Outcomes of liver transplantation in non-alcoholic steatohepatitis (NASH) versus non-NASH associated hepatocellular carcinoma.

BACKGROUND: Non-alcoholic steatohepatitis (NASH)-associated hepatocellular carcinoma (HCC) is a rising indication for liver transplantation. This unique population, with multiple comorbidities, has potential for worse post-transplant outcomes. We compared post-transplant survival of NASH and non-NASH HCC patients using a large cohort. METHODS: Adults transplanted for HCC between 2008 and 2018, from United Network for Organ Sharing (UNOS) and University Health Network (UHN) databases were divided into two populations: NASH and non-NASH. Recipient characteristics and post-transplant survival were compared. Subgroup analyses were performed within and beyond Milan criteria. RESULTS: 2071 of 20,672 (10.0%) patients underwent transplantation for NASH HCC, with annual proportional increase of 1.2%UHN (p = 0.02) and 1.3%UNOS (p < 0.001). The 1-,3-,5-year post-transplant survival were 90.8%, 83.9%, 76.3% NASH HCC versus 91.9%, 82.1%, 74.9% non-NASH HCC (p = 0.94). No survival differences were observed in populations within or beyond Milan. Competing-risk analysis demonstrated no differences in risk for cardiovascular-related death (HR1.24, 95%CI 0.87-1.55, p = 0.16), or HCC recurrence-related death (HR1.21, 95%CI 0.89-1.65, p = 0.23). NASH HCC patients had lower risk of liver-related deaths (HR0.57, 95%CI 0.34-0.98, p = 0.04). DISCUSSION: NASH HCC is a rising indication for liver transplantation. Despite demographic differences, no post-transplantation survival differences were observed between NASH and non-NASH HCC. This justifies equivalent organ allocation, irrespective of NASH status.

Kidney Transplantation Outcomes From Uncontrolled Donation After Circulatory Death: A Systematic Review and Meta-analysis.

BACKGROUND: Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys. This study reviewed uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD). METHODS: MEDLINE, Cochrane, and Embase databases were searched. Data on demographic information and transplant outcomes were extracted from included studies. Meta-analyses were performed, and risk ratios (RR) were estimated to compare transplant outcomes from uDCD to cDCD. RESULTS: Nine cohort studies were included, from 2178 uDCD kidney transplants. There was a moderate degree of bias, as 4 studies did not account for potential confounding factors. The median incidence of primary nonfunction in uDCD was 12.3% versus 5.7% for cDCD (RR, 1.85; 95% confidence intervals, 1.06-3.23; P = 0.03, I 2 = 75). The median rate of delayed graft function was 65.1% for uDCD and 52.0% for cDCD. The median 1-y graft survival for uDCD was 82.7% compared with 87.5% for cDCD (RR, 1.43; 95% confidence intervals, 1.02-2.01; P = 0.04; I 2 = 71%). The median 5-y graft survival for uDCD and cDCD was 70% each. Notably, the use of normothermic regional perfusion improved primary nonfunction rates in uDCD grafts. CONCLUSIONS: Although uDCD outcomes may be inferior in the short-term, the long-term outcomes are comparable to cDCD.

Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012.

PURPOSE: We determined the use of the Clavien-Dindo classification in urological articles. We also assessed the recent trend in the use of different postoperative complication reporting classifications by authors in major journals from 2010 to 2012. MATERIALS AND METHODS: We reviewed all articles from 5 major urological journals published between January 2010 and October 2012. All studies reporting surgical outcomes were included in analysis and individually assessed after retrieving the full text. We recorded the use of complication classifications with particular emphasis on the Clavien-Dindo classification. RESULTS: A total of 907 articles mentioned surgical outcomes, of which 137 reported no complications. A descriptive classification was the most common method (483 of 770 articles or 62.7%), followed by the Clavien-Dindo classification (256 of 770 or 33.3%). Use of the Clavien-Dindo classification in articles from all 5 journals that discussed surgical outcomes increased from 21.4% in 2010 to 50.2% in 2012. Of the 770 articles 287 (37.3%) used any standardized criteria for surgical outcome reporting in 2010 to 2012. Of the 287 articles that reported surgical outcomes the Clavien-Dindo classification was used in 256 (89.5%). CONCLUSIONS: Increasing use of classification systems was seen in the most recently published articles. When a system was adopted by authors, the Clavien-Dindo classification was used most frequently. While there has been increased use of standardized reporting systems in articles mentioning surgical complications, there is room for increased implementation.

Conversion rates of abstracts presented at the Urological Society of Australia and New Zealand (USANZ) Annual Scientific Meeting into full-text journal articles.

What's known on the subject? and What does the study add? It is well known that the transition of a presented abstract in a scientific meeting to a journal article improves the quality of the meeting and prevents an abstract being incorporated into meta-analyses or practice guidelines without proper appraisal. This is the first analysis of USANZ Annual Scientific Meeting abstracts' conversion to full publication. With relatively low publication rates compared to other international meetings, this review identifies the need for mechanisms to encourage USANZ researchers to convert their abstracts into published articles. The numbers and characteristics of the abstracts presented at the Annual Scientific Meetings (ASM) of the Urological Society of Australia and New Zealand (USANZ) that are converted to peer-reviewed publications have not previously been analysed and published. We undertook a review of all abstracts presented at the USANZ ASM from 2005 to 2009. A PubMed search was performed between 15 June and 15 July 2012, using a search algorithm to identify the full-text publications of the presented abstracts. Correlation between abstract characteristics and publication rate was then examined to distinguish the predictors for publications. Of 614 abstracts that were presented at USANZ ASM between 2005 and 2009, 183 papers were published, giving a publication rate of 29.80%. The papers were predominantly published in urological journals and were more likely to be published if they were presented by an international author or were retrospective studies or if basic science research. The mean (SD) time to publication was 14.46 (13.89) months and the mean Impact Factor of journals where papers were published was 2.90. The overall publication rate was relatively low compared with other urological meetings held in America and Europe. USANZ has a challenge of encouraging higher-quality research from the authors to further enhance its publication rate and consequently the calibre of the meeting itself.

Right Lobe Versus Left Lobe Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Donor and Recipient Outcomes.

BACKGROUND: Living donor liver transplantation (LDLT) is an established treatment for advanced liver disease. Whether right lobe (RL) or left lobe (LL) LDLT provides the best outcomes for donors and recipients remains contentious. METHODS: MedLine, Embase, PubMed, and Cochrane Central were searched to identify studies comparing RL- and LL-LDLT and reporting donor and/or recipient outcomes. Effect sizes were pooled using random-effect meta-analysis. Meta-regressions were used to explore heterogeneity. RESULTS: Sixty-seven studies were included. RL donors were more likely to experience major complications (relative risk [RR] = 1.63; 95% confidence interval [CI] = 1.30-2.05; I2 = 19%) than LL donors; however, no difference was observed in the risk of any biliary complication (RR = 1.41; 95% CI = 0.91-2.20; I2 = 59%), bile leaks (RR = 1.56; 95% CI = 0.97-2.51; I2 = 52%), biliary strictures (RR = 0.99; 95% CI = 0.43-1.88; I2 = 27%), or postoperative death (RR = 0.51; 95% CI = 0.25-1.05; I2 = 0%). Among recipients, the incidence of major complications (RR = 0.85; 95% CI = 0.68-1.06; I2 = 21%), biliary complications (RR = 1.10; 95% CI = 0.91-1.33; I2 = 8%), and vascular complications (RR = 0.79; 95% CI = 0.44-1.43; I2 = 0%) was similar. Although the rate of small for size syndrome (RR = 0.47; 95% CI = 0.30-0.74; I2 = 0%) and postoperative deaths (RR = 0.62; 95% CI = 0.44-0.87; I2 = 0%) was lower among RL-LDLT recipients, no differences were observed in long-term graft (hazard ratio = 0.87; 95% CI = 0.55-1.38; I2 = 74%) and overall survival (hazard ratio = 0.86; 95% CI = 0.60-1.22; I2 = 44%). CONCLUSIONS: LL donors experience fewer complications than RL donors, and LL-LDLT recipients had similar outcomes to RL-LDLT recipients. These findings suggest that LL-LDLT offers the best outcomes for living donors and similar outcomes for recipients when measures are taken to prevent small for size syndrome.

Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis.

Background: Liver retransplantation remains as the only treatment for graft failure. This investigation aims to assess the incidence, post-transplant outcomes, and risk factors in liver retransplantation recipients in Canada. Materials and Methods: The Canadian Organ Replacement Register was used to obtain and analyse data on all adult liver retransplant recipients, matched donors, transplant-specific variables, and post-transplant outcomes from January 2000 to December 2018. Results: 377 (6.5%) patients underwent liver retransplantation. Autoimmune liver disease and hepatitis C virus (HCV) were the most common underlying diagnoses. Graft failure was 7.9% and 12.5%, and overall survival was 77.1% and 65.6% at 1 year and 5 years, respectively. In contrast to recipients receiving their first graft transplant, the retransplantation group had a significantly higher incidence of graft failure (p < 0.001) and lower overall survival (p < 0.001). The graft failure and patient survival rates were comparable between second transplant and repeat retransplant recipients. Furthermore, there were no differences in graft failure and patient survival when stratified according to time to retransplantation. Recipient and donor age (HR = 1.12, p=0.011; HR = 1.09, p=0.008), recipient HCV status (HR = 1.81, p=0.014), and donor cytomegalovirus status (HR = 4.10, p=0.006) were predictors of patient mortality. Conclusion: This analysis of liver retransplantation demonstrates that this is a safe treatment for early and late graft failure. Furthermore, even in patients requiring more than two grafts, similar outcomes to initial retransplantation can be achieved with careful selection.

Early experience photoselective vaporisation of the prostate using the 180W lithium triborate and comparison with the 120W lithium triborate laser.

PURPOSE: There is a paucity of information on the clinical efficacy and safety of the photoselective vaporization (PVP) of the prostate using the 180W lithium triborate (LBO) laser. We report on initial outcomes of PVP with the 180W laser, comparing the first 50 cases with the last 50 cases performed with the 120W LBO laser. METHODS: All cases performed by a single surgeon (HHW) have been prospectively maintained. The last 50 cases treated with the 120W LBO laser (December 2009 to August 2010) were compared with the first 50 cases treated with the 180W LBO (July 2010 to June 2011). Patient variables were recorded preoperatively and at 3 months postoperatively. Perioperative data was also recorded. RESULTS: The 180W cases had a larger median transrectal ultrasound prostate volume (68 mL vs. 51 mL, P<0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (not significant [NS] at P=0.22), lasering time 49.6 and 54.6 minutes (NS, P=0.30) and energy utilisation 477.6 kJ and 377.9 kJ (P<0.05) respectively. When compared per gram of prostate tissue lasered, the 180W is quicker at 0.67 min/g vs. 1.0 min/g for the 120W laser. Complications using the Clavien-Dindo classification included 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser. The 120 W LBO laser had 4 grade 1 complications and 1 grade 2. CONCLUSIONS: There is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. The 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There appears to be a trend toward shorter laser times.