Donor criteria for liver transplantation: A comparative study of the effects of donor liver selection

In a case-control study, the relevance of donor parameters used for donor selection on final transplant outcome was studied. Two matched groups of 17 donors were created: one group of 'ideal' donors and a control group not meeting the criteria for 'ideal' donors. Recipients of livers from both groups were matched for liver disease, Karnovsky-score, Child-Pugh sumscore, and preservation solution used (EuroCollins or UW-solution). The effect of the donor liver selection criteria on transplant outcome was measured by comparing the following parameters in both groups: intra-operative blood loss, the ALT in the first 3 days after grafting, occurrence of major postoperative complications, ICU-stay and graft and patient survival. Although, in the control group, bacterial infections and abdominal hemorrhages occurred more frequently, while leakage from the bile duct anastomosis was more prevalent in the 'ideal' group, the results for the other parameters studied indicated no statistical differences between the two groups. It was concluded that adherence to strict selection criteria for liver donors did not improve final transplant outcome. However, use of less strict criteria possibly may cause a more complicated course directly after transplantation

Traditional versus up-front [F-18] fluorodeoxyglucose-positron emission tomography staging of non-small-cell lung cancer: A Dutch cooperative randomized study

Purpose We investigated whether application of positron emission tomography (PET) immediately after first presentation might simplify staging while maintaining accuracy, as compared with traditional strategy in routine clinical setting. Methods At first presentation, patients with a provisional diagnosis of lung cancer without overt dissemination were randomly assigned to traditional work-up (TWU) according to international guidelines or early PET followed by histologic/cytologic verification of lesions, or imaging and follow-up. Patients with [F-18] fluorodeoxyglucose ((18)FDG) -avid, noncentral tumors without suspicion of mediastinal or distant metastases on PET proceeded directly to thoracotomy. Follow-up in presumed benign lesions was at least 12 months. In patients treated with surgery or neoadjuvant therapy, the quality of staging was measured by comparing the clinical stage to the final stage (combination of peroperative staging and 6 months of follow-up). To investigate test substitution, we analyzed the number of (non)invasive tests to achieve clinical TNM staging, and its associated costs. Results Between 1999 and 2001, 465 patients (233 TWU, 232 PET) were enrolled at 22 hospitals. The mean (standard deviation) number of procedures to finalize staging was equal in the TWU arm and the PET arm: 7.9 (2.0) v 7.9 (1.9), P = .90, respectively. Mediastinoscopies occurred significantly less often in the PET arm. Agreement between clinical and final stage was good in both arms (kappa = .85 v .78; P = .07). Costs did not differ significantly. Conclusion Up-front (18)FDG-PET in patients with (suspected) lung cancer does not reduce the overall number of diagnostic test, but it maintains quality of TNM staging with the use of less invasive surgery