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Machine learning in liver surgery:Benefits and pitfalls

World Journal of Clinical Cases 2024年第12期12卷 2134-2137页

作者： rafael calleja Manuel Durán María Dolores Ayllón Ruben Ciria Javier Briceño Hepatobiliary Surgery and Liver Transplantation Unit Hospital Universitario Reina SofíaMaimonides Biomedical Research Institute of CordobaCórdoba 14004Spain

The application of machine learning(ML)algorithms in various fields of hepatology is an issue of interest.However,we must be cautious with the results.In this letter,based on a published ML prediction model for acute kidney injury after liver surgery,we discuss some limitations of ML models and how they may be addressed in the future.Although the future faces significant challenges,it also holds a great potential.

关键词： Machine learning Liver surgery Artificial intelligence Random forest Prediction model

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Artificial intelligence and liver transplantation:Looking for the best donor-recipient pairing

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Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 347-353页

作者： Javier Briceno rafael calleja César Hervás Unit of Liver Transplantation Department of General SurgeryHospital Universitario Reina SofíaCórdobaSpain Maimónides Institute of Biomedical Research of Córdoba(IMIBIC) CórdobaSpain Department of Computer Sciences and Numerical Analysis Universidad de CórdobaCórdobaSpain

Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taking into account the huge number of factors and variables involved in donor-recipient(DR)matching,AI models may be well suited to improve organ allocation.AI-based models should provide two solutions:complement decision-making with current metrics based on logistic regression and improve their predictability.Hundreds of classifiers could be used to address this problem.However,not all of them are really useful for D-R pairing.Basically,in the decision to assign a given donor to a candidate in waiting list,a multitude of variables are handled,including donor,recipient,logistic and perioperative variables.Of these last two,some of them can be inferred indirectly from the team’s previous experience.Two groups of AI models have been used in the D-R matching:artificial neural networks(ANN)and random forest(RF).The former mimics the functional architecture of neurons,with input layers and output layers.The algorithms can be uni-or multi-objective.In general,ANNs can be used with large databases,where their generalizability is improved.However,they are models that are very sensitive to the quality of the databases and,in essence,they are black-box models in which all variables are important.Unfortunately,these models do not allow to know safely the weight of each variable.On the other hand,RF builds decision trees and works well with small cohorts.In addition,they can select top variables as with logistic regression.However,they are not useful with large databases,due to the extreme number of decision trees that they would generate,making them impractical.Both ANN and RF allow a successful donor allocation in over 80%of D-R pairing,a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease,balance of risk score,and survival outcomes following liver tra

关键词： Donor-recipient matching Artificial intelligence Deep learning Artificial neural networks Random forest Liver transplantation outcome

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Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

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World Journal of Gastroenterology 2023年第20期29卷 3066-3083页

作者： Manuel Durán rafael calleja Angus Hann George Clarke Ruben Ciria Anisa Nutu Rebeca Sanabria-Mateos María Dolores Ayllón Pedro López-Cillero Hynek Mergental Javier Briceño M Thamara P R Perera Department of Liver Transplantation Reina Sofía University HospitalCórdoba 14004Spain The Liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for Liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft injury.Damage to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage.This problem continues to trouble clinicians,and may have catastrophic consequences for the graft and patient.Ischemic injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft failure.However,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial compromise.Both the warm and cold ischemic period duration appear to influence the onset of ITBL.All of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of ITBL.As clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to consider.In this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically reviewed.Inconsistencies with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation challenging.Overall,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold storage.The evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

关键词： Liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion Donation after circulatory death

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Short-term outcomes of robotic liver resection: An initial singleinstitution experience

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World Journal of Hepatology 2022年第1期14卷 224-233页

作者： Manuel Durán Javier Briceño Ana Padial Ferdinando Massimiliano Anelli Juan Manuel Sánchez-Hidalgo María Dolores Ayllón rafael calleja-Lozano Carmen García-Gaitan Unit of Hepatobiliary Surgery and Liver Transplantation General and Digestive Surgery DepartmentReina Sofia University HospitalCordoba 14004Spain GC18 Translational Research in Surgery of Solid Organ Transplantation Maimonides Biomedical Research InstituteCórdoba 14004Spain GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery Maimonides Biomedical Research InstituteCórdoba 14004Spain Department of Anesthesiology and Resuscitation Reina Sofia University HospitalCordoba 14004Spain

BACKGROUND Liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced hands.The robotic approach has gradually been introduced in liver surgery and has increased notably in recent years.However,few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic approach.AIM To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary center.METHODS A total of forty consecutive patients underwent robotic liver resection(da Vinci Xi,***,United States)between June 2019 and January 2021.Patients were prospectively followed and retrospectively reviewed.Clinicopathological characteristics and perioperative and short-term outcomes were analyzed.Data are expressed as mean and standard deviation.The study was approved by the Institutional Review Board.RESULTS The mean age of patients was 59.55 years,of which 18(45%)were female.The mean body mass index was 29.41 kg/m^(2).Nine patients(22.5%)were cirrhotic.Patients were divided by type of resection as follows:Ten segmentectomies,three wedge resections,ten left lateral sectionectomies,six bisegmentectomies(two VVI bisegmentectomies and four IVb-V bisegmentectomies),two right anterior sectionectomies,five left hepatectomies and two right hepatectomies.Malignant lesions occurred in twenty-nine(72.5%)of the patients.The mean operative time was 258.11 min and two patients were transfused intraoperatively(5%).Inflow occlusion was used in thirty cases(75%)and the mean total clamping time was 32.62 min.There was a single conversion due to uncontrollable hemorrhage.Major postoperative complications(Clavien–Dindo>Ⅲb)occurred in three patients(7.5%)and mortality in one(2.5%).No patient required readmission to the hospital.The mean hospital stay was 5.6 d.CONCLUSION Although robotic hepatectomy is a safe and feasible procedure wi

关键词： Robotics Hepatectomy Minimally invasive surgery Liver surgery Da vinci

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在临床研究中,索磷布韦/维帕他韦用于伴随使用质子泵抑制剂的患者时安全有效

在临床研究中,索磷布韦/维帕他韦用于伴随使用质子泵抑制剂的患者...

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第十届全国疑难及重症肝病大会

作者： rafael Esteban Kosh Agarwal Jose Luis calleja Jean Francois Dufour Steven L.Flamm Stuart C.Gordon Luisa Stamm Liyun Ni Diana Brainard Kris V.Kowdley Curtis Cooper Juan Antonio Pineda Lluis Castells Maria Buti Sabela Lens UniversityofBarcelona SwedishMedicalCenter GileadSciencesInc. HospitalUniversitariValld’Hebron GileadSciences Inc. VallD’hebronUniversityHospital NorthwesternUniversityHealthSystem HospitalUniversitarioPuertaDeHierro HospitalUniversitarioVirgenDeValme UniversityofBern LiverUnit InternalMedicineDepartmentHospitalUniversitariVallDeHebrón InstituteofLiverStudies King’sCollegeHospitalNHSTrust HenryFordHealthSystem TheOttawaHospital

背景在1期药物相互作用数据可用之前,在有关索磷布韦/维帕他韦(SOF/VEL)的临床试验中禁止伴随使用质子泵抑制剂(PPI)。之后的临床研究允许使用最多20mg的奥美拉唑或等效剂量的药物。本分析评估了接受12周的SOF/VEL治疗并且报告伴随使用...

背景在1期药物相互作用数据可用之前,在有关索磷布韦/维帕他韦(SOF/VEL)的临床试验中禁止伴随使用质子泵抑制剂(PPI)。之后的临床研究允许使用最多20mg的奥美拉唑或等效剂量的药物。本分析评估了接受12周的SOF/VEL治疗并且报告伴随使用PPI的伴有和不伴有代偿期肝硬化的患者的疗效和安全性。

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索磷布韦/维帕他韦用于伴代偿期肝硬化的慢性基因3型HCV患者:一项针对2期和3期临床试验的综合分析

索磷布韦/维帕他韦用于伴代偿期肝硬化的慢性基因3型HCV患者:一项...

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第十届全国疑难及重症肝病大会

作者： Stuart Keith Roberts Maria Buti Graham R.Foster Jose Luis calleja Ajit Sood Vasily A.Isakov Ola R Hj Weiland Luisa Stamm Liyun Ni Evguenia Svarovskaia Diana Brainard David L.Wyles Juan Antonio Pineda Alexander Thompson rafael Esteban Alessandra Mangia Alfred Hospital

背景在当前的直接作用抗病毒药物时代中,基因3型HCV感染和伴有肝硬化的患者成为更加难以治愈的人群。已经有多项2期和3期临床试验评估了SOF/VEL用于基因3型和伴有代偿期肝硬化的患者时的效果。方法本研究是针对来自于在一项2期试验和5项...

背景在当前的直接作用抗病毒药物时代中,基因3型HCV感染和伴有肝硬化的患者成为更加难以治愈的人群。已经有多项2期和3期临床试验评估了SOF/VEL用于基因3型和伴有代偿期肝硬化的患者时的效果。方法本研究是针对来自于在一项2期试验和5项3期试验中接受12周的SOF/VELFDC治疗

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