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Prediction of survival after left-sided pancreatic resection for adenocarcinoma: Introduction of a new prognostic score

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Hepatobiliary & Pancreatic Diseases International 2019年第6期18卷 569-575页

作者： jill gwiasda Zhi Qu Harald Schrem Felix Oldhafer Markus Winny Jürgen Klempnauer Gerrit Grannas Alexander Kaltenborn Transplant Center Hannover Medical SchoolCarl-Neuberg Str.130625 HannoverGermany Department of General Visceral and Transplant SurgeryHannover Medical SchoolHannoverGermany

Background:Due to the clinically unapparent course the entity of left-sided pancreatic adenocarcinoma is often diagnosed at advanced stages,resulting in small numbers of patients qualifying for *** study strives to develop a prognostic model for survival after left-sided pancreatic ***:A total of 54 patients were ***-and intra-operative predictive factors for 18-month mortality were identified with multivariable binary logistic regression analysis and compiled into a prognostic *** applicability was evaluated by assessment of the area under the receiver operating characteristic curve(AUROC).The model was internally validated applying a randomized backwards bootstrapping ***:The 18-month mortality rate was 74.1%(n=40).Mean survival was 19.1 months.A prognostic model for 18-month mortality after left sided-pancreatectomy showed an AUROC>0.800:18-month mortality risk in%=Exp(Y)/(1+Exp(Y))with y=-0.927+(1.724,if CA 19-9 elevated,otherwise 0)+(1.212×number of intra-operative transfused packed red blood cells)+(2.771,if prior abdominal surgery,otherwise 0)-(3.612,if gastric resection,otherwise 0)This model was internally validated in 40 randomized backwards bootstrapping steps with AUROCs ranging from 0.757 to ***:The 18-month mortality risk for patients after left-sided pancreatectomy for adenocarcinoma of the pancreatic body can be assessed with the number of intra-operatively transfused packed red blood cells,elevated CA 19-9 levels,additional gastric resection and prior abdominal surgeries in the patient’s history.

关键词： Pancreatic cancer Mortality Risk factors

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Biliary complications following liver transplantation: Singlecenter experience over three decades and recent risk factors

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World Journal of Hepatology 2017年第3期9卷 147-154页

作者： Alexander Kaltenborn André Gutcke jill gwiasda Jürgen Klempnauer Harald Schrem Department of Trauma and Orthopedic Surgery Federal Armed Forces Hospital Wester-stede Core Facility Quality Management and Health Tech-nology Assessment in Transplantation Integrated Research and Treatment Facility Transplantation (IFB-Tx)Hannover Medical School Department of General Visceral and Transplant Surgery Hannover Medical School

AIM To identify independent risk factors for biliary complications in a center with three decades of experience in liver *** A total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease(MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logisticregression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate. RESULTS Biliary complications were observed in 227 cases(14.1%). Four hundred and seventeen(26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21%(n = 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46%(n = 41)], anastomotic strictures [25%(n = 22)], cholangitis [8%(n = 7)] and non-anastomotic strictures [3%(n = 3)]. The remaining 18%(n = 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation(P = 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively(P = 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation(P = 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of *** The parallel occurrence of high recipient MELD and imp

关键词： Biliary complications Liver transplantation Prognostic model Risk factors Multivariable analyses

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Decision modelling for economic evaluation of liver transplantation

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World Journal of Hepatology 2018年第11期10卷 837-848页

作者： Zhi Qu Christian Krauth Volker Eric Amelung Alexander Kaltenborn jill gwiasda Lena Harries Jan Beneke Harald Schrem Sebastian Liersch Core Facility Quality Management and Health Technology Assessment in Transplantation Integrated Research and Treatment Facility Transplantation (IFB-Tx) Hannover Medical School Hannover 30625 Germany Institute for Epidemiology Social Medicine and Health Systems Research Hannover Medical School Hannover 30625 Germany Visceral and Transplant Surgery Hannover Medical School Hannover 30625 Germany

As the gap between a shortage of organs and the im-mense demand for liver grafts persists, every available donor liver needs to be optimized for utility, urgency and equity. To overcome this challenge, decision modelling might allow us to gather evidence from previous studies as well as compare the costs and consequences of alternative options. For public health policy and clinical intervention assessment, it is a potentially powerful tool. The most commonly used types of decision analytical models include decision trees, the Markov model, microsimulation, discrete event simulation and the system dynamic model. Analytic models could support decision makers in the field of liver transplantation when facing specifc problems by synthesizing evidence, comprising all relevant options, generalizing results to other contexts, extending the time horizon and exploring the uncertainty. For modeling studies of economic evaluation for transplantation, understanding the current nature of the disease is crucial, as well as the selection of appropriate modelling techniques. The quality and availability of data is another key element for the selection and development of decision analytical models. In addition, good practice guidelines should be complied, which is important for standardization and comparability between economic outputs.

关键词： Cost benefit analysis Decision tree Liver transplantation Decision analysis Decision support models Resource allocation Cost effectiveness

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