Marco P. A. W. Claasen

University Health Network

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Co-Authors

Gonzalo Sapisochín

Toronto General Hospital

Tommy Ivanics

Henry Ford Hospital

Luckshi Rajendran

University Health Network

Chaya Shwaartz

University of Toronto

Christian Tibor Josef Magyar

University of Bern

Bettina E. Hansen

Erasmus MC

Nazia Selzner

University Health Network

Woo Jin Choi

University of Toronto

Trevor Reichman

University Health Network

Ian D. McGilvray

University Health Network

Cooperative Institutions

University of Toronto

137

University Health Network

133

Toronto General Hospital

Princess Margaret Cancer Centre

European Foundation for the Study of Chronic Liver Failure

Center for Disease Analysis

Heidelberg University

University College London

University Hospital of Zurich

German Cancer Research Center

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Outcomes of Stereotactic Body Radiotherapy Compared with Surgical Resection in Patients with Hepatocellular Carcinoma and Macrovascular Invasion: A Propensity Score-Matched Analysis

Annals of Surgical Oncology (2024)

Michael Yan Zhihao Li Marco P. A. W. Claasen Anna Theresa Santiago Luckshi Rajendran

Surgical oncology

10.1245/s10434-024-16456-6

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Citations (0)

ASO Visual Abstract: The Association of Viral Hepatitis Status and Post-hepatectomy Outcomes in the Era of Direct-Acting Antivirals

Annals of Surgical Oncology (2023)

Luckshi Rajendran Woo Jin Choi Hala Muaddi Tommy Ivanics Jordan J. Feld

Surgical oncology

Viral Hepatitis

10.1245/s10434-023-13145-8

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Living Donor Availability Improves Patient Survival in a North American Center

Annals of Surgery (2024)

Zhihao Li Owen Jones Christian Tibor Josef Magyar Marco P. A. W. Claasen Tommy Ivanics

Objective: Assess the impact of having a living donor on waitlist outcomes and overall survival through an intention-to-treat analysis. Background: Living-donor liver transplantation (LDLT) offers an alternative to deceased donation in the face of organ shortage. An as-treated analysis revealed that undergoing LDLT, compared to staying on the waiting list, is associated with improved survival, even at Model for End-stage Liver Disease-sodium (MELD-Na) score of 11. Methods: Liver transplant candidates listed at the Ajmera Transplant Centre (2000-2021) were categorized as pLDLT (having a potential living donor) or pDDLT (without a living donor). Employing Cox proportional-hazard regression with time-dependent covariates, we evaluated pLDLT’s impact on waitlist dropout and overall survival through a risk-adjusted analysis. Results: Of 4,124 candidates, 984 (24%) had potential living donors. The pLDLT group experienced significantly lower overall waitlist dropouts (5.2%vs. 34.4%, P <0.001) and mortality (3.8%vs. 24.4%, P <0.001) compared to the pDDLT group. Possessing a living donor correlated with a 26% decline in the risk of waitlist dropout (adjusted hazard ratio 0.74, 95%CI 0.55-0.99, P =0.042). The pLDLT group also demonstrated superior survival outcomes at 1- (84.9%vs. 80.1%), 5- (77.6%vs. 61.7%), and 10-year (65.6%vs.52.9%) from listing (log-rank P <0.001) with a 35% reduced risk of death (adjusted hazard ratio 0.65, 95%CI 0.56-0.76, P <0.001). Moreover, the predicted hazard ratios consistently remained below 1 across the MELD-Na range 11-26. Conclusions: Having a potential living donor significantly improves survival in end-stage liver disease patients, even with MELD-Na scores as low as 11. This emphasizes the need to promote awareness and adoption of LDLT in liver transplant programs worldwide.

10.1097/sla.0000000000006451

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Citations (1)

The effect of perioperative packed red blood cells transfusion on patient outcomes after liver transplant for hepatocellular carcinoma

HPB (2021)

Hala Muaddi Phillipe Abreu Tommy Ivanics Marco P. A. W. Claasen Peter Yoon

10.1016/j.hpb.2021.06.425

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Citations (4)

The management of post-transplantation recurrence of hepatocellular carcinoma

Clinical and Molecular Hepatology (2021)

Luckshi Rajendran Tommy Ivanics Marco P. A. W. Claasen Hala Muaddi Gonzalo Sapisochín

The annual incidence of hepatocellular carcinoma (HCC) continues to rise. Over the last two decades, liver transplantation (LT) has become the preferable treatment of HCC, when feasible and strict selection criteria are met. With the rise in HCC-related LT, compounded by downstaging techniques and expansion of transplant selection criteria, a parallel increase in number of post-transplantation HCC recurrence is expected. Additionally, in the context of an immunosuppressed transplant host, recurrences may behave aggressively and more challenging to manage, resulting in poor prognosis. Despite this, no consensus or best practice guidelines for post-transplantation cancer surveillance and recurrence management for HCC currently exist. Studies with adequate population sizes and high-level evidence are lacking, and the role of systemic and locoregional therapies for graft and extrahepatic recurrences remains under debate. This review seeks to summarize the existing literature on post-transplant HCC surveillance and recurrence management. It highlights the value of early tumour detection, re-evaluating the immunosuppression regimen, and staging to differentiate disseminated recurrence from intrahepatic or extrahepatic oligo-recurrence. This ultimately guides decision-making and maximizes treatment effect. Treatment recommendations specific to recurrence type are provided based on currently available locoregional and systemic therapies.

Milan criteria

Immunosuppression

Regimen

10.3350/cmh.2021.0217

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Citations (51)

Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis

Canadian Journal of Gastroenterology and Hepatology (2022)

Peter Yoon Madhukar S. Patel Carla Fiorella Murillo Perez Tommy Ivanics Marco P. A. W. Claasen

Liver retransplantation remains as the only treatment for graft failure. This investigation aims to assess the incidence, post-transplant outcomes, and risk factors in liver retransplantation recipients in Canada.The Canadian Organ Replacement Register was used to obtain and analyse data on all adult liver retransplant recipients, matched donors, transplant-specific variables, and post-transplant outcomes from January 2000 to December 2018.377 (6.5%) patients underwent liver retransplantation. Autoimmune liver disease and hepatitis C virus (HCV) were the most common underlying diagnoses. Graft failure was 7.9% and 12.5%, and overall survival was 77.1% and 65.6% at 1 year and 5 years, respectively. In contrast to recipients receiving their first graft transplant, the retransplantation group had a significantly higher incidence of graft failure (p < 0.001) and lower overall survival (p < 0.001). The graft failure and patient survival rates were comparable between second transplant and repeat retransplant recipients. Furthermore, there were no differences in graft failure and patient survival when stratified according to time to retransplantation. Recipient and donor age (HR = 1.12, p=0.011; HR = 1.09, p=0.008), recipient HCV status (HR = 1.81, p=0.014), and donor cytomegalovirus status (HR = 4.10, p=0.006) were predictors of patient mortality.This analysis of liver retransplantation demonstrates that this is a safe treatment for early and late graft failure. Furthermore, even in patients requiring more than two grafts, similar outcomes to initial retransplantation can be achieved with careful selection.

Liver disease

Hepatitis C

10.1155/2022/9932631

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Citations (11)

Survival After Liver Transplantation: An International Comparison Between the United States and the United Kingdom in the Years 2008–2016

Transplantation (2021)

Tommy Ivanics David Wallace Phillipe Abreu Marco P. A. W. Claasen Chris Callaghan

Background. Compared with the United States, risk-adjusted mortality in the United Kingdom has historically been worse in the first 90 d following liver transplantation (LT) and better thereafter. In the last decade, there has been considerable change in the practice of LT internationally, but no contemporary large-scale international comparison of posttransplant outcomes has been conducted. This study aimed to determine disease-specific short- and long-term mortality of LT recipients in the United States and the United Kingdom. Methods. This retrospective international multicenter cohort study analyzed adult (≥18 y) first-time LT recipients between January 2, 2008, and December 31, 2016, using the Organ Procurement and Transplantation Network/United Network for Organ Sharing and the UK Transplant Registry databases. Time-dependent Cox regression estimated hazard ratios (HRs) comparing disease-specific risk-adjusted mortality in the first 90 d post-LT, between 90 d and 1 y, and between 1 and 5 y. Results. Forty-two thousand eight hundred seventy-four US and 4950 UK LT recipients were included. The main LT indications in the United States and the United Kingdom were hepatocellular carcinoma (25.4% and 24.9%, respectively) and alcohol-related liver disease (20.3% and 27.1%, respectively). There were no differences in mortality during the first 90 d post-LT (reference: United States; HR, 0.96; 95% confidence interval [CI], 0.82–1.12). However, between 90 d and 1 y (HR, 0.71; 95% CI, 0.59–0.85) and 1 and 5 y (HR, 0.71; 95% CI, 0.63–0.81]) the United Kingdom had lower mortality. The mortality differences between 1 and 5 y were most marked in hepatocellular carcinoma (HR, 0.71; 95% CI, 0.58–0.88) and alcohol-related liver disease patients (HR, 0.64; 95% CI, 0.45–0.89). Conclusions. Risk-adjusted mortality in the United States and the United Kingdom was similar in the first 90 d post-LT but better in the United Kingdom thereafter. International comparisons of LT may highlight differences in healthcare delivery and help benchmarking by identifying modifiable factors that can facilitate improved global outcomes in LT.

Liver disease

10.1097/tp.0000000000003978

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Citations (10)

Trends in liver transplantation for autoimmune liver diseases: a Canadian study

Canadian Journal of Surgery (2022)

Carla Fiorella Murillo Perez Tommy Ivanics Marco P. A. W. Claasen Peter Yoon David Wallace

To our knowledge, no analysis of data from liver transplantation registries exists in Canada. We aimed to describe temporal trends in the number of liver transplantation procedures, patient characteristics and posttransplantation outcomes for autoimmune liver diseases (AILDs) in Canada.We used administrative data from the Canadian Organ Replacement Register, which contains liver transplantation information from 6 centres in Canada. This study included transplantation information from 5 of the centres, as liver transplantation procedures in children were not included. We included adult (age ≥ 18 yr) patients with a diagnosis of primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH) or overlap syndrome (PBC-AIH or PSC-AIH) who received a liver transplant from 2000 to 2018.Of 5722 primary liver transplantation procedures performed over the study period, 1070 (18.7%) were for an AILD: 489 (45.7%) for PSC, 341 (31.9%) for PBC, 220 (20.6%) for AIH and 20 (1.9%) for overlap syndrome. There was a significant increase in the absolute number of procedures for PSC, with a yearly increase of 0.6 (95% confidence interval 0.1 to 1.2), whereas the absolute number of procedures for PBC and AIH remained stable. The proportion of transplantation procedures decreased for PBC and AIH but remained stable for PSC. Recipient age at transplantation increased over time for males with PBC (median 53 yr in 2000-2005 to 57 yr in 2012-2018, p = 0.03); whereas the median age among patients with AIH decreased, from 53 years in 2000-2005 to 44 years in 2006-2011 (p = 0.03). The Model for Endstage Liver Disease score at the time of transplantation increased over time for all AILDs, particularly AIH (median 16 in 2000-2005 v. 24 in 2012-2018, p < 0.001). There was a trend toward improved survival in the PBC group, with a 5-year survival rate of 81% in 2000-2005 and 90% in 2012-2018 (p = 0.06).Between 2000 and 2018, the absolute number of liver transplantation procedures in Canada increased for PSC but remained stable for PBC and AIH; proportionally, PBC and AIH decreased as indications for transplantation. Posttransplantation survival improved only for the PBC group. An improved understanding of trends and outcomes on a national scale among patients with AILD undergoing liver transplantation can identify disparities and areas for potential health care improvement.

Primary Sclerosing Cholangitis

Autoimmune Hepatitis

Primary Biliary Cirrhosis

Overlap syndrome

10.1503/cjs.012121

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Citations (6)

1117: COMPARING RESECTION AND STEREOTACTIC BODY RADIATION THERAPY FOR HCC WITH MACROVASCULA R INVASION

Radiotherapy and Oncology (2024)

Michael Yan Zhihao Li Pablo Muñoz-Schuffenegger Anna Theresa Santiago Christian Tibor Josef Magyar

Stereotactic radiation therapy

10.1016/s0167-8140(24)01581-0