ABSTRACT
Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time. There was no significant difference in bile duct complications, graft survival or survival of the patient. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality.
Subject(s)
Allografts/physiology , Liver Transplantation/methods , Liver/physiology , Organ Preservation/methods , Temperature , Tissue and Organ Harvesting/methods , Adolescent , Adult , Aged , Aged, 80 and over , Allografts/pathology , Allografts/physiopathology , Allografts/standards , Bile Ducts/pathology , Bile Ducts/physiology , Bile Ducts/physiopathology , Female , Graft Survival , Humans , Length of Stay , Liver/enzymology , Liver Transplantation/adverse effects , Male , Middle Aged , Organ Preservation/adverse effects , Perfusion , Survival Analysis , Tissue Donors/supply & distribution , Tissue and Organ Harvesting/adverse effects , Treatment Outcome , Waiting Lists , Young AdultABSTRACT
UNLABELLED: Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Active surveillance of small renal masses has traditionally been reserved for elderly patients deemed unfit for surgery or ablation. There is increasing evidence showing the safety of active surveillance in the management of small renal masses. In this retrospective study we compared outcomes for patients with small renal masses managed with active surveillance, radical nephrectomy and partial nephrectomy. We showed that active surveillance was safe and appeared as effective as immediate surgery in the management of small renal tumours. OBJECTIVE: ⢠To compare the oncological outcomes of active surveillance (AS), radical nephrectomy (RN) and partial nephrectomy (PN) in the management of T1a small renal masses (SRMs). PATIENTS AND METHODS: ⢠At present AS is used in the treatment of SRMs in elderly patients with multiple co-morbidities or in those who decline surgery. ⢠We identified all patients with T1a SRMs managed with RN, PN or AS. ⢠Retrospective data were collected from patient case records with survival data and cause of death cross-referenced with the Oxford Cancer Intelligence Unit. RESULTS: ⢠A total of 202 patients with 234 T1a SRMs (solid or Bosniak IV) were identified; 71 patients were managed with AS, 41 with an RN and 90 by PN. ⢠Over a median follow-up of 34 months the mean growth rate on AS was 0.21 cm/year with 53% of SRMs managed with AS showing negative or zero growth. ⢠No statistically significant difference was observed in overall (OS) and cancer-specific (CSS) survival for AS, RN and PN (AS-CSS 98.6%, AS-OS 83%; RN-CSS 92.6%, RN-OS 80.4%; PN-CSS 96.6%, PN-OS 90.0%). CONCLUSIONS: ⢠Active surveillance of SRMs offers oncological efficacy equivalent to surgery in the short/intermediate term. ⢠The results of this study support a multicentre prospective randomized controlled trial designed to compare the oncological efficacy of AS and surgery.