"Super-rapid" Technique in Donation After Circulatory Death Liver Donors: Advantages and Disadvantages.

In recent years, donation after circulatory death (DCD) has increased as an option to overcome the organ donor shortage crisis and to decrease the large number of patients on liver transplant waiting lists. The "super-rapid" technique is now the "gold standard" procurement method because of its availability, reproducibility, low cost, and extensive experience. Recently, extracorporeal support has been implemented, with encouraging results. Strict donor acceptance criteria have proven to be essential to optimize the DCD liver graft outcomes and minimize biliary complication rates. In this study we assessed the state of the art of DCD liver transplantation with regard to its development and the actual strategies to prevent graft complications, with aim of expanding the pool of marginal liver donors.

Prediction model to discard a priori liver allografts.

BACKGROUND: The use of expanded criteria for donors to expand the donor pool has increased the number of discarded liver grafts in situ. The aim of our study was to elaborate a prediction model to reduce the percentage of liver grafts discarded before the procuring team is sent out. METHODS: We analyzed the donor factors of 244 evaluated candidates for liver donation. We performed a multiple logistic regression to evaluate the probability of liver grafts discarded (PD). RESULTS: The PD was determined by use of 3 variables: age, pathological ultrasonography, and body mass index >30. The area under curve was 82.7%, and, for a PD of 70%, the false-positive probability was 1.2%. CONCLUSIONS: We have created a useful clinical prediction model that could avoid up to 20% of discarded liver grafts.

Tumores del estroma gastrointestinal (GIST): factores pronósticos de supervivencia tras citorreducción R0 / No disponible

Objetivo: analizar los posibles factores pronósticos de supervivenciaen tumores estromales gastrointestinales c-kit positivo(GIST), tras citorreducción óptima R0.Pacientes y método: estudio de 35 pacientes intervenidosen nuestra Unidad desde enero 2002 a febrero 2007, con tumoresdel estroma gastrointestinal CD117/c-kit positivo en los quese alcanzó citorreducción quirúrgica sin residuo tumoral macroscópico.Una base de datos prospectiva nos proporcionó las distintasvariables analizadas, de carácter demográfico, anatómico, clínico,histopatológico e inmunohistoquímico, entre otras. Elanálisis de la supervivencia actuarial se realizó según el método deKaplan-Meier y el análisis multivariante mediante el método de regresiónmúltiple de Cox.Resultados: la supervivencia global a 5 años fue del 77%,con una supervivencia media de 52 meses. El riesgo de malignidadsegún la clasificación de Fletcher y el tamaño tumoral mayorde 10 cm, influyeron significativamente de forma negativa sobrela supervivencia de los pacientes, tras el análisis univariante realizado(p < 0,05). La actividad proliferativa Ki-67 mayor del 50%fue la única covariable con significación estadística en el análisismultivariante. El 20% de los tumores recurrieron. Sólo 3 pacientesmetastáticos recibieron tratamiento adyuvante con mesilato deimatinib, todos ellos con Ki-67 > 50% y vivos en la actualidad.Conclusiones: el índice proliferativo Ki-67 podría representarun excelente marcador pronóstico de supervivencia en aquellospacientes con tumores del estroma gastrointestinal c-kit positivo.Su confirmación y el punto de corte adecuado deberían serobjeto de futuros estudios prospectivos, así como su posible utilidadpara seleccionar pacientes candidatos al tratamiento con mesilatode imatinib

Objective: to analyze the different factors predictive of survivalassociated with optimal R0-cytoreduction in c-kit-positivegastrointestinal stromal tumors.Methods: thirty-five patients were operated on in our OncologicalSurgery Department from January 2002 to February2007 because of CD117/c-kit-positive gastrointestinal stromal tumors,and an optimal surgical cytoreduction was obtained withoutmacroscopical residual disease. Demographic, anatomical, clinical,pathological, and immunohistochemical variables were analyzedfrom a specific database. Survival and multivariate analyseswere developed using Kaplan-Meier and multiple Cox regressionmodels, respectively.Results: five-year overall survival was 77% with a mean survivalof 52 months. Risk of malignant behaviour according toFletcher’s classification and tumor size higher than 10 cm had asignificantly negative influence on overall survival in the univariateanalysis (p < 0.05). Proliferative Ki-67 activity higher than 50%was the only statistically significant variable in the multivariateanalysis. Twenty percent of tumors recurred. Only 3 patients withmetastatic disease received adjuvant treatment with imatinib mesylate,all of them with Ki-67 > 50% and currently alive.Conclusions: the poliferative Ki-67 index could represent anexcellent predictive factor for survival in patients with c-kit-positivestromal gastrointestinal tumors. Confirmation and an adequatecut-off level should be the main objectives for futureprospective studies, mostly focused on the appropriate selectionof optimal candidates to imatinib-mesylate-based treatment

Carney's triad: case report and review.

INTRODUCTION: Carney's triad is a rare pathogenic entity which consists of the association in young women of multiple condromatosis in the lung, gastric leiomyosarcoma, and extradrenal paraganglioma; although the presence of three at the same time is not required for its diagnosis. CASE REPORT: We present the case of a 27-year-old woman who was diagnosed of pulmonary multiple hamartomatosis and gastric stromal tumor. DISCUSSION: A review of the literature shows the most important prognosis factors and therapeutic options. Surgery for gastrointestinal stromal tumors and extradrenal paraganglioma seems to be the best treatment up to date.

[Gastrointestinal stromal tumors (GIST): factors predictive of survival after R0-cytoreduction]. / Tumores del estroma gastrointestinal (GIST): factores pronósticos de supervivencia tras citorreducción R0.

OBJECTIVE: To analyze the different factors predictive of survival associated with optimal R0-cytoreduction in c-kit-positive gastrointestinal stromal tumors. METHODS: Thirty-five patients were operated on in our Oncological Surgery Department from January 2002 to February 2007 because of CD117/c-kit-positive gastrointestinal stromal tumors, and an optimal surgical cytoreduction was obtained without macroscopical residual disease. Demographic, anatomical, clinical, pathological, and immunohistochemical variables were analyzed from a specific database. Survival and multivariate analyses were developed using Kaplan-Meier and multiple Cox regression models, respectively. RESULTS: Five-year overall survival was 77% with a mean survival of 52 months. Risk of malignant behaviour according to Fletcher s classification and tumor size higher than 10 cm had a significantly negative influence on overall survival in the univariate analysis (p < 0.05). Proliferative Ki-67 activity higher than 50% was the only statistically significant variable in the multivariate analysis. Twenty percent of tumors recurred. Only 3 patients with metastatic disease received adjuvant treatment with imatinib mesylate, all of them with Ki-67 > 50% and currently alive. CONCLUSIONS: The poliferative Ki-67 index could represent an excellent predictive factor for survival in patients with c-kit-positive stromal gastrointestinal tumors. Confirmation and an adequate cut-off level should be the main objectives for future prospective studies, mostly focused on the appropriate selection of optimal candidates to imatinib-mesylate-based treatment.