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Organ Reconditioning and Machine Perfusion in Transplantation
Get PDFSociety’s self-sufficiency in terms of organ replacement is still far away from being achieved, given the large disparity between transplant demand and donor organ availability. In the attempt to reduce this discrepancy and expand the donor pool, the transplant community has progressively increased the utilisation of extended-criteria donors (ECD) such as older donors, donors with comorbidities and donation after circulatory death (DCD). The main challenge preventing a wider utilisation of ECD and DCD allografts is the higher susceptibility to the ischemia-reperfusion injury (IRI) (1), an unavoidable part of the transplantation process. For this reason, in the last decades, there has been an exponential development on organ reconditioning strategies, in order to enable graft resuscitation and viability assessment prior to implantation (2)
Liver transplantation for neuroendocrine neoplasms liver metastases
No full textLiver transplantation (LT) can be proposed for a selected group of patients with Neuroendocrine neoplasm liver metastases (NELM) that fulfill the well-established selection criteria. Indeed, outcomes of LT for NELM have improved after the introduction of such criteria in the mid-2000s, like the Milan criteria. However, it is necessary to refine the process of selecting patients who are eventually eligible for transplantation and also for liver resection, taking into account the most recent advances in procedures such as the three-dimension imaging and robotic approach. A better understanding of the tumor molecular profiling may be useful in characterizing tumor biology and behavior and could be incorporated into the therapeutic decision-making process. Alternative techniques such as Split, LDLT (classical technique or RAPID-ALDAPT variation) should be offered to NELM transplant candidates. Despite a high rate of post-transplant recurrence, such lesions should be treated aggressively using a multidisciplinary approach with a combination of therapie
The place of liver transplantation in the treatment of rare primary and secondary lesions
No full textLiver transplantation and vascular tumours.
No full textSummary Based on analysis of the literature and of the audited ELITA (European Liver Intestinal Transplant Association)-ELTR (European Liver Transplant Registry) data, the place of liver transplantation (LT) in the treatment of vascular tumours is discussed. Hepatic epithelioid haemangioendothelioma has currently become a good indication for LT with 5- and 10-year post-LT patient survival rates of 83% and 74% respectively and 5- and 10-year recurrence-free survival rates of 82% and 64% respectively. In contrast, the results of LT for haemangiosarcoma (HAS) are disastrous with an universal tumour recurrence within 6 months and no single patient survival after 2 years. Therefore, HAS remains an absolute contraindication to LT. The value of LT in the treatment of infantile haemangioendothelioma is more difficult to evaluate because of the very reduced number of reported cases and because of the often difficult differential diagnosis with angiosarcoma. LT should be reserved to those children not responding to medical treatment on the condition that sarcomatous modifications are excluded by expert pathologists to avoid a futile transplant procedure
Comment on Experience With Establishing a Robotic Donor Hepatectomy Program for Pediatric Liver Transplantation
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