What’s Hot, What’s New at WTC—Clinical Science

Mueller, Thomas; Oberkofler, Christian E.; Clavien, P.A.

doi:10.1111/ajt.13081

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…This notion is corroborated by Samstein et al 2 who demonstrated a significant difference in MELD at transplant between DDLT and LDLT (mean, 20.3 vs. 15.2) among 1,036 liver transplant recipients. 3 Analysis of U.S. registry data by Hoehn et al 4 demonstrated a median MELD score of 15 among LDLTs compared to 19 among DDLTs. Between 2007 and 2012, only 14 LDLTs were performed among patients with MELD 28–34 and 3 among patients with MELD 35–40.…”

Section: Discussionmentioning

confidence: 99%

Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher

Perumpail

Yoo

Cholankeril

et al. 2016

JCTH

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Background and Aims: Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.). We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT.Methods: All U.S. adult LDLT recipients with MELD < 25 were evaluated using the 1995–2012 United Network for Organ Sharing registry. Survival following LDLT was stratified into three MELD categories (MELD < 15 vs. MELD 15–19 vs. MELD 20–24) and evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards models.Results: Overall, 2,258 patients underwent LDLT. Compared to patients with MELD < 15, overall 5-year survival following LDLT was similar among patients with MELD 15–19 (80.9% vs. 80.3%, p = 0.77) and MELD 20–24 (81.2% vs. 80.3%, p = 0.73). When compared to patients with MELD < 15, there was no significant difference in long-term post-LDLT survival among those with MELD 15–19 (HR: 1.11, 95% CI: 0.85−1.45, p = 0.45) and a non-significant trend towards lower survival in patients with MELD 20–24 (HR: 1.28, 95% CI: 0.91−1.81, p = 0.16). Only 14% of LDLTs were performed in patients with MELD 20–24 and the remaining 86% in patients with MELD < 20.Conclusion: LDLT is underutilized in patients with MELD 20 and higher.

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Section: Discussionmentioning

confidence: 99%

Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher

Perumpail

Yoo

Cholankeril

et al. 2016

JCTH

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“…The wider success of robotic kidney procurement and transplantation seems in fact mainly related to the more favorable anatomy of the kidney, compared with the complex vascular reconstruction needed in liver transplantation. (5) Clear benefits of the robotic approach for LDLT are yet to be demonstrated, and given the significant risk of morbidity and mortality associated with this procedure, only experienced surgical centers should perform it. (6) One of the most interesting perspectives is the possibility to integrate the robotic platform with intraoperative imaging guidance and augmented reality.…”

Section: Robotic Liver Donor Rightmentioning

confidence: 99%

Robotic liver donor right hepatectomy: A pure, minimally invasive approach

et al. 2017

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We read with great interest the article by Chen et al. recently published in Liver Transplantation. (1) We compliment the authors for their valuable contribution to the development of a minimally invasive approach to living donor liver transplantation (LDLT). In fact, although safety and feasibility of robotic surgery for liver resections have been described in the literature, the role of the robotic platform in liver transplantation is still a pioneering one. (2,3) In particular, we strongly support their cautiousness for the diffusion of this technique that is so well described in their manuscript. First of all, we should notice that the robotic platform is currently lacking liverspecific tools for hepatic dissection. (4) Therefore, the complex anatomy of the liver, together with the absence of inflow control and the need for a short ischemia time, may result in a higher risk for both donor and graft safety. The wider success of robotic kidney procurement and transplantation seems in fact mainly related to the more favorable anatomy of the kidney, compared with the complex vascular reconstruction needed in liver transplantation. (5) Clear benefits of the robotic approach for LDLT are yet to be demonstrated, and given the significant risk of morbidity and mortality associated with this procedure, only experienced surgical centers should perform it. (6) One of the most interesting perspectives is the possibility to integrate the robotic platform with intraoperative imaging guidance and augmented reality. (7) However, as is well depicted by Iuppa et al. in their editorial, it seems not possible to navigate the replacement of an open approach with a minimally invasive one without taking risks. (8) It is mandatory to preserve donor safety but also to identify a favorable milieu for such a transition, with an effort from institutions and local authorities to lead this development. We need formal indications by surgical societies to prevent reckless attempts by inexperienced surgeons, rigorous guidelines to guarantee that adverse events will not stop this process, and the development of robotic-friendly liver dissection tools to preserve donor safety. In conclusion, we believe that the development of robotic surgery for complex operations has been ignited and should not be discouraged. However, while developing new technologies, we should guarantee high quality standards and an ethics-driven surgical growth. (9) REFERENCES 1) Chen PD, Wu CY, Hu RH, Ho CM, Lee PH, Lai HS, et al.Robotic liver donor right hepatectomy: a pure, minimally invasive approach. Liver Transpl 2016;22:1509-1518. Address reprint requests to

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Pediatric liver transplantation: a North American perspective

Kerkar

Lakhole

2016

Expert Review of Gastroenterology & Hepatology

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Liver transplantation (LT) is an important component in the therapeutic armamentarium of managing end-stage liver disease. In North American children, biliary atresia remains the most common indication for LT compared to hepatitis C in adults, while hepatoblastoma is the most common liver tumor requiring LT, versus Hepatocellular carcinoma in adults. Rejection, lymphoproliferative disease, renal insufficiency, metabolic syndrome, recurrent disease, 'de novo' autoimmune hepatitis and malignancy require careful surveillance and prompt action in adults and children after LT. In children, specific attention to EBV viremia, growth, development, adherence and transition to the adult services is also required. Antibody mediated rejection and screening for donor specific antibodies is becoming important in managing liver graft dysfunction. Biomarkers to identify and predict tolerance are being developed. Machine perfusion and stem cells (iPS) to synthesize organs are generating interest and are a focus for research.

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What’s Hot, What’s New at WTC—Clinical Science

Cited by 4 publications

References 29 publications

Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher

Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher

Robotic liver donor right hepatectomy: A pure, minimally invasive approach

Pediatric liver transplantation: a North American perspective

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