![Page 1: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/1.jpg)
Prelevements hepatiques : enjeux actuels
et ameliorations futures
Dr Niccolo Petrucciani
![Page 2: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/2.jpg)
ABM 2015
Prelevement hepatique
![Page 3: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/3.jpg)
ABM 2015
Organ shortage extended criteria donors
![Page 4: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/4.jpg)
- Age
- HBV and HCV
Extended criteria donors
![Page 5: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/5.jpg)
DONOR RISK INDEX CALCULATOR
![Page 6: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/6.jpg)
- 5939 liver transplants in Eurotransplant
- DRI was higher in Eurotransplant versus OPNT (USA)
- DRI was strongly correlated with outcomes and the most significant factors influencing outcomes
![Page 7: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/7.jpg)
![Page 8: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/8.jpg)
![Page 9: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/9.jpg)
- 1361 prélèvements hépatiques/1782 donneurs (76.4%)
- Age moyenne de donneur: 56.2 ans
- Donneurs >65 ans = 38%
![Page 10: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/10.jpg)
- DRI was modified to ET-DRI
- ET-DRI includes all covariates of DRI except race and weight
- GGT and rescue offer were added
- Location was modified (local, regional, extra-regional)
![Page 11: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/11.jpg)
- ET-DRI had high predictive value for outcomes after LT
![Page 12: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/12.jpg)
- Neither the DRI nor the ET-DRI were validated against French dataset.
- Important donor and candidates differences
- New adaptation of DRI?
![Page 13: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/13.jpg)
![Page 14: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/14.jpg)
- 1361 prélèvements hépatiques/1782 donneurs (76.4%)
- Age moyenne de donneur: 56.2 ans
- Donneurs >65 ans = 38%
ABM 2015
![Page 15: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/15.jpg)
Age
- The proportion of older donors has continuously increased in France
- Concerns: biliary complications, arterial thrombosis, poor initial function, overall graft survival (especially in HCV+ recipients)
![Page 16: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/16.jpg)
- 149 LTs, donor age >60 y in 47 and <60 in 102
- In older donors group:
> non anastomotic biliary strictures
< graft survival
Serrano et al.
![Page 17: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/17.jpg)
Serrano et al.
![Page 18: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/18.jpg)
- 157 donors >75 y compared with 253 <60y
- Older group: better liver tests, only 3 cardiac arrests
- No differences in complications (biliary, arterial, non-function) and graft survival
![Page 19: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/19.jpg)
Prelevement hepatique
![Page 20: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/20.jpg)
Age
- Results highly variables in the different studies
- No cut-off
![Page 21: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/21.jpg)
- Study on UNOS database
- D-MELD (donor age x recipient MELD) accurately predicts patients and graft survival
- Useful for allocation
![Page 22: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/22.jpg)
- 120 patients classified according to D-MELD (donor age x recipient MELD)
- D-MELD <1000 = 101
- D-MELD >1000 = 19
![Page 23: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/23.jpg)
![Page 24: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/24.jpg)
![Page 25: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/25.jpg)
- Liver steatosis
- Rescue liver (hors tours)
- Cold ischemia
- DCD donors
Other factors
Interpretation of all donor’s and recipient’s factors to define the risk
![Page 26: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/26.jpg)
- Risk analysis in 37255 patients of UNOS
- 6 predictors of survival after LT identified: recipient MELD, cold ischemia time, recipient age, donor age, previous OLT, life support dependence
- BAR (Balance of Risk) score stratified patients better than previous scores
Dutkowski et al.
![Page 27: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/27.jpg)
![Page 28: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/28.jpg)
![Page 29: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/29.jpg)
![Page 30: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/30.jpg)
![Page 31: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/31.jpg)
- Analysis of quality in organ procurement in Netherlands
- Procurement program: “multi organ procurement training” for surgeons since 2005
- Procurement teams: surgeons, scrub nurses, anesthesiologists, instruments
![Page 32: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/32.jpg)
PREVIOUS DATA
- Injuries in procured livers = 10-34%
- Clinically relevant = 6.6%-23%
- Pancreas = 8%-13% of procured pancreata were discarded form transplantation for surgical injury
- Kidney injuries = 7-21%
![Page 33: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/33.jpg)
- 754 organs from 2012 to 2013
- 133 livers, 38 pancreas, 420 kidneys
- Injuries = 25%
![Page 34: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/34.jpg)
- Organ discarded for injuries = 2%
![Page 35: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/35.jpg)
- BMI for renal procurement
- DCD donation for livers
![Page 36: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/36.jpg)
- Center volume = less kidney and pancreas injuries
![Page 37: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/37.jpg)
Outcomes of transplantation
- Organs with repaired injuries have the same survival that non-injured organs
![Page 38: Pŕl̀vements h́patiques : enjeux actuels et aḿliorations ... · PDF fileDr Niccolo Petrucciani . ABM 2015 Prelevement hepatique . ABM 2015 Organ shortage extended criteria donors](https://reader030.vdocuments.net/reader030/viewer/2022020411/5aba73817f8b9ad1768b82af/html5/thumbnails/38.jpg)
DONOR
Age
Steatosis
Infections
Ischemia
RECIPIENT
MELD
Age
BMI
PV Thrombosis
CHC