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French editorial from the ACHBPT:blood salvage and autotransfusion during liver transplantation for advanced hepatocellular carcinoma

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 367-369页

作者： Charlotte Maulat Paul Boulard fabrice muscari The Digestive Surgery and Liver Transplantation Department Toulouse University HospitalToulouseFrance

We read with great interest the recently(Annals of Surgery,March,2021)published article by Kwon and collaborators(1)about the effects of autotransfusion of salvaged blood with single leukoreduction for liver transplant recipients with advanced hepatocellular carcinoma(HCC).This retrospective study assessed the impact of autotransfusion of salvaged blood with post-transplant tumor recurrence.

关键词： transfusion Surgery hepatocellular

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

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World Journal of Hepatology 2016年第21期8卷 881-890页

作者： Bérénice Charrière Charlotte Maulat Bertrand Suc fabrice muscari Department of Visceral Surgery Toulouse-Rangueil University Hospital Service de Chirurgie Digestive CHU Toulouse Rangueil

Alpha-fetoprotein(AFP) is the main tumor biomarker available for the management of hepatocellular carcinoma(HCC). Although it is neither a good screening test nor an accurate diagnostic tool for HCC, it seems to be a possible prognostic marker. However, its contribution in liver transplantation for HCC has not been fully determined, although its use to predict recurrence after liver transplantation has been underlined by international societies. In an era of organ shortages, it could also have a key role in the selection of patients eligible for liver transplantation. Yet unanswered questions remain. First, the cut-off value of serum AFP above which liver transplantation should not be performed is still a subject of debate. We show that a concentration of 1000 ng/m L could be an exclusion criterion, whereas values of < 15 ng/m L indicate patients with an excellent prognosis whatever the size and number of tumors. Monitoring the dynamics of AFP could also prove useful. However, evidence is lacking regarding the values that should be used. Today, the real input of AFP seems to be its integration into new criteria to select patients eligible for a liver transplantation. These recent tools have associated AFP values with morphological criteria, thus refining pre-existing criteria, such as Milan, University of California, San Francisco, or "up-to-seven". We provide a review of the different criteria submitted within the past years. Finally, AFP can be used to monitor recurrence after transplantation, although there is little evidence to support this claim. Future challenges will be to draft new international guidelines to implement the use of AFP as a selection tool, and to determine a clear cut-off value above which liver transplantation should not be performed.

关键词： Hepatocellular carcinoma Downstaging Alpha-fetoprotein Liver transplantation Selection criteria

Outcomes of nonresected main-duct intraductal papillary mucinous neoplasms of the pancreas

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World Journal of Gastroenterology 2015年第9期21卷 2658-2667页

作者： Mathieu Daudé fabrice muscari Camille Buscail Nicolas Carrère Philippe Otal Janick Selves Louis Buscail Barbara Bournet Department of Gastroenterology CHU Toulouse RangueilUniversity of Toulouse31059 ToulouseFrance Department of Digestive Surgery CHU Toulouse Rangueil and PurpanUniversity of Toulouse31059 ToulouseFrance Department of Public Health and Epidemiology CHU Rennes PontchaillouUniversity of Rennes35033 RennesFrance Department of Radiology CHU Toulouse RangueilUniversity of Toulouse31059 ToulouseFrance Department of Pathology CHU Toulouse PurpanUniversity of Toulouse31300 ToulouseFrance

AIM:To compare characteristics and outcomes of resected and nonresected main-duct and mixed intraductal papillary mucinous neoplasms of the pancreas(IPMN).METHODS:Over a 14-year period,50 patients who did not undergo surgery for resectable main-duct or mixed IPMN,for reasons of precluding comorbidities,age and/or refusal,were compared with 74 patients who underwent resection to assess differences in rates of survival,recurrence/occurrence of malignancy,and prognostic *** study participants had dilatation of the main pancreatic duct by ≥ 5 mm,with or without dilatation of the branch *** of the nonsurgical patients showed evidence of mucus upon perendoscopic retrograde cholangiopancreatography or endoscopic ultrasound and/or after fine needle *** the surgical patients,pathologic analysis of resected specimens confirmed a diagnosis of IPMN with involvement of the main pancreatic duct or of both branch ducts as well as the main pancreatic *** and biologic follow-ups were conducted for all patients at least annually,through hospitalization or consultation every six months during the first year of follow-up,together with abdominal imaging analysis(magnetic resonance cholangiopancreatography or computed tomography) and,if necessary,endoscopic ultrasound with or without fine needle ***:The overall five-year survival rate of patients who underwent resection was significantly greater than that for the nonsurgical patients(74% vs 58%; P =0.019).The parameters of age( 10 mm,branch ductdiameter > 30 mm,or presence of extra pancreatic cancers did not significantly influence the *** the nonsurgical patients,pancreatic malignancy occurred in 36% of cases within a mean time of 33 mo(median:29 mo; range:8-141 mo).Comparison of the nonsurgical patients who experienced disease progression

关键词： Main-duct intraductal papillary mucinous neoplasms

Caval replacement with parietal peritoneum tube graft for septic thrombophlebitis after hepatectomy: A case report

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World Journal of Hepatology 2019年第1期11卷 133-137页

作者： Charlotte Maulat Léopoldine Lapierre Isabelle Migueres Xavier Chaufour Guillaume Martin-Blondel fabrice muscari Digestive Surgery Toulouse UniversityHospital Department of Infectious and Tropical Diseases Toulouse-Purpan University Hospital Vascular Surgery Department Toulouse-Rangueil University Hospital

BACKGROUND Caval vein thrombosis after hepatectomy is rare, although it increases mortality and morbidity. The evolution of this thrombosis into a septic thrombophlebitis responsible for persistent septicaemia after a hepatectomy has not been reported to date in the literature. We here report the management of a 54-year-old woman operated for a peripheral cholangiocarcinoma who developed a suppurated thrombophlebitis of the vena cava following a *** SUMMARY This patient was operated by left lobectomy extended to segment V with bile duct resection and Roux-en-Y hepaticojejunostomy. After the surgery, she developed Streptococcus anginosus, Escherichia coli, and Enterococcus faecium bacteraemias, as well as Candida albicans fungemia. A computed tomography scan revealed a bilioma which was percutaneously drained. Despite adequate antibiotic therapy,the patient's condition remained septic. A diagnosis of septic thrombophlebitis of the vena cava was made on post-operative day 25. The patient was then operated again for a surgical thrombectomy and complete caval reconstruction with a parietal peritoneum tube graft. Use of the peritoneum as a vascular graft is an inexpensive technique, it is readily and rapidly available, and it allows caval replacement in a septic area. Septic thrombophlebitis of the vena cava after hepatectomy has not been described previously and it warrants being added to the spectrum of potential complications of this *** Septic thrombophlebitis of the vena cava was successfully treated with antibiotic and anticoagulation treatments, prompt surgical thrombectomy and caval reconstruction.

关键词： Bilioma Septic thrombophlebitis Septicaemia Parietal peritoneum tube graft Complete caval reconstruction Case report

Predictive factors of histological response of colorectal liver metastases after neoadjuvant chemotherapy

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World Journal of Gastrointestinal Oncology 2019年第4期11卷 295-309页

作者： Chloé Serayssol Charlotte Maulat Florence Breibach Fatima-Zohra Mokrane Janick Selves Rosine Guimbaud Philippe Otal Bertrand Suc Emilie Berard fabrice muscari Department of Digestive Surgery and Liver Transplantation Toulouse-Rangueil University Hospital Department of Pathology Toulouse University Hospital Department of Radiology Toulouse-Rangueil University Hospital Department of Oncology Toulouse-Rangueil University Hospital The Toulouse Research Methodology Support Unit Toulouse University Hospital

BACKGROUND Colorectal cancer is the third most common cancer in men and the second most common in women worldwide. Almost a third of the patients has or will develop liver metastases. Neoadjuvant chemotherapy(NAC) has recently become nearly systematic prior to surgery of colorectal livers metastases(CRLMs). The response to NAC is evaluated by radiological imaging according to morphological *** recently, the response to NAC has been evaluated based on histological criteria of the resected specimen. The most often used score is the tumor regression grade(TRG), which considers the necrosis, fibrosis, and number of viable tumor *** To analyze the predictive factors of the histological response, according to the TRG, on CRLM surgery performed after *** January 2006 to December 2013, 150 patients who had underwent surgery for CRLMs after NAC were included. The patients were separated into two groups based on their histological response, according to Rubbia-Brandt *** on their TRG, each patient was either assigned to the responder(R) group(TRG 1, 2, and 3) or to the non-responder(NR) group(TRG 4 and 5). All of the histology slides were re-evaluated in a blind manner by the same specialized pathologist. Univariate and multivariate analyses were *** Seventy-four patients were classified as responders and 76 as *** postoperative mortality rate was 0.7%, with a complication rate of 38%.Multivariate analysis identified five predictive factors of histological *** were predictive of non-response: More than seven NAC sessions, the absence of a radiological response after NAC, and a repeat hepatectomy(P <0.005). Two were predictive of a good response: A rectal origin of the primary tumor and a liver-first strategy(P < 0.005). The overall survival was 57% at 3 yr and 36% at 5 yr. The disease-free survival rates were 14% at 3 yr and 11% at 5 *** factors contributing to a poor prognosis for disease-free survi

关键词： Colorectal liver metastasis Tumor regression grade Neoadjuvant chemotherapy Liver surgery Histological response Hepatectomy

High tacrolimus intra-patient variability is associated with graft rejection,and de novo donor-specific antibodies occurrence after liver transplantation

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World Journal of Gastroenterology 2018年第16期24卷 1795-1802页

作者： Arnaud Del Bello Nicolas Congy-Jolivet Marie Danjoux fabrice muscari Laurence Lavayssière Laure Esposito Anne-Laure Hebral Julie Bellière Nassim Kamar Department of Nephrology and Organ Transplantation CHU RangueilToulouse 31000France Université Paul Sabatier Toulouse 31000France Molecular Immunogenetics Laboratory Facultéde Médecine PurpanIFR150(INSERM)Montréal H3G 1Y6France Department of Immunology CHU de ToulouseHopital de RangueilCHU de ToulouseToulouse 31000France Department of Pathology Institut Universitaire du CancerCHU Toulouse 31000France Department of Surgery and Liver Transplantation Toulouse 31000France INSERM IFR-BMTCHU PurpanToulouse 31000France

AIM To investigate the role of tacrolimus intra-patient variability(IPV) in adult liver-transplant *** We retrospectively assessed tacrolimus variability in a cohort of liver-transplant recipients and analyzed its effect on the occurrence of graft rejection and de novo donor-specific antibodies(dn DSAs), as well as graft survival during the first 2 years posttransplantation. Between 02/08 and 06/2015, 116 patients that received tacrolimus plus mycophenolate mofetil(with or without steroids) were included. RESULTS Twenty-two patients(18.5%) experienced at least one acute-rejection episode(BPAR). Predictive factors for a BPAR were a tacrolimus IPV of > 35% [OR = 3.07 95%CI(1.14-8.24), P = 0.03] or > 40% [OR = 4.16(1.38-12.50), P = 0.01), and a tacrolimus trough level of 35% [OR = 4.83, 95%CI(1.39-16.72), P = 0.01] and > 40% [OR = 9.73, 95%CI(2.65-35.76), P = 0.001] were identified as predictors to detect dn DSAs. IPV did not impact on patient-or graft-survival rates during the follow-up. CONCLUSION Tacrolimus-IPV could be a useful tool to identify patients with a greater risk of graft rejection and of developing a de novo DSA after liver

关键词： Variability Liver transplantation Donorspecific antibodies Immunosuppression

Rescue associating liver partition and portal vein ligation for staged hepatectomy after portal embolization: Our experience and literature review

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World Journal of Clinical Oncology 2017年第4期8卷 351-359页

作者： Charlotte Maulat Antoine Philis Bérénice Charriere Fatima-Zohra Mokrane Rosine Guimbaud Philippe Otal Bertrand Suc fabrice muscari Department of Visceral Surgery Toulouse-Rangueil University Hospital Department of Radiology Toulouse-Rangueil University Hospital Department of Digestive Oncology Toulouse-Rangueil University Hospital

AIM To report a single-center experience in rescue associating liver partition and portal vein ligation for staged hepatectomy(ALPPS), after failure of previous portal embolization. We also performed a literature *** Between January 2014 and December 2015, every patient who underwent a rescue ALPPS procedure in Toulouse Rangueil University Hospital, France, was included. Every patient included had a project of major hepatectomy and a previous portal vein embolization(PVE) with insufficient future liver remnant to body weight ratio after the procedure. The ALPPS procedure was performed in two steps(ALPPS-1 and ALPPS-2), separated by an interval phase. ALPPS-2 was done within 7 to 9 d after ALPPS-1. To estimate the FLR, a computed tomography scan examination was performed 3 to 6 wk after the PVE procedure and 6 to 8 d after ALPPS-1. A transcystic stent was placed during ALPPS-1 and remained opened duringthe interval phase, in order to avoid biliary complications. Postoperative liver failure was defined using the 50-50 criteria. Postoperative complications were assessed according to the Dindo-Clavien *** From January 2014 to December 2015, 7 patients underwent a rescue ALPPS procedure. Median FLR before PVE, ALPPS-1 and ALPPS-2 were respectively 263 cc(221-380), 450 cc(372-506), and 660 cc(575-776). Median FLR/BWR before PVE, ALPPS-1 and ALPPS-2 were respectively 0.4%(0.3-0.5), 0.6%(0.5-0.8), and 1%(0.8-1.2). Median volume growth of FLR was 69%(18-92) after PVE, and 45%(36-82) after ALPPS-1. The combination of PVE and ALPPS induced a growth of median initial FLR of +408 cc(254-513), leading to an increase of +149%(68-199). After ALPPS-2, 4 patients had stage Ⅰ-Ⅱ complications. Three patients had more severe complications(one stage Ⅲ, one stage Ⅳ and one death due to bowel perforation). Two patients suffered from postoperative liver failure according to the 50/50 criteria. None of our patients developed any biliary complication during the A

关键词： Rescue associating liver partition and portal vein ligation for staged hepatectomy Associating liver partition and portal vein ligation for staged hepatectomy Portal vein embolization Liver resection Future liver remnant

Prognostication algorithm for non-cirrhotic non-B non-C hepatocellular carcinoma-a multicenter study under the aegis of the French Association of Hepato-Biliary Surgery and liver Transplantation

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Hepatobiliary Surgery and Nutrition 2023年第2期12卷 192-204,I0002-I0004页

作者： Charlotte Maulat Stéphanie Truant Christian Hobeika Louise Barbier Astrid Herrero Alexandre Doussot Johan Gagnière Édouard Girard Hadrien Tranchart Jean-Marc Regimbeau David Fuks François Cauchy Mathieu Prodeau Antoine Notte Cyprien Toubert Ephrem Salamé Mehdi El Amrani Sandrine Andrieu fabrice muscari Jason Shourick Bertrand Suc Department of Digestive Surgery Hepatobiliary and Pancreatic Surgery and Liver Transplantation UnitToulouse University HospitalToulouseFrance Department of Digestive Surgery and Transplantation Claude-HuriezHospitalCHRU LilleLilleFrance CANTHER laboratory“Cancer Heterogeneity Plasticity and Resistance to Therapies”Inserm UMR-S1277 Teams“MucinsCancer and Drug Resistance”LilleFrance Department of Hepato-bilio-pancreatic Surgery and Liver Transplantation Beaujon HospitalAPHPClichyFrance Department of Digestive Surgery and Liver Transplantation Trousseau HospitalTours University HospitalToursFrance Department of Digestive Surgery and Liver Transplantation Saint Eloi HospitalMontpellier University HospitalMontpellierFrance Department of Digestive Surgery and Liver Transplantation Besançon University HospitalBesançonFrance Department of Digestive and Hepatobiliary Surgery University Hospital of Clermont-FerrandClermont-FerrandFrance U1071 Inserm/UniversitéClermont-Auvergne Clermont-FerrandFrance Department of Digestive Surgery and Emergency CHU Grenoble-AlpesGrenobleFrance Department of Mini-invasive Surgery Antoine Béclère HospitalAPHPClamartFrance Department of Digestive Surgery Amiens Picardie University Hospital and Picardie Jules Verne UniversityAmiensFrance Department of Digestive Surgery Institut Mutualiste MontsourisParisFrance Department of Epidemiology Toulouse University HospitalToulouseFrance

Background:Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma(HCC).Few data exist concerning the prognosis of patients resected for non-cirrhotic *** objectives of this study were to determine the prognostic factors of recurrence-free survival(RFS)and overall survival(OS)and to develop a prognostication algorithm for non-cirrhotic ***:French multicenter retrospective study including HCC patients with non-cirrhotic liver without underlying viral hepatitis:F0,F1 or F2 ***:A total of 467 patients were included in 11 centers from 2010 to ***-cirrhotic liver had a fibrosis score of F0(n=237,50.7%),F1(n=127,27.2%)or F2(n=103,22.1%).OS and RFS at 5 years were 59.2%and 34.5%,*** multivariate analysis,microvascular invasion and HCC differentiation were prognostic factors of OS and RFS and the number and size were prognostic factors of RFS(P10 cm(n=176,Group 2);>2 HCC regardless of size Conclusions:We developed a prognostication algorithm based on the number(≤or>2)and size(≤or>10 cm),which could be used as a treatment decision support concerning the need for perioperative *** case of bifocal HCC,surgery should not be a contraindication.

关键词： Hepatocellular carcinoma(HCC) non-cirrhotic liver prognostic factors recurrence-free survival(RFS) prognostication algorithm

Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation

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World Journal of Gastroenterology 2009年第27期15卷 3426-3430页

作者： Nassim Kamar Laurence Lavayssière fabrice muscari Janick Selves Céline Guilbeau-Frugier Isabelle Cardeau Laure Esposito Olivier Cointault Marie Béatrice Nogier Jean Marie Peron Philippe Otal Marylise Fort Lionel Rostaing Department of Nephrology Dialysis and Multi-Organ Transplantation CHU RangueilTSA 50032 31059 Toulouse Cédex 9 France INSERM U858 IFR 31 CHU Rangueil TSA 50032 31059 Toulouse Cédex 9 France Department of Liver Transplantation CHU RangueilTSA 50032 31059 Toulouse Cédex 9 France Department of Histopathology CHU PurpanTSA 50032 31059 Toulouse Cédex 9 France Department of Histopathology CHU RangueilTSA 50032 31059 Toulouse Cédex 9 France Department of Histopathology CHU PurpanTSA 50032 31059 Toulouse Cédex 9 France Department of Radiology CHU RangueilTSA 50032 31059 Toulouse Cédex 9 France Department of Immunology CHU RangueilTSA 50032 31059 Toulouse Cédex 9 France INSERM U563 IFR 30 CHU PurpanTSA 50032 31059 Toulouse Cédex 9 France

Acute humoral rejection （AHR） is uncommon after ABO- compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Uver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab. Liver enzymes returned to within normal range 18 d after diagnosis. Uver biopsies, at 3 and 9 mo post-transplant, showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.

关键词： Acute humoral rejection Liver transplantation Donor-specific antibodies Rituximab Plasmapheresis