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Recent outcomes of liver transplantation for Budd-Chiari syndrome: A study of the European Liver Transplant Registry (ELTR) and affiliated centers
E. Dongelmans, N. Erler, R. Adam, S. Nadalin, V. Karam, S. Yilmaz, C. Kelly, J. Pirenne, K. Acarli, M. Allison, A. Hakeem, V. Dhakshinamoorthy, D. Fedaruk, O. Rummo, M. Kilic, A. Nordin, L. Fischer, A. Parente, D. Mirza, W. Bennet, Y. Tokat, F....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, multicentrická studie
- MeSH
- Buddův-Chiariho syndrom * chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- přežívání štěpu * MeSH
- registrace * statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- transplantace jater * statistika a číselné údaje MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND AND AIMS: Management of Budd-Chiari syndrome (BCS) has improved over the last decades. The main aim was to evaluate the contemporary post-liver transplant (post-LT) outcomes in Europe. APPROACH AND RESULTS: Data from all patients who underwent transplantation from 1976 to 2020 was obtained from the European Liver Transplant Registry (ELTR). Patients < 16 years, with secondary BCS or HCC were excluded. Patient survival (PS) and graft survival (GS) before and after 2000 were compared. Multivariate Cox regression analysis identified predictors of PS and GS after 2000. Supplemental data was requested from all ELTR-affiliated centers and received from 44. In all, 808 patients underwent transplantation between 2000 and 2020. One-, 5- and 10-year PS was 84%, 77%, and 68%, and GS was 79%, 70%, and 62%, respectively. Both significantly improved compared to outcomes before 2000 ( p < 0.001). Median follow-up was 50 months and retransplantation rate was 12%. Recipient age (aHR:1.04,95%CI:1.02-1.06) and MELD score (aHR:1.04,95%CI:1.01-1.06), especially above 30, were associated with worse PS, while male sex had better outcomes (aHR:0.63,95%CI:0.41-0.96). Donor age was associated with worse PS (aHR:1.01,95%CI:1.00-1.03) and GS (aHR:1.02,95%CI:1.01-1.03). In 353 patients (44%) with supplemental data, 33% had myeloproliferative neoplasm, 20% underwent TIPS pre-LT, and 85% used anticoagulation post-LT. Post-LT anticoagulation was associated with improved PS (aHR:0.29,95%CI:0.16-0.54) and GS (aHR:0.48,95%CI:0.29-0.81). Hepatic artery thrombosis and portal vein thrombosis (PVT) occurred in 9% and 7%, while recurrent BCS was rare (3%). CONCLUSIONS: LT for BCS results in excellent patient- and graft-survival. Older recipient or donor age and higher MELD are associated with poorer outcomes, while long-term anticoagulation improves both patient and graft outcomes.
Center for Organ Transplantation Medipol University Hospital Istanbul Turkey
Department of Abdominal Surgery and Transplantation CHU Liege Liege Belgium
Department of Abdominal Transplant Surgery Universitaire Ziekenhuizen Leuven Belgium
Department of Biostatistics Erasmus University Medical Center Rotterdam The Netherlands
Department of Gastroenterology and Hepatology C H U de Grenoble Grenoble France
Department of Gastroenterology and Transplantation Università Politecnica delle Marche Ancona Italy
Department of Gastroenterology University Medical Center Lubljana Ljubljana Slovenia
Department of General and Digestive Surgery Clinica Universitaria de Navarra Pamplona Spain
Department of General and Digestive Surgery Hospital Universitario Rio Hortega Valladolid Spain
Department of General Visceral and Transplant Surgery Universitätsklinik Tübingen Tubingen Germany
Department of General Visceral Vascular and Transplant Surgery University Hospital Magdeburg Germany
Department of HBP Surgery and Liver Transplantation Cruces University hospital Bilbao Spain
Department of Hepatology and Liver Transplantation Royal Free Hospital London UK
Department of HPB Surgery and Liver Transplantation Leeds Teaching Hospitals NHS Trust Leeds UK
Department of HPB Surgery and Transplantation C H R U de Strasbourg Strasbourg France
Department of HPB surgery and Transplantation Hospital Virgen del Rocio Sevilla Spain
Department of Liver and Biliary Tract Surgery Memorial Hospital Istanbul Turkey
Department of Medical Liver Transplant Unit and Liver Hôpital Henri Mondor Creteil France
Department of Medicine Hospital Universitario Puerta de Hierro Madrid Spain
Department of Surgery and Medical and Surgical Specialties University of Catania Catania Italy
Department of Surgery Hôpital Universitaire de Genève Geneve Switzerland
Department of Surgery Hospital Universitari de Bellvitge Barcelona Spain
Department of Surgery Kent Hospital Izmir Turkey
Department of Surgery Liver Transplant Institute Turgut Özal Medical Center Malatya Turkey
Department of Surgery Sahlgrenska University Hospital Gothenburg Sweden
Department of Surgery Universitätsklinikum Hamburg Eppendorf Hamburg Germany
Department of Surgery University of Medicine Carol Davila Bucharest Romania
Department of Transplantation Surgery Karolinska University Hospital Huddinge Sweden
Department of Transplantation Surgery Medical University of Vienna Wien Austria
Department of Visceral Transplant and Thoracic Surgery University Hospital Innsbruck Austria
Edinburgh Transplant Center Royal Infirmary of Edinburgh Edinburg UK
Institute of Liver Studies King's College Hospital London UK
Liver Unit Queen Elizabeth Hospital Birmingham UK
Transplantation and Liver Surgery Unit Helsinki University Hospital Helsinki Finland
Citace poskytuje Crossref.org
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- $a Dongelmans, Edo $u Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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- $a BACKGROUND AND AIMS: Management of Budd-Chiari syndrome (BCS) has improved over the last decades. The main aim was to evaluate the contemporary post-liver transplant (post-LT) outcomes in Europe. APPROACH AND RESULTS: Data from all patients who underwent transplantation from 1976 to 2020 was obtained from the European Liver Transplant Registry (ELTR). Patients < 16 years, with secondary BCS or HCC were excluded. Patient survival (PS) and graft survival (GS) before and after 2000 were compared. Multivariate Cox regression analysis identified predictors of PS and GS after 2000. Supplemental data was requested from all ELTR-affiliated centers and received from 44. In all, 808 patients underwent transplantation between 2000 and 2020. One-, 5- and 10-year PS was 84%, 77%, and 68%, and GS was 79%, 70%, and 62%, respectively. Both significantly improved compared to outcomes before 2000 ( p < 0.001). Median follow-up was 50 months and retransplantation rate was 12%. Recipient age (aHR:1.04,95%CI:1.02-1.06) and MELD score (aHR:1.04,95%CI:1.01-1.06), especially above 30, were associated with worse PS, while male sex had better outcomes (aHR:0.63,95%CI:0.41-0.96). Donor age was associated with worse PS (aHR:1.01,95%CI:1.00-1.03) and GS (aHR:1.02,95%CI:1.01-1.03). In 353 patients (44%) with supplemental data, 33% had myeloproliferative neoplasm, 20% underwent TIPS pre-LT, and 85% used anticoagulation post-LT. Post-LT anticoagulation was associated with improved PS (aHR:0.29,95%CI:0.16-0.54) and GS (aHR:0.48,95%CI:0.29-0.81). Hepatic artery thrombosis and portal vein thrombosis (PVT) occurred in 9% and 7%, while recurrent BCS was rare (3%). CONCLUSIONS: LT for BCS results in excellent patient- and graft-survival. Older recipient or donor age and higher MELD are associated with poorer outcomes, while long-term anticoagulation improves both patient and graft outcomes.
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