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Patel A, Chen A, Lalos AT. Inflammatory pseudotumors in the liver associated with influenza: A case report. World J Hepatol 2023; 15:1164-1169. [PMID: 37970616 PMCID: PMC10642433 DOI: 10.4254/wjh.v15.i10.1164] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) is a rare and benign lesion that mimics malignancy and can develop in any part of the body. The pathophysiology and etiology of these quasineoplastic lesions remain unclear. CASE SUMMARY We report a case of a 65-year-old male who presented with fevers, night sweats, and unintentional weight loss following an influenza infection and was found to have multiple hepatic IPT's following an extensive work up. CONCLUSION Our case highlights the importance of considering hepatic IPT's in the differential in a patient who presents with symptoms and imaging findings mimicking malignancy shortly following a viral infection.
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Affiliation(s)
- Ankoor Patel
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States.
| | - Alexander Chen
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Alexander T Lalos
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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Johnson-Laghi KA, Woo SM, Zafar Z, Fernandez S, Desale S, Robertazzi SE, Smith CI, Thomas AM, Lalos AT, Georgia SJ, Jenkins ML, Faust TW, Fishbein TM, Satoskar RS, Rangnekar AS, Hsu CC. Alcohol-associated liver disease predicts increased post-liver transplant opioid use. Clin Transplant 2022; 36:e14811. [PMID: 36057863 DOI: 10.1111/ctr.14811] [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: 11/18/2021] [Revised: 03/23/2022] [Accepted: 08/14/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Alcohol-associated liver disease (ALD) is a rising indication for liver transplantation (LT). Prolonged opioid use after LT leads to increased graft loss and mortality. The aim is to determine if patients transplanted with a primary diagnosis of ALD had higher risk of post-LT opioid use (p-LTOU) compared to non-ALD patients. METHODS This is a retrospective study of patients who underwent LT between 2015 and 2018 at Medstar Georgetown Transplant Institute. Patients with prolonged hospitalization post-LT (>90 days), death within 90 days post-LT, and re-transplants were excluded. RESULTS Two hundred and ninety seven patients were transplanted, among 29% for indications of ALD. ALD patients were younger (52 vs. 56 years), more likely to be male (76% vs. 61%), Caucasian (71% vs. 44%), have higher MELD (28.8±8.8 vs. 25±8.8), and psychiatric disease than non-ALD patients (P < .05). There was no difference in pre-LT use of opioids, tobacco, marijuana, or illicit drugs between ALD and non-ALD patients. Pre-LT opioid use (OR = 11.7, P < .001), ALD (OR = 2.5, P = .01), and MELD score (OR = .95, P = .02) independently predicted 90-day p-LTOU. CONCLUSIONS ALD, pre-LT opioid use, and MELD score independently predict p-LTOU. Special attention should be paid to identify post-LT prolonged opioid use in ALD patients.
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Affiliation(s)
| | - Stephanie M Woo
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Zaeema Zafar
- Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | | | - Sameer Desale
- MedStar Health Research Institute, Washington, DC, USA
| | - Suzanne E Robertazzi
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Coleman I Smith
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Arul M Thomas
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Alexander T Lalos
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Sarah J Georgia
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Michelle L Jenkins
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Thomas W Faust
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Thomas M Fishbein
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Rohit S Satoskar
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Amol S Rangnekar
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Christine C Hsu
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
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Yang M, Qamer SZ, Hill AP, Case BC, Gilbert AJ, Satoskar RS, Lalos AT, Valdiviezo C, Rogers T, Satler LF, Waksman R, Ben-Dor I. Postoperative Myocardial Injury and Outcomes in Liver and Kidney Transplant Patients. Cardiovasc Revasc Med 2022; 41:154-158. [PMID: 35304096 DOI: 10.1016/j.carrev.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Myocardial injury after noncardiac surgery (MINS) is associated with major adverse cardiac events (MACE), but its significance post-liver and post-kidney transplantation is not well-defined. METHODS/MATERIALS We retrospectively studied consecutive patients undergoing single-organ liver or kidney transplantation at a large tertiary transplant center. Liver and kidney transplant patients with troponins drawn within 30 days of transplantation were included. The primary exposure was MINS, defined as troponin elevation above the 99th percentile of the upper reference limit within 30 days of transplantation. The primary outcome was MACE, defined as death, myocardial infarction, revascularization, stroke, or heart failure hospitalization. RESULTS Overall, 112 patients were included: 58 (51.7%) were liver transplant recipients, and 54 (48.3%) were kidney transplant recipients. Patients with MINS were significantly older (mean age 59 vs. 54 years, p = 0.01) and more likely to have diabetes (35% vs. 17%, p = 0.03). Other baseline characteristics were similar. Sixteen patients (14.2%) developed MACE, including 11 (9.8%) with 1-year MACE. MINS patients were significantly more likely to develop 1-year MACE (adjusted hazard ratio, 10.4; 95% confidence interval, 1.8-198). Kaplan-Meier cumulative MACE was significantly higher in the MINS group (p = 0.03). CONCLUSIONS Liver and kidney transplant recipients with MINS are significantly more likely to develop 1-year MACE compared to those without MINS. Future prospective studies are needed to further delineate the cardiac risk and outcomes in transplanted patients.
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Affiliation(s)
- Michael Yang
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Syed Z Qamer
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Andrew P Hill
- MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Brian C Case
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Alexander J Gilbert
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Rohit S Satoskar
- Department of Hepatology, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Alexander T Lalos
- Department of Hepatology, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Carolina Valdiviezo
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Lowell F Satler
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Case BC, Yang M, Qamer SZ, Kumar S, Yerasi C, Forrestal BJ, Chezar-Azerrad C, Medranda GA, Bernardo NL, Rogers T, Satler LF, Hashim H, Satoskar RS, Lalos AT, Waksman R, Ben-Dor I. Pre-Operative Cardiovascular Testing before Liver Transplantation. Am J Cardiol 2021; 152:132-137. [PMID: 34103158 DOI: 10.1016/j.amjcard.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
End-stage liver disease (ESLD) is increasingly prevalent and shares many risk factors with coronary artery disease (CAD). No specific guidelines exist for pre-liver transplant evaluation of CAD, and pretransplant cardiovascular testing varies widely. The aim of this study is to characterize pre-transplant cardiac testing practices with post-transplant clinical outcomes. We retrospectively reviewed patients undergoing initial liver transplantation at our transplant center between January 2015 and March 2019. Patients with previous liver transplantation or multi-organ transplantation were excluded. Electronic medical records were reviewed for relevant demographic and clinical data. We included 285 patients with a mean follow-up of 2.4 years. Of 274 patients (96.1%) with pre-transplant transthoracic echocardiogram (TTE), 18 (6.6%) were abnormal. Non-invasive ischemic testing was performed in 193 (68%) patients: 165 (58%) underwent stress TTE, 24 (8%) underwent myocardial perfusion imaging, 3 underwent coronary computed tomography, and 1 underwent exercise electrocardiogram. Sixteen patients (6%) had left heart catheterization of which 10 (63%) were abnormal and 5 proceeded to revascularization before transplant. There were 4 (1.4%) deaths within 30 days of transplant and 23 deaths (8.1%) in total. ST-elevation myocardial infarction was seen in 1 patient within 30 days and 1 patient after 30 days (0.7% total). No cardiovascular deaths were observed. Among patients undergoing liver transplantation, pre-transplantation cardiovascular testing is exceedingly common and post-transplant cardiovascular complications are rare. Additional research is needed to determine the optimal testing and surveillance in this patient population.
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Higley C, Hsu CC, Smith C, Nadella S, Lalos AT. Safety and efficacy of sofosbuvir/velpatasvir/voxilaprevir in post-liver transplant patients with previous direct-acting antiviral failure: Six case reports. World J Hepatol 2020; 12:1341-1348. [PMID: 33442459 PMCID: PMC7772723 DOI: 10.4254/wjh.v12.i12.1341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/10/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Direct-acting antiviral (DAA) therapy regimens are highly effective at eliminating hepatitis C virus (HCV) infection but rates of sustained virologic response (SVR) are lower in patients with decompensated cirrhosis or hepatocellular carcinoma. Since many of these patients will be referred for liver transplant, they will require retreatment after transplantation. Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is recommended by guidelines as the preferred regimen to treat HCV in DAA-experienced patients following liver transplant however there is limited data.
CASE SUMMARY We present the cases of six liver transplant recipients who had previous treatment failure with sofosbuvir-based DAA therapy prior to transplantation and who then received SOF/VEL/VOX after transplant.
CONCLUSION This case series demonstrate the real-world efficacy and safety of SOF/VEL/VOX in the post liver transplant setting. Treatment was successful with all patients achieving SVR, it was well tolerated, and there were minimal drug-drug interactions with their immunosuppressants.
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Affiliation(s)
- Cory Higley
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Christine C Hsu
- Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Coleman Smith
- Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Sandeep Nadella
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Alexander T. Lalos
- Transplant Institute, MedStar Georgetown University Hospital, Washington, DC 20007, United States
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Vakiti A, Cho MH, Lee W, Liang JJ, Lalos AT, Fishbein DA. Use of direct-acting antivirals for hepatitis C viral infection and association with intrahepatic cholangiocarcinoma: Is there a linkage? J Oncol Pharm Pract 2018; 25:1743-1748. [PMID: 30253731 DOI: 10.1177/1078155218800147] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatitis C viral infection is recognized worldwide as a leading cause of cirrhosis and hepatocellular carcinoma. The goal of hepatitis C viral antiviral therapy is the permanent eradication of hepatitis C viral RNA, commonly referred to as a sustained virologic response - defined as "undetectable" RNA at 12 weeks following the completion of therapy. Hepatitis C viral treatment has dramatically advanced with the FDA approval of several new agents known as direct-acting antivirals. These drugs target specific nonstructural proteins of the virus, which disrupt viral replication, and therefore halt infection. However, recently, there has been a concern for increased risk of recurrence of treated hepatocellular carcinoma or denovo occurrence of hepatocellular carcinoma after treatment with direct-acting antivirals. We are now reporting three cases of intrahepatic cholangiocarcinoma that developed after sustained virologic response following hepatitis C viral treatment with direct-acting antivirals.
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Affiliation(s)
- Anusha Vakiti
- 1 Department of Internal Medicine, MedStar Washington Hospital Center, Washington D.C., USA
| | - Min Ho Cho
- 1 Department of Internal Medicine, MedStar Washington Hospital Center, Washington D.C., USA
| | - Wen Lee
- 2 Department of Pathology, MedStar Washington Hospital Center, Washington D.C., USA
| | - John J Liang
- 2 Department of Pathology, MedStar Washington Hospital Center, Washington D.C., USA
| | - Alexander T Lalos
- 3 MedStar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington D.C., USA
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Lalos AT, Smith CI. Contrasting the academic and nonacademic hepatology practice settings. Clin Liver Dis (Hoboken) 2017; 9:144-146. [PMID: 30992980 PMCID: PMC6467160 DOI: 10.1002/cld.638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/22/2017] [Revised: 03/15/2017] [Accepted: 03/18/2017] [Indexed: 02/04/2023] Open
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Lalos AT, Bansal P, Rishikesh R. Case of fulminant colitis after docetaxel therapy for breast carcinoma in a patient with underlying ulcerative colitis. Am J Gastroenterol 2009; 104:2651-2. [PMID: 19806113 DOI: 10.1038/ajg.2009.366] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Patient acceptance of ambulatory colonoscopy is important for colon cancer screening programs to be successful. The goal of this study was to assess patient satisfaction with the method of conscious sedation that is standard in most endoscopy units. The authors also attempted to identify patient characteristics associated with a poor sedation experience. The findings suggest that 90% of ambulatory patients undergoing colonoscopy are adequately sedated with the standard meperidine midazolam regimen. The only patient characteristic found to predict poor sedation response was the preceding use of a prescription narcotic as an outpatient.
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Affiliation(s)
- A T Lalos
- Geisinger Medical Group/Lake Scranton, Scranton, PA 18505, USA
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Lalos AT, Yeager HC, Weiss JP. Ascites and myxedema in a patient with polycystic disease of the kidney and liver. Am J Gastroenterol 1994; 89:2237-9. [PMID: 7977249] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- A T Lalos
- Department of Medicine, Moses Taylor Hospital, Scranton, Pennsylvania
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Georgetson MJ, Yarze JC, Lalos AT, Webster GF, Martin P. Exacerbation of psoriasis due to interferon-alpha treatment of chronic active hepatitis. Am J Gastroenterol 1993; 88:1756-8. [PMID: 8213720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Interferon-alpha is an immune modulating drug which is indicated for the treatment of chronic viral hepatitis B and C. Several previous reports have suggested an association between treatment of patients with interferon-alpha and the development or exacerbation of autoimmune diseases. We report two patients with chronic viral hepatitis in whom treatment with interferon-alpha was associated with dramatic worsening of previously diagnosed psoriasis, necessitating discontinuation of the drug.
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Affiliation(s)
- M J Georgetson
- Department of Gastroenterology and Hepatology, Guthrie Clinic, Sayre, Pennsylvania
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Goldberg MA, Lalos AT, Bunn HF. The effect of erythrocyte membrane preparations on the polymerization of sickle hemoglobin. J Biol Chem 1981; 256:193-7. [PMID: 7451434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We have investigated the effect of erythrocyte membrane preparations on the rate of polymerization and the solubility of deoxyhemoglobin S. The kinetics of polymerization was monitored by measuring changes in turbidity of hemoglobin S solutions as a function of time in a temperature-controlled cuvette. The solubility of deoxyhemoglobin S, an equilibrium measurement, was determined by measuring the hemoglobin concentration of the supernatant following centrifugation of the polymerized hemoglobin S solution. The solubility of deoxyhemoglobin S was unaffected by the presence of red cell membrane ghosts, inside-out red cell vesicles, or inside-out vesicles enriched in erythrocyte spectrin and actin (Bands 1, 2, and 5) in the hemoglobin solution. Furthermore, inside-out vesicles had no significant effect on kinetics of polymerization. The addition of erythrocyte membrane ghosts to the hemoglobin solution, in ratios approximating that of the intact red cell, increased the rate of polymerization up to 8-fold. However, when corrections were made for the excluded volume contributed by the membrane ghosts, the enhancement of the rate of polymerization was reduced to less than 3-fold. These results fail to show significant facilitation of intracellular sickling by nucleation sites on the red cell membrane.
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