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RISS 인기검색어
- 검색키워드
- 저자 : ( Christophe Duvoux ) (검색결과 2 건)
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European Liver Transplant Registry: Achievements and Evolution within a 30-Year History
( Rene Adam Vincent Karam ),( Valerie Cailliez ),( Christophe Duvoux ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Methods: Data from participating centers are collected on a voluntary basis at regular intervals using a two-part, standardized questionnaire designed by the ELTR Coordinating Committee to capture information on donors and recipients. Part 1 focuses on donor and recipient data, on technical aspects of liver transplantation and induc tion immunosuppression. Part 2 comprises questions on post-transplant mortality, graft failure and maintenance immunosuppression during patient follow-up. Audits of contributing centers are randomly performed each year to assess the quality of the data. The methods used to populate the registry and obtain the data have been de scribed previously.1 The ELTR represents around 95% of all the LT procedures performed in Europe. It is in close connection with all the national and multi-national organ sharing organizations for the exchange and quality control of the data. Results: We analyzed the ELTR data within the period from January 1988 to December 2016 with 147,161 LT. Patient survival was 83% at 1 year (yr), 71% at 5 yrs, 61% at 10 yrs, and 41% at 20 yrs. Forty-six percent of deaths and 67% of re-LTs occur within the first year after LT. Cirrhosis was the most frequent indication (50%) followed by cancer (17%), cholestatic diseases (10%), acute hepatic failure (9%) and metabolic disease (6%). 10-yr patient survival was 59% for cirrhosis and for acute hepatic failure, and 50% for cancer (P < 0.001). In cirrhotic patients, 10-yr survival was better for primary biliary cirrhosis (71%) than for alcoholic or virus-related cirrhosis (58%)(P < 0.001). In viral cirrhosis patients, 10-yr survival of HBV patients was better than HCV (68% vs 52%, P < 0.01). 10-yr patient survival in pediatric recipients was 78%. Age influenced 10-yr survival in adults (66%: 18-45 yrs, 59%: 45-60 yrs, 49%: 60-70 yrs, 40% in septuagenarians) (P < 0.001). In recent years, alter natives to the full-size graft LT after brain death (FSDBD) represent more than 20% overall, and more than 70% in pediatric patients. The best 10-yr graft survival was obtained with living donors and split-liver grafts (61% and 58%, respectively), intermediate with reduced and Full-Size Donor Brain Death (DBD) grafts (54% and 53%, respectively), and the worst with Donor Cardiac Death (DCD) and domino grafts (47% and 44%, respectively). Recently, different new cold static preservation solutions have been increasingly used as alternative to the UW. 10-yr graft survival for the main solutions was 62% for UW, 61% for Celsior and IGL-1, and 55% for HTK. Ac cordingly, this latter solution has been independently associated to a risk of graft loss in a recent publication.2 Comments: The ELTR has become the reference to assess the outcome and evolution of LT in Europe. Along its 30-year history, it has contributed to better define the indications of LT, to report the results of living related LT, to assess the risk for the living donor, as well as to choose the best preservation solutions for the liver graft (2) and the type of immunosuppression.3 It represents a model of European scientific collaboration that gathers pro spectively and analyses continuously more than 150,000 liver transplantations. With the analysis of this Big Data, ELTR provides valuable information not only to the professionals, but also to the patients.
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( Beat Müllhaupt ),( Paul Kwo ),( Kosh Agarwal ),( Christophe Duvoux ),( Francois Durand ),( Marcus Peck-Radosavljevic ),( Eric M. Yoshida ),( Leslie Lilly ),( Bernard Willems ),( Hugo Vargas ),( Prin 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: The aim of this analysis is to evaluate outcomes in patients who underwent liver transplant after initiating treatment with ledipasvir (LDV)/sofosbuvir (SOF)+ribavirin (RBV) in the SOLAR-1 and SOLAR-2 trials. Methods: We combined data from the SOLAR-1 and SOLAR-2 studies, in which 7 groups of patients with HCV genotype (GT) 1 or 4 were randomized to receive 12 or 24 weeks of LDV/SOF+ RBV: patients without a transplant with 1) Child-Pugh-Turcotte (CPT) B or 2) CPT C cirrhosis; or transplanted patients with 3) no cirrhosis (F0 to F3), 4) CPT A, 5) CPT B or, 6) CPT C cirrhosis, or 7) fibrosing cholestatic hepatitis. Results: Seventeen patients underwent liver transplantation during the study. For all but one patient, this was the first liver transplant. Six were CPT B at screening (5 Group 1, 1 Group 5) and 11 were CPT C (Group 2). Median baseline MELD score was 17 (range 7-23), with the majority (11/17) having scores ≥15. Seven patients underwent transplant prior to completing their full course of treatment. All patients were HCV RNA <LLOQ at the time of liver transplant. All but one patient (94%, 16/17) maintained virologic response 12 weeks after transplant (pTVR12). All patients who achieved pTVR12 received at least 11 weeks of LDV/SOF+RBV. The one patient who did not achieve pTVR12 discontinued study drug on day 21 and underwent liver transplant the following day. Conclusions: Few patients with decompensated cirrhosis treated in the SOLAR studies underwent liver transplantation after initiating LDV/SOF+RBV therapy. For the 17 who did undergo transplant, 94% achieved pTVR12. The data suggest that 11 weeks of treatment prior to transplantation can prevent reinfection of the graft. Future studies are needed to assess the optimal timing and length of treatment in the peri-transplant setting.
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