systolic arterial pressure) and reperfusion biopsies served as early indicators of IRI. We included 47 pediatric recipients (15 HOPE-Split, 17 SCS-Split, and 15 LDLT). In comparison to SCS-Split, HOPE-Split had a significantly shorter cold ischemia time (CIT) (470min vs. 538 min; p =0.02), lower PRS rates (13.3% vs. 47.1%; p = 0.04) and a lower IRI score (3 vs. 4; p = 0.03). The overall IRI score (3 vs. 3; p = 0.28) and PRS (13.3% vs. 13.3%; p = 1) after HOPE-Split were comparable to LDLT, despite a longer CIT (470 min vs. 117 min; p < 0.001). Surgical complications, one-year graft, and recipient survival did not differ among the groups. In conclusion, HOPE-Split mitigates early IRI in pediatric recipients in comparison to SCS-Split, approaching the gold standard of LDLT.

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Section: Discussionmentioning

confidence: 99%

HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation

Rossignol,

Muller,

Ruiz

et al. 2024

Transpl Int

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“…LT stands as a crucial life-saving procedure globally, with a growing demand for organs amidst a scarcity of donors. There is currently a shortage of organs available for patients on the waiting lists, which means the mortality rates of patients on the waiting list are increasing, as well as dropout rates [2,3]. As an example, in 2020, in France, over 1841 new patients were listed, revealing a stark contrast to the 1128 LTs performed, with 38% originated from donors aged over 65 (only 6% in 2000), resulting in about 800 patients still awaiting LTs at the end of the year.…”

Section: Introductionmentioning

confidence: 99%

“…As an example, in 2020, in France, over 1841 new patients were listed, revealing a stark contrast to the 1128 LTs performed, with 38% originated from donors aged over 65 (only 6% in 2000), resulting in about 800 patients still awaiting LTs at the end of the year. Moreover, due to the development of transplant oncology and possible new indications for LT (HCC after downstaging, intra-hepatic cholangiocarcinoma, and unresectable colorectal liver metastases), the gap between grafts and needs may soon worsen [3].…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation from Elderly Donors (≥85 Years Old)

Romano,

Cano,

Pietrasz

et al. 2024

Cancers

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Background: Despite the ongoing trend of increasing donor ages in liver transplantation (LT) setting, a notable gap persists in the availability of comprehensive guidelines for the utilization of organs from elderly donors. This study aimed to evaluate the viability of livers grafts from donors aged ≥85 years and report the post-LT outcomes compared with those from “ideal” donors under 40 years old. Methods: Conducted retrospectively at a single center from 2005 to 2023, this study compared outcomes of LTs from donors aged ≥85 y/o and ≤40 y/o, with the propensity score matching to the recipient’s gender, age, BMI, MELD score, redo-LT, LT indication, and cause of donor death. Results: A total of 76 patients received grafts from donors ≥85 y/o and were compared to 349 liver grafts from donors ≤40 y/o. Prior to PSM, the 5-year overall survival was 63% for the elderly group and 77% for the young group (p = 0.002). After PSM, the 5-year overall survival was 63% and 73% (p = 0.1). A nomogram, developed at the time of graft acceptance and including HCC features, predicted 10-year survival after LT using a graft from a donor aged ≥85. Conclusions: In the context of organ scarcity, elderly donors emerge as a partial solution. Nonetheless, without proper selection, LT using very elderly donors yields inferior long-term outcomes compared to transplantation from very young donors ≤40 y/o. The resulting nomogram based on pre-transplant criteria allows for the optimization of elderly donor/recipient matching to achieve satisfactory long-term results, in addition to traditional matching methods.

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ASO Author Reflections: Ante Situm Hepatectomy—When Transplant and Resection Techniques Are Combined for Extreme Liver Surgery

Addeo,

de Mathelin,

Paul

et al. 2024

Ann Surg Oncol

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The development of Transplant Oncology may worsen the liver gap and needs new technical options in liver transplantation

Cited by 5 publications

References 12 publications

HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation

HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation

Liver Transplantation from Elderly Donors (≥85 Years Old)

ASO Author Reflections: Ante Situm Hepatectomy—When Transplant and Resection Techniques Are Combined for Extreme Liver Surgery

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