The scarcity of donor livers has increased the interest in donation after cardiac death(DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD g...The scarcity of donor livers has increased the interest in donation after cardiac death(DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD grafts have been suboptimal due to an increased rate of complications, as well as decreased graft survival. These challenges have led to many developments in DCD donation outcome, as well as basic and translational research. In this article we review the unique characteristics of DCD donors, nuances of DCD organ procurement, the effect of prolonged warm and cold ischemia times, and discuss major studies that compared DCD to donation after brain death liver transplantation, in terms of outcomes and complications. We also review the different methods of donor treatment that has been applied to ameliorate DCD organ outcome, and we discuss the role of machine perfusion techniques in organ reconditioning. We discuss the two major perfusionmodels, namely, hypothermic machine perfusion and normothermic machine perfusion; we compare both methods, and delineate their major differences.展开更多
A better understanding of colorectal liver metastasis(CRLM)onco-genomics and the improvement of systemic treatments,including targeted and immune therapies,have shifted the paradigm of CRLM prognosis over the past two...A better understanding of colorectal liver metastasis(CRLM)onco-genomics and the improvement of systemic treatments,including targeted and immune therapies,have shifted the paradigm of CRLM prognosis over the past two decades.While 40%of the patients with colorectal cancers are likely to develop CRLM[and 50%of them to be non-resectable(nCRLM)],current oncologic management allows for the identification of a subset of CRLM patients with controlled diseases likely to highly benefit from curative resections and,perhaps,liver transplantation(LT).Indeed,the Norwegian SECA I trial in 2013(1)triggered a growing interest in LT as a curative treatment for non-resectable colorectal liver metastasis(nCRLM).This strategy is supported by several pilot studies reporting up to 80%of 5-year estimated overall survival(OS)after LT for CRLM,in contrast to the poor results obtained in the early 80’s series.展开更多
文摘The scarcity of donor livers has increased the interest in donation after cardiac death(DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD grafts have been suboptimal due to an increased rate of complications, as well as decreased graft survival. These challenges have led to many developments in DCD donation outcome, as well as basic and translational research. In this article we review the unique characteristics of DCD donors, nuances of DCD organ procurement, the effect of prolonged warm and cold ischemia times, and discuss major studies that compared DCD to donation after brain death liver transplantation, in terms of outcomes and complications. We also review the different methods of donor treatment that has been applied to ameliorate DCD organ outcome, and we discuss the role of machine perfusion techniques in organ reconditioning. We discuss the two major perfusionmodels, namely, hypothermic machine perfusion and normothermic machine perfusion; we compare both methods, and delineate their major differences.
文摘A better understanding of colorectal liver metastasis(CRLM)onco-genomics and the improvement of systemic treatments,including targeted and immune therapies,have shifted the paradigm of CRLM prognosis over the past two decades.While 40%of the patients with colorectal cancers are likely to develop CRLM[and 50%of them to be non-resectable(nCRLM)],current oncologic management allows for the identification of a subset of CRLM patients with controlled diseases likely to highly benefit from curative resections and,perhaps,liver transplantation(LT).Indeed,the Norwegian SECA I trial in 2013(1)triggered a growing interest in LT as a curative treatment for non-resectable colorectal liver metastasis(nCRLM).This strategy is supported by several pilot studies reporting up to 80%of 5-year estimated overall survival(OS)after LT for CRLM,in contrast to the poor results obtained in the early 80’s series.
