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Leon D, Tanaka M, Thabet A, Bozorgzadeh A, Pratt DS, Kalva SP, Wu V. Intracardiac Echocardiography Guidance for Percutaneous Closure of Surgical Portocaval Shunt after Liver Transplant. Cardiovasc Intervent Radiol 2024; 47:273-276. [PMID: 37902856 DOI: 10.1007/s00270-023-03582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023]
Affiliation(s)
- David Leon
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Mari Tanaka
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Ashraf Thabet
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Adel Bozorgzadeh
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Daniel S Pratt
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Vincent Wu
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA.
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2
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Long JJ, Motter JD, Jackson KR, Chen J, Orandi BJ, Montgomery RA, Stegall MD, Jordan SC, Benedetti E, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Verbesey JE, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Wellen JR, Bozorgzadeh A, Gaber AO, Heher EC, Weng FL, Djamali A, Helderman JH, Concepcion BP, Brayman KL, Oberholzer J, Kozlowski T, Covarrubias K, Massie AB, McAdams-DeMarco MA, Segev DL, Garonzik-Wang JM. Characterizing the risk of human leukocyte antigen-incompatible living donor kidney transplantation in older recipients. Am J Transplant 2023; 23:1980-1989. [PMID: 37748554 PMCID: PMC10767749 DOI: 10.1016/j.ajt.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Older compatible living donor kidney transplant (CLDKT) recipients have higher mortality and death-censored graft failure (DCGF) compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant (ILDKT) recipients who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997, and December 15, 2016, we compared mortality, DCGF, delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age ≥60 years) and 1172 younger (age 18-59 years) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17 542 CLDKT recipients, we used an interaction term to determine whether the relationship between posttransplant outcomes and transplant type (ILDKT vs CLDKT) was modified by age. Overall, older recipients had higher mortality (hazard ratio: 1.632.072.65, P < .001), lower DCGF (hazard ratio: 0.360.530.77, P = .001), and AR (odds ratio: 0.390.540.74, P < .001), and similar DGF (odds ratio: 0.461.032.33, P = .9) and LOS (incidence rate ratio: 0.880.981.10, P = 0.8) compared to younger recipients. The impact of age on mortality (interaction P = .052), DCGF (interaction P = .7), AR interaction P = .2), DGF (interaction P = .9), and LOS (interaction P = .5) were similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.
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Affiliation(s)
- Jane J Long
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer D Motter
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Kyle R Jackson
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Jennifer Chen
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Babak J Orandi
- Department of Surgery, University of Alabama, Birmingham, Alabama, USA
| | - Robert A Montgomery
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Mark D Stegall
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stanley C Jordan
- Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, California, USA
| | - Enrico Benedetti
- Department of Surgery, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Ty B Dunn
- Department of Surgery, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Sandip Kapur
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Ronald P Pelletier
- Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - John P Roberts
- Department of Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Marc L Melcher
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Pooja Singh
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Philadelphia, USA
| | - Debra L Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Marc P Posner
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jose M El-Amm
- Integris Baptist Medical Center, Transplant Division, Oklahoma City, Oklahoma, USA
| | - Ron Shapiro
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | - Jennifer E Verbesey
- Medstar Georgetown Transplant Institute, Washington, District of Columbia, USA
| | - George S Lipkowitz
- Department of Surgery, Baystate Medical Center Springfield, Massachusetts, Massachusetts, USA
| | - Michael A Rees
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Christopher L Marsh
- Department of Surgery, Scripps Clinic and Green Hospital, La Jolla, California, USA
| | | | - David A Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jason R Wellen
- Department of Surgery, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Adel Bozorgzadeh
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Eliot C Heher
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francis L Weng
- Renal and Pancreas Transplant Division, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Arjang Djamali
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - J Harold Helderman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Beatrice P Concepcion
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenneth L Brayman
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jose Oberholzer
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Tomasz Kozlowski
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Karina Covarrubias
- Department of Surgery, University of California San Diego, San Diego, California, USA
| | - Allan B Massie
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA; Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA; Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
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3
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Yamamoto T, Atthota S, Agarwal D, Crisalli K, MacConmara M, Nakamura T, Teo R, Dageforde LA, Kimura S, Elias N, Yeh H, Bozorgzadeh A, Kawai T, Markmann JF. Impact of Portable Normothermic Machine Perfusion for Liver Transplantation From Adult Deceased Donors. Ann Surg 2023; 278:e922-e929. [PMID: 37581260 DOI: 10.1097/sla.0000000000006032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To assess how liver allografts preserved using portable normothermic machine perfusion (NMP) compare against those that underwent ischemic cold storage (ICS) in the setting of donation after brain death (DBD) and donation after circulatory death (DCD) liver transplantation (LT). BACKGROUND Compared with conventional ICS, NMP may offer more homeostatic preservation, permit physiological assessment of organ function, and provide opportunities for graft improvement/modification. We report a single-center US experience of liver NMP. METHODS A single-center, retrospective analysis of collected data on 541 adult whole LTs from 469 DBD donors [NMP (n = 58) vs ICS (n = 411)] and 72 DCD donors [NMP (n = 52) vs ICS (n = 20)] between January 2016 and December 2022. RESULTS In DBD LT, male sex [odds ratio (95% CI): 1.83 (1.08-3.09)] and >10% macrosteatosis of the donor liver [1.85 (1.10-3.10)] were statistically significant independent risk factors of early allograft dysfunction (EAD). Donor age >40 years and cold ischemia time >7 hours were independent risk factors of reperfusion syndrome (RPS). One-year, 3-year, and 5-year incidences of ischemic cholangiopathy (IC) did not differ significantly in DBD cases between the NMP and ICS cohorts. In DCD LT, NMP was an independent protective factor against EAD [0.11 (0.03-0.46)] and RPS [0.04 (0.01-0.25)]. The incidence of IC in the DCD cases at 1-year and 3-year time points was significantly lower in the NMP cohort (1.9% compared with 20% in the ICS group). CONCLUSIONS Compared with conventional ICS, NMP can significantly reduce the incidence of EAD, RPS, and IC after DCD LT.
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Affiliation(s)
- Takayuki Yamamoto
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Srilakshmi Atthota
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Divyansh Agarwal
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Kerry Crisalli
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | | | - Tsukasa Nakamura
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Richard Teo
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Leigh Anne Dageforde
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Shoko Kimura
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Nahel Elias
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Heidi Yeh
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Adel Bozorgzadeh
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Tatsuo Kawai
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - James F Markmann
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, MA
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4
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Nakamura T, Sasaki K, Kojima L, Teo R, Inaba Y, Yamamoto T, Kimura S, Dageforde LA, Yeh H, Elias N, Bozorgzadeh A, Kawai T, Markmann JF. Impact of donor sex on hepatocellular carcinoma recurrence in liver transplantation after brain death. Clin Transplant 2023; 37:e14989. [PMID: 37039506 DOI: 10.1111/ctr.14989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/17/2023] [Accepted: 04/02/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is predominantly seen in males but has a better prognosis in females. No prior studies have investigated HCC recurrence based on sex combination following liver transplant donated after brain death (DBDLT). This study sought to elucidate the effects of donor and recipient sex on HCC recurrence rates. METHODS 9232 adult recipients from the United Network for Organ Sharing (UNOS) database who underwent DBDLT for HCC from 2012 to 2018 were included. Donor-recipient pairs were divided into (1) female donor/female recipient (F-F) (n = 1089); (2) male donor/female recipient (M-F) (n = 975); (3) female donor/male recipient (F-M) (n = 2691); (4) male donor/male recipient (M-M) (n = 4477). The primary prognostic outcome was HCC recurrence. A multivariable competing risk regression analysis was used to assess prognostic influences. RESULTS The median recipient age and model for end-stage liver disease (MELD) scores were similar among the four groups. Livers of male recipients demonstrated greater in size and number of HCC (both p-values were <.0001). There was also a higher rate of vascular invasion in male recipients compared to female (p < .0001). Competing risk analyses showed that the cumulative HCC recurrence rate was significantly lower in the M-F group (p = .013). After adjusting for tumor characteristics, liver grafts from male donors were associated with a lower HCC recurrence rate in female recipients (HR: .62 95%CI: .42-.93) (p = .021). CONCLUSION In DBDLT, male donor to female recipient pairing exhibited lower HCC recurrence rates. SUMMARY Lowest rates of HCC recurrence were confirmed among the female recipients of male donor grafts group in the deceased donor LT cohort. A competing risk multivariable regression analysis demonstrated that male donor sex was significantly associated with low HCC recurrence in female but not male recipients.
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Affiliation(s)
- Tsukasa Nakamura
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplantation, Stanford University, Stanford, California, USA
| | - Lisa Kojima
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard Teo
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yosuke Inaba
- Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba, Japan
| | - Takayuki Yamamoto
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shoko Kimura
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leigh Anne Dageforde
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Heidi Yeh
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nahel Elias
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adel Bozorgzadeh
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tatsuo Kawai
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James F Markmann
- Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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5
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Pal Chaudhary S, Reyes S, Chase ML, Govindan A, Zhao L, Luther J, Bhan I, Bethea E, Franses JW, Paige Walsh E, Anne Dageford L, Kimura S, Elias N, Yeh H, Markman J, Bozorgzadeh A, Tanabe K, Ferrone C, Zhu AX, Andersson K, Thiim M, Antonio Catalano O, Kambadakone A, Vagefi PA, Qadan M, Pratt D, Hashemi N, Corey KE, Misdraji J, Goyal L, Clark JW. Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies. Oncologist 2023; 28:341-350. [PMID: 36763374 PMCID: PMC10078904 DOI: 10.1093/oncolo/oyac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/19/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies. METHODS Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients. RESULTS Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant. CONCLUSIONS Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs.
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Affiliation(s)
- Surendra Pal Chaudhary
- Division of Oncology, Mass General Cancer Center and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Lei Zhao
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jay Luther
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Irun Bhan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Bethea
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joseph W Franses
- Division of Oncology, Mass General Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Elizabeth Paige Walsh
- Division of Oncology, Mass General Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Leigh Anne Dageford
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shoko Kimura
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nahel Elias
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Heidi Yeh
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James Markman
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Adel Bozorgzadeh
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kenneth Tanabe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew X Zhu
- Jiahui Health, Jiahui International Cancer Center, Shanghai, People's Republic of China
| | - Karin Andersson
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael Thiim
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Parsia A Vagefi
- Division of Surgical Transplantation, University of Texas Southwestern, Dallas, TX, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Pratt
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nikroo Hashemi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathleen E Corey
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joseph Misdraji
- Department of Pathology, Yale New Haven Hospital, Yale University, New Haven, CT, USA
| | - Lipika Goyal
- Division of Oncology, Mass General Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Division of Oncology, Mass General Cancer Center and Harvard Medical School, Boston, MA, USA
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6
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Martins PN, Buchwald JE, Movahedi B, Torres U, Emhoff T, Walker J, DeBusk MG, Bozorgzadeh A. Successful treatment of complete traumatic transection of the suprahepatic inferior vena cava with veno-venous and cardiopulmonary bypass with hypothermic circulatory arrest. Hepatobiliary Pancreat Dis Int 2021; 20:601-610. [PMID: 33468417 DOI: 10.1016/j.hbpd.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/23/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Paulo N Martins
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA
| | - Julianna E Buchwald
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA
| | - Babak Movahedi
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA
| | - Ulises Torres
- Department of Surgery, Division of Trauma, University of Massachusetts, Worcester, MA 01655, USA
| | - Timothy Emhoff
- Department of Surgery, Division of Trauma, University of Massachusetts, Worcester, MA 01655, USA
| | - Jennifer Walker
- Department of Surgery, Division of Cardiac Surgery, University of Massachusetts, Worcester, MA 01655, USA
| | - Michael G DeBusk
- Department of Surgery, Division of Trauma, University of Massachusetts, Worcester, MA 01655, USA
| | - Adel Bozorgzadeh
- Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, USA.
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7
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Tomkins-Tinch CH, Daly JS, Gladden-Young A, Theodoropoulos NM, Madaio MP, Yu N, Vanguri VK, Siddle KJ, Adams G, Krasilnikova LA, Movahedi B, Bozorgzadeh A, Simin K, Lemieux JE, Luban J, Park DJ, MacInnis BL, Sabeti PC, Levitz SM. SARS-CoV-2 Reinfection in a Liver Transplant Recipient. Ann Intern Med 2021; 174:1178-1180. [PMID: 33872044 PMCID: PMC8059415 DOI: 10.7326/l21-0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Jennifer S Daly
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | | | - Michael P Madaio
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Neng Yu
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Vijay K Vanguri
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Katherine J Siddle
- The Broad Institute of MIT and Harvard and Harvard University, Cambridge, Massachusetts
| | - Gordon Adams
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Lydia A Krasilnikova
- The Broad Institute of MIT and Harvard and Harvard University, Cambridge, Massachusetts
| | - Babak Movahedi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Adel Bozorgzadeh
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karl Simin
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jeremy Luban
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Daniel J Park
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Pardis C Sabeti
- The Broad Institute of MIT and Harvard and Harvard University, Cambridge, Massachusetts
| | - Stuart M Levitz
- University of Massachusetts Medical School, Worcester, Massachusetts
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8
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Motter JD, Jackson KR, Long JJ, Waldram MM, Orandi BJ, Montgomery RA, Stegall MD, Jordan SC, Benedetti E, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Verbesey JE, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Wellen JR, Bozorgzadeh A, Gaber AO, Heher EC, Weng FL, Djamali A, Helderman JH, Concepcion BP, Brayman KL, Oberholzer J, Kozlowski T, Covarrubias K, Massie AB, Segev DL, Garonzik-Wang JM. Delayed graft function and acute rejection following HLA-incompatible living donor kidney transplantation. Am J Transplant 2021; 21:1612-1621. [PMID: 33370502 PMCID: PMC8016719 DOI: 10.1111/ajt.16471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/17/2020] [Accepted: 12/08/2020] [Indexed: 02/05/2023]
Abstract
Incompatible living donor kidney transplant recipients (ILDKTr) have pre-existing donor-specific antibody (DSA) that, despite desensitization, may persist or reappear with resulting consequences, including delayed graft function (DGF) and acute rejection (AR). To quantify the risk of DGF and AR in ILDKT and downstream effects, we compared 1406 ILDKTr to 17 542 compatible LDKT recipients (CLDKTr) using a 25-center cohort with novel SRTR linkage. We characterized DSA strength as positive Luminex, negative flow crossmatch (PLNF); positive flow, negative cytotoxic crossmatch (PFNC); or positive cytotoxic crossmatch (PCC). DGF occurred in 3.1% of CLDKT, 3.5% of PLNF, 5.7% of PFNC, and 7.6% of PCC recipients, which translated to higher DGF for PCC recipients (aOR = 1.03 1.682.72 ). However, the impact of DGF on mortality and DCGF risk was no higher for ILDKT than CLDKT (p interaction > .1). AR developed in 8.4% of CLDKT, 18.2% of PLNF, 21.3% of PFNC, and 21.7% of PCC recipients, which translated to higher AR (aOR PLNF = 1.45 2.093.02 ; PFNC = 1.67 2.403.46 ; PCC = 1.48 2.243.37 ). Although the impact of AR on mortality was no higher for ILDKT than CLDKT (p interaction = .1), its impact on DCGF risk was less consequential for ILDKT (aHR = 1.34 1.621.95 ) than CLDKT (aHR = 1.96 2.292.67 ) (p interaction = .004). Providers should consider these risks during preoperative counseling, and strategies to mitigate them should be considered.
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Affiliation(s)
- Jennifer D. Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kyle R. Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane J. Long
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Babak J. Orandi
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Robert A. Montgomery
- The NYU Transplant Institute, New York University Langone Medical Center, New York, NY
| | | | - Stanley C. Jordan
- Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - Enrico Benedetti
- Department of Surgery, University of Illinois-Chicago, Chicago, IL
| | - Ty B. Dunn
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - Sandip Kapur
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Ronald P. Pelletier
- Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - John P. Roberts
- Department of Surgery, University of California-San Francisco, San Francisco, CA
| | | | - Pooja Singh
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia. PA
| | - Debra L. Sudan
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Marc P. Posner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Jose M. El-Amm
- Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK
| | - Ron Shapiro
- Recanti Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| | | | | | | | - Michael A. Rees
- Department of Urology, University of Toledo Medical Center, Toledo, OH
| | | | | | - David A. Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jason R. Wellen
- Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO
| | - Adel Bozorgzadeh
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - A. Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Eliot C. Heher
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Francis L. Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ
| | - Arjang Djamali
- Department of Medicine, University of Wisconsin, Madison, WI
| | | | | | | | - Jose Oberholzer
- Department of Surgery, University of Virginia, Charlottesville, VA
| | | | - Karina Covarrubias
- Department of Surgery, University of California San Diego, San Diego, CA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Scientific Registry of Transplant Recipients, Minneapolis, MN
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9
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Jackson KR, Long J, Motter J, Bowring MG, Chen J, Waldram MM, Orandi BJ, Montgomery RA, Stegall MD, Jordan SC, Benedetti E, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Verbesey JE, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Wellen J, Bozorgzadeh A, Gaber AO, Heher E, Weng FL, Djamali A, Helderman JH, Concepcion BP, Brayman KL, Oberholzer J, Kozlowski T, Covarrubias K, Desai N, Massie AB, Segev DL, Garonzik-Wang J. Center-level Variation in HLA-incompatible Living Donor Kidney Transplantation Outcomes. Transplantation 2021; 105:436-442. [PMID: 32235255 PMCID: PMC8080262 DOI: 10.1097/tp.0000000000003254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Desensitization protocols for HLA-incompatible living donor kidney transplantation (ILDKT) vary across centers. The impact of these, as well as other practice variations, on ILDKT outcomes remains unknown. METHODS We sought to quantify center-level variation in mortality and graft loss following ILDKT using a 25-center cohort of 1358 ILDKT recipients with linkage to Scientific Registry of Transplant Recipients for accurate outcome ascertainment. We used multilevel Cox regression with shared frailty to determine the variation in post-ILDKT outcomes attributable to between-center differences and to identify any center-level characteristics associated with improved post-ILDKT outcomes. RESULTS After adjusting for patient-level characteristics, only 6 centers (24%) had lower mortality and 1 (4%) had higher mortality than average. Similarly, only 5 centers (20%) had higher graft loss and 2 had lower graft loss than average. Only 4.7% of the differences in mortality (P < 0.01) and 4.4% of the differences in graft loss (P < 0.01) were attributable to between-center variation. These translated to a median hazard ratio of 1.36 for mortality and 1.34 of graft loss for similar candidates at different centers. Post-ILDKT outcomes were not associated with the following center-level characteristics: ILDKT volume and transplanting a higher proportion of highly sensitized, prior transplant, preemptive, or minority candidates. CONCLUSIONS Unlike most aspects of transplantation in which center-level variation and volume impact outcomes, we did not find substantial evidence for this in ILDKT. Our findings support the continued practice of ILDKT across these diverse centers.
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Affiliation(s)
- Kyle R. Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane Long
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary G Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Madeleine M. Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Babak J Orandi
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Robert A. Montgomery
- The NYU Transplant Institute, New York University Langone Medical Center, New York, NY
| | | | - Stanley C. Jordan
- Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - Enrico Benedetti
- Department of Surgery, University of Illinois-Chicago, Chicago, IL
| | - Ty B. Dunn
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - Sandip Kapur
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Ronald P. Pelletier
- Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - John P. Roberts
- Department of Surgery, University of California-San Francisco, San Francisco, CA
| | | | - Pooja Singh
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia. PA
| | - Debra L. Sudan
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Marc P. Posner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Jose M. El-Amm
- Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK
| | - Ron Shapiro
- Recanti Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| | | | | | | | - Michael A. Rees
- Department of Urology, University of Toledo Medical Center, Toledo, OH
| | | | | | - David A. Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jason Wellen
- Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO
| | - Adel Bozorgzadeh
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - A. Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Eliot Heher
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Francis L. Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ
| | - Arjang Djamali
- Department of Medicine, University of Wisconsin, Madison, WI
| | | | | | | | - Jose Oberholzer
- Department of Surgery, University of Virginia, Charlottesville, VA
| | | | - Karina Covarrubias
- Department of Surgery, University of California San Diego, San Diego, CA
| | - Niraj Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Scientific Registry of Transplant Recipients, Minneapolis, MN
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10
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Navarro MED, Yao CC, Whiteley A, Movahedi B, Devuni D, Barry C, Zacharias I, Theodoropoulos NM, Bozorgzadeh A, Martins PN. Liver transplant evaluation for fulminant liver failure due to acute hepatitis A infection: Case series and literature review. Transpl Infect Dis 2020; 23:e13476. [PMID: 32989849 DOI: 10.1111/tid.13476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 12/29/2022]
Abstract
Hepatitis A virus can cause liver damage ranging from mild illness to fulminant hepatic failure, constituting 0.35% of all cases of fulminant liver failure. While rates of spontaneous remission are higher for hepatitis A, recent outbreaks attributable to vaccine shortages in highly populated urban cities plagued by insufficient affordable housing and inaccessible sanitation, and changes in the epidemiology of viral strains have resulted in increased hospitalizations and deaths. While the prognosis for patients with FHF has improved since the introduction of transplantation, the decision to transplant is often difficult to reach. We present five patients with HAV and subsequent FHF, one of whom successfully received a liver transplant. We have reviewed all published cases of HAV FHF in the literature and report ten patients, seven of whom received liver transplantation. There are few predictive models that attempt to distinguish between fulminant hepatitis A and spontaneous recovery. Patients found to have positive hepatitis A IgM, encephalopathy, worsening LFT's and coagulation should be monitored closely and referred to transplant centers urgently for management.
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Affiliation(s)
- Maria Eugenia D Navarro
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine C Yao
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Adam Whiteley
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Babak Movahedi
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Deepika Devuni
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Curtis Barry
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Isabel Zacharias
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nicole M Theodoropoulos
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Paulo N Martins
- Division of Gastroenterology, Department of Medicine, Division of Infectious Diseases & Immunology, Department of Medicine, Division of Transplant Surgery, Department of Transplant Surgery, University of Massachusetts Medical School, Worcester, MA, USA
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11
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Theodoropoulos NM, Bolstorff B, Bozorgzadeh A, Brandeburg C, Cumming M, Daly JS, Ellison RT, Forsberg K, Gade L, Gibson L, Greenough T, Litvintseva AP, Mack DA, Madoff L, Martins PN, McHale E, Melvin Z, Movahedi B, Stiles T, Vallabhaneni S, Levitz SM. Candida auris outbreak involving liver transplant recipients in a surgical intensive care unit. Am J Transplant 2020; 20:3673-3679. [PMID: 32530145 DOI: 10.1111/ajt.16144] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 01/25/2023]
Abstract
Candida auris is a yeast that is difficult to eradicate and has caused outbreaks in health care facilities. We report a cluster of 5 patients in 1 intensive care unit who were colonized or infected in 2017. The initial 2 patients were recipients of liver transplants who had cultures that grew C auris within 3 days of each other in June 2017 (days 43 and 30 posttransplant). Subsequent screening cultures identified 2 additional patients with C auris colonization. Respiratory and urine cultures from a fifth patient yielded C auris. All isolates were fluconazole resistant but susceptible to echinocandins. Whole genome sequencing showed the strains were clonal, suggesting in-hospital transmission, and related but distinct from New York/New Jersey strains, consistent with a separate introduction. However, no source or contact was found. Two of the 5 patients died. C auris infection likely contributed to 1 patient death by infecting a vascular aneurysm at the graft anastomosis. Strict infection control precautions were initiated to control the outbreak. Our experience reveals that although severe disease from C auris can occur in transplant recipients, outbreaks can be controlled using recommended infection control practices. We have had no further patients infected with C auris to date.
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Affiliation(s)
- Nicole M Theodoropoulos
- Division of Infectious Disease, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Adel Bozorgzadeh
- Division of Transplant Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Melissa Cumming
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Jennifer S Daly
- Division of Infectious Disease, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Richard T Ellison
- Division of Infectious Disease, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Lalitha Gade
- Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Laura Gibson
- Division of Infectious Disease, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas Greenough
- Division of Infectious Disease, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Deborah A Mack
- UMass Memorial Medical Center Infection Control Department, Worcester, Massachusetts
| | - Lawrence Madoff
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Paulo N Martins
- Division of Transplant Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Eileen McHale
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Zita Melvin
- UMass Memorial Medical Center Infection Control Department, Worcester, Massachusetts
| | - Babak Movahedi
- Division of Transplant Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tracy Stiles
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Stuart M Levitz
- Division of Infectious Disease, University of Massachusetts Medical School, Worcester, Massachusetts
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12
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Roubil JG, Martins PN, Babak M, Bledsoe J, Bludevich BM, Barry C, Bozorgzadeh A. Resolution of Severe Graft Steatosis Before Living-Donor Liver Transplant After 86 Pounds of Weight Loss. EXP CLIN TRANSPLANT 2020; 20:874-877. [PMID: 32778015 DOI: 10.6002/ect.2019.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Living-donor liver transplant allows for expedited transplant, with outcomes shown to be superior compared with deceased-donor liver transplant due to earlier intervention, with reduced hospital costs. However, they only comprise about 5% of liver transplants nationally. This is due to a limited pool of willing donors and donor exclusions for medical and psycho-social reasons. The leading reason for why potential living liver donors are not eligible is nonalcoholic fatty liver disease. Donor hepatic steatosis limits the number of potential living-donor liver transplants because it is associated with perioperative complications in both donors and recipients. Here, we describe a 37-year-old male potential living donor who presented with hepatic steatosis based on preoperative imaging. Over a 1-year period, he was able to completely reverse his hepatic steatosis by losing about 86 pounds (from 279 to 193 pounds), reducing his body mass index from 40 to 28.55 kg/m². Computed tomography and biopsy results after his weight loss showed that he had no hepatic steatosis, allowing him to become a living donor for his mother. Postoperative periods for both the donor and recipient were uncomplicated. This case suggests that the pool of living liver donors could be expanded through dietary and behavior modifications, thus increasing the number of potential living donors and providing potential recipients with more transplant options. Enlarging this pool of donors will also improve transplant outcomes for donors and recipients and lower overall health care costs compared with deceased-donor liver transplant.
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Affiliation(s)
- John G Roubil
- From the Department of Surgery, Transplant Division, University of Massachusetts, UMass Memorial Hospital, Worcester, Massachusetts, USA
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13
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Lui JK, Spaho L, Hakimian S, Devine M, Bui R, Touray S, Holzwanger E, Patel B, Ellis D, Fridlyand S, Ogunsua AA, Mahboub P, Daly JS, Bozorgzadeh A, Kopec SE. Pleural Effusions Following Liver Transplantation: A Single-Center Experience. J Intensive Care Med 2020; 36:862-872. [PMID: 32527176 DOI: 10.1177/0885066620932448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. METHODS A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. RESULTS In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. CONCLUSIONS In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.
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Affiliation(s)
- Justin K Lui
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Lidia Spaho
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Shahrad Hakimian
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Michael Devine
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Rosa Bui
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Sunkaru Touray
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA.,Carlsbad Medical Center, NM, USA
| | - Erik Holzwanger
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Boskey Patel
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel Ellis
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Svetlana Fridlyand
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Adedotun A Ogunsua
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Cardiology, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Paria Mahboub
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer S Daly
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Division of Infectious Diseases, 3354University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Scott E Kopec
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA
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14
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Lee P, Ma Y, Zacharias I, Bozorgzadeh A, Wilson S, Foley K, Rava P, Masciocchi M, Ding L, Bledsoe J, Fitzgerald TJ, Sioshansi S. Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma in Patients With Child-Pugh B or C Cirrhosis. Adv Radiat Oncol 2020; 5:889-896. [PMID: 33083650 PMCID: PMC7557134 DOI: 10.1016/j.adro.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/31/2019] [Accepted: 01/27/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose Our purpose was to report outcomes in patients with Child-Pugh B or C (CP B/C) hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT). Methods and Materials Patients with HCC suitable for SBRT were prospectively enrolled in the study from 2012 to 2018. Outcomes in patients with CP B/C were analyzed. Cox proportional hazard models were used to compare survival outcomes between baseline CP score and post-SBRT CP score. Results Twenty-three patients with CP B/C with a total of 29 HCC tumors were treated with SBRT. Eighty-seven percent of patients were CP B8-C10. Median tumor size was 3.1 cm (range, 1-10 cm). Median dose delivered was 40 Gy in a median of 5 fractions. Eighteen of 23 patients (78.3%) had been previously treated with transarterial chemoembolization. Median follow-up was 14.5 months. Rates of 6- and 12-month local control were 100% and 92.3%, respectively. Six- and 12-month survival rates were 73.9% and 56.5%, respectively. Median survival was 14.5 months overall and 9.2, 22.5, 14.5, and 14.4 months for patients with CP B7, B8, B9, and C10, respectively. No patients exhibited symptoms of classic radiation-induced liver disease. However, 10 patients had CP score progression, with 4 patients (17%) having a ≥2-point increase in CP score by 6 months (or time of censor). There were 7 liver-related deaths, and based on independent review by a hepatologist, 1 of these deaths may have been attributable to SBRT-related liver injury. Fifteen of 23 patients were listed for liver transplant (LT) at the time of SBRT and 9 went on to receive LT with a pathologic complete response rate of 63.6%. Median survival, excluding patients who received LT, was 7.3 months. Conclusions SBRT is a reasonable treatment option for carefully selected patients with CP B7-C10. In our small cohort, there was no detectable difference between local control or overall survival and baseline CP score.
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Affiliation(s)
- Peter Lee
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Yunsheng Ma
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Isabel Zacharias
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Adel Bozorgzadeh
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Sean Wilson
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Kim Foley
- UMass Memorial Medical Center, Worcester, Massachusetts
| | - Paul Rava
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mark Masciocchi
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Linda Ding
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Jacob Bledsoe
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Thomas J Fitzgerald
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Shirin Sioshansi
- University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
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15
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Buchwald JE, Xu J, Bozorgzadeh A, Martins PN. Therapeutics administered during ex vivo liver machine perfusion: An overview. World J Transplant 2020; 10:1-14. [PMID: 32110510 PMCID: PMC7031625 DOI: 10.5500/wjt.v10.i1.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/26/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023] Open
Abstract
Although the use of extended criteria donors has increased the pool of available livers for transplant, it has also introduced the need to develop improved methods of protection against ischemia-reperfusion injury (IRI), as these "marginal" organs are particularly vulnerable to IRI during the process of procurement, preservation, surgery, and post-transplantation. In this review, we explore the current basic science research investigating therapeutics administered during ex vivo liver machine perfusion aimed at mitigating the effects of IRI in the liver transplantation process. These various categories of therapeutics are utilized during the perfusion process and include invoking the RNA interference pathway, utilizing defatting cocktails, and administering classes of agents such as vasodilators, anti-inflammatory drugs, human liver stem cell-derived extracellular vesicles, and δ-opioid agonists in order to reduce the damage of IRI. Ex vivo machine perfusion is an attractive alternative to static cold storage due to its ability to continuously perfuse the organ, effectively deliver substrates and oxygen required for cellular metabolism, therapeutically administer pharmacological or cytoprotective agents, and continuously monitor organ viability during perfusion. The use of administered therapeutics during machine liver perfusion has demonstrated promising results in basic science studies. While novel therapeutic approaches to combat IRI are being developed through basic science research, their use in clinical medicine and treatment in patients for liver transplantation has yet to be explored.
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Affiliation(s)
- Julianna E Buchwald
- Division of Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Jing Xu
- Division of Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Adel Bozorgzadeh
- Division of Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Paulo N Martins
- Division of Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, United States
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16
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Dolgin NH, Movahedi B, Anderson FA, Brüggenwirth IMA, Martins PN, Bozorgzadeh A. Impact of recipient functional status on 1-year liver transplant outcomes. World J Transplant 2019; 9:145-157. [PMID: 31850158 PMCID: PMC6914386 DOI: 10.5500/wjt.v9.i7.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Karnofsky Performance Status (KPS) scale has been widely validated for clinical practice for over 60 years.
AIM To examine the extent to which poor pre-transplant functional status, assessed using the KPS scale, is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.
METHODS This study included 38278 United States adults who underwent first, non-urgent, liver-only transplantation from 2005 to 2014 (Scientific Registry of Transplant Recipients). Functional impairment/disability was categorized as severe, moderate, or none/normal. Analyses were conducted using multivariable-adjusted Cox survival regression models.
RESULTS The median age was 56 years, 31% were women, median pre-transplant Model for End-Stage for Liver Disease score was 18. Functional impairment was present in 70%; one-quarter of the sample was severely disabled. After controlling for key recipient and donor factors, moderately and severely disabled patients had a 1-year mortality rate of 1.32 [confidence interval (CI): 1.21-1.44] and 1.73 (95%CI: 1.56-1.91) compared to patients with no impairment, respectively. Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13 (CI: 1.02-1.24) and 1.16 (CI: 1.02-1.31), respectively.
CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year post-transplant patient and graft survival.
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Affiliation(s)
- Natasha H Dolgin
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
- Department of Quantitative Health Sciences, Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA 01605, United States
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Babak Movahedi
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Frederick A Anderson
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01655, United States
| | - Isabel MA Brüggenwirth
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen 9713GZ, Netherlands
| | - Paulo N Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
| | - Adel Bozorgzadeh
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, United States
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17
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Tran AP, Martins PN, Papazian ZG, Vanguri VK, Movahedi B, Fan PY, Bodziak KA, Yates JK, Sokoloff MH, Bozorgzadeh A. Transplantation of Renal Allograft After Removal of Renal Cell Carcinoma: Case Report and Review of the Literature. EXP CLIN TRANSPLANT 2019; 19:732-735. [PMID: 31580237 DOI: 10.6002/ect.2018.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the rising incidence of end-stage renal disease in the United States, patients needing renal transplants are waiting longer for increasingly scarce grafts. Formerly, the general practice was to avoid organs with tumors for transplant because of the risk of malignancy transmission to the recipient. However, with comprehensive donor selection and a small-sized primary tumor, the positive outcomes of transplant outweigh the risks of transmission after a partial nephrectomy. In our case, a 31-year-old woman, the daughter of the recipient, underwent a laparoscopic nephrectomy with an existing 8-mm tumor later confirmed as renal cell carcinoma. An ex vivo tumor enucleation was performed before the allograft was transplanted into the 69-year-old patient with endstage renal disease. At last follow-up, graft function has remained excellent with no evidence of local recurrence or metastasis in both the donor and recipient. Here, we describe our case and perform a literature review on the incidence and management of renal allografts with incidentally detected renal cell carcinoma during transplant.
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Affiliation(s)
- Anthony P Tran
- From the Department of Surgery, Division of Organ Transplantation, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, Massachusetts, USA
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18
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Martins PN, Rawson A, Movahedi B, Brüggenwirth IMA, Dolgin NH, Martins AB, Mahboub P, Bozorgzadeh A. Single-Center Experience With Liver Transplant Using Donors With Very High Transaminase Levels. EXP CLIN TRANSPLANT 2019; 17:498-506. [DOI: 10.6002/ect.2017.0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Dolgin NH, Smith AJ, Harrington SG, Movahedi B, Martins PNA, Bozorgzadeh A. Association Between Sarcopenia and Functional Status in Liver Transplant Patients. EXP CLIN TRANSPLANT 2018; 17:653-664. [PMID: 30295589 DOI: 10.6002/ect.2018.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A growing body of evidence shows that frailty and functional performance predict liver transplant outcomes. The Organ Procurement and Transplant Network uses the Karnofsky Performance Status scale to adjust for transplant center case mix in assessing quality measures. This study explores the strength of the relationship between Karnofsky Performance Status scores and objective measures of frailty. MATERIALS AND METHODS This observational study includes 136 adult, first-time liver transplant recipients at UMass Memorial (2006-2015) who had 2 abdominal computed tomography scans available (at ≤ 90 days pretransplant and ≥ 7 days before that). We analyzed the relationship between Karnofsky Performance Status and muscle wasting using absolute and change in psoas muscle size and quality pretransplant. RESULTS The mean age was 55 years, mean Model for End-Stage Liver Disease was 22, and 34% of patients were women. In the study group, 50% of patients had sarcopenia pretransplant and 71.3% demonstrated declined lean psoas area at an average rate of 11% per month. Patients who experienced muscle wasting at a rate of ≥ 1% per month had 2.83 times the risk (95% confidence interval, 1.18-6.80) of being severely impaired/disabled pretransplant. The risk increased by 2.32-fold (95% confidence interval, 1.44-3.75) for every standard deviation decrease in pretransplant lean psoas area. CONCLUSIONS Provider-assessed physical health status moderately correlates with objective measures of frailty.
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Affiliation(s)
- Natasha H Dolgin
- From the Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, Boston, Massachusetts, USA
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20
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Hendrix RJ, Martins PN, Stoff JS, Ahearn A, Bozorgzadeh A, Movahedi B. Successful Renal Transplantation after Presumed Cyanide Toxicity Treated with Hydroxocobalamin and Review of the Literature. Case Rep Transplant 2018; 2018:3753479. [PMID: 30271651 PMCID: PMC6151203 DOI: 10.1155/2018/3753479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 11/18/2022] Open
Abstract
We report two cases of successful renal transplantation with allografts from donors who suffered anoxic brain injury as the primary cause of death from house fires. Each was treated prophylactically with hydroxocobalamin (Cyanokit) for suspected cyanide toxicity. During organ procurement, gross examination was notable for deep discoloration of the parenchymal tissues. Approximately 6 and 18 months after transplantation, both recipients have excellent renal graft function and remain independent from hemodialysis (HD). Hydroxocobalamin is the antidote for suspected acute cyanide toxicity. While largely tolerated by the recipient, there is concern over the potential functional implications of the associated side effects of dramatic tissue discoloration and development of oxalate crystals. Furthermore, difficulties performing hemodialysis in patients treated with hydroxocobalamin have been reported due to discoloration of the effluent fluid impacting the colorimetric sensor, causing false alarms and repetitive interruptions. As such, many transplant centers in the United States (US) continue to reject these organs. We seek to highlight two cases of successful transplantation following donor administration of hydroxocobalamin (Cyanokit) and present the first documented case of successful perioperative intermittent hemodialysis following transplantation of an allograft exposed to hydroxocobalamin. Furthermore, we emphasize the importance of optimal organ utilization and caution against unnecessary refusal.
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Affiliation(s)
- Ryan J. Hendrix
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Paulo N. Martins
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Jeffrey S. Stoff
- University of Massachusetts Medical School, Department of Medicine, Division of Nephrology, USA
| | - Aaron Ahearn
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Adel Bozorgzadeh
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
| | - Babak Movahedi
- University of Massachusetts Medical School, Department of Surgery, Division of Organ Transplantation, USA
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21
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Orandi BJ, Luo X, King EA, Garonzik-Wang JM, Bae S, Montgomery RA, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Gaber AO, Segev DL. Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study. Am J Transplant 2018; 18:650-658. [PMID: 28834181 PMCID: PMC5820188 DOI: 10.1111/ajt.14472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/06/2017] [Accepted: 08/11/2017] [Indexed: 01/25/2023]
Abstract
Thirty percent of kidney transplant recipients are readmitted in the first month posttransplantation. Those with donor-specific antibody requiring desensitization and incompatible live donor kidney transplantation (ILDKT) constitute a unique subpopulation that might be at higher readmission risk. Drawing on a 22-center cohort, 379 ILDKTs with Medicare primary insurance were matched to compatible transplant-matched controls and to waitlist-only matched controls on panel reactive antibody, age, blood group, renal replacement time, prior kidney transplantation, race, gender, diabetes, and transplant date/waitlisting date. Readmission risk was determined using multilevel, mixed-effects Poisson regression. In the first month, ILDKTs had a 1.28-fold higher readmission risk than compatible controls (95% confidence interval [CI] 1.13-1.46; P < .001). Risk peaked at 6-12 months (relative risk [RR] 1.67, 95% CI 1.49-1.87; P < .001), attenuating by 24-36 months (RR 1.24, 95% CI 1.10-1.40; P < .001). ILDKTs had a 5.86-fold higher readmission risk (95% CI 4.96-6.92; P < .001) in the first month compared to waitlist-only controls. At 12-24 (RR 0.85, 95% CI 0.77-0.95; P = .002) and 24-36 months (RR 0.74, 95% CI 0.66-0.84; P < .001), ILDKTs had a lower risk than waitlist-only controls. These findings of ILDKTs having a higher readmission risk than compatible controls, but a lower readmission risk after the first year than waitlist-only controls should be considered in regulatory/payment schemas and planning clinical care.
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Affiliation(s)
- Babak J. Orandi
- Department of Surgery, University of California-San Francisco, San Francisco, CA
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth A. King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A. Montgomery
- The NYU Transplant Institute, New York University Langone Medical Center, NY, NY
| | | | - Stanley C. Jordan
- Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - Jose Oberholzer
- Department of Surgery, University of Illinois-Chicago, Chicago IL
| | - Ty B. Dunn
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - Sandip Kapur
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | | | - John P. Roberts
- Department of Surgery, University of California-San Francisco, San Francisco, CA
| | | | - Pooja Singh
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Debra L. Sudan
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Marc P. Posner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Jose M. El-Amm
- Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK
| | - Ron Shapiro
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| | | | | | - Michael A. Rees
- Department of Urology, University of Toledo Medical Center, Toledo, OH
| | | | | | - David A. Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Paul W. Nelson
- Department of Surgery, University of Nevada, Las Vegas, NV
| | - Jason Wellen
- Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO
| | - Adel Bozorgzadeh
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - A. Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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22
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Axelrod D, Lentine KL, Schnitzler MA, Luo X, Xiao H, Orandi BJ, Massie A, Garonzik-Wang J, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Osama Gaber A, Montgomery RA, Segev DL. The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis. Am J Transplant 2017; 17:3123-3130. [PMID: 28613436 DOI: 10.1111/ajt.14392] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 01/25/2023]
Abstract
Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end-stage renal disease patients with willing but HLA-incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource-intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell-depleting antibody treatment, as well as protocol biopsies and donor-specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p < 0.0001 for all). ILDKT was associated with longer median length of stay (12.9 vs. 7.8 days), higher Medicare payments ($91 330 vs. $63 782 p < 0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.
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Affiliation(s)
- D Axelrod
- Department of Transplantation, Lahey Hospital and Health System, Burlington, MA
| | - K L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - M A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - X Luo
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - H Xiao
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - B J Orandi
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - A Massie
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - J Garonzik-Wang
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - M D Stegall
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - S C Jordan
- Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA
| | - J Oberholzer
- Department of Surgery, University of Illinois-Chicago, Chicago, IL
| | - T B Dunn
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - L E Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - S Kapur
- Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - R P Pelletier
- Department of Surgery, The Ohio State University, Columbus, OH
| | - J P Roberts
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - M L Melcher
- Department of Surgery, Stanford University, Palo Alto, CA
| | - P Singh
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - D L Sudan
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - M P Posner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - J M El-Amm
- Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK
| | - R Shapiro
- Department of Surgery, Mt. Sinai Medical Center, New York, NY
| | - M Cooper
- Medstar Georgetown Transplant Institute, Washington, DC
| | - G S Lipkowitz
- Department of Surgery, Baystate Medical Center, Springfield, MA
| | - M A Rees
- Department of Urology, University of Toledo Medical Center, Toledo, OH
| | - C L Marsh
- Division of Organ Transplantation, Scripps Center for Organ Transplantation, Department of Surgery, Scripps Clinic and Green Hospital, La Jolla, CA
| | - B R Sankari
- Department of Urology, Cleveland Clinic, Cleveland, OH
| | - D A Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - P W Nelson
- Department of Surgery, University of Nevada, Las Vegas, NV
| | - J Wellen
- Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO
| | - A Bozorgzadeh
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - R A Montgomery
- Department of Surgery, New York University Langone Medical Center, New York, NY
| | - D L Segev
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
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23
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Thijssen MF, Moore CG, Xiaofei E, Wang X, Mandrekar P, Bozorgzadeh A, Porte RJ, Kowalik TF, Martins P. Silencing p53 Pathway of Apoptosis Alleviates Ischemia-Reperfusion Injury (IRI) in the Liver. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Martins PN, Kim I, Bozorgzadeh A. Allocation of organs to cognitively impaired patients. Pediatr Transplant 2017; 21. [PMID: 28574199 DOI: 10.1111/petr.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Paulo N Martins
- Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA, USA
| | - Irene Kim
- Transplant Division, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Adel Bozorgzadeh
- Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA, USA
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25
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Marecki H, Bozorgzadeh A, Porte RJ, Leuvenink HG, Uygun K, Martins PN. Liver ex situ machine perfusion preservation: A review of the methodology and results of large animal studies and clinical trials. Liver Transpl 2017; 23:679-695. [PMID: 28240817 DOI: 10.1002/lt.24751] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
Ex vivo machine perfusion (MP) is a promising way to better preserve livers prior to transplantation. Currently, no methodology has a verified benefit over simple cold storage. Before becoming clinically feasible, MP requires validation in models that reliably predict human performance. Such a model has been found in porcine liver, whose physiological, anatomical, and immunological characteristics closely resemble the human liver. Since the 1930s, researchers have explored MP as preservation, but only recently have clinical trials been performed. Making this technology clinically available holds the promise of expanding the donor pool through more effective preservation of extended criteria donor (ECD) livers. MP promises to decrease delayed graft function, primary nonfunction, and biliary strictures, which are all common failure modes of transplanted ECD livers. Although hypothermic machine perfusion (HMP) has become the standard for kidney ex vivo preservation, the precise settings and clinical role for liver MP have not yet been established. In research, there are 2 schools of thought: normothermic machine perfusion, closely mimicking physiologic conditions, and HMP, to maximize preservation. Here, we review the literature for porcine ex vivo MP, with an aim to summarize perfusion settings and outcomes pertinent to the clinical establishment of MP. Liver Transplantation 23 679-695 2017 AASLD.
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Affiliation(s)
- Hazel Marecki
- Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA
| | - Adel Bozorgzadeh
- Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA
| | - Robert J Porte
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Henri G Leuvenink
- Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Korkut Uygun
- Center of Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Paulo N Martins
- Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA
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26
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Sheppard SE, Marecki HL, Psoinos CM, Movahedi B, Furman MJ, Bozorgzadeh A, Martins PN. Acute Appendicitis after Liver Transplantation: A Case Report and Review of the Literature. Int J Organ Transplant Med 2017; 8:208-212. [PMID: 29321837 PMCID: PMC5756903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Acute appendicitis is one of the most common etiologies for acute abdomen. However, fewer than 30 cases of acute appendicitis after liver transplantation have so far been reported in the literature. Previous case studies have concluded that acute appendicitis after liver transplantation may present differently than in non-immunosuppressed patients and thus may lead to more complications. Herein, we describe the fourth case of laparoscopic appendectomy in a 40-year-old female presenting with an acute abdomen, 10 years after orthotopic liver transplantation for autoimmune hepatitis. Additionally, we review the literature, and emphasize the importance for laparoscopic, rather than open appendectomy after liver transplantation. Overall, despite the small number of reported cases of appendicitis after orthotopic liver transplantation, we found the incidence and clinical presentation are similar to patients without liver transplantation. The etiologies for appendicitis in patients after liver transplantation may be different than in those not chronically immunosuppressed, with significantly less lymphoid hyperplasia and increased fecalith and cytomegaloviral infections. Preliminary results showed that laparoscopic appendectomy after liver transplantation results in decreased hospital stays and fewer complications.
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Affiliation(s)
| | | | | | | | | | | | - P. N. Martins
- Correspondence: Dr. Paulo N Martins MD, PhD, Assistant Professor of Surgery, Dept of Surgery, Transplant Division, University of Massachusetts Medical School, 55 North Lake Avenue, S6-412 Worcester, MA 01655, United States ,Tel: +1-508-334-2023, Fax: +1-508-856-1102, E-mail:
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Scortegagna E, Karam AR, Sioshansi S, Bozorgzadeh A, Barry C, Hussain S. Hepatocellular carcinoma recurrence pattern following liver transplantation and a suggested surveillance algorithm. Clin Imaging 2016; 40:1131-1134. [DOI: 10.1016/j.clinimag.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/16/2016] [Accepted: 07/05/2016] [Indexed: 12/29/2022]
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Dolgin NH, Martins PNA, Movahedi B, Lapane KL, Anderson FA, Bozorgzadeh A. Functional status predicts postoperative mortality after liver transplantation. Clin Transplant 2016; 30:1403-1410. [PMID: 27439897 DOI: 10.1111/ctr.12808] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Frail patients are more vulnerable to perioperative stressors of liver transplantation (LT). Program Specific Reports, used in transplant center auditing, risk-adjust for frailty using the Karnofsky Performance Status (KPS) scale. We evaluate the extent to which functional impairment/disability is associated with increased risk of postoperative death. METHODS We included 24 505 first-time LT recipients from the Scientific Registry of Transplant Recipients (2006-2011). We categorized patients as Severe, Moderate, or Normal function/disability using the KPS scale and evaluated risk of 30- and 90-day mortality. Analyses took potential center-specific differences in KPS measurement protocols into account using hierarchal logistic modeling. RESULTS Over one-quarter of our population was Severely impaired/disabled, and 30.5% had no functional limitations. Severely and Moderately impaired/disabled patients had 2.56 (95% CI 1.91-3.44) and 1.40 (95% CI 1.10-1.78) times the odds of 30-day mortality, respectively, after adjusting for key recipient and donor factors. Estimates remained consistent regardless of Model for End-Stage Liver Disease score, medical condition, or clustering analyses by center. Technical/operative complications and multiorgan failure/hemorrhage were more common causes of death among more Severely disabled patients than in higher functioning groups. CONCLUSIONS Pre-transplant functional status, assessed using the KPS scale, is a reliable predictor of post-LT mortality in the United States.
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Affiliation(s)
- Natasha H Dolgin
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA. .,Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA. .,Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Paulo N A Martins
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Babak Movahedi
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, Clinical & Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA
| | - Fred A Anderson
- Department of Surgery, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
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Mahboub P, Bozorgzadeh A, Martins PN. Potential approaches to improve the outcomes of donation after cardiac death liver grafts. World J Transplant 2016; 6:314-320. [PMID: 27358776 PMCID: PMC4919735 DOI: 10.5500/wjt.v6.i2.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/23/2015] [Accepted: 03/25/2016] [Indexed: 02/05/2023] Open
Abstract
There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft’s for transplantation, improve the outcomes, and decrease the mortality on the waiting list.
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Orandi BJ, Luo X, Massie AB, Garonzik-Wang JM, Lonze BE, Ahmed R, Van Arendonk KJ, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Gaber AO, Montgomery RA, Segev DL. Survival Benefit with Kidney Transplants from HLA-Incompatible Live Donors. N Engl J Med 2016; 374:940-50. [PMID: 26962729 PMCID: PMC4841939 DOI: 10.1056/nejmoa1508380] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND A report from a high-volume single center indicated a survival benefit of receiving a kidney transplant from an HLA-incompatible live donor as compared with remaining on the waiting list, whether or not a kidney from a deceased donor was received. The generalizability of that finding is unclear. METHODS In a 22-center study, we estimated the survival benefit for 1025 recipients of kidney transplants from HLA-incompatible live donors who were matched with controls who remained on the waiting list or received a transplant from a deceased donor (waiting-list-or-transplant control group) and controls who remained on the waiting list but did not receive a transplant (waiting-list-only control group). We analyzed the data with and without patients from the highest-volume center in the study. RESULTS Recipients of kidney transplants from incompatible live donors had a higher survival rate than either control group at 1 year (95.0%, vs. 94.0% for the waiting-list-or-transplant control group and 89.6% for the waiting-list-only control group), 3 years (91.7% vs. 83.6% and 72.7%, respectively), 5 years (86.0% vs. 74.4% and 59.2%), and 8 years (76.5% vs. 62.9% and 43.9%) (P<0.001 for all comparisons with the two control groups). The survival benefit was significant at 8 years across all levels of donor-specific antibody: 89.2% for recipients of kidney transplants from incompatible live donors who had a positive Luminex assay for anti-HLA antibody but a negative flow-cytometric cross-match versus 65.0% for the waiting-list-or-transplant control group and 47.1% for the waiting-list-only control group; 76.3% for recipients with a positive flow-cytometric cross-match but a negative cytotoxic cross-match versus 63.3% and 43.0% in the two control groups, respectively; and 71.0% for recipients with a positive cytotoxic cross-match versus 61.5% and 43.7%, respectively. The findings did not change when patients from the highest-volume center were excluded. CONCLUSIONS This multicenter study validated single-center evidence that patients who received kidney transplants from HLA-incompatible live donors had a substantial survival benefit as compared with patients who did not undergo transplantation and those who waited for transplants from deceased donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.).
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Affiliation(s)
- Babak J Orandi
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Xun Luo
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Allan B Massie
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Jacqueline M Garonzik-Wang
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Bonne E Lonze
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Rizwan Ahmed
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Kyle J Van Arendonk
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Mark D Stegall
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Stanley C Jordan
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Jose Oberholzer
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Ty B Dunn
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Lloyd E Ratner
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Sandip Kapur
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Ronald P Pelletier
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - John P Roberts
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Marc L Melcher
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Pooja Singh
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Debra L Sudan
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Marc P Posner
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Jose M El-Amm
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Ron Shapiro
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Matthew Cooper
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - George S Lipkowitz
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Michael A Rees
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Christopher L Marsh
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Bashir R Sankari
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - David A Gerber
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Paul W Nelson
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Jason Wellen
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Adel Bozorgzadeh
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - A Osama Gaber
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Robert A Montgomery
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
| | - Dorry L Segev
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (B.J.O., X.L., A.B.M., B.E.L., R.A., K.J.V.A., R.A.M., D.L. Segev); the Department of Surgery, Barnes-Jewish Hospital, St. Louis (J.M.G.-W., J.W.); the Department of Surgery, Mayo Clinic, Rochester (M.D.S.), and the Department of Surgery, University of Minnesota, Minneapolis (T.B.D.) - both in Minnesota; the Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles (S.C.J.), the Department of Surgery, University of California,San Francisco, San Francisco (J.P.R.), the Department of Surgery, Stanford University, Palo Alto (M.L.M.), and the Department of Surgery, Scripps Clinic and Green Hospital, La Jolla (C.L.M.) - all in California; the Department of Surgery, University of Illinois-Chicago, Chicago (J.O.); the Department of Surgery, Columbia University Medical Center (L.E.R.), and the Department of Surgery, New York Presbyterian-Weill Cornell Medical Center (S.K.) - both in New York; the Department of Surgery, Ohio State University, Columbus (R.P.P.), the Department of Urology, University of Toledo Medical Center, Toledo (M.A.R.), and the Department of Urology, Cleveland Clinic, Cleveland (B.R.S.) - all in Ohio; the Department of Medicine, Thomas Jefferson University Hospital, Philadelphia (P.S.); the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh (R.S.); the Department of Surgery, Duke University Medical Center, Durham (D.L. Sudan), and the Department of Surgery, University of North Carolina School of Medicine, Chapel Hill (D.A.G.) - both in North Carolina; the Department of Surgery, Virginia Commonwealth University, Richmond (M.P.P.); Integris Baptist Medical Center, Transplant Division, Oklahoma City (J.M.E.-A.); Medstar Georgetown Transplant Institute, Washington, DC (M.C.); the Department of Surgery, Baystate Medical Center, Springfield (G.S.L.), and the Department of Surgery, University of Massachusetts Memorial Medical Ce
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Punzalan CS, Barry C, Zacharias I, Rodrigues J, Mehta S, Bozorgzadeh A, Barnard GF. Sofosbuvir plus simeprevir treatment of recurrent genotype 1 hepatitis C after liver transplant. Clin Transplant 2015; 29:1105-11. [PMID: 26358816 DOI: 10.1111/ctr.12634] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with recurrent hepatitis C (HCV) infection post-liver transplant can be difficult to treat safely and effectively. A prior (COSMOS) study in patients with non-transplant HCV, using sofosbuvir plus simeprevir, had high efficacy and tolerability in treating patients with HCV genotype 1, even prior non-responders to interferon therapy and those with cirrhosis. Our aim was to evaluate the efficacy of sofosbuvir and simeprevir in patients with genotype 1 HCV post-liver transplant. METHODS In this prospective, observational study, patients received sofosbuvir 400 mg plus simeprevir 150 mg daily for 12 wk without ribavirin. The primary end point was a sustained virologic response 12 wk after the end of therapy. RESULTS Forty-two patients completed the treatment. Twenty-six percent started the treatment ≤ 6 months post-liver transplant. Nineteen percent of the included patients had cirrhosis, 14% with decompensation. At week 4 on the treatment, 21% of patients had detectable virus but at the end of the treatment, 100% were undetectable. Twelve weeks after the end of the treatment, 95% of the patients had undetectable hepatitis C. The regimen was generally well tolerated. CONCLUSION The oral regimen of sofosbuvir plus simeprevir without ribavirin is efficacious and well tolerated in the treatment of patients with genotype 1 hepatitis C post-liver transplant.
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Affiliation(s)
- Carmi Santos Punzalan
- Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Curtis Barry
- Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Isabel Zacharias
- Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Julie Rodrigues
- Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Savant Mehta
- Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Transplant Surgery, Department of Surgery, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Graham F Barnard
- Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
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Orandi BJ, Garonzik-Wang JM, Massie AB, Zachary AA, Montgomery JR, Van Arendonk KJ, Stegall MD, Jordan SC, Oberholzer J, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Nelson PW, Wellen J, Bozorgzadeh A, Gaber AO, Montgomery RA, Segev DL. Quantifying the risk of incompatible kidney transplantation: a multicenter study. Am J Transplant 2014; 14:1573-80. [PMID: 24913913 DOI: 10.1111/ajt.12786] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 01/25/2023]
Abstract
Incompatible live donor kidney transplantation (ILDKT) offers a survival advantage over dialysis to patients with anti-HLA donor-specific antibody (DSA). Program-specific reports (PSRs) fail to account for ILDKT, placing this practice at regulatory risk. We collected DSA data, categorized as positive Luminex, negative flow crossmatch (PLNF) (n = 185), positive flow, negative cytotoxic crossmatch (PFNC) (n = 536) or positive cytotoxic crossmatch (PCC) (n = 304), from 22 centers. We tested associations between DSA, graft loss and mortality after adjusting for PSR model factors, using 9669 compatible patients as a comparison. PLNF patients had similar graft loss; however, PFNC (adjusted hazard ratio [aHR] = 1.64, 95% confidence interval [CI]: 1.15-2.23, p = 0.007) and PCC (aHR = 5.01, 95% CI: 3.71-6.77, p < 0.001) were associated with increased graft loss in the first year. PLNF patients had similar mortality; however, PFNC (aHR = 2.04; 95% CI: 1.28-3.26; p = 0.003) and PCC (aHR = 4.59; 95% CI: 2.98-7.07; p < 0.001) were associated with increased mortality. We simulated Centers for Medicare & Medicaid Services flagging to examine ILDKT's effect on the risk of being flagged. Compared to equal-quality centers performing no ILDKT, centers performing 5%, 10% or 20% PFNC had a 1.19-, 1.33- and 1.73-fold higher odds of being flagged. Centers performing 5%, 10% or 20% PCC had a 2.22-, 4.09- and 10.72-fold higher odds. Failure to account for ILDKT's increased risk places centers providing this life-saving treatment in jeopardy of regulatory intervention.
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Affiliation(s)
- B J Orandi
- Departments of Surgery and Medicine, Johns Hopkins Hospital, Baltimore, MD
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Saidi R, Rajeshkumar B, Walter O, Shariftabrizi A, Dresser K, Bozorgzadeh A. Human C1 inhibitor attenuates liver ischemia-reperfusion injury and promotes liver regeneration. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jain A, Venkataramanan R, Sharma R, Kwong T, Abt P, Orloff M, Kashyap R, Tsoulfas G, Bozorgzadeh A. Pharmacokinetics of Mycophenolic Acid in Live Donor Liver Transplant Patients vs Deceased Donor Liver Transplant Patients. J Clin Pharmacol 2013; 48:547-52. [PMID: 18440919 DOI: 10.1177/0091270008315317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ashok Jain
- University of Rochester Medical Center, Department of Surgery, Division of Solid Organ Transplantation, Rochester, NY 14642, USA.
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Mariano EA, Bathini VG, Barnard G, Anwar N, Bozorgzadeh A, Saidi R, Jabbour N, D'Antonio A, Barry C, Switzer BA. Single-institution experience with sorafenib for hepatocellular carcinoma (HCC) in the post-liver transplant setting (Ltx). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
237 Background: Sorafenib plays a role in the treatment of advanced HCC; however its role after Ltx has not yet been defined in the adjuvant setting. Patients at high risk for HCC recurrence, or those with recurrence after Ltx may benefit from this therapy. Methods: We present our institution’s experience of the use of sorafenib in the post Ltx setting in 11 patients. High risk for HCC recurrence (9 patients) was defined as vascular invasion, lymphovascular invasion, liver capsule invasion, or >3 tumors present in the liver explant. 2 patients had recurrent HCC post Ltx. The starting dose of sorafenib varied, but was most commonly 200mg po BID. Patients were seen monthly while on sorafenib, and 4-phase liver CTs or MRIs were performed every 3 months. Results: Median age at Ltx was 55 (range 48-77). Median time between Ltx and start of sorafenib was 150 days (range 30-543). Reasons for sorafenib use were high risk of recurrence 8/11 (72.7%), recurrence 2/11 (18.2%), rising AFP 1/11 (9%). Median duration of therapy was 152 days (range 21-295). Only 1/9 (11%) of patients could not complete 6 months of adjuvant therapy due to toxicity. 2 patients have yet to comple 6 months of adjuvant sorafenib. All 9 patients receiving therapy for high risk of recurrence are alive with longest survival of 40 months. Both patients with recurrent disease have died. Toxicity:36% (4 patients) had Grade 2 or 3 hand foot syndrome, 18% (2 patients) had grade 1 diarrhea and hypertension, 9% (1 patient) had grade 3 elevation in liver function tests, 9% (1 patient) had grade 3 parasthesias. Other side effects include grade 2 nausea (1 patient); grade 2 muscle weakness (1 patient), grade 1 lightheadedness (1 patient), grade 1 hair loss (1 patient), and grade 1 LFT elevation (1 patient). Zero patients reported no toxicity. Conclusions: Sorafenib in the post Ltx setting was well tolerated with manageable toxicities. The majority of patients at high risk for recurrent HCC were able to complete 6 months of adjuvant therapy. Further studies investigating this therapy in post transplant patients are warranted.
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Affiliation(s)
| | | | - Graham Barnard
- University of Massachusetts Medical Center, Worcester, MA
| | - Nadeem Anwar
- University of Massachusetts Medical Center, Worcester, MA
| | | | - Reza Saidi
- University of Massachusetts Medical Center, Worcester, MA
| | | | | | - Curtis Barry
- University of Massachusetts Medical Center, Worcester, MA
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Saidi RF, Jabbour N, Shah SA, Li Y, Bozorgzadeh A. Improving Outcomes of Liver Transplantation for Polycystic Disease in MELD Era. Int J Organ Transplant Med 2013; 4:27-9. [PMID: 25013650 PMCID: PMC4089305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) for polycystic liver disease (PLD) has evolved to be an option for treating these patients. Patients with PLD suffer from incapacitating symptoms because of very large liver volumes but liver function is preserved until a late stage. OBJECTIVE/METHODS Herein, we reviewed the outcome of adult patients with PLD who underwent LT in the US comparing pre-MELD (1990-2001) to MELD era (2002-2009). RESULTS During this period, only 309 patients underwent LT for PLD. The number of LT for PLD is very low comparing the two eras. The percentage of patients who had combined liver and kidney transplantation (CLKT) for this disease has not changed during MELD era (42.8% vs 38.6%). The waiting time for LT (337 vs 272 days) and CLKT (289 vs 220) has increased in MELD era (p<0.001). In MELD era, 53.4% of LT and 31.2% of CLKT were done as MELD exceptional cases. The allograft and patent survival have significantly improved in MELD era. CONCLUSION Patients with PLD had marked improvement of their outcomes after LT in MELD era.
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Affiliation(s)
- R. F. Saidi
- Correspondence: Reza F. Saidi, MD, Assistant Professor of Surgery, Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, S6-426, Worcester MA, 01655, USA, Tel: +1-508-334-2023, Fax: +1-508-856-1102
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Saidi RF, Jabbour N, Shah SA, Li YF, Bozorgzadeh A. Liver transplantation from hepatitis B surface antigen-positive donors. Transplant Proc 2012; 45:279-80. [PMID: 23267801 DOI: 10.1016/j.transproceed.2012.05.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/30/2012] [Indexed: 12/16/2022]
Abstract
One possibility to increase the organ pool is to use grafts from hepatitis B virus (HBV) surface antigen (HBsAg)-positive donors, but few data are currently available in this setting. Herein, we reviewed the outcome of 92 liver transplantations using allografts from HBsAg-positive donors in the United States (1990-2009). They had experienced HBV-related (n = 68) or HBV-unrelated disease (n = 24). There was no difference between patients who received HBsAg-positive versus HBsAg-negative allografts based on age, Model for End-stage Liver Disease (MELD) score, length of stay, wait time, and donor risk index. HBsAg-positive allografts were more likely to be imported and used in MELD exceptional cases. Allograft and patient survival were comparable between the two groups. HBsAg-positive allografts deserve consideration when no other organ is available in a suitable waiting time in the present era of highly effective antiviral therapy.
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Affiliation(s)
- R F Saidi
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Abstract
BACKGROUND Using SRTR/UNOS data, it has previously been shown that increased liver transplant centre volume improves graft and patient survival. In the current era of health care reform and pay for performance, the effects of centre volume on quality, utilization and cost are unknown. METHODS Using the UHC database (2009-2010), 63 liver transplant centres were identified that were organized into tertiles based on annual centre case volume and stratified by severity of illness (SOI). Utilization endpoints included hospital and intensive care unit (ICU) length of stay (LOS), cost and in-hospital mortality. RESULTS In all, 5130 transplants were identified. Mortality was improved at high volume centres (HVC) vs. low volume centres (LVC), 2.9 vs. 3.4%, respectively. HVC had a lower median LOS than LVC (9 vs. 10 days, P < 0.0001), shorter median ICU stay than LVC and medium volume centres (MVC) (2 vs. 3 and 3 days, respectively, P < 0.0001) and lower direct costs than LVC and MVC ($90,946 vs. $98,055 and $101,014, respectively, P < 0.0001); this effect persisted when adjusted for severity of illness. CONCLUSIONS This UHC-based cohort shows that increased centre volume results in improved long-term post-liver transplant outcomes and more efficient use of hospital resources thereby lowering the cost. A better understanding of these mechanisms can lead to informed decisions and optimization of the pay for performance model in liver transplantation.
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Affiliation(s)
- Christopher W Macomber
- Department of Surgery Outcomes Analysis & Research, University of MassachusettsWorcester
| | - Joshua J Shaw
- Department of Surgery Outcomes Analysis & Research, University of MassachusettsWorcester
| | - Heena Santry
- Department of Surgery Outcomes Analysis & Research, University of MassachusettsWorcester
| | - Reza F Saidi
- Department of Surgery Outcomes Analysis & Research, University of MassachusettsWorcester
| | - Nicolas Jabbour
- Department of Surgery Outcomes Analysis & Research, University of MassachusettsWorcester
| | | | - Adel Bozorgzadeh
- Department of Surgery Outcomes Analysis & Research, University of MassachusettsWorcester
| | - Shimul A Shah
- Department of Surgery Outcomes Analysis & Research, University of MassachusettsWorcester
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Abstract
OBJECTIVES Living donor liver transplantation (LDLT) is an accepted treatment for patients with end-stage liver disease. To minimize risk to the donor, left lobe (LL) LDLT may be an ideal option in adult LDLT. METHODS This study assessed the outcomes of LL-LDLT compared with right lobe (RL) LDLT in adults (1998-2010) as reported to the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN). RESULTS A total of 2844 recipients of LDLT were identified. Of these, 2690 (94.6%) underwent RL-LDLT and 154 (5.4%) underwent LL-LDLT. A recent increase in the number of LL-LDLTs was noted: average numbers of LL-LDLTs per year were 5.2 during 1998-2003 and 19.4 during 2004-2010. Compared with RL-LDLT recipients, LL-LDLT recipients were younger (mean age: 50.5 years vs. 47.0 years), had a lower body mass index (BMI) (mean BMI: 24.5 kg/m(2) vs. 26.8 kg/m(2)), and were more likely to be female (64.6% vs. 41.9%). Donors in LL-LDLT had a higher BMI (mean BMI: 29.4 kg/m(2) vs. 26.5 kg/m(2)) and were less likely to be female (30.9% vs. 48.1%). Recipients of LL-LDLT had a longer mean length of stay (24.9 days vs. 18.2 days) and higher retransplantation rates (20.3% vs. 10.9%). Allograft survival in LL-LDLT was significantly lower than in RL-LDLT and there was a trend towards inferior patient survival. In Cox regression analysis, LL-LDLT was found to be associated with an increased risk for allograft failure [hazard ratio (HR): 2.39)] and inferior patient survival (HR: 1.86). CONCLUSIONS The number of LL-LDLTs has increased in recent years.
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Affiliation(s)
- Reza F Saidi
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Nickels MW, Cullen JP, Demme RA, Vetter M, Boulay R, Betts R, McKee M, Orloff M, Bozorgzadeh A. A psychosocial evaluation process for living liver donors: the University of Rochester model. Int J Psychiatry Med 2012; 41:295-308. [PMID: 22238836 DOI: 10.2190/pm.41.4.a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The donation of livers by living donors entails complex processes, both surgically and psychosocially, potentially involving risks in both domains. Thorough psychosocial evaluation is necessary to minimize those risks, yet little has been written about the donor assessment process. This article describes one such process, utilized by a transplant program in upstate New York. METHOD Donor candidates undergo multiple psychosocial interviews early in the overall transplant evaluation process. Evaluators subsequently meet as a group, along with an independent ethicist, to determine psychosocial candidacy prior to final medical/surgical clearance. RESULTS Between 2003 and 2007, 416 donor candidates initiated and/or underwent full evaluation, resulting in a 17.5% surgery and 55.5% exclusion rate among those individuals. Of those ruled out, 20.8% were for (medical or psychosocial) reasons associated with the recipient, and 8.7% were for donor-related psychosocial issues. CONCLUSION Given the primacy ofpsychosocial and ethical issues in living liver donor candidate evaluation, the multiple interview process, followed by team discussion and overseen by an ethicist removed from other transplant program functions, has advantages as a donor assessment model.
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Affiliation(s)
- M W Nickels
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Saidi RF, Jabbour N, Li YF, Shah SA, Bozorgzadeh A. Liver Transplantation in Patients with Portal Vein Thrombosis: Comparing Pre-MELD and MELD era. Int J Organ Transplant Med 2012; 3:105-10. [PMID: 25013632 PMCID: PMC4089289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) used to be a relative contraindication for liver transplantation (LT). This obstacle has been dealt with following the improvement of LT-related techniques. OBJECTIVE To compare the outcome of adult patients with PVT who underwent LT before and after adopting MELD. METHODS We retrospectively searched our database for deceased donor LT recipients who had PVT, were operated between 1990 and 2009, and were 18 years old or more. The outcome of patients operated in pre-MELD era (1990-2001) was then compared with that of those operated in MELD era (2002-2009). RESULTS The incidence of patients undergoing LT with PVT has increased from 1.2% (491/40,730) in pre-MELD era to 6% (2540/42,601) in MELD era (p<0.01). Patients with PVT in MELD era were older (53.6 vs 50.5), had higher calculated MELD (21.3 vs 18.9), shorter length of hospital stay after LT (25 vs 21.7 days), more likely to develop HCC (14.8% vs 0), and more likely to receive DCD allograft (3.9% vs 0.8%). Donor risk indices were comparable in both groups (1.9 vs 1.9). The median waiting time before transplantation decreased during MELD era (71 vs 99 days). Allograft and patients survival was comparable between the two eras. However, allograft and patients survival rates were lower in patients with PVT compared to those without. In Cox regression analysis, PVT was associated with worse allograft (HR=1.3, 95% CI: 1.2-1.4, p<0.001) and patient survival (HR=1.3, 95% CI: 1.2-1.5, p<0.001) compared to non-PVT patients. CONCLUSIONS The incidence of patients with PVT has increased in MELD era without improvement in outcomes. Donor and recipients characteristics changed in MELD era. PVT is still associated with poor outcomes compared to patients without PVT.
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Affiliation(s)
- R. F. Saidi
- Correspondence: Reza F. Saidi, MD, Assistant Professor of Surgery, Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, S6-426, Worcester MA, 01655, Tel: +1-508-334-2023, Fax: +1-508-856-1102, E-mail:
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Abstract
BACKGROUND Organ shortage has resulted in greater emphasis on partial liver transplantation (PLT) as an alternative to whole-organ liver transplantation. METHODS This study was conducted to assess outcomes in PLT and to compare outcomes of deceased donor split-liver transplantation (DD-SLT) and live donor liver transplantation (LDLT) in adults transplanted in the USA using data reported to the United Network for Organ Sharing in the era of Model for End-stage Liver Disease (MELD) scores. RESULTS Between 2002 and 2009, 2272 PLTs were performed in the USA; these represented 5.3% of all liver transplants carried out in the country and included 557 (24.5%) DD-SLT and 1715 LDLT (75.5%) procedures. The most significant differences between the DD-SLT and LDLT groups related to mean MELD scores, which were lower in LDLT recipients (14.5 vs. 20.9; P < 0.001), mean recipient age, which was lower in the LDLT group (50.7 years vs. 52.8 years; P < 0.001), and mean donor age, which was lower in the DD-SLT group (23.0 years vs. 37.3 years; P < 0.001). Allograft survival was comparable between the two groups (P= 0.438), but patient survival after LDLT was better (P= 0.04). In Cox regression analysis, LDLT was associated with better allograft (hazards ratio [HR]= 0.7, 95% confidence interval [CI] 0.630-0.791; P < 0.0001) and patient (HR = 0.6, 95% CI 0.558-0.644; P < 0.0001) survival than DD-SLT. CONCLUSIONS Partial liver transplantation represents a potentially underutilized resource in the USA. Despite the differences in donor and recipient characteristics, LDLT is associated with better allograft and patient survival than DD-SLT. A different allocation system for DD-SLT allografts that takes into consideration cold ischaemia time and recipient MELD score should be considered.
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Affiliation(s)
- Reza F Saidi
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, USA.
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Ozhathil DK, Li YF, Smith JK, Tseng JF, Saidi RF, Bozorgzadeh A, Shah SA. Impact of center volume on outcomes of increased-risk liver transplants. Liver Transpl 2011; 17:1191-9. [PMID: 21604357 DOI: 10.1002/lt.22343] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The use of high-risk donor livers, which is reflective of the gross national shortage of organs available for transplantation, has gained momentum. Despite the demand, many marginal livers are discarded annually. We evaluated the impact of center volume on survival outcomes associated with liver transplantation using high-donor risk index (DRI) allografts. We queried the Scientific Registry of Transplant Recipients database for deceased donor liver transplants (n = 31,576) performed between 2002 and 2008 for patients who were 18 years old or older, and we excluded partial and multiple liver transplants. A high-DRI cohort (n = 15,668), which was composed of patients receiving grafts with DRIs > 1.90, was analyzed separately. Transplant centers (n = 102) were categorized into tertiles by their annual procedure volumes: high-volume centers (HVCs; 78-215 cases per year), medium-volume centers (MVCs; 49-77 cases per year), and low-volume centers (LVCs; 5-48 cases per year). The endpoints were allograft survival and recipient survival. In comparison with their lower volume counterparts, HVCs used donors with higher mean DRIs (2.07 for HVCs, 2.01 for MVCs, and 1.91 for LVCs), more donors who were 60 years old or older (18.02% for HVCs, 16.85% for MVCs, and 12.39% for LVCs), more donors who died after a stroke (46.52% for HVCs, 43.71% for MVCs, and 43.36% for LVCs), and more donation after cardiac death organs (5.04% for HVCs, 4.45% for MVCs, and 3.51% for LVCs, all P values < 0.001). Multivariate risk-adjusted frailty models showed that increased procedure volume at a transplant center led to decreased risks of allograft failure [hazard ratio (HR) = 0.93, 95% confidence interval (CI) = 0.89-0.98, P = 0.002] and recipient death (HR = 0.90, 95% CI = 0.83-0.97, P = 0.004) for high-DRI liver transplants. In conclusion, HVCs more frequently used higher DRI livers and achieved better risk-adjusted allograft and recipient survival. A greater understanding of the outcomes of transplantation with high-DRI livers may improve their utilization, the postoperative outcomes, and future allocation practices.
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Affiliation(s)
- Deepak K Ozhathil
- Solid Organ Transplantation, Surgical Outcomes Analysis & Research (SOAR), Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Abstract
BACKGROUND A growth in the utilization of high-risk allografts is reflective of a critical national shortage and the increasing waiting list mortality. Using risk-adjusted models, the aim of the present study was to determine whether a volume-outcome relationship existed among liver transplants at high risk for allograft failure. METHODS From 2002 to 2008, the Scientific Registry of Transplant Recipients (SRTR) database for all adult deceased donor liver transplants (n = 31 587) was queried. Transplant centres (n = 102) were categorized by volume into tertiles: low (LVC; 31 cases/year), medium (MVC: 64 cases/year) and high (HVC: 102 cases/year). Donor risk comparison groups were stratified by quartiles of the Donor Risk Index (DRI) spectrum: low risk (DRI ≤ 1.63), moderate risk (1.64 > DRI > 1.90), high risk (1.91 > DRI > 2.26) and very high risk (DRI ≥ 2.27). RESULTS HVC more frequently used higher-risk livers (median DRI: LVC: 1.82, MVC: 1.90, HVC: 1.97; P < 0.0001) and achieved better risk adjusted allograft survival outcomes compared with LVC (HR: 0.90, 95%CI: 0.85-0.95). For high and very high risk groups, transplantation at a HVC did contribute to improved graft survival [high risk: hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.76-0.96; Very High Risk: HR: 0.88, 95%CI: 0.78-0.99]. CONCLUSION While DRI remains an important aspect of allograft survival prediction models, liver transplantation at a HVC appears to result in improved allograft survival with high and very high risk DRI organs compared with LVC.
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Affiliation(s)
- Deepak K Ozhathil
- Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA, USA
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Colombo B, Singla A, Li Y, Tseng JF, Saidi RF, Bozorgzadeh A, Shah SA. Current trends and short-term outcomes of live donor nephrectomy: a population-based analysis of the nationwide inpatient sample. World J Surg 2011; 34:2985-90. [PMID: 20811748 DOI: 10.1007/s00268-010-0770-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recent United Network for Organ Sharing (UNOS) data suggest that live kidney donation is stagnant. Current practices and trends in laparoscopic donor nephrectomy (LDN) among the transplant community remain largely unknown. MATERIALS AND METHODS From the Nationwide Inpatient Sample (NIS) from 1998 to 2006, patients undergoing LDN (n = 9,437) were identified. RESULTS Live kidney donation in the United States did not show an increase in the NIS. Of the live donor cases recorded, 58 (0.61%) were associated with a major short-term complication. The number of LDNs performed by transplant surgeons decreased over the study period from 76.5% in 1998 to 30.4% in 2006. CONCLUSIONS In the United Stares, LDNs are performed safely with a low short-term complication rate. Despite the use of laparoscopy and the increased need of donor organs, the rate of LDN in kidney transplantation has not increased proportionally.
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Affiliation(s)
- Beth Colombo
- Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, 55 Lake Avenue North, S6-432, Worcester, MA 01655, USA
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Zand MS, Orloff MS, Abt P, Patel S, Tsoulfas G, Kashyap R, Jain A, Safadjou S, Bozorgzadeh A. High mortality in orthotopic liver transplant recipients who require hemodialysis. Clin Transplant 2011; 25:213-21. [PMID: 20331690 DOI: 10.1111/j.1399-0012.2010.01238.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Martin S Zand
- Division of Nephrology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Ozhathil D, Li Y, Burr A, Tseng J, Saidi R, Bozorgzadeh A, Shah S. Expanded Criteria Donor Allografts And Effects Of Center Volume On Liver Transplantation. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ozhathil D, Li Y, Burr A, Tseng J, Saidi R, Bozorgzadeh A, Shah S. Expanded Criteria Donor Allografts And Effects Of Center Volume On Liver Transplantation. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Switzer BA, Harvey K, Grossman SR, Phillips DA, Shah SA, Bozorgzadeh A, Piperdi B. Single-institution experience using transarterial chemoembolization (TACE) with carboplatinum (carbo) and doxorubicin in patients (pts) with hepatocellular carcimona (HCC) awaiting liver transplantation (LTx). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
336 Background: LTx is the best treatment option for multinodular HCC and those with advanced liver dysfunction. Tumor progression occurs in 20-50% of pts on liver transplant list. TACE is increasingly used as locoregional therapy and as a bridge to LTx. We report here our single institutional experience with TACE using carbo and doxorubicin in pts with HCC awaiting LTx. Methods: Retrospective chart review was performed in all pts who had TACE between 2008 and June 2010. Our institutional protocol uses a fixed dose of carbo 300mg, doxorubicin 50mg, in 10ml of lipoidol solution. We analyzed pt demographics, etiologies of liver disease, Child-Pugh status, CLIP scores, size of tumor, alpha-fetoprotein (AFP), toxicity, length of stay, and transplantation statistics. Results: 32 pts (28 men) were treated with 39 TACE procedures. The median age was 57 (32-83). 28 of 32 had cirrhosis with Child's A/B/C 36/51/18% respectively. The major etiologies of cirrhosis were hepatitis C (HCV) 8, alcohol and HCV 19, alcohol 7; portal vein thrombosis in 8 pts. The median tumor size was 6.2 cm (range 2-12 cm) and 81% were multifocal CLIP score 0,1/2,>3 were 5/62/38%. There were no mortality within 30 days of TACE procedure. The majority of the pts were discharged after 24 hr observation; 6 pts require readmissions within 30days. There was no systemic hematologic toxicity. 11 pts had elevated AFP at baseline and 6/11 (54%) had >50 % reduction in AFP value. 11pts (34%) received Ltx; 3 pts came off the LTx list due to disease progression, 2 pts are still on transplant list, and 16pts not able to be listed. 42% of pts received sorafenib in addition to TACE. The median time from last TACE to LTx was 55 days and 4 pts received transplantation within 30days. Very good pathological treatment effect was observed in 8/11 explanted liver. Conclusions: Our regimen of TACE with carbo/doxorubicin appears to be a safe and tolerable approach for localized treatment as a bridge to liver transplantation. It has acceptable toxicity and is associated with good AFP and pathological responses. We plan to evaluate different baseline parameters for better pt selection. No significant financial relationships to disclose.
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Affiliation(s)
- B. A. Switzer
- University of Massachusetts Medical Center, Worcester, MA; Department of Cancer Biology, University of Massachusetts Medical School, Worcester, MA; Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA
| | - K. Harvey
- University of Massachusetts Medical Center, Worcester, MA; Department of Cancer Biology, University of Massachusetts Medical School, Worcester, MA; Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA
| | - S. R. Grossman
- University of Massachusetts Medical Center, Worcester, MA; Department of Cancer Biology, University of Massachusetts Medical School, Worcester, MA; Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA
| | - D. A. Phillips
- University of Massachusetts Medical Center, Worcester, MA; Department of Cancer Biology, University of Massachusetts Medical School, Worcester, MA; Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA
| | - S. A. Shah
- University of Massachusetts Medical Center, Worcester, MA; Department of Cancer Biology, University of Massachusetts Medical School, Worcester, MA; Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA
| | - A. Bozorgzadeh
- University of Massachusetts Medical Center, Worcester, MA; Department of Cancer Biology, University of Massachusetts Medical School, Worcester, MA; Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA
| | - B. Piperdi
- University of Massachusetts Medical Center, Worcester, MA; Department of Cancer Biology, University of Massachusetts Medical School, Worcester, MA; Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA
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Tretheway D, Jain A, LaPoint R, Sharma R, Orloff M, Milot P, Bozorgzadeh A, Ryan C. Should trichrome stain be used on all post-liver transplant biopsies with hepatitis C virus infection to estimate the fibrosis score? Liver Transpl 2008; 14:695-700. [PMID: 18324621 DOI: 10.1002/lt.21422] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recurrent hepatitis C is virtually universal after liver transplantation; however, an individual patient's clinical course and disease burden are highly variable and difficult to predict. The fibrosis score determined on posttransplant biopsies appears to be a sensitive and specific marker of disease progression and severity. Currently, the fibrosis score is determined from hematoxylin and eosin (H&E)-stained tissue sections supplemented by variable use of trichrome stain or other connective tissue-specific stains. In this study, we compare the fibrosis score on H&E stain with that obtained with trichrome stain in posttransplant liver biopsies of patients with hepatitis C. A total of 197 liver biopsies from 105 allograft patients with hepatitis C were reviewed. The mean fibrosis stage was 1.0 +/- 1.25 with H&E stain versus 1.69 +/- 1.42 with trichrome stain (P < 0.00001). The trichrome staging score was higher in 53.3%, lower in 3%, and the same in 43.7%. The fibrosis stage was raised by 2 or more points in 17.8% and elevated into a bridging category in 14.7%. No significant differences in clinical and laboratory levels were measured in patients with higher fibrosis scores. In conclusion, the hepatic fibrosis score is significantly underestimated by H&E stain in the posttransplant setting in patients with hepatitis C. The fibrosis stage may be an indicator of significant liver damage in these patients. Accuracy of its determination may be most easily facilitated by employment of a connective tissue stain.
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Affiliation(s)
- David Tretheway
- Department of Pathology and Laboratory Medicine, Department of Surgery, Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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