Idiopathic mediastinal fibrosis

peer reviewedFibrosing mediastinitis is a rare condition characterized by an excessive growth of dense fibrous tissue within the mediastinum. The etiology of the disease is most often a fungal infection and may in some cases be idiopathic. We present the case of a patient with chronic obstructive pulmonary disease (COPD) suffering from fibrosing mediastinitis of undetermined origin and in whom the diagnosis was established by histopathological analysis after mediastinoscopy

Impact of donor age over 70 years in donation after circulatory death liver transplantation: a 15 years of experience

peer reviewedBackground: Advanced donor age has been identified as a risk factor in donation after circulatory death (DCD 3) liver transplantation (LT), associated with poor graft function and development of ischemic cholangiopathy. In this study, we evaluated the results after DCD 3 LT using grafts from donors over 70 years compared to younger grafts (<70 years). Methods: We retrospectively analysed outcome after DCD 3 LT (n=228), comparing donors 70 years (n=53) and <70 years (n=175) from our center between 2003 and 2020. The two age groups were compared in terms of graft and patient survivals at 1, 3 and 5 years, in terms of donor and recipient demographics, transplant conditions and labora- tory values. Results: The overall graft survivals at 1, 3 and 5 years were 88, 75, 70 per cent respectively. Graft survival rates were not significantly diffe- rent at 5 years between the two groups (P = 0,536). No difference was noted in incidence of acute rejection, biliary strictures, hepatic artery thrombosis or retransplantation rates between the two groups. The time of cold ischemia was significatively lower in the older group (mean 235 min; SD 72) than in younger donor (mean 258 min; SD 72) (p=0.012). The posttransplant AST peak was significatively higher in the advanced age donor group than the second group with 2201±2703 U/L vs 1561U/L (SD 2151±2151 U/L), respectively (p= 0.04).Conclusions: Results for DCD LT from 70-yr-old grafts were similar to those from younger donors. Advanced donors should not be discarded for liver donation if other donor risk factors (such as cold ischemia time and graft quality) are limited

Overlap syndrome consisting of PSC-AIH with concomitant presence of a membranous glomerulonephritis and ulcerative colitis

Abstract The association of primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) is known as an overlap syndrome (OS). OS can also be described in the setting of concomitant presence of AIH and PSC. These diseases can in some cases be associated with ulcerative colitis. In this case report we describe, to our knowledge, the first case in the literature of a young Caucasian male suffering from ulcerative colitis and an overlap syndrome consisting of an association between PSC-AIH, with the concomitant presence of a membranous glomerulonephritis

Considerations on liver transplantation in the alcoholic patients

peer reviewedIn Belgium as in many other countries, alcohol is one of the leading causes of adult liver transplantation. Liver transplantation for terminal liver failure due to excessive alcohol intake raises clear ethical issues concerning the use of grafts to save patients suffering from a self-inflecting affection. Alcoholic liver disease is one of the best indications for liver transplantation, with excellent results in terms of length of survival and post transplantation quality of life, if this transplantation is proposed by a multidisciplinary team in a patient able to and helped by a supporting family and social environment.En Belgique, comme dans beaucoup d’autres pays, la maladie alcoolique constitue une des causes les plus fréquentes menant à la transplantation hépatique chez l’adulte. Or la transplantation hépatique chez des patients alcooliques pose de claires questions éthiques concernant l’utilisation de greffons pour soigner des patients souffrant d’une maladie trop souvent considérée comme étant auto- infligée. La maladie alcoolique du foie est une des meil- leures indications de greffe hépatique, avec d’excellents résultats en termes de durée de survie et de qualité de vie après transplantation. Le pré-requis est que cette trans- plantation soit proposée par une équipe multidisciplinaire, chez un patient capable de se prendre en charge et sou- tenu par un environnement familial et social favorable

Increased neoplastic risks in ulcerative colitis associated with primary sclerosing cholangitis

peer reviewedUlcerative ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by the presence of continuous, uniform, gapless lesions of healthy mucous membrane extending integrally from the anus over a variable portion of the colon. It is a multisystemic pathology for which we will describe one of its hepatic manifestations, primary sclerosing cholangitis (PSC). We present here the story of a patient, a carrier of the Breast Cancer type 1 gene mutation (BRCA1), who initially presented with epigastric and peri-umbilical abdominal pain associated with several episodes of bloody diarrhea. The initial assessment made it possible to diagnose BRCA1 and the fortuitous discovery of biliary tract stenosis of an undetermined nature. Further investigations led to the conclusion that there was a strong presumption of UC associated with PSC or even cholangiocarcinoma (CCA). In the course of treatment, cancer of the gallbladder was also detected. This clinical case makes it possible to review, in the light of recent publications, the pathophysiological link existing between UC and PSC. This article also presents an in-depth analysis of this entity with malignant potential that can affect different sites of the digestive tract, and its own management, which is the subject of new recommendations

Alcoholic hepatitis

peer reviewedAlcoholic hepatitis is a syndrome defined primarily by the clinical onset of jaundice in patients with a concomitant heavy consumption of alcoholic beverages. This pathology is managed by alcohol withdrawal with a 30-day survival rate of 90 %. For patients with severe alcoholic hepatitis, with a Maddrey score greater than 32 (taking into account bilirubin and prothrombin time), treatment with corticosteroids is discussed provided that a possible infection can be sufficiently excluded or adequately managed. The administration of corticosteroids is continued for 28 days if the Lille score, calculated after 7 days of treatment, is favourable (inferior to 0.45), leading to a survival rate of 80-90 %. However, if the Lille score is unfavourable (superior to 0.45), the prognosis is bad, with a survival of only 25-30 % at 6 months. Special attention needs to be paid to assure a sufficient caloric intake during the treatment period for a successful management. Liver transplantation, previously prohibited for this indication, can be discussed under certain circumstances. However, the success of treatment is contingent upon the alcohol withdrawal. Innovative drugs are currently under investigation to improve the prognosis of this condition.L’hépatite alcoolique aiguë (HAA) se définit selon des paramètres essentiellement cliniques (ictère d’appari- tion récente chez un patient avec une consommation abu- sive d’alcool). L’HAA peu sévère est prise en charge par un sevrage éthylique, avec un espoir de survie de 90 % à un mois. Pour les patients atteints d’HAA sévère (évaluée par le score de Maddrey > 32, tenant compte de la biliru- bine et du temps de prothrombine), un traitement par corti- coïdes se discute, pour autant qu’une éventuelle infection ait pu être exclue ou jugulée. Le traitement par corticoïdes est poursuivi 28 jours si le score de Lille, calculé après 7 jours de corticoïdes, est favorable ( 0,45), le pronostic est nettement plus péjo- ratif avec une survie de 25-30 % à 6 mois. Dans la prise en charge, on apportera une attention toute particulière à la nutrition avec un apport calorique suffisant. La trans- plantation hépatique, autrefois non autorisée dans cette indication, peut actuellement être discutée dans certaines circonstances particulières. La clé de la réussite résidera, de toute façon, dans le sevrage. Des médicaments nova- teurs sont actuellement en cours d’étude pour améliorer le pronostic de cette affection

Multidisciplinary management of the primary liver cancers

In Belgium and around the world, the incidence of primary malignant liver tumours is increasing, both for hepatocarcinoma and cholangiocarcinoma. Their curative treatment is based on multidisciplinary and specialized care, of which surgery (including liver transplantation) remains the cornerstone, often associated with other logoregional treatments, as radioembolisation, radiofrequency ablation, and chemoembolisation. For advanced cases, the prognosis remains poor, in particular due to a certain chemoresistance of these tumours. New treatments include targeted therapies (including various tyrosine kinase inhibitors) and immunotherapy. A specialized multidisciplinary discussion is therefore necessary to define the best therapeutic management, individualized to each patient. In this article, the authors review the most recent data relating to the treatment of hepatocarcinoma and cholangiocarcinoma.En Belgique et dans le monde, l’incidence des tumeurs malignes primitives du foie augmente, tant pour l’hépatocarcinome que le cholangiocarcinome. Leur traitement curatif repose sur une prise en charge multidisciplinaire et spécialisée, dont la chirurgie (incluant la transplantation hépatique) reste la pièce angulaire, souvent associée à d’autres traitements logo-régionaux (radioembolisation, radiofréquence, chimio-embolisation). Pour les cas avancés, le pronostic reste sombre, notamment en raison d’une certaine chimiorésistance de ces tumeurs. Les nouvelles prises en charge incluent des thérapies ciblées (notamment, divers inhibiteurs de tyrosine kinase) et de l’immunothérapie. Une discussion pluridisciplinaire spécialisée est donc nécessaire pour définir la meilleure prise en charge thérapeutique, individualisée pour chaque patient. Dans cet article, les auteurs revoient les données récentes relatives au traitement de l’hépatocarcinome et du cholangiocarcinome

Organ transplantation during SARS-CoV-2 epidemic : the 2020-2021 Liege transplant Center experience

peer reviewedThe «Severe Acute Respiratory Syndrome coronavirus 2» (SARS-CoV-2) pandemic has disrupted medical care and intra-hospital organization during 2020, both in Belgium and throughout the world. Solid organ transplantation was not spared and in Belgium, the number of organ donors and transplants overall decreased by 20 % for livers and by 33 % for hearts between 2019 and 2020. The aim of this article is to summarize the experience acquired in 2020 and 2021 on the organizational and medical implications of the coronavirus disease 2019 (COVID-19) pandemic with regard to the care of patients transplanted or awaiting for organ transplants, and to draw conclusions both for the aftermath of COVID-19 but also for future pandemics. Vaccination against SARS-CoV-2 is highly recommended and particularly important in organ transplant recipients, even if the response rate is lower than in the non-transplanted population. A third injection is now advised in immunosuppressed patients.La pandémie de «severe acute respiratory syndrome coronavirus 2» (SARS-CoV-2) a bouleversé les soins médicaux et l’organisation intra-hospitalière durant l’année 2020 en Belgique et dans le monde. La transplantation d’organes ne fut pas épargnée et en Belgique, le nombre de donneurs d’organes et de transplantations a globalement diminué de 20% pour les foies et de 33% pour les cœurs entre 2019 et 2020. Le but de cet article est de résumer l’expérience acquise en 2020 et 2021 sur les implications organisationnelles et médicales de la pandémie de «coronavirus disease 2019 » (COVID-19) quant à la prise en charge des patients transplantés ou en attente de greffe d’organes, et d’en tirer les conclusions à la fois pour les suites du SARS-CoV-2 mais aussi pour les futures pandémies. La vaccination anti-SARS-CoV-2 est recommandée et particulièrement importante chez les patients transplantés d’organe, même si le taux de réponse est inférieur à la population non-transplantée. Une troisième injection est conseillée chez les patients immunodéprimés

18FDG PET scanner as a selection criterion in liver transplantation for hepatocarcinoma

peer reviewedFor years, Milan criteria have been the standard for selection criteria for liver transplantation (LT) of patients with hepatocellular carcinoma (HCC). Previous retrospective studies suggested that 18 FDG positron tomography (18FDG-PET) could be an effective tool to select HCC patients beyond Milan criteria for LT if their tumour is not FDG avid. A prospective national study evaluating the potential role of 18FDG-PET in LT for HCC was initiated by BeLIAC and financed by the National Cancer Foundation for the years 2019-2022. Complete results of this study with 2-year follow-up will be available by the end of 2024. In this report the authors aimed to present the preliminary results of this study in the CHU Liege LT centre. Methods: This study is a prospective national study accepted by all Belgian transplant centres and BeLIAC. All patients signed an informed consent form. Between January 2019 and October 2022, 51 patients (43 males, mean age 63y) were transplanted with HCC, and 44 had PET CT before LT or neoadjuvant therapy. Amongst these 44 HCC patients with PET, 28 were Milan-in, 1 Milan-in after successful downstaging, and 13 were Milan-out (11 Milan-out Up-to-seven-in and 2 Milan-out up-to-seven-out) at time of listing. Two Milan-in patients were PET positive, and all others were PET negative. Results: Three patients died during the follow-up, without recurrence. No patients developed recurrence at 1- and 2-year follow-up. Three patients developed recurrence between 2- and 3-year follow-up and all were Milan-in. Importantly, no Milan-out PET negative patients developed recurrence at October 2022 follow-up. Conclusions: PET FDG could be an important tool to offer potential LT opportunity to HCC patients outside Milan criteria. A longer follow-up and complete Belgian data are important before drawing further conclusions on this important matter