Publications by authors named "Boudjema Karim"

Background: Hepatocellular carcinoma (HCC) associated with major vasculature tumor extension is considered an advanced stage of disease to which palliative radiotherapy or chemotherapy is proposed. Surgical resection associated with chemotherapy or chemoembolization could be an opportunity to improve overall survival and recurrence-free survival in selected cases in a high-volume hepatobiliary center. Moreover, it has been 25 years since Couinaud described the entity of a posterior liver located behind an axial plane crossing the portal bifurcation.

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The discrepancy between donor organ availability and demand leads to a significant waiting-list dropout rate and mortality. Although quantitative tools such as the Donor Risk Index (DRI) help assess organ suitability, many potentially viable organs are still discarded due to the lack of universally accepted markers to predict post-transplant outcomes. Normothermic machine perfusion (NMP) offers a platform to assess viability before transplantation.

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Biliary complications remain a real issue in liver transplantation (LT). Despite meta-analyses, the anastomosis technique, especially the use of biliary drain as T-Tube drain (TT) or transcystic drain, remains controversial. This study conducted by the ARCHET research group examine the incidence and types of biliary complications (BC) after LT according to the presence or absence of a biliary drain.

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Article Synopsis
  • When liver transplants are done at night, doctors wanted to see if it causes more problems afterwards.
  • They looked at 790 patients who had liver transplants from 2012 to 2018.
  • The study found that transplants done late at night had more serious complications and needed more blood transfusions compared to those done during the day.
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Background: Laparoscopic right anterior sectionectomy (LRAS) remains a technically demanding procedure as it requires two transection planes where the middle and right hepatic veins run; however, the main difficulty is locating these two planes. The aim of this video was to show the technique of an LRAS performed with a transparenchymal glissonean pedicle approach and guided by indocyanine green (ICG) staining.

Methods: This was the case of an 80-year-old man with a history of hemochromatosis and normal liver function.

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Background: Although the incidence of BTC is raising, national healthcare strategies to improve care lack. We aimed to explore patient clinical care pathways and strategies to improve biliary tract cancer (BTC) care.

Methods: We analysed the French National Healthcare database of all BTC inpatients between January 1, 2017 and December 31, 2021.

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Introduction: This document is a summary of the French intergroup guidelines of the management of biliary tract cancers (BTC) (intrahepatic, perihilar and distal cholangiocarcinomas, and gallbladder carcinomas) published in September 2023, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org).

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Interim analysis of the DOSISPHERE-01 study demonstrated a strong improvement in response and overall survival (OS) on using Y-loaded glass microspheres with personalized dosimetry compared with standard dosimetry in patients with nonoperable locally advanced hepatocellular carcinoma. This report sought to provide a long-term analysis of OS. In this phase II study (ClinicalTrials.

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Objective: To describe the feasibility of hypothermic machine perfusion (HMP) in uterus transplantation (UT) to potentially improve the preservation of the uterus and enhance graft preservation in the donation after brainstem death (DBD) context. Uterus transplantation is a new surgical approach to treating absolute uterine infertility; it can be performed after living donation or after DBD. In the DBD context, the uterus is typically the last organ removed after other vital organs, with the exception of the Baylor team, which removes the uterus first.

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Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor after hepatocellular carcinoma (HCC). Management depends on their resectability at the time of diagnosis. Two types can be distinguished by imaging: resectable ICCs amenable to surgery and locally advanced and/or metastatic ICCs, that are treated by chemotherapy, radiotherapy or loco-regional treatment (radioembolization, chemoembolization, intra-arterial chemotherapy and thermoablation).

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Objective: The aim of this study was to evaluate the efficacy of yttrium-90 transarterial radioembolization (TARE) to convert to resection initially unresectable, single, large (≥5 cm) hepatocellular carcinoma (HCC).

Background: TARE can downsize cholangiocarcinoma to resection but its role in HCC resectability remains debatable.

Methods: All consecutive patients with a single large HCC treated between 2015 and 2020 in a single tertiary center were reviewed.

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Article Synopsis
  • Advanced liver-only intrahepatic cholangiocarcinoma (iCCA) treatment using selective internal radiation therapy (SIRT) combined with chemotherapy has shown promising results when compared to chemotherapy alone.
  • A study analyzed data from multiple clinical trials, highlighting a significant improvement in overall and progression-free survival for patients receiving the SIRT and chemotherapy combination.
  • While findings suggest SIRT may enhance treatment outcomes, further randomized controlled trials are necessary for confirmation.
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  • This project developed a framework for managing patients with synchronous colorectal cancer and liver metastases, addressing terminology, diagnosis, and treatment strategies.* -
  • A multi-organizational consensus was reached through a Delphi process, resulting in twelve key statements with at least 70% agreement on issues like treatment pathways and tumor board composition.* -
  • Key findings include definitions for metastases timing, guidelines for clinical assessments, and recommendations for various treatment approaches, aimed at improving clinical practice for affected patients.*
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Objective: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities.

Background: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures.

Methods: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a 5-year period (2016-2020).

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Background: Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management.

Methods: This project was a multiorganizational, multidisciplinary consensus.

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Background: Acute liver failure (ALF) is a rare but life-threatening condition mostly requiring intensive care unit (ICU) admission. ALF induces immune disorders and may promote infection acquisition. However, the clinical spectrum and impact on patients' prognosis remain poorly explored.

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Therapeutic targeting of the transforming growth factor beta (TGFβ) pathway in cancer represents a clinical challenge since TGFβ exhibits either tumor suppressive or tumor promoting properties, depending on the tumor stage. Thus, treatment with galunisertib, a small molecule inhibitor of TGFβ receptor type 1, demonstrated clinical benefits only in subsets of patients. Due to the functional duality of TGFβ in cancer, one can hypothesize that inhibiting this pathway could result in beneficial or adverse effects depending on tumor subtypes.

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Background: With a mortality rate of up to 30%, post-pancreatectomy hemorrhage (PPH) remains a serious complication after pancreatoduodenectomy (PD) for cancer. Little is known about the long-term survival of patients after PPH. This retrospective study aimed to evaluate the impact of PPH on long-term survival after PD.

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Purpose: A transjugular intrahepatic portosystemic shunt (TIPS) before the liver transplantation (LT) has been considered a contraindication in cases of hepatocellular carcinoma (HCC) because of the risk of tumour growth. We aimed to assess the impact of TIPS on incidental HCC and oncological outcomes in transplanted patients with pre-existing HCC.

Methods: All consecutive transplanted patients for cirrhosis who had a previous TIPS with or without HCC were included.

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Article Synopsis
  • Graft rejection poses a significant challenge in solid-organ transplants, but understanding the low immunogenicity of liver allografts, particularly through the role of HLA-G, may enhance tolerogenic properties in other organs.
  • In a study of 118 liver transplant patients, researchers found that HLA-G plasma levels increased in the first three months post-transplant and were linked to lower rejection rates, especially when levels exceeded 50 ng/ml on day eight post-transplant.
  • There was a noted association between high HLA-G levels and lower levels of donor-specific anti-HLA antibodies, suggesting that enhancing HLA-G levels might offer new therapeutic avenues for reducing rejection in organ transplants.
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Background & Aims: Liver transplantation (LT) is the only available treatment for end-stage non-alcoholic fatty liver disease (NAFLD) (related decompensated cirrhosis and/or hepatocellular carcinoma). The aim of our study was to evaluate the risk of disease recurrence after LT and the factors influencing it.

Method: This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers.

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Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model's original thresholds.

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