Maria Hoppe-Lotichius - Academia.edu (original) (raw)
Papers by Maria Hoppe-Lotichius
Transplantation Proceedings, 2020
Background. In past decades, liver transplant (LT) patients were not routinely screened for hepat... more Background. In past decades, liver transplant (LT) patients were not routinely screened for hepatitis E virus (HEV) infection, and thus it might have been misdiagnosed as an acute rejection episode. Our aim was to analyze a real-world cohort of LT patients who presented with at least 1 episode of biopsy-proven acute rejection (BPAR) and suffered from persistent elevated transaminases, to evaluate the frequency of HEV infection misdiagnosed as a rejection episode. Methods. Data from 306 patients transplanted between 1997 and 2017, including 565 liver biopsies, were analyzed. Biopsies from patients suffering from hepatitis C (n ¼ 79; 25.8%) and from patients who presented with a Rejection Activity Index <5 (n ¼ 134; 43.8%) were excluded. A subgroup of 74 patients (with 134 BPAR) with persistently elevated liver enzymes was chosen for further HEV testing. Results. Positive HEV IgG was detectable in 18 of 73 patients (24.7%). Positive HEV RNA was diagnosed in 3 of 73 patients with BPAR (4.1%). Patients with HEV infection showed no difference in etiology of the liver disease, type of immunosuppression, or median Rejection Activity Index. Conclusion. Few HEV infections were misdiagnosed as acute rejection episodes in this real-world cohort. Thus, HEV infection is an infrequent diagnosis in cases with persistent elevated liver enzymes and BPAR after LT.
HPB, 2019
Background: Liver grafts from donors with chronic and active history of alcohol abuse are usually... more Background: Liver grafts from donors with chronic and active history of alcohol abuse are usually discarded for liver transplantation (LT). Our aim is to report our results with those grafts. Methods: We performed a case control study on 113 LT from 2015 to 2016. Inclusion criteria for the study group were adult patients transplanted with livers from donors with chronic active alcohol abuse. The control group consisted in randomly matched LTs with similar recipient (R) and donor (D) age, sex and ischemia time, performed in those two years with standard livers. The ratio of case-tocontrol was 1:2. Short term results, biochemical data from day 0 to 30 after LT, complications and survival are reported. Data were compared. P 0.5 was considered statistically significant. Results: The study group consisted of 4 LT whereas 8 patients transplanted with standard grafts served as control group. Mean micro-macro steatosis percentage in livers from donors with alcohol abuse was 36AE16%. Laboratory exams showed statistically significant worse values for Aspartate Aminotransferase and International Normalized Ratio at Day 0, and Total Bilirubin at day 8, for livers from donors with alcohol abuse. No statistical difference was found in the occurrence of rejection episodes. All patients of both groups are alive after 347AE264 days (range 24-725) from LT. Conclusion: May be it's time to reconsider the use for LT of livers from donors with chronic and active alcohol abuse.
HPB, 2019
Background: Hepatic artery thrombosis (HAT) is a rare but severe complication after liver transpl... more Background: Hepatic artery thrombosis (HAT) is a rare but severe complication after liver transplantation (LT). The aim was to study risk factors of HAT, notably a recipient celiac trunk stenosis and a variant anatomy of the recipient hepatic artery, in our single center experience. Methods: Between 1997 and 2013, a total of 709 LT in 618 patients were performed at our center. Early (<30 days) HAT (EHAT) occurred in 18, late HAT (LHAT) in 12 patients. Patients with EHAT and LHAT were compared to a randomized control group of 100 patients without HAT. Recipient celiac trunk stenosis was assessed on pre-LT imaging by two independent radiologists. Univariate analysis by Fishers exact test and a multivariate logistic regression were used the EHAT group, a descriptive analysis in the LHAT group. Results: In univariate analysis, stenosis of the recipient celiac trunk, presence of accessory hepatic arteries, retransplantation, use of an aortic conduit and the amount of transfused FFP were significantly associated with the development of EHAT. Upon multivariate regression, only a stenosis of the celiac trunk (p=0.001) and retransplantation (p=0.002) were significantly associated with EHAT. LHAT seemed to be associated with the use of an aortic conduit and retransplantation. Conclusion: This is the first study to identify a stenosis of the recipient celiac trunk as a significant risk factor for the development of early hepatic artery thrombosis after LT. Patients should be systematically screened.
72. Jahrestagung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten mit Sektion Endoskopie – 11. Herbsttagung der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie gemeinsam mit den Arbeitsgemeinschaften der DGAV, 2017
Liver Transplantation, 2019
In patients with hepatocellular carcinoma (HCC) meeting the Milan criteria (MC), the benefit of l... more In patients with hepatocellular carcinoma (HCC) meeting the Milan criteria (MC), the benefit of locoregional therapies (LRTs) in the context of liver transplantation (LT) is still debated. Initial biases in the selection between treated and untreated patients have yielded conflicting reported results. The study aimed to identify, using a competing risk analysis, risk factors for HCC-dependent LT failure, defined as pretransplant tumor-related delisting or posttransplant recurrence. The study was registered at www.clini caltr ials.gov (identification number NCT03723304). In order to offset the initial limitations of the investigated population, an inverse probability of treatment weighting (IPTW) analysis was used: 1083 MC-in patients (no LRT = 182; LRT = 901) were balanced using 8 variables: age, sex, Model for End-Stage Liver Disease (MELD) value, hepatitis C virus status, hepatitis B virus status, largest lesion diameter, number of nodules, and alpha-fetoprotein (AFP). All the covariates were available at the first referral. After the IPTW, a pseudo-population of 2019 patients listed for LT was analyzed, comparing 2 homogeneous groups of untreated (n = 1077) and LRT-treated (n = 942) patients. Tumor progression after LRT was the most important independent risk factor for HCC-dependent failure (subhazard ratio [SHR], 5.62; P < 0.001). Other independent risk factors were major tumor diameter, AFP, MELD, patient age, male sex, and period of wait-list registration. One single LRT was protective compared with no treatment (SHR, 0.51; P < 0.001). The positive effect was still observed when 2-3 treatments were performed (SHR, 0.66; P = 0.02), but it was lost in the case of ≥4 LRTs (SHR, 0.80; P = 0.27). In conclusion, for MC-in patients, up to 3 LRTs are beneficial for success in intention-to-treat LT patients, with a 49% to 34% reduction in failure risk compared with untreated patients. This benefit is lost if more LRTs are required. A poor response to LRT is associated with a higher risk for HCC-dependent transplant failure.
Journal of Clinical Medicine
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Frontiers in Oncology
BackgroundLong-term survival after liver transplantation (LT) for hepatocellular cancer (HCC) con... more BackgroundLong-term survival after liver transplantation (LT) for hepatocellular cancer (HCC) continues to increase along with the modification of inclusion criteria. This study aimed at identifying risk factors for 5- and 10-year overall and HCC-specific death after LT.MethodsA total of 1,854 HCC transplant recipients from 10 European centers during the period 1987–2015 were analyzed. The population was divided in three eras, defined by landmark changes in HCC transplantability indications. Multivariable logistic regression analyses were used to evaluate the significance of independent risk factors for survival.ResultsFive- and 10-year overall survival (OS) rates were 68.1% and 54.4%, respectively. Two-hundred forty-two patients (13.1%) had HCC recurrence. Five- and 10-year recurrence rates were 16.2% and 20.3%. HCC-related deaths peaked at 2 years after LT (51.1% of all HCC-related deaths) and decreased to a high 30.8% in the interval of 6 to 10 years after LT. The risk factors fo...
Supplemental Material for Long-term observation of hepatocellular carcinoma recurrence after live... more Supplemental Material for Long-term observation of hepatocellular carcinoma recurrence after liver transplantation at a European transplantation centre by Friedrich Foerster, Maria Hoppe-Lotichius, Johanna Vollmar, Jens U Marquardt, Arndt Weinmann, Marcus-Alexander Wörns, Gerd Otto, Tim Zimmermann and Peter R Galle in United European Gastroenterology Journal
Einleitung: Verdacht auf Klatskin-Tumor ist eine häufige Zuweisungsdiagnose bei Patienten mit hil... more Einleitung: Verdacht auf Klatskin-Tumor ist eine häufige Zuweisungsdiagnose bei Patienten mit hilärer Gallengangsstenose. Durch präoperative Diagnostik gelingt es oft nicht, gutartige und bösartige Befunde im Vorfeld zu unterscheiden. In der folgenden retrospektiven Analyse wurde[for full text, please go to the a.m. URL]
Transplantation Journal, 2012
Journal of Hepatology, 2012
However, they did not differ regarding total cholesterol, HDL and LDL-cholesterol, triglycerides ... more However, they did not differ regarding total cholesterol, HDL and LDL-cholesterol, triglycerides and blood pressure. Table shows CB results. Cardiovascular biomarkers results Variable NASH (n = 19) LTR (n = 42) Controls
European Journal of Gastroenterology & Hepatology, 2019
Background and aim Body composition has emerged as a prognostic factor for end-stage liver diseas... more Background and aim Body composition has emerged as a prognostic factor for end-stage liver disease. We therefore investigated muscle mass, body fat and other clinical-pathological variables as predictors of posttransplant survival. Methods A total of 368 patients, who underwent orthotopic liver transplantation (OLT) at our institution, were assessed prior to OLT and followed for a median of 9.0 years (range 2.0-10.0 years) after OLT. Psoas, erector spinae and the combined paraspinal muscle area, as well as the corresponding indices normalized by body-height squared, were quantified by a lumbar (L3) cross-sectional computed tomography. In addition, absolute body fat and bone density were estimated by the same computed tomography approach. Results Paraspinal muscle index (PSMI) (hazard ratio 0.955, P = 0.039) and hepatitis C (hazard rati 1.498, P = 0.038) were independently associated with post-OLT mortality. In contrast, body fat and bone density did not significantly affect post-OLT outcome (P > 0.05). The PSMI also predicted one-year posttransplant mortality with a receiver operating characteristics-area under the curve of 0.671 [95% confidence interval (CI) 0.589-0.753, P < 0.001) in male patients and outperformed individual psoas and erector spinae muscle group assessments in this regard. In male patients, a defined PSMI cutoff (<18.41 cm 2 /m 2) was identified as suitable determinant for sarcopenia and posttransplant one-year mortality. In female OLT-recipients, however, sarcopenia was not predictive for patient survival und a women-specific cutoff could not be derived from this study.
Journal of Gastrointestinal and Liver Diseases, 2019
Background & Aims: Fibrosis progression (FP) after liver transplantation (LT) increases morbidity... more Background & Aims: Fibrosis progression (FP) after liver transplantation (LT) increases morbidity and mortality. Biomarkers are needed for early prediction of FP. A recipient's seven-gene cirrhosis risk score (CRS) has been associated with FP, especially in non-transplant cohorts. A broader validation of CRS, including the genotype of the donor-organ and HCV-negative patients is lacking. We therefore analyzed the impact of donor-and recipient-specific genotypes on FP after LT in a large cohort of HCV-positive and-negative patients. Method: Genotyping from liver biopsies (n=201 donors) and peripheral blood (n=442 recipients) was performed. Cirrhosis risk score was correlated with FP at 1 and 5 years after LT. Results: Fibrosis ≥F2 was documented in 26.5% of the recipients' CRS group (R-CRS) (defined by recipient's genotype) and in 23.4% of the donors' CRS-group (D-CRS) (defined by donor's genotype). Cumulative incidence for fibrosis ≥F2 was higher in patients with D-CRS >0.7 (p=0.03). While the R-CRS showed no prognostic relevance, D-CRS >0.7 was associated with higher hazard ratios (HRs) for fibrosis ≥F2 (HR=2.04; p=0.01), especially in HCV-negative patients (HR=2.59, p=0.03). Donors' CRS >0.7 was associated with higher risk for ≥F2 in 1-year protocol biopsies (p<0.001). Among the patients in whom both the recipient's and donor's CRS were available, fibrosis ≥F2 was encountered more frequently in patients with a D-CRS >0.7, in combination with any R-CRS, compared to patients with D-CRS scores ≤0.7 (p=0.034). Donors' AZIN1, STXBP5L, TRPM5 genotypes carried a higher risk for fibrosis ≥F2 in subgroups. Conclusion: High D-CRS >0.7 predicted early FP after LT, especially in HCV negative patients.
JAMA surgery, 2021
Importance Living-donor liver transplant (LDLT) offers advantages over deceased-donor liver trans... more Importance Living-donor liver transplant (LDLT) offers advantages over deceased-donor liver transplant (DDLT) of improved intention-to-treat outcomes and management of the shortage of deceased-donor allografts. However, conflicting data still exist on the outcomes of LDLT in patients with hepatocellular carcinoma (HCC). Objective To investigate the potential survival benefit of an LDLT in patients with HCC from the time of waiting list inscription. Design, Setting, and Participants This multicenter cohort study with an intention-to-treat design analyzed the data of patients aged 18 years or older who had an HCC diagnosis and were on a waiting list for a first transplant. Patients from 12 collaborative centers in Europe, Asia, and the US who were on a transplant waiting list between January 1, 2000, and December 31, 2017, composed the international cohort. The Toronto cohort comprised patients from 1 transplant center in Toronto, Ontario, Canada who were on a waiting list between Jan...
Importance Accurate preoperative prediction of hepatocellular carcinoma (HCC) recurrence after li... more Importance Accurate preoperative prediction of hepatocellular carcinoma (HCC) recurrence after liver transplant is the mainstay of selection tools used by transplant-governing bodies to discern candidacy for patients with HCC. Although progress has been made, few tools incorporate objective measures of tumor biological characteristics, resulting in inclusion of patients with high recurrence rates and exclusion of others who could otherwise be cured. Objective To externally validate the New York/California (NYCA) score, a recently published multi-institutional US HCC selection tool that was the first model incorporating a dynamic α-fetoprotein response (AFP-R) and compare the validated score with currently accepted HCC selection tools, namely, the Milan Criteria (MC), the French-AFP (F-AFP), and Metroticket 2.0 models. Design, Setting, and Participants A retrospective, multicenter prognostic analysis of prospectively collected databases of 2236 adults undergoing liver transplant for ...
Hepatobiliary & Pancreatic Diseases International
European Journal of Gastroenterology & Hepatology
PURPOSE The model of end-stage liver disease (MELD) score has been shown to predict 3-month progn... more PURPOSE The model of end-stage liver disease (MELD) score has been shown to predict 3-month prognosis following transjugular intrahepatic portosystemic stent shunt (TIPS) in liver cirrhosis; however, that score was derived from a mixed cohort, including patients with refractory ascites and variceal bleeding. This study re-evaluates the role of the MELD score and focuses on differences between both groups of patients. METHODS A total of 301 patients (192 male and 109 female) received TIPS, 213 because of refractory ascites and 88 because of variceal bleeding. Univariate and multivariate Cox analyses were performed to identify predictors of mortality and area under the receiver operator characteristics (AUROC) were used to assess the prognostic capacity of the MELD score and of the results of predictors of the multivariate analyses. RESULTS In refractory ascites, age, bilirubin and albumin were independent predictors of mortality. In variceal bleeding, emergency TIPS during ongoing bleeding, concomitant grade III ascites, history of hepatic encephalopathy, spontaneous bacterial peritonitis, bilirubin and platelet count proved significant. AUROCs of the MELD score for 3-month survival yielded 0.543 and 0.836 for refractory ascites and variceal bleeding, respectively (P < 0.001). For 1-year survival, the respective AUROCs yielded 0.533 and 0.767 (P < 0.001). In contrast to MELD, the AUROCs based on the calculated risk scores of this study resulted in 0.660 and 0.876 for 3-month survival, and 0.665 and 0.835 for 1-year survival in patients with ascites and variceal bleeding, respectively. CONCLUSION In refractory ascites, the prognostic capability of MELD is significantly inferior compared to variceal bleeding. The results of our multivariate analyses and AUROC calculations corroborate the impact of different prognostic variables in patients undergoing TIPS for ascites and variceal bleeding.
BMC Surgery, Apr 15, 2020
BackgroundIntrahepatic cholangiocarcinoma (ICC) is often diagnosed at an advanced stage resulting... more BackgroundIntrahepatic cholangiocarcinoma (ICC) is often diagnosed at an advanced stage resulting in a low resectability rate. Even after potentially curative resection the risk for tumor recurrence is high. Although the extent and value of lymphadenectomy is part of ongoing discussion, the role of preoperative imaging for assessment of suspicious lymph nodes (suspLN) has only been studied modestly. Aim of this study is to demonstrate the influence of suspicious lymph nodes in preoperative imaging on resectability, recurrence, and long-term outcome.MethodsAll patients who underwent exploration for ICC between January 2008 and June 2018 were included. Preoperative imaging (CT or MRI) was analysed with focus on suspLN at the hepatoduodenal ligament, lesser curvature, interaortocaval, and superior to the diaphragm; suspLN were classified according to the universally accepted RECIST 1.1 criteria; histopathology served as gold standard.ResultsOut of 187 patients resection was performed in 137 (73.3%), in 50 patients the procedure was terminated after exploration. Overall, suspLN were found preoperatively in 73/187 patients (39%). Comparing patients who underwent resection and exploration only, suspLN were significantly more common in the exploration group (p = 0.011). Regarding lymph node stations, significant differences could be shown regarding resectability: All tumors with suspLN superior to the diaphragm were irresectable. Preoperative imaging assessment showed a strong correlation with final histopathology, especially of suspLN of the hepatoduodenal ligament and the lesser curvature. Sensitivity of suspLN was 71.1%, specificity 90.8%. Appearance of tumor recurrence was not affected by suspLN (p = 0.289). Using a short-axis cut-off of <> 1 cm, suspLN had significant influence on recurrence-free survival (RFS, p = 0.009) with consecutive 1-, 3-, and 5-year RFS of 41, 21, and 15% versus 29, 0, and 0%, respectively. Similarly, 1-, 3- and 5-year overall survival (OS) was 75, 30, and 18% versus 59, 18, and 6%, respectively (p = 0.040).ConclusionSuspicious lymph nodes in preoperative imaging are predictor for unresectability and worse survival. Explorative laparoscopy should be considered, if distant suspicious lymph nodes are detected in preoperative imaging. Nevertheless, given a sensitivity of only 71.1%, detection of suspicious lymph nodes in the preoperative imaging alone is not sufficient to allow for a clear-cut decision against a surgical approach.
Transplantation Proceedings, 2020
Background. In past decades, liver transplant (LT) patients were not routinely screened for hepat... more Background. In past decades, liver transplant (LT) patients were not routinely screened for hepatitis E virus (HEV) infection, and thus it might have been misdiagnosed as an acute rejection episode. Our aim was to analyze a real-world cohort of LT patients who presented with at least 1 episode of biopsy-proven acute rejection (BPAR) and suffered from persistent elevated transaminases, to evaluate the frequency of HEV infection misdiagnosed as a rejection episode. Methods. Data from 306 patients transplanted between 1997 and 2017, including 565 liver biopsies, were analyzed. Biopsies from patients suffering from hepatitis C (n ¼ 79; 25.8%) and from patients who presented with a Rejection Activity Index <5 (n ¼ 134; 43.8%) were excluded. A subgroup of 74 patients (with 134 BPAR) with persistently elevated liver enzymes was chosen for further HEV testing. Results. Positive HEV IgG was detectable in 18 of 73 patients (24.7%). Positive HEV RNA was diagnosed in 3 of 73 patients with BPAR (4.1%). Patients with HEV infection showed no difference in etiology of the liver disease, type of immunosuppression, or median Rejection Activity Index. Conclusion. Few HEV infections were misdiagnosed as acute rejection episodes in this real-world cohort. Thus, HEV infection is an infrequent diagnosis in cases with persistent elevated liver enzymes and BPAR after LT.
HPB, 2019
Background: Liver grafts from donors with chronic and active history of alcohol abuse are usually... more Background: Liver grafts from donors with chronic and active history of alcohol abuse are usually discarded for liver transplantation (LT). Our aim is to report our results with those grafts. Methods: We performed a case control study on 113 LT from 2015 to 2016. Inclusion criteria for the study group were adult patients transplanted with livers from donors with chronic active alcohol abuse. The control group consisted in randomly matched LTs with similar recipient (R) and donor (D) age, sex and ischemia time, performed in those two years with standard livers. The ratio of case-tocontrol was 1:2. Short term results, biochemical data from day 0 to 30 after LT, complications and survival are reported. Data were compared. P 0.5 was considered statistically significant. Results: The study group consisted of 4 LT whereas 8 patients transplanted with standard grafts served as control group. Mean micro-macro steatosis percentage in livers from donors with alcohol abuse was 36AE16%. Laboratory exams showed statistically significant worse values for Aspartate Aminotransferase and International Normalized Ratio at Day 0, and Total Bilirubin at day 8, for livers from donors with alcohol abuse. No statistical difference was found in the occurrence of rejection episodes. All patients of both groups are alive after 347AE264 days (range 24-725) from LT. Conclusion: May be it's time to reconsider the use for LT of livers from donors with chronic and active alcohol abuse.
HPB, 2019
Background: Hepatic artery thrombosis (HAT) is a rare but severe complication after liver transpl... more Background: Hepatic artery thrombosis (HAT) is a rare but severe complication after liver transplantation (LT). The aim was to study risk factors of HAT, notably a recipient celiac trunk stenosis and a variant anatomy of the recipient hepatic artery, in our single center experience. Methods: Between 1997 and 2013, a total of 709 LT in 618 patients were performed at our center. Early (<30 days) HAT (EHAT) occurred in 18, late HAT (LHAT) in 12 patients. Patients with EHAT and LHAT were compared to a randomized control group of 100 patients without HAT. Recipient celiac trunk stenosis was assessed on pre-LT imaging by two independent radiologists. Univariate analysis by Fishers exact test and a multivariate logistic regression were used the EHAT group, a descriptive analysis in the LHAT group. Results: In univariate analysis, stenosis of the recipient celiac trunk, presence of accessory hepatic arteries, retransplantation, use of an aortic conduit and the amount of transfused FFP were significantly associated with the development of EHAT. Upon multivariate regression, only a stenosis of the celiac trunk (p=0.001) and retransplantation (p=0.002) were significantly associated with EHAT. LHAT seemed to be associated with the use of an aortic conduit and retransplantation. Conclusion: This is the first study to identify a stenosis of the recipient celiac trunk as a significant risk factor for the development of early hepatic artery thrombosis after LT. Patients should be systematically screened.
72. Jahrestagung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten mit Sektion Endoskopie – 11. Herbsttagung der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie gemeinsam mit den Arbeitsgemeinschaften der DGAV, 2017
Liver Transplantation, 2019
In patients with hepatocellular carcinoma (HCC) meeting the Milan criteria (MC), the benefit of l... more In patients with hepatocellular carcinoma (HCC) meeting the Milan criteria (MC), the benefit of locoregional therapies (LRTs) in the context of liver transplantation (LT) is still debated. Initial biases in the selection between treated and untreated patients have yielded conflicting reported results. The study aimed to identify, using a competing risk analysis, risk factors for HCC-dependent LT failure, defined as pretransplant tumor-related delisting or posttransplant recurrence. The study was registered at www.clini caltr ials.gov (identification number NCT03723304). In order to offset the initial limitations of the investigated population, an inverse probability of treatment weighting (IPTW) analysis was used: 1083 MC-in patients (no LRT = 182; LRT = 901) were balanced using 8 variables: age, sex, Model for End-Stage Liver Disease (MELD) value, hepatitis C virus status, hepatitis B virus status, largest lesion diameter, number of nodules, and alpha-fetoprotein (AFP). All the covariates were available at the first referral. After the IPTW, a pseudo-population of 2019 patients listed for LT was analyzed, comparing 2 homogeneous groups of untreated (n = 1077) and LRT-treated (n = 942) patients. Tumor progression after LRT was the most important independent risk factor for HCC-dependent failure (subhazard ratio [SHR], 5.62; P < 0.001). Other independent risk factors were major tumor diameter, AFP, MELD, patient age, male sex, and period of wait-list registration. One single LRT was protective compared with no treatment (SHR, 0.51; P < 0.001). The positive effect was still observed when 2-3 treatments were performed (SHR, 0.66; P = 0.02), but it was lost in the case of ≥4 LRTs (SHR, 0.80; P = 0.27). In conclusion, for MC-in patients, up to 3 LRTs are beneficial for success in intention-to-treat LT patients, with a 49% to 34% reduction in failure risk compared with untreated patients. This benefit is lost if more LRTs are required. A poor response to LRT is associated with a higher risk for HCC-dependent transplant failure.
Journal of Clinical Medicine
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Frontiers in Oncology
BackgroundLong-term survival after liver transplantation (LT) for hepatocellular cancer (HCC) con... more BackgroundLong-term survival after liver transplantation (LT) for hepatocellular cancer (HCC) continues to increase along with the modification of inclusion criteria. This study aimed at identifying risk factors for 5- and 10-year overall and HCC-specific death after LT.MethodsA total of 1,854 HCC transplant recipients from 10 European centers during the period 1987–2015 were analyzed. The population was divided in three eras, defined by landmark changes in HCC transplantability indications. Multivariable logistic regression analyses were used to evaluate the significance of independent risk factors for survival.ResultsFive- and 10-year overall survival (OS) rates were 68.1% and 54.4%, respectively. Two-hundred forty-two patients (13.1%) had HCC recurrence. Five- and 10-year recurrence rates were 16.2% and 20.3%. HCC-related deaths peaked at 2 years after LT (51.1% of all HCC-related deaths) and decreased to a high 30.8% in the interval of 6 to 10 years after LT. The risk factors fo...
Supplemental Material for Long-term observation of hepatocellular carcinoma recurrence after live... more Supplemental Material for Long-term observation of hepatocellular carcinoma recurrence after liver transplantation at a European transplantation centre by Friedrich Foerster, Maria Hoppe-Lotichius, Johanna Vollmar, Jens U Marquardt, Arndt Weinmann, Marcus-Alexander Wörns, Gerd Otto, Tim Zimmermann and Peter R Galle in United European Gastroenterology Journal
Einleitung: Verdacht auf Klatskin-Tumor ist eine häufige Zuweisungsdiagnose bei Patienten mit hil... more Einleitung: Verdacht auf Klatskin-Tumor ist eine häufige Zuweisungsdiagnose bei Patienten mit hilärer Gallengangsstenose. Durch präoperative Diagnostik gelingt es oft nicht, gutartige und bösartige Befunde im Vorfeld zu unterscheiden. In der folgenden retrospektiven Analyse wurde[for full text, please go to the a.m. URL]
Transplantation Journal, 2012
Journal of Hepatology, 2012
However, they did not differ regarding total cholesterol, HDL and LDL-cholesterol, triglycerides ... more However, they did not differ regarding total cholesterol, HDL and LDL-cholesterol, triglycerides and blood pressure. Table shows CB results. Cardiovascular biomarkers results Variable NASH (n = 19) LTR (n = 42) Controls
European Journal of Gastroenterology & Hepatology, 2019
Background and aim Body composition has emerged as a prognostic factor for end-stage liver diseas... more Background and aim Body composition has emerged as a prognostic factor for end-stage liver disease. We therefore investigated muscle mass, body fat and other clinical-pathological variables as predictors of posttransplant survival. Methods A total of 368 patients, who underwent orthotopic liver transplantation (OLT) at our institution, were assessed prior to OLT and followed for a median of 9.0 years (range 2.0-10.0 years) after OLT. Psoas, erector spinae and the combined paraspinal muscle area, as well as the corresponding indices normalized by body-height squared, were quantified by a lumbar (L3) cross-sectional computed tomography. In addition, absolute body fat and bone density were estimated by the same computed tomography approach. Results Paraspinal muscle index (PSMI) (hazard ratio 0.955, P = 0.039) and hepatitis C (hazard rati 1.498, P = 0.038) were independently associated with post-OLT mortality. In contrast, body fat and bone density did not significantly affect post-OLT outcome (P > 0.05). The PSMI also predicted one-year posttransplant mortality with a receiver operating characteristics-area under the curve of 0.671 [95% confidence interval (CI) 0.589-0.753, P < 0.001) in male patients and outperformed individual psoas and erector spinae muscle group assessments in this regard. In male patients, a defined PSMI cutoff (<18.41 cm 2 /m 2) was identified as suitable determinant for sarcopenia and posttransplant one-year mortality. In female OLT-recipients, however, sarcopenia was not predictive for patient survival und a women-specific cutoff could not be derived from this study.
Journal of Gastrointestinal and Liver Diseases, 2019
Background & Aims: Fibrosis progression (FP) after liver transplantation (LT) increases morbidity... more Background & Aims: Fibrosis progression (FP) after liver transplantation (LT) increases morbidity and mortality. Biomarkers are needed for early prediction of FP. A recipient's seven-gene cirrhosis risk score (CRS) has been associated with FP, especially in non-transplant cohorts. A broader validation of CRS, including the genotype of the donor-organ and HCV-negative patients is lacking. We therefore analyzed the impact of donor-and recipient-specific genotypes on FP after LT in a large cohort of HCV-positive and-negative patients. Method: Genotyping from liver biopsies (n=201 donors) and peripheral blood (n=442 recipients) was performed. Cirrhosis risk score was correlated with FP at 1 and 5 years after LT. Results: Fibrosis ≥F2 was documented in 26.5% of the recipients' CRS group (R-CRS) (defined by recipient's genotype) and in 23.4% of the donors' CRS-group (D-CRS) (defined by donor's genotype). Cumulative incidence for fibrosis ≥F2 was higher in patients with D-CRS >0.7 (p=0.03). While the R-CRS showed no prognostic relevance, D-CRS >0.7 was associated with higher hazard ratios (HRs) for fibrosis ≥F2 (HR=2.04; p=0.01), especially in HCV-negative patients (HR=2.59, p=0.03). Donors' CRS >0.7 was associated with higher risk for ≥F2 in 1-year protocol biopsies (p<0.001). Among the patients in whom both the recipient's and donor's CRS were available, fibrosis ≥F2 was encountered more frequently in patients with a D-CRS >0.7, in combination with any R-CRS, compared to patients with D-CRS scores ≤0.7 (p=0.034). Donors' AZIN1, STXBP5L, TRPM5 genotypes carried a higher risk for fibrosis ≥F2 in subgroups. Conclusion: High D-CRS >0.7 predicted early FP after LT, especially in HCV negative patients.
JAMA surgery, 2021
Importance Living-donor liver transplant (LDLT) offers advantages over deceased-donor liver trans... more Importance Living-donor liver transplant (LDLT) offers advantages over deceased-donor liver transplant (DDLT) of improved intention-to-treat outcomes and management of the shortage of deceased-donor allografts. However, conflicting data still exist on the outcomes of LDLT in patients with hepatocellular carcinoma (HCC). Objective To investigate the potential survival benefit of an LDLT in patients with HCC from the time of waiting list inscription. Design, Setting, and Participants This multicenter cohort study with an intention-to-treat design analyzed the data of patients aged 18 years or older who had an HCC diagnosis and were on a waiting list for a first transplant. Patients from 12 collaborative centers in Europe, Asia, and the US who were on a transplant waiting list between January 1, 2000, and December 31, 2017, composed the international cohort. The Toronto cohort comprised patients from 1 transplant center in Toronto, Ontario, Canada who were on a waiting list between Jan...
Importance Accurate preoperative prediction of hepatocellular carcinoma (HCC) recurrence after li... more Importance Accurate preoperative prediction of hepatocellular carcinoma (HCC) recurrence after liver transplant is the mainstay of selection tools used by transplant-governing bodies to discern candidacy for patients with HCC. Although progress has been made, few tools incorporate objective measures of tumor biological characteristics, resulting in inclusion of patients with high recurrence rates and exclusion of others who could otherwise be cured. Objective To externally validate the New York/California (NYCA) score, a recently published multi-institutional US HCC selection tool that was the first model incorporating a dynamic α-fetoprotein response (AFP-R) and compare the validated score with currently accepted HCC selection tools, namely, the Milan Criteria (MC), the French-AFP (F-AFP), and Metroticket 2.0 models. Design, Setting, and Participants A retrospective, multicenter prognostic analysis of prospectively collected databases of 2236 adults undergoing liver transplant for ...
Hepatobiliary & Pancreatic Diseases International
European Journal of Gastroenterology & Hepatology
PURPOSE The model of end-stage liver disease (MELD) score has been shown to predict 3-month progn... more PURPOSE The model of end-stage liver disease (MELD) score has been shown to predict 3-month prognosis following transjugular intrahepatic portosystemic stent shunt (TIPS) in liver cirrhosis; however, that score was derived from a mixed cohort, including patients with refractory ascites and variceal bleeding. This study re-evaluates the role of the MELD score and focuses on differences between both groups of patients. METHODS A total of 301 patients (192 male and 109 female) received TIPS, 213 because of refractory ascites and 88 because of variceal bleeding. Univariate and multivariate Cox analyses were performed to identify predictors of mortality and area under the receiver operator characteristics (AUROC) were used to assess the prognostic capacity of the MELD score and of the results of predictors of the multivariate analyses. RESULTS In refractory ascites, age, bilirubin and albumin were independent predictors of mortality. In variceal bleeding, emergency TIPS during ongoing bleeding, concomitant grade III ascites, history of hepatic encephalopathy, spontaneous bacterial peritonitis, bilirubin and platelet count proved significant. AUROCs of the MELD score for 3-month survival yielded 0.543 and 0.836 for refractory ascites and variceal bleeding, respectively (P < 0.001). For 1-year survival, the respective AUROCs yielded 0.533 and 0.767 (P < 0.001). In contrast to MELD, the AUROCs based on the calculated risk scores of this study resulted in 0.660 and 0.876 for 3-month survival, and 0.665 and 0.835 for 1-year survival in patients with ascites and variceal bleeding, respectively. CONCLUSION In refractory ascites, the prognostic capability of MELD is significantly inferior compared to variceal bleeding. The results of our multivariate analyses and AUROC calculations corroborate the impact of different prognostic variables in patients undergoing TIPS for ascites and variceal bleeding.
BMC Surgery, Apr 15, 2020
BackgroundIntrahepatic cholangiocarcinoma (ICC) is often diagnosed at an advanced stage resulting... more BackgroundIntrahepatic cholangiocarcinoma (ICC) is often diagnosed at an advanced stage resulting in a low resectability rate. Even after potentially curative resection the risk for tumor recurrence is high. Although the extent and value of lymphadenectomy is part of ongoing discussion, the role of preoperative imaging for assessment of suspicious lymph nodes (suspLN) has only been studied modestly. Aim of this study is to demonstrate the influence of suspicious lymph nodes in preoperative imaging on resectability, recurrence, and long-term outcome.MethodsAll patients who underwent exploration for ICC between January 2008 and June 2018 were included. Preoperative imaging (CT or MRI) was analysed with focus on suspLN at the hepatoduodenal ligament, lesser curvature, interaortocaval, and superior to the diaphragm; suspLN were classified according to the universally accepted RECIST 1.1 criteria; histopathology served as gold standard.ResultsOut of 187 patients resection was performed in 137 (73.3%), in 50 patients the procedure was terminated after exploration. Overall, suspLN were found preoperatively in 73/187 patients (39%). Comparing patients who underwent resection and exploration only, suspLN were significantly more common in the exploration group (p = 0.011). Regarding lymph node stations, significant differences could be shown regarding resectability: All tumors with suspLN superior to the diaphragm were irresectable. Preoperative imaging assessment showed a strong correlation with final histopathology, especially of suspLN of the hepatoduodenal ligament and the lesser curvature. Sensitivity of suspLN was 71.1%, specificity 90.8%. Appearance of tumor recurrence was not affected by suspLN (p = 0.289). Using a short-axis cut-off of <> 1 cm, suspLN had significant influence on recurrence-free survival (RFS, p = 0.009) with consecutive 1-, 3-, and 5-year RFS of 41, 21, and 15% versus 29, 0, and 0%, respectively. Similarly, 1-, 3- and 5-year overall survival (OS) was 75, 30, and 18% versus 59, 18, and 6%, respectively (p = 0.040).ConclusionSuspicious lymph nodes in preoperative imaging are predictor for unresectability and worse survival. Explorative laparoscopy should be considered, if distant suspicious lymph nodes are detected in preoperative imaging. Nevertheless, given a sensitivity of only 71.1%, detection of suspicious lymph nodes in the preoperative imaging alone is not sufficient to allow for a clear-cut decision against a surgical approach.