BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and com...BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and comprehensive complication index(CCI)in predicting outcomes after SPK.METHODS Data for patients undergoing SPK between 1999-2019 were analyzed.Information on recipients’baseline characteristics,peri-operative management and postoperative complications were collated.Length of hospital stay(LOS)was the primary study outcome,and the associations with CDC and CCI were evaluated using Spearman’s(ρ)correlation coefficients.RESULTS In the study period,data were available for 128 patients(female n=44,34.4%).Sixty-nine patients had at least one complication with the highest CDC grade of I,II,III,and IV in 8(6.3%),22(17.2%),32(25%),and 7(5.5%)patients,respectively. The mean LOS was 21.4 ± 17.7 days. Both classification systems were correlated with LOS, yet CCI was stronger(Spearman’s ρ: 0.694 vs 0.602, P < 0.001). Female patients (P = 0.019) and patients with pre-transplant cardiovascularevents (P = 0.02) had longer LOS. After adjusted multivariable analysis, the link between LOS and both theCDC and CCI remained relevant. CCI had a superior fit compared to CDC (r2 = 0.729 vs r2 = 0.481), with every 10CCI points being associated with a 5.27 day (P < 0.001) increased LOS.CONCLUSIONThis study showed that the CCI was better linked with LOS compared to CDC and might represent a useful scoreto evaluate the overall burden of postoperative complications in patients undergoing SPK.展开更多
BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to t...BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.展开更多
The last decade has been notable for increasing high-quality research and dramatic improvement in outcomes with dynamic liver preservation.Robust evidence from numerous randomized controlled trials has been pooled by ...The last decade has been notable for increasing high-quality research and dramatic improvement in outcomes with dynamic liver preservation.Robust evidence from numerous randomized controlled trials has been pooled by meta-analyses,providing the highest available evidence on the protective effect of machine perfusion(MP)over static cold storage in liver transplantation(LT).Based on a protective effect with less complications and improved graft survival,the field has seen a paradigm shift in organ preservation.This editorial focuses on the role of MP in LT and how it could become the new“gold standard”.Strong collaborative efforts are needed to explore its effects on long-term outcomes.展开更多
Despite being the second most frequent primary liver tumor in humans,early diagnosis and treatment of cholangiocarcinoma(CCA)are still unsatisfactory.In fact,survival after 5 years is expected in less than one fourth ...Despite being the second most frequent primary liver tumor in humans,early diagnosis and treatment of cholangiocarcinoma(CCA)are still unsatisfactory.In fact,survival after 5 years is expected in less than one fourth of patients diagnosed with this disease.Rare incidence,late appearance of symptoms and heterogeneous biology are all factors contributing to our limited knowledge of this cancer and determining its poor prognosis in the clinical setting.Several efforts have been made in the last decades in order to achieve an improved classification/understanding with regard to the diverse CCA forms.Location within the biliary tree has helped to distinguish between intrahepatic,perihilar and distal CCA types.Sequence analysis contributed to identifying several characteristic genetic aberrations in CCA that may also serve as possible targets for therapy.Novel findings are expected to significantly improve the management of this malignancy in the near future.In this changing scenario our review focuses on the current and future strategies for CCA treatment.Both systemic and surgical treatments are discussed in detail.The results of the main studies in this field are reported,together with the ongoing trials.The current findings suggest that an integrated multidisciplinary approach to this malignancy would be helpful to improve its outcome.展开更多
For patients with fulminant liver failure and end-stage liver disease,liver transplantation remains the only effective treatment.Over the years,as a result of the ageing population,the average age of liver transplant ...For patients with fulminant liver failure and end-stage liver disease,liver transplantation remains the only effective treatment.Over the years,as a result of the ageing population,the average age of liver transplant donors and recipients has increased and currently about one quarter of patients receiving transplantation in the United States are above the age of 65.Recently,a study reported that patients aged 65 years or older had lower one-year survival compared to a younger cohort.Herein,we express our opinion about this interesting publication.展开更多
Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been de...Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been debated,due to mounting evidence that they could be harmful rather than beneficial.Based on recent published articles,Liu et al reported that the routine use of prophylactic drains in total laparoscopic distal gastrectomy might not be necessary for all patients.Herein,we express our opinion regarding this interesting publication.展开更多
Reduced-order models offer a cost-effective and accurate approach to analyzing high-dimensional combustion problems.These surrogate models are built in a data-driven manner by combining computational fluid dynamics si...Reduced-order models offer a cost-effective and accurate approach to analyzing high-dimensional combustion problems.These surrogate models are built in a data-driven manner by combining computational fluid dynamics simulations with Proper Orthogonal Decomposition(POD)for dimensionality reduction and Gaussian Process Regression(GPR)for nonlinear regression.However,these models can yield physically inconsistent results,such as negative mass fractions.As a linear decomposition method,POD complicates the enforcement of constraints in the reduced space,while GPR lacks inherent provisions to ensure physical consistency.To address these challenges,this study proposes a novel constrained reduced-order model framework that enforces physical consistency in predictions.Dimensionality reduction is achieved by downsampling the dataset through low-cost Singular Value Decomposition(lcSVD)using optimal sensor placement,ensuring that the retained data points preserve physical information in the reduced space.We integrate finite-support parametric distribution functions,such as truncated Gaussian and beta distribution scaled to the interval[a,b],into the GPR framework.These bounded likelihood functions explicitly model the observational noise in the bounded space and use variational inference to approximate analytically intractable posterior distributions,producing GP estimations that satisfy physical constraints by construction.We validate the proposed methods using a synthetic dataset and a benchmark case of one-dimensional laminar NH3/H2 flames.The results show that the thermo-chemical state predictions comply with physical constraints while maintaining the high accuracy of unconstrained reduced-order models.展开更多
文摘BACKGROUND Detailed data on the relation of post-operative complications with clinical outcomes after simultaneous pancreas-kidney(SPK)transplantation is lacking.AIM To compare Clavien-Dindo classification(CDC)and comprehensive complication index(CCI)in predicting outcomes after SPK.METHODS Data for patients undergoing SPK between 1999-2019 were analyzed.Information on recipients’baseline characteristics,peri-operative management and postoperative complications were collated.Length of hospital stay(LOS)was the primary study outcome,and the associations with CDC and CCI were evaluated using Spearman’s(ρ)correlation coefficients.RESULTS In the study period,data were available for 128 patients(female n=44,34.4%).Sixty-nine patients had at least one complication with the highest CDC grade of I,II,III,and IV in 8(6.3%),22(17.2%),32(25%),and 7(5.5%)patients,respectively. The mean LOS was 21.4 ± 17.7 days. Both classification systems were correlated with LOS, yet CCI was stronger(Spearman’s ρ: 0.694 vs 0.602, P < 0.001). Female patients (P = 0.019) and patients with pre-transplant cardiovascularevents (P = 0.02) had longer LOS. After adjusted multivariable analysis, the link between LOS and both theCDC and CCI remained relevant. CCI had a superior fit compared to CDC (r2 = 0.729 vs r2 = 0.481), with every 10CCI points being associated with a 5.27 day (P < 0.001) increased LOS.CONCLUSIONThis study showed that the CCI was better linked with LOS compared to CDC and might represent a useful scoreto evaluate the overall burden of postoperative complications in patients undergoing SPK.
文摘BACKGROUND Aorto-hepatic conduits(AHCs)are an effective revascularization method for liver allografts when the native hepatic artery is unusable.Various studies have confirmed that outcomes with AHCs are inferior to those with native hepatic artery inflow.AIM To investigate the published evidence on the outcomes according to different inflow site for AHCs.METHODS A systematic search was conducted for studies reporting on AHCs in liver transplantation over the last 10 years(January 2014 onwards).Two independent reviewers selected articles,assessed quality,and evaluated bias in the included systematic reviews.The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.The protocol was registered with PROSPERO(CRD42024545810).Review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis statement standards.RESULTS Fourteen studies identified a total of 32486 deceased donor liver transplants,of which 1136(3.5%)required AHCs.The most frequent indications for AHC use included poor arterial flow,intimal dissections,and hepatic artery thrombosis.Among all AHCs,207(18.2%)were supra-coeliac(SC)AHCs,738(65.0%)infrarenal(IR)AHCs,25(2.2%)iliac artery conduits,and 166(14.6%)had unspecified origins.Pooled analysis revealed comparable demographic characteristics.The median follow-up duration ranged from 18 to 52 months.There were no significant differences in early occlusions of AHCs[odds ratio(OR)=0.94(0.48,1.84);P=0.86],late occlusions of AHCs[OR=0.46(0.16,1.32);P=0.15],early allograft dysfunction[OR=0.82(0.46,1.47);P=0.51],biliary complications[OR=1.10(0.69,1.76);P=0.68],post-transplant renal replacement therapy(RRT)requirement[OR=1.12(0.72,1.72);P=0.62],and major surgical complications(Clavien-Dindo>3b)[OR=1.06(0.70,1.61);P=0.79].The median duration for graft occlusion was approximately 142 days,ranging from 13 to 3313 days.One-year graft and patient survival rates for SC conduits were 77%to 81.1%and 80%to 85.1%,respectively.For IR conduits,one-year graft and patient survival rates were 66%to 79.1%and 73%to 88.3%,respectively.Five-year graft and patient survival rates for SC conduits were 53.9%to 67%and 67.8%to 74%,respectively.For IR conduits,five-year graft and patient survival rates were 50%to 56%and 56%to 64.9%,respectively.CONCLUSION Considering these findings,there is no significant difference in early and late outcomes between SC and IR AHCs,although there is a discernible tendency towards higher late occlusion rates in the IR group.
文摘The last decade has been notable for increasing high-quality research and dramatic improvement in outcomes with dynamic liver preservation.Robust evidence from numerous randomized controlled trials has been pooled by meta-analyses,providing the highest available evidence on the protective effect of machine perfusion(MP)over static cold storage in liver transplantation(LT).Based on a protective effect with less complications and improved graft survival,the field has seen a paradigm shift in organ preservation.This editorial focuses on the role of MP in LT and how it could become the new“gold standard”.Strong collaborative efforts are needed to explore its effects on long-term outcomes.
文摘Despite being the second most frequent primary liver tumor in humans,early diagnosis and treatment of cholangiocarcinoma(CCA)are still unsatisfactory.In fact,survival after 5 years is expected in less than one fourth of patients diagnosed with this disease.Rare incidence,late appearance of symptoms and heterogeneous biology are all factors contributing to our limited knowledge of this cancer and determining its poor prognosis in the clinical setting.Several efforts have been made in the last decades in order to achieve an improved classification/understanding with regard to the diverse CCA forms.Location within the biliary tree has helped to distinguish between intrahepatic,perihilar and distal CCA types.Sequence analysis contributed to identifying several characteristic genetic aberrations in CCA that may also serve as possible targets for therapy.Novel findings are expected to significantly improve the management of this malignancy in the near future.In this changing scenario our review focuses on the current and future strategies for CCA treatment.Both systemic and surgical treatments are discussed in detail.The results of the main studies in this field are reported,together with the ongoing trials.The current findings suggest that an integrated multidisciplinary approach to this malignancy would be helpful to improve its outcome.
文摘For patients with fulminant liver failure and end-stage liver disease,liver transplantation remains the only effective treatment.Over the years,as a result of the ageing population,the average age of liver transplant donors and recipients has increased and currently about one quarter of patients receiving transplantation in the United States are above the age of 65.Recently,a study reported that patients aged 65 years or older had lower one-year survival compared to a younger cohort.Herein,we express our opinion about this interesting publication.
文摘Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal surgery.Recently,the utilization of such drains has been debated,due to mounting evidence that they could be harmful rather than beneficial.Based on recent published articles,Liu et al reported that the routine use of prophylactic drains in total laparoscopic distal gastrectomy might not be necessary for all patients.Herein,we express our opinion regarding this interesting publication.
基金support of the HECO2-Axe-1 project,funded by the Walloon Region under the REPowerEU initiative,Bel-giumfinancial support from the ERC proof of concept grant INVENT(grant agreement No:101123406).
文摘Reduced-order models offer a cost-effective and accurate approach to analyzing high-dimensional combustion problems.These surrogate models are built in a data-driven manner by combining computational fluid dynamics simulations with Proper Orthogonal Decomposition(POD)for dimensionality reduction and Gaussian Process Regression(GPR)for nonlinear regression.However,these models can yield physically inconsistent results,such as negative mass fractions.As a linear decomposition method,POD complicates the enforcement of constraints in the reduced space,while GPR lacks inherent provisions to ensure physical consistency.To address these challenges,this study proposes a novel constrained reduced-order model framework that enforces physical consistency in predictions.Dimensionality reduction is achieved by downsampling the dataset through low-cost Singular Value Decomposition(lcSVD)using optimal sensor placement,ensuring that the retained data points preserve physical information in the reduced space.We integrate finite-support parametric distribution functions,such as truncated Gaussian and beta distribution scaled to the interval[a,b],into the GPR framework.These bounded likelihood functions explicitly model the observational noise in the bounded space and use variational inference to approximate analytically intractable posterior distributions,producing GP estimations that satisfy physical constraints by construction.We validate the proposed methods using a synthetic dataset and a benchmark case of one-dimensional laminar NH3/H2 flames.The results show that the thermo-chemical state predictions comply with physical constraints while maintaining the high accuracy of unconstrained reduced-order models.
