The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing li... more The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). Summary and Background Data: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov: NCT00355862), the effect of sirolimus on the recurrence of HCC after LT was investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was
International Journal of Colorectal Disease, Dec 12, 2014
Purpose The main cause of death of colorectal cancer patients is metastatic disease. Approximatel... more Purpose The main cause of death of colorectal cancer patients is metastatic disease. Approximately 20-25 % of the patients present with metastases at time of diagnosis. The clinical course of patients who develop metachronous metastases, however, is less clear. The aims of this study were to describe the incidence, treatment and survival of patients with metachronous metastases from colorectal cancer and to determine risk factors for developing metachronous metastases. Methods From the Netherlands Cancer Registry, patients diagnosed with colorectal carcinoma in the period 2002-2003 in NorthEast Netherlands were selected. Patients were followed for 5 years after diagnosis of the primary tumour. Kaplan-Meier method and Cox regression analyses were used to determine predictors for developing metastases and to analyse overall survival. Results In total, 333 of 1743 (19 %) patients developed metachronous metastases. The majority (83 %) of these metastases were diagnosed within 3 years, and the most frequent site was the liver. Patients with advanced stage and patients with tumours in the descending colon or in the rectum were more likely to develop metastases. Approximately 10 % of all patients underwent intentionally curative treatment for their metastases, with a 5-year survival rate of 60 %. Treatment of metastases and pathologic N (pN) status were independent prognostic factors for overall survival. Conclusions Site and stage of the primary tumour were predictors for developing metachronous metastases. A limited number of patients with metastatic disease were treated with a curative intent. These patients had a good prognosis. Therefore, focus should be on identifying more patients who could benefit from curative treatment.
To compare the accuracy of freehand versus robotic antenna placement in CT-guided microwave ablat... more To compare the accuracy of freehand versus robotic antenna placement in CT-guided microwave ablation (MWA) of liver tumors. Materials and Methods: This study was conducted as a prospective single-center nonblinded randomized controlled trial (Netherlands Trial Registry, NTR6023). Eligible study participants had undergone clinically indicated CT-guided MWA of liver tumors and were able to receive a CT contrast agent. Randomization was performed per tumor after identification on contrast material-enhanced CT images. The primary outcome was the number of antenna repositionings, which was compared by using the Mann-Whitney U test. Secondary outcomes were lateral targeting error stratified by in-plane and out-of-plane targets and targeting time. Results: Between February 14 and November 12, 2017, 31 participants with a mean age of 63 years (range, 25-88 years) were included: 17 women (mean age, 57 years; range, 25-77 years) and 14 men (mean age, 70 years; range, 52-88 years). The freehand study arm consisted of 19 participants, while the robotic study arm consisted of 18 participants; six participants with multiple tumors were included in both arms. Forty-seven tumors were assessed; five tumors were excluded from the analysis because of technical limitations. In the robotic arm, no antenna repositioning was required. In the freehand arm, a median of one repositioning was required (range, zero to seven repositionings; P , .001). For out-of-plane targets, lateral targeting error was 10.1 mm 6 4.0 and 5.9 mm 6 2.9 (P = .007) for freehand and robotic procedures, respectively, and for in-plane targets, lateral targeting error was 6.2 mm 6 2.7 and 7.7 mm 6 5.9, respectively (P = .51). Mean targeting time was 19 minutes (range, 8-55 minutes) and 36 minutes (range, 3-70 minutes; P = .001) for freehand and robotic procedures, respectively. Conclusion: Robotic antenna guidance reduces the need for antenna repositioning in microwave ablation to accurately target liver tumors and increases accuracy for out-of-plane targets. However, targeting time was greater with robotic guidance than with freehand targeting.
... Rafael & Gasthuisberg Leuven (Belgium) E-mail: gert. vanassche@ uz. kuleuven. ac. be ... more ... Rafael & Gasthuisberg Leuven (Belgium) E-mail: gert. vanassche@ uz. kuleuven. ac. be Prof. dr. CGMI Baeten Department of Surgery University Medical Center Maastricht Maastricht (the Netherlands) E-mail: c. baeten@ surgery. azm. nl Prof. dr. ...
Nederlands Tijdschrift voor Geneeskunde, Apr 12, 2008
Radiofrequency ablation (RFA) destroys liver tumours by the application of heat. A substantial nu... more Radiofrequency ablation (RFA) destroys liver tumours by the application of heat. A substantial number of patients with unresectable liver tumours can now be treated by local ablation, with or without partial liver resection. Another great advantage is the possibility of percutaneous RFA treatment, which has minimal morbidity. Although definite proofofits equivalence to other treatments is still lacking, RFA deserves a place in the spectrum of therapies for liver tumours.
Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduod... more Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduodenectomy. Consensus is lacking regarding the cut-off value of amylase to diagnosis clinically relevant postoperative pancreatic fistulae (POPF). The present study proposes a model based on Amylase Value in the Drain (AVD) measured in the first three postoperative days to predict a POPF. Amylase cut-offs were selected from a previous published systematic review and the accuracy were validated in a multicentre database from 12 centres in 2 countries. The present study defined POPF the 2016 ISGPS criteria (3 times the upper limit of normal serum amylase). A learning machine method was used to correlate AVD with the diagnosis of POPF. Overall, 454 (27%) of 1638 patients developed POPF. Machine learning excluded a clinically relevant postoperative pancreatic fistulae with an AUC of 0.962 (95% CI 0.940–0.984) in the first five postoperative days. An AVD at a cut-off of 270 U/L in 2 days in the first three postoperative days excluded a POPF with an AUC of 0.869 (CI 0.81–0.90, p < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five.
Human Precision-cut intestinal slices (hPCIS) are used to study intestinal physiology, pathophysi... more Human Precision-cut intestinal slices (hPCIS) are used to study intestinal physiology, pathophysiology, drug efficacy, toxicology, kinetics, and metabolism. However, the use of this ex vivo model is restricted to approximately a 24 h timeframe because of declining viability of the hPCIS during traditional culture. We hypothesized that we could extend the hPCIS viability by using organoid medium. Therefore, we cultured hPCIS for up to 72 h in organoid media [expansion medium (Emed) and differentiation medium (Dmed)]. After incubation, we assessed culture-induced changes on viability markers, specific cell type markers and we assessed the metabolic activity of enterocytes by measuring midazolam metabolite formation. We show that the adenosine triphosphate (ATP)/protein ratio of Emed-cultured hPCIS and morphology of both Emed-and Dmedcultured hPCIS was improved compared to WME-cultured hPCIS. Emed-cultured hPCIS showed an increased expression of proliferation and stem cell markers, whereas Dmed-cultured hPCIS showed an increased expression of proliferation and enterocyte markers, along with increased midazolam metabolism. Using the Emed, the viability of hPCIS could be extended for up to 72 h, and proliferating stem cells remained preserved. Using Dmed, hPCS also remained viable for up to 72 h, and specifically rescued the metabolizing enterocytes during culture. In conclusion, by using two different organoid culture media, we could extend the hPCIS viability for up to 72 h of incubation and specifically steer stem cells or enterocytes towards their original function, metabolism, and proliferation, potentially allowing pharmacokinetic and toxicology studies beyond the 24 h timeframe.
were recruited to the study. The patient demographics, type of surgery, histopathology, operative... more were recruited to the study. The patient demographics, type of surgery, histopathology, operatives findings and perioperative morbidity and mortality were evaluated. The factors associated with mortality and morbidity were analysed. Results: Twenty-one patients underwent PD of the 170 cases of obstructive jaundice managed during the study period. There were three peri-operative deaths. The overall morbidity was 23%, with a pancreatic fistula rate of 14%. Factors associated with peri-operative death include intra-operative blood loss, associated liver fibrosis, experience of surgeon and age of the patient. For those that survive the procedure, overall survival ranges from 13 to 84 months. Histology of those leaving above 5 years include papillary cancer, periampullary cancer and adenocarcinoma of pancreatic head. Number of cases performed is increasing every year. Conclusions: With adequate mentoring, difficult surgeries like PD can be performed in low volume center in developing countries with comparable result. We recommend that such model be adopted by high volume centers to improve the availability of this skill set in developing countries.
Disclaimer: This article is for information only and should not be used for the diagnosis or trea... more Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Although pancreaticoduodenectomy (PD) outcomes have improved, it remains a procedure with high pe... more Although pancreaticoduodenectomy (PD) outcomes have improved, it remains a procedure with high perioperative complications. Surgical site infection (SSI) is one of the most common complications after PD, but difficulty remains in identifying high-risk patients. We present a risk stratification tool to predict patients at highest risk for SSI. Methods: Data was retrospectively collected on all patients undergoing PD at a tertiary hospital (9/2011e8/2014). Univariate analysis was performed to determine factors individually associated with SSI. These were incorporated into a multivariate logistic regression model with receiver operating characteristics analysis. The resulting odds ratios were converted into a point system to create a SSI score with internal validation. Results: 679 patients underwent PD and were split into test (443 patients) and validation groups (236 patients). There was no difference in patient or perioperative demographics between groups. Thirty-day SSI was observed in 16.7% (n = 114). By univariate analysis, history of chemoradiation, pre-operative chemotherapy and/or radiation, bile stent, absence of a superficial wound vacuum device, and vascular resection were associated with SSI (all p < 0.05). On multivariable analysis, pre-operative bile stent or drain and neoadjuvant chemotherapy were independent predictors of SSI (all p < 0.001). Predicted risk of SSI using this score was 0%, 32%, and 64% for 0, 1, and 2 points, respectively (AUC = 0.73, R 2 = 0.93). The model performed equivalently in the validation group (AUC = 0.77, R 2 = 0.99). Conclusion: This novel, validated risk stratification score accurately predicts SSI risk after pancreaticoduodenectomy. Identifying patients with the highest risk of SSI can help target interventions to reduce SSI, such as superficial wound vacuum devices.
Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant tran... more Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant transformation. Data on the indication for surgery are scarce. We analyzed indications and outcome of patients operated for HCAs < 50 mm compared to HCAs ≥ 50 mm. Changes in final postoperative diagnosis were assessed. We performed a retrospective study that included patients who underwent resection for (suspected) HCAs in the Netherlands from 2014 to 2019. Indication for resection was analyzed and stratified for small How to cite this article:
Nederlands Tijdschrift voor Geneeskunde, Oct 14, 2006
OBJECTIVE. To describe the experience with combined liver and kidney transplantation at the Unive... more OBJECTIVE. To describe the experience with combined liver and kidney transplantation at the University Medical Centre Groningen, The Netherlands. DESIGN. Retrospective. Data were analysed from all patients who underwent combined liver and kidney transplantation in the University Medical Centre Groningen, in the period November 1994-December 2005. During the study period 582 orthotopic liver transplantations and 1026 isolated kidney transplantations were performed. 16 patients underwent combined liver and kidney transplantation: 4 were children (aged 17 months-16 years) and 12 were adults (aged 19-59 years). For all patients, both organs were obtained from the same post-mortem donor. Indications for combined liver and kidney transplantation were primary hyperoxaluria type I (n=6), polycystic liver and kidney disease (n=3) and unrelated liver and kidney failure (n=7). The 1- and 5-year survival rate was 88% (14/16), which was not significantly different from the results after isolated liver transplantation. Two patients died 11 days and 74 months after combined transplantation, due to complications from unsuccessful retransplantation of the liver for hepatic artery thrombosis and secondary biliary cirrhosis, respectively. A third patient died 51 days after combined transplantation due to sepsis. Combined liver and kidney transplantation was a life-saving intervention in this selected group of patients with combined liver and kidney failure. Patient survival was comparable to that of patients undergoing isolated liver transplantation.
The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing li... more The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). Summary and Background Data: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov: NCT00355862), the effect of sirolimus on the recurrence of HCC after LT was investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was
International Journal of Colorectal Disease, Dec 12, 2014
Purpose The main cause of death of colorectal cancer patients is metastatic disease. Approximatel... more Purpose The main cause of death of colorectal cancer patients is metastatic disease. Approximately 20-25 % of the patients present with metastases at time of diagnosis. The clinical course of patients who develop metachronous metastases, however, is less clear. The aims of this study were to describe the incidence, treatment and survival of patients with metachronous metastases from colorectal cancer and to determine risk factors for developing metachronous metastases. Methods From the Netherlands Cancer Registry, patients diagnosed with colorectal carcinoma in the period 2002-2003 in NorthEast Netherlands were selected. Patients were followed for 5 years after diagnosis of the primary tumour. Kaplan-Meier method and Cox regression analyses were used to determine predictors for developing metastases and to analyse overall survival. Results In total, 333 of 1743 (19 %) patients developed metachronous metastases. The majority (83 %) of these metastases were diagnosed within 3 years, and the most frequent site was the liver. Patients with advanced stage and patients with tumours in the descending colon or in the rectum were more likely to develop metastases. Approximately 10 % of all patients underwent intentionally curative treatment for their metastases, with a 5-year survival rate of 60 %. Treatment of metastases and pathologic N (pN) status were independent prognostic factors for overall survival. Conclusions Site and stage of the primary tumour were predictors for developing metachronous metastases. A limited number of patients with metastatic disease were treated with a curative intent. These patients had a good prognosis. Therefore, focus should be on identifying more patients who could benefit from curative treatment.
To compare the accuracy of freehand versus robotic antenna placement in CT-guided microwave ablat... more To compare the accuracy of freehand versus robotic antenna placement in CT-guided microwave ablation (MWA) of liver tumors. Materials and Methods: This study was conducted as a prospective single-center nonblinded randomized controlled trial (Netherlands Trial Registry, NTR6023). Eligible study participants had undergone clinically indicated CT-guided MWA of liver tumors and were able to receive a CT contrast agent. Randomization was performed per tumor after identification on contrast material-enhanced CT images. The primary outcome was the number of antenna repositionings, which was compared by using the Mann-Whitney U test. Secondary outcomes were lateral targeting error stratified by in-plane and out-of-plane targets and targeting time. Results: Between February 14 and November 12, 2017, 31 participants with a mean age of 63 years (range, 25-88 years) were included: 17 women (mean age, 57 years; range, 25-77 years) and 14 men (mean age, 70 years; range, 52-88 years). The freehand study arm consisted of 19 participants, while the robotic study arm consisted of 18 participants; six participants with multiple tumors were included in both arms. Forty-seven tumors were assessed; five tumors were excluded from the analysis because of technical limitations. In the robotic arm, no antenna repositioning was required. In the freehand arm, a median of one repositioning was required (range, zero to seven repositionings; P , .001). For out-of-plane targets, lateral targeting error was 10.1 mm 6 4.0 and 5.9 mm 6 2.9 (P = .007) for freehand and robotic procedures, respectively, and for in-plane targets, lateral targeting error was 6.2 mm 6 2.7 and 7.7 mm 6 5.9, respectively (P = .51). Mean targeting time was 19 minutes (range, 8-55 minutes) and 36 minutes (range, 3-70 minutes; P = .001) for freehand and robotic procedures, respectively. Conclusion: Robotic antenna guidance reduces the need for antenna repositioning in microwave ablation to accurately target liver tumors and increases accuracy for out-of-plane targets. However, targeting time was greater with robotic guidance than with freehand targeting.
... Rafael &amp; Gasthuisberg Leuven (Belgium) E-mail: gert. vanassche@ uz. kuleuven. ac. be ... more ... Rafael &amp; Gasthuisberg Leuven (Belgium) E-mail: gert. vanassche@ uz. kuleuven. ac. be Prof. dr. CGMI Baeten Department of Surgery University Medical Center Maastricht Maastricht (the Netherlands) E-mail: c. baeten@ surgery. azm. nl Prof. dr. ...
Nederlands Tijdschrift voor Geneeskunde, Apr 12, 2008
Radiofrequency ablation (RFA) destroys liver tumours by the application of heat. A substantial nu... more Radiofrequency ablation (RFA) destroys liver tumours by the application of heat. A substantial number of patients with unresectable liver tumours can now be treated by local ablation, with or without partial liver resection. Another great advantage is the possibility of percutaneous RFA treatment, which has minimal morbidity. Although definite proofofits equivalence to other treatments is still lacking, RFA deserves a place in the spectrum of therapies for liver tumours.
Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduod... more Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduodenectomy. Consensus is lacking regarding the cut-off value of amylase to diagnosis clinically relevant postoperative pancreatic fistulae (POPF). The present study proposes a model based on Amylase Value in the Drain (AVD) measured in the first three postoperative days to predict a POPF. Amylase cut-offs were selected from a previous published systematic review and the accuracy were validated in a multicentre database from 12 centres in 2 countries. The present study defined POPF the 2016 ISGPS criteria (3 times the upper limit of normal serum amylase). A learning machine method was used to correlate AVD with the diagnosis of POPF. Overall, 454 (27%) of 1638 patients developed POPF. Machine learning excluded a clinically relevant postoperative pancreatic fistulae with an AUC of 0.962 (95% CI 0.940–0.984) in the first five postoperative days. An AVD at a cut-off of 270 U/L in 2 days in the first three postoperative days excluded a POPF with an AUC of 0.869 (CI 0.81–0.90, p < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five.
Human Precision-cut intestinal slices (hPCIS) are used to study intestinal physiology, pathophysi... more Human Precision-cut intestinal slices (hPCIS) are used to study intestinal physiology, pathophysiology, drug efficacy, toxicology, kinetics, and metabolism. However, the use of this ex vivo model is restricted to approximately a 24 h timeframe because of declining viability of the hPCIS during traditional culture. We hypothesized that we could extend the hPCIS viability by using organoid medium. Therefore, we cultured hPCIS for up to 72 h in organoid media [expansion medium (Emed) and differentiation medium (Dmed)]. After incubation, we assessed culture-induced changes on viability markers, specific cell type markers and we assessed the metabolic activity of enterocytes by measuring midazolam metabolite formation. We show that the adenosine triphosphate (ATP)/protein ratio of Emed-cultured hPCIS and morphology of both Emed-and Dmedcultured hPCIS was improved compared to WME-cultured hPCIS. Emed-cultured hPCIS showed an increased expression of proliferation and stem cell markers, whereas Dmed-cultured hPCIS showed an increased expression of proliferation and enterocyte markers, along with increased midazolam metabolism. Using the Emed, the viability of hPCIS could be extended for up to 72 h, and proliferating stem cells remained preserved. Using Dmed, hPCS also remained viable for up to 72 h, and specifically rescued the metabolizing enterocytes during culture. In conclusion, by using two different organoid culture media, we could extend the hPCIS viability for up to 72 h of incubation and specifically steer stem cells or enterocytes towards their original function, metabolism, and proliferation, potentially allowing pharmacokinetic and toxicology studies beyond the 24 h timeframe.
were recruited to the study. The patient demographics, type of surgery, histopathology, operative... more were recruited to the study. The patient demographics, type of surgery, histopathology, operatives findings and perioperative morbidity and mortality were evaluated. The factors associated with mortality and morbidity were analysed. Results: Twenty-one patients underwent PD of the 170 cases of obstructive jaundice managed during the study period. There were three peri-operative deaths. The overall morbidity was 23%, with a pancreatic fistula rate of 14%. Factors associated with peri-operative death include intra-operative blood loss, associated liver fibrosis, experience of surgeon and age of the patient. For those that survive the procedure, overall survival ranges from 13 to 84 months. Histology of those leaving above 5 years include papillary cancer, periampullary cancer and adenocarcinoma of pancreatic head. Number of cases performed is increasing every year. Conclusions: With adequate mentoring, difficult surgeries like PD can be performed in low volume center in developing countries with comparable result. We recommend that such model be adopted by high volume centers to improve the availability of this skill set in developing countries.
Disclaimer: This article is for information only and should not be used for the diagnosis or trea... more Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Although pancreaticoduodenectomy (PD) outcomes have improved, it remains a procedure with high pe... more Although pancreaticoduodenectomy (PD) outcomes have improved, it remains a procedure with high perioperative complications. Surgical site infection (SSI) is one of the most common complications after PD, but difficulty remains in identifying high-risk patients. We present a risk stratification tool to predict patients at highest risk for SSI. Methods: Data was retrospectively collected on all patients undergoing PD at a tertiary hospital (9/2011e8/2014). Univariate analysis was performed to determine factors individually associated with SSI. These were incorporated into a multivariate logistic regression model with receiver operating characteristics analysis. The resulting odds ratios were converted into a point system to create a SSI score with internal validation. Results: 679 patients underwent PD and were split into test (443 patients) and validation groups (236 patients). There was no difference in patient or perioperative demographics between groups. Thirty-day SSI was observed in 16.7% (n = 114). By univariate analysis, history of chemoradiation, pre-operative chemotherapy and/or radiation, bile stent, absence of a superficial wound vacuum device, and vascular resection were associated with SSI (all p < 0.05). On multivariable analysis, pre-operative bile stent or drain and neoadjuvant chemotherapy were independent predictors of SSI (all p < 0.001). Predicted risk of SSI using this score was 0%, 32%, and 64% for 0, 1, and 2 points, respectively (AUC = 0.73, R 2 = 0.93). The model performed equivalently in the validation group (AUC = 0.77, R 2 = 0.99). Conclusion: This novel, validated risk stratification score accurately predicts SSI risk after pancreaticoduodenectomy. Identifying patients with the highest risk of SSI can help target interventions to reduce SSI, such as superficial wound vacuum devices.
Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant tran... more Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant transformation. Data on the indication for surgery are scarce. We analyzed indications and outcome of patients operated for HCAs < 50 mm compared to HCAs ≥ 50 mm. Changes in final postoperative diagnosis were assessed. We performed a retrospective study that included patients who underwent resection for (suspected) HCAs in the Netherlands from 2014 to 2019. Indication for resection was analyzed and stratified for small How to cite this article:
Nederlands Tijdschrift voor Geneeskunde, Oct 14, 2006
OBJECTIVE. To describe the experience with combined liver and kidney transplantation at the Unive... more OBJECTIVE. To describe the experience with combined liver and kidney transplantation at the University Medical Centre Groningen, The Netherlands. DESIGN. Retrospective. Data were analysed from all patients who underwent combined liver and kidney transplantation in the University Medical Centre Groningen, in the period November 1994-December 2005. During the study period 582 orthotopic liver transplantations and 1026 isolated kidney transplantations were performed. 16 patients underwent combined liver and kidney transplantation: 4 were children (aged 17 months-16 years) and 12 were adults (aged 19-59 years). For all patients, both organs were obtained from the same post-mortem donor. Indications for combined liver and kidney transplantation were primary hyperoxaluria type I (n=6), polycystic liver and kidney disease (n=3) and unrelated liver and kidney failure (n=7). The 1- and 5-year survival rate was 88% (14/16), which was not significantly different from the results after isolated liver transplantation. Two patients died 11 days and 74 months after combined transplantation, due to complications from unsuccessful retransplantation of the liver for hepatic artery thrombosis and secondary biliary cirrhosis, respectively. A third patient died 51 days after combined transplantation due to sepsis. Combined liver and kidney transplantation was a life-saving intervention in this selected group of patients with combined liver and kidney failure. Patient survival was comparable to that of patients undergoing isolated liver transplantation.
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