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Brain death diagnoses and evaluation of the number of potential organ donors in Quebec hospitals.

https://arctichealth.org/en/permalink/ahliterature168630
Source
Can J Anaesth. 2006 Jul;53(7):716-21
Publication Type
Article
Date
Jul-2006
Author
Réal Cloutier
Dana Baran
Jean E Morin
Raymond Dandavino
Denis Marleau
Alain Naud
Robert Gagnon
Marc Billard
Author Affiliation
Transplantation Committee, Québec College of Physicians, Montreal, Canada. rcloutier@cim-conseil.qc.ca
Source
Can J Anaesth. 2006 Jul;53(7):716-21
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Brain Death - diagnosis
Hospitals - statistics & numerical data
Hospitals, Urban - statistics & numerical data
Humans
Middle Aged
Quebec
Retrospective Studies
Tissue Donors - psychology - statistics & numerical data
Transplants - statistics & numerical data
Abstract
Faced with our inability to respond to the growing number of Quebec patients waiting for organ transplants, we sought to determine the number of potential organ donors (OD) in acute care hospitals.
A retrospective chart review of all acute care, in-hospital deaths in Quebec in the year 2000 was undertaken. Hospital record librarians provided statistics and completed questionnaires on each chart after applying exclusion and inclusion criteria.
There were 24,702 acute care in-hospital deaths reported by 83 hospitals participating in the study on a voluntary basis. Analyzing 2,067 files meeting inclusion criteria, we identified 348 potential OD (1.4% of deaths). In hospitals not providing tertiary adult trauma care, the potential donor rate was 0.99% of all deaths. There were 4.5 times more potential donors in tertiary care adult trauma centers. Brain death was formally diagnosed in 268/348 patients, and organ donation discussed as an option with 230/268 families. Consent for donation was given in 70% of cases, although not all these patients proved to be suitable after evaluation. There were 125 actual donors in Quebec in the year 2000 (18 per million population).
The gap between used and potential donors can be explained by several factors including failure to approach families for organ donation, family refusal, incomplete neurological assessment of patients, and medical unsuitability of some consented donors. There is room for improvement in the identification of potential donors and in the presentation of organ donation as an end of life option to families.
PubMed ID
16803920 View in PubMed
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Early steroid withdrawal after liver transplantation: the Canadian tacrolimus versus microemulsion cyclosporin A trial: 1-year follow-up.

https://arctichealth.org/en/permalink/ahliterature185117
Source
Liver Transpl. 2003 Jun;9(6):587-95
Publication Type
Article
Date
Jun-2003
Author
Paul Greig
Leslie Lilly
Charles Scudamore
Siegfried Erb
Eric Yoshida
Norman Kneteman
Vince Bain
Cameron Ghent
Paul Marotta
David Grant
William Wall
Jean Tchervenkov
Jeffrey Barkun
Andre Roy
Denis Marleau
Vivian McAlister
Kevork Peltekian
Author Affiliation
University of Toronto, Canada. paul.greig@uhn.on.ca
Source
Liver Transpl. 2003 Jun;9(6):587-95
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adrenal Cortex Hormones - administration & dosage - adverse effects
Adult
Aged
Aged, 80 and over
Canada
Child
Chronic Disease
Cyclosporine - administration & dosage
Emulsions
Female
Follow-Up Studies
Graft Rejection - drug therapy - mortality
Graft Survival - drug effects
Humans
Immunosuppressive Agents - administration & dosage
Liver Transplantation
Male
Middle Aged
Prospective Studies
Tacrolimus - administration & dosage
Abstract
Corticosteroid therapy contributes significant toxicity to liver transplantation. The safety and efficacy of early steroid withdrawal were determined in patients treated with either tacrolimus or microemulsion cyclosporin A (micro-CsA). The primary outcome was the proportion of patients who were steroid-free 1 year posttransplantation. From the seven Canadian adult liver transplant centers, 143 patients were randomly allocated oral treatment with either tacrolimus (n = 71) or micro-CsA (n = 72), together with corticosteroids and azathioprine. Eligibility criteria for steroid withdrawal included freedom from acute rejection for a minimum of 3 months, and prednisone
PubMed ID
12783400 View in PubMed
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Identification of new donor variables associated with graft survival in a single-center liver transplant cohort.

https://arctichealth.org/en/permalink/ahliterature138989
Source
Liver Transpl. 2010 Dec;16(12):1393-9
Publication Type
Article
Date
Dec-2010
Author
Otmane Nafidi
Denis Marleau
André Roy
Marc Bilodeau
Author Affiliation
Department of Surgery, Centre hospitalier de l'Université de Montréal, Saint Luc Hospital, Montreal, Quebec, Canada.
Source
Liver Transpl. 2010 Dec;16(12):1393-9
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adult
Female
Graft Survival
Hemoglobins - metabolism
Humans
Liver - pathology
Liver Transplantation - standards
Living Donors
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Quebec
Respiratory Function Tests
Retrospective Studies
Abstract
We currently face the more widespread use of marginal livers for organ transplantation. Therefore, it is imperative to adequately identify the factors affecting early and late graft survival in that setting. The objective of this study was to determine the donor variables associated with graft survival in the liver transplant program of the University of Montreal. We retrospectively studied the survival of 634 grafts transplanted into 634 recipients between 1990 and 2008. The variables associated with 1- and 5-year graft survival were identified with the Cox proportional hazards regression model. The donor population was characterized by a mean age of 45.24 ± 18.15 years; 52.8% had at least 1 of the currently recognized extended criteria donor factors. The recipients had a mean age of 52.51 ± 10.80 years and a mean Child-Pugh score of 9.58 ± 2.32. Liver grafts were considered inadequate with respect to their gross appearance in 16 cases (2.5%). The 1- and 5-year graft survival rates were 78.7% and 71.1%, respectively. According to a Cox regression multivariate analysis, the independent determining factors associated with graft survival were (1) the graft appearance (P
PubMed ID
21117249 View in PubMed
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Liver transplantation for hepatic epithelioid hemangioendothelioma: the Canadian multicentre experience.

https://arctichealth.org/en/permalink/ahliterature154685
Source
Can J Gastroenterol. 2008 Oct;22(10):821-4
Publication Type
Article
Date
Oct-2008
Author
Carmine G Nudo
Eric M Yoshida
Vincent G Bain
Denis Marleau
Phil Wong
Paul J Marotta
Eberhard Renner
Kymberly D Watt
Marc Deschênes
Author Affiliation
McGill University, Montréal, Québec. carmine.nudo@mail.mcgill.edu
Source
Can J Gastroenterol. 2008 Oct;22(10):821-4
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada - epidemiology
Female
Follow-Up Studies
Hemangioendothelioma, Epithelioid - mortality - pathology - surgery
Humans
Liver Neoplasms - mortality - pathology - surgery
Liver Transplantation
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local
Splenic Neoplasms - secondary
Survival Rate
Treatment Outcome
Young Adult
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare entity. At the present time, there is no standardized effective therapy. Liver transplantation (LT) has emerged as a treatment for this rare tumour.
To evaluate the outcome of liver transplantation for HEHE at eight centres across Canada.
The charts of patients who were transplanted for HEHE at eight centres across Canada were reviewed.
A total of 11 individuals (eight women and three men) received a LT for HEHE. All LTs were performed between 1991 and 2005. The mean (+/- SD) age at LT was 38.7+/-13 years. One patient had one large liver lesion (17 cm x 14 cm x 13 cm), one had three lesions, one had four lesions and eight had extensive (five or more) liver lesions. One patient had spleen involvement and two had involved lymph nodes at the time of transplantation. The mean duration of follow-up was 78+/-63 months (median 81 months). Four patients (36.4%) developed recurrence of HEHE with a mean time to recurrence of 25+/-25 months (median 15.6 months) following LT. The calculated survival rate following LT for HEHE was 82% at five years.
The results of LT for HEHE are encouraging, with a recurrence rate of 36.4% and a five-year survival rate of 82%. Further studies are needed to help identify patients who would benefit most from LT for this rare tumour.
Notes
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PubMed ID
18925305 View in PubMed
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Liver transplantation for incidental cholangiocarcinoma: analysis of the Canadian experience.

https://arctichealth.org/en/permalink/ahliterature172356
Source
Liver Transpl. 2005 Nov;11(11):1412-6
Publication Type
Article
Date
Nov-2005
Author
Peter Ghali
Paul J Marotta
Eric M Yoshida
Vincent G Bain
Denis Marleau
Kevork Peltekian
Peter Metrakos
Marc Deschênes
Author Affiliation
Department of Medicine, McGill University, Montréal, Québec, Canada.
Source
Liver Transpl. 2005 Nov;11(11):1412-6
Date
Nov-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bile Duct Neoplasms - mortality - pathology - surgery
Bile Ducts, Intrahepatic
Canada
Cholangiocarcinoma - pathology - surgery
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Incidental Findings
Liver Transplantation - adverse effects - methods
Male
Middle Aged
Postoperative Complications - epidemiology
Probability
Retrospective Studies
Risk assessment
Survival Analysis
Abstract
Cholangiocarcinoma is a biliary tumor, which not infrequently complicates primary sclerosing cholangitis. It carries a poor prognosis and, with the exception of carefully selected individuals in research protocols, contraindicates orthotopic liver transplantation. There has been some suggestion that cholangiocarcinomas incidentally discovered at the time of transplantation carry a better prognosis. The goal of this retrospective study was to perform a national review of outcomes after liver transplantation in Canadian recipients found to have incidental cholangiocarcinoma in their explanted native liver. Six of the seven liver transplant centers in Canada provided clinical and follow-up information on all liver transplant recipients found to have incidental cholangiocarcinoma in their explants. The diagnosis or suspicion of cholangiocarcinoma prior to transplantation were exclusion criteria for this study. Ten individuals with cholangiocarcinoma were transplanted between 1996 and 2003. The median duration of follow-up was 28 months. Eight of the 10 had PSC. All of the tumors were stage I or II. The 3-year survival for these patients was 30%. The median time to recurrence was 26 months (95% confidence interval 13-37), and the median time to death was 30 months (95% confidence interval 28-53). In conclusion, although early survival of patients transplanted for incidental cholangiocarcinoma appears good, intermediate- and long-term survival rates are not better than for individuals historically transplanted with known cholangiocarcinoma. Aggressive investigation for cholangiocarcinoma is mandated. Incidentally found tumours remain a difficult treatment problem, and prospective adjuvant chemo-, radio-, and immunotherapies should be investigated.
PubMed ID
16237695 View in PubMed
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Recurrent hepatitis C post-transplantation: where are we now and where do we go from here? A report from the Canadian transplant hepatology workshop.

https://arctichealth.org/en/permalink/ahliterature166488
Source
Can J Gastroenterol. 2006 Nov;20(11):725-34
Publication Type
Article
Date
Nov-2006
Author
Kymberly D S Watt
Kelly Burak
Marc Deschênes
Les Lilly
Denis Marleau
Paul Marotta
Andrew Mason
Kevork M Peltekian
Eberhard L Renner
Eric M Yoshida
Author Affiliation
Dalhousie University QEII HSC, Halifax, Canada. wattk@cdha.nshealth.ca
Source
Can J Gastroenterol. 2006 Nov;20(11):725-34
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Gastroenterology - methods - trends
Hepatitis C, Chronic - epidemiology - etiology - prevention & control
Humans
Liver Transplantation - adverse effects
Postoperative Complications
Prognosis
Recurrence - prevention & control
Abstract
Approximately 400 liver transplants are performed in Canada every year and close to 6000 per year in the United States. Forty per cent to 45% of all liver transplants are performed for patients with underlying hepatitis C virus (HCV)-related liver disease. These patients have a different natural history, new complication risks and different treatment efficacy than nontransplant HCV patients. Every effort must be made to identify those patients at highest risk for progressive liver disease post-transplant. Recurrent HCV is an Achilles' heel to transplant hepatology. The true natural history of this disease is only starting to unravel and many questions remain unanswered on the optimal management of these patients after liver transplantation. The present report summarizes the literature and ongoing research needs that are specific to HCV-related liver transplantation.
Notes
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PubMed ID
17111055 View in PubMed
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6 records – page 1 of 1.