Clinical Application of the Hanover Classification for Iatrogenic Bile Duct Lesions

Background. There is only limited evidence available to justify generalized clinical classification and treatment recommendations for iatrogenic bile duct lesions. Methods. Data of 93 patients with iatrogenic bile duct lesions was evaluated retrospectively to analyse the variety of encountered lesions with the Hanover classification and its impact on surgical treatment and outcomes. Results. Bile duct lesions combined with vascular lesions were observed in 20 patients (21.5%). 18 of these patients were treated with additional partial hepatectomy while the majority were treated by hepaticojejunostomy alone (n = 54). Concomitant injury to the right hepatic artery resulted in additional right anatomical hemihepatectomy in 10 of 18 cases. 8 of 12 cases with type A lesions were treated with drainage alone or direct suture of the bile leak while 2 patients with a C2 lesion required a Whipple's procedure. Observed congruence between originally proposed lesion-type-specific treatment and actually performed treatment was 66–100% dependent on the category of lesion type. Hospital mortality was 3.2% (n = 3). Conclusions. The Hannover classification may be helpful to standardize the systematic description of iatrogenic bile duct lesions in order to establish evidence-based and lesion-type-specific treatment recommendations

Factors influencing deceased organ donation rates in OECD countries:a panel data analysis

Objectives: This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the necessary data to facilitate the development of more efficient strategies for improving deceased organ donation rates. Design:Retrospective study. Setting:Publicly available secondary annual data.Participants:The study includes 36 OECD countries as panel members for data analysis. Outcome measures:Multivariable panel data regression analysis was employed, encompassing data from 2010 to 2018 for all investigated variables in the included countries. Results:The following variables had a significant influence on deceased organ donation rates: 'opt-in' system (β=-4.734, p&lt;0.001, ref: 'opt-out' system), only donation after brain death (DBD) donors allowed (β=-4.049, p=0.002, ref: both DBD and donation after circulatory death (DCD) donors allowed), number of hospital beds per million population (pmp) (β=0.002, p&lt;0.001), total healthcare employment pmp (β=-0.00012, p=0.012), World Giving Index (β=0.124, p=0.008), total tax revenue as a percentage of gross domestic product (β=0.312, p=0.009) and percentage of population aged .65 years (β=0.801, p&lt;0.001) as well as high education population in percentage (β=0.118, p=0.017). Conclusions:Compared with the promotion of socioeconomic factors with a positive significant impact on deceased organ donation rates, the following policies have been shown to significantly increase rates of deceased organ donation, which could be further actively promoted: the adoption of an 'opt-out' system with presumed consent for deceased organ donation and the legal authorisation of both DBD and DCD for transplantation.</p

Comparable outcome of liver transplantation with Histidine-Tryptophan-Ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trial

I studien har 12 elevgrupper från 10 kommunala skolor i Malmö studerats statistiskt frånläsåren 2005/06 till 2013/14. Utifrån elevernas socioekonomiska bakgrund undersöktes effekten av skolornas resursutbud för PISA-resultaten i årskurs 9. Genom teorier om skolan som arena för social reproduktion av medelklassens värden, visade analysen att skolan inte uppväger för arbetarklasselever utan eftergymnasialt utbildade föräldrar. Slutsatserna visade att observationsgruppernas höga lärarbehörighet kombinerat med ökad lärartäthet för utsatta elevgrupper, inte ensamt utjämnar bakgrundsrelaterad skolsegregation. Som insatskomplement bör skolornas elevsammansättning ses som en administrativt förändringsbar resurs, jämte utökat arbete för bredare konsensus mellan hem och skola kring utbildningens betydelse och form.This study carries out a Qualitative Comparative Analysis [QCA] of 12 groups of studentsfrom 10 public schools in Malmoe. Based on students’ socioeconomic background, the study examines the effect of school resources across 9 years of elementary school; on PISA results in grade 9. Using the theoretical framework that school is an institution to promote social reproduction of middle-class values; the analysis demonstrates that school does not compensate working class students. The study's conclusions where that the observation groups generally high teaching qualifications; combined with increased teacher ratio for vulnerable student groups, not alone were sufficient resources to equalize background related school segregation. These need to be complemented with a broader consensus between home and school about the importance of education and its execution. Also the school pupil homogeneous composition should thereto be seen as an administrative opportunity to level the playing field in the present segregated school situation

Liver Transplantation for Hepatocellular Carcinoma: A Single Center Resume Overlooking Four Decades of Experience

Background. This is a single center oncological resume overlooking four decades of experience with liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods. All 319 LT for HCC that were performed between 1975 and 2011 were included. Predictors for HCC recurrence (HCCR) and survival were identified by Cox regression, Kaplan-Meier analysis, Log Rank, and χ2-tests where appropriate. Results. HCCR was the single strongest hazard for survival (exp⁡B=10.156). Hazards for HCCR were tumor staging beyond the histologic MILAN (exp⁡B=3.645), bilateral tumor spreading (exp⁡B=14.505), tumor grading beyond G2 (exp⁡B=8.668), and vascular infiltration of small or large vessels (exp⁡B=11.612, exp⁡B=18.324, resp.). Grading beyond G2 (exp⁡B=10.498) as well as small and large vascular infiltrations (exp⁡B=13.337, exp⁡B=16.737, resp.) was associated with higher hazard ratios for long-term survival as compared to liver transplantation beyond histological MILAN (exp⁡B=4.533). Tumor dedifferentiation significantly correlated with vascular infiltration (χ2p=0.006) and intrahepatic tumor spreading (χ2p=0.016). Conclusion. LT enables survival from HCC. HCC dedifferentiation is associated with vascular infiltration and intrahepatic tumor spreading and is a strong hazard for HCCR and survival. Pretransplant tumor staging should include grading by biopsy, because grading is a reliable and easily accessible predictor of HCCR and survival. Detection of dedifferentiation should speed up the allocation process

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss

Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/&gt;1h, ≤2h/&gt;2h, ≤3h/&gt;3h, . . ., ≤nh/&gt;nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best 2 was identified. First and second derivative were then implemented into the curvature formula ( ) = ( )/(1 + ( ) 2 ) 3/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern ( ) = ⋅ (1 + ⋅ ( ⋅ ) ) with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM-6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss

Factors influencing deceased organ donation rates in OECD countries:a panel data analysis

Objectives: This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the necessary data to facilitate the development of more efficient strategies for improving deceased organ donation rates. Design:Retrospective study. Setting:Publicly available secondary annual data.Participants:The study includes 36 OECD countries as panel members for data analysis. Outcome measures:Multivariable panel data regression analysis was employed, encompassing data from 2010 to 2018 for all investigated variables in the included countries. Results:The following variables had a significant influence on deceased organ donation rates: 'opt-in' system (β=-4.734, p&lt;0.001, ref: 'opt-out' system), only donation after brain death (DBD) donors allowed (β=-4.049, p=0.002, ref: both DBD and donation after circulatory death (DCD) donors allowed), number of hospital beds per million population (pmp) (β=0.002, p&lt;0.001), total healthcare employment pmp (β=-0.00012, p=0.012), World Giving Index (β=0.124, p=0.008), total tax revenue as a percentage of gross domestic product (β=0.312, p=0.009) and percentage of population aged .65 years (β=0.801, p&lt;0.001) as well as high education population in percentage (β=0.118, p=0.017). Conclusions:Compared with the promotion of socioeconomic factors with a positive significant impact on deceased organ donation rates, the following policies have been shown to significantly increase rates of deceased organ donation, which could be further actively promoted: the adoption of an 'opt-out' system with presumed consent for deceased organ donation and the legal authorisation of both DBD and DCD for transplantation.</p

Prognostic Abilities and Quality Assessment of Models for the Prediction of 90-Day Mortality in Liver Transplant Waiting List Patients.

Model of end-stage liver disease (MELD)-score and diverse variants are widely used for prognosis on liver transplant waiting-lists.818 consecutive patients on the liver transplant waiting-list included to calculate the MELD, MESO Index, MELD-Na, UKELD, iMELD, refitMELD, refitMELD-Na, upMELD and PELD-scores. Prognostic abilities for 90-day mortality were investigated applying Receiver-operating-characteristic-curve analysis. Independent risk factors for 90-day mortality were identified with multivariable binary logistic regression modelling. Methodological quality of the underlying development studies was assessed with a systematic assessment tool.74 patients (9%) died on the liver transplant waiting list within 90 days after listing. All but one scores, refitMELD-Na, had acceptable prognostic performance with areas under the ROC-curves (AUROCs)>0.700. The iMELD performed best (AUROC = 0.798). In pediatric cases, the PELD-score just failed to reach the acceptable threshold with an AUROC = 0.699. All scores reached a mean quality score of 72.3%. Highest quality scores could be achieved by the UKELD and PELD-scores. Studies specifically lack statistical validity and model evaluation.Inferior quality assessment of prognostic models does not necessarily imply inferior prognostic abilities. The iMELD might be a more reliable tool representing urgency of transplantation than the MELD-score. PELD-score is assumedly not accurate enough to allow graft allocation decision in pediatric liver transplantation