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Panayotova GG, Lunsford KE, Quillin RC, Rana A, Agopian VG, Lee-Riddle GS, Markovic D, Paterno F, Griesemer AD, Amin A, Alonso D, Rocca JP, Borja-Cacho D, Hernandez-Alejandro R, Fung JJ, Pelletier SJ, Shah SA, Guarrera JV. Portable hypothermic oxygenated machine perfusion for organ preservation in liver transplantation: A randomized, open-label, clinical trial. Hepatology 2024; 79:1033-1047. [PMID: 38090880 PMCID: PMC11019979 DOI: 10.1097/hep.0000000000000715] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/01/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIMS In liver transplantation, cold preservation induces ischemia, resulting in significant reperfusion injury. Hypothermic oxygenated machine perfusion (HMP-O 2 ) has shown benefits compared to static cold storage (SCS) by limiting ischemia-reperfusion injury. This study reports outcomes using a novel portable HMP-O 2 device in the first US randomized control trial. APPROACH AND RESULTS The PILOT trial (NCT03484455) was a multicenter, randomized, open-label, noninferiority trial, with participants randomized to HMP-O 2 or SCS. HMP-O 2 livers were preserved using the Lifeport Liver Transporter and Vasosol perfusion solution. The primary outcome was early allograft dysfunction. Noninferiority margin was 7.5%. From April 3, 2019, to July 12, 2022, 179 patients were randomized to HMP-O 2 (n=90) or SCS (n=89). The per-protocol cohort included 63 HMP-O 2 and 73 SCS. Early allograft dysfunction occurred in 11.1% HMP-O 2 (N=7) and 16.4% SCS (N=12). The risk difference between HMP-O 2 and SCS was -5.33% (one-sided 95% upper confidence limit of 5.81%), establishing noninferiority. The risk of graft failure as predicted by Liver Graft Assessment Following Transplant score at seven days (L-GrAFT 7 ) was lower with HMP-O 2 [median (IQR) 3.4% (2.4-6.5) vs. 4.5% (2.9-9.4), p =0.024]. Primary nonfunction occurred in 2.2% of all SCS (n=3, p =0.10). Biliary strictures occurred in 16.4% SCS (n=12) and 6.3% (n=4) HMP-O 2 ( p =0.18). Nonanastomotic biliary strictures occurred only in SCS (n=4). CONCLUSIONS HMP-O 2 demonstrates safety and noninferior efficacy for liver graft preservation in comparison to SCS. Early allograft failure by L-GrAFT 7 was lower in HMP-O 2 , suggesting improved early clinical function. Recipients of HMP-O 2 livers also demonstrated a lower incidence of primary nonfunction and biliary strictures, although this difference did not reach significance.
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Affiliation(s)
- Guergana G. Panayotova
- Department of Surgery, Division of Transplant and HPB Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Keri E. Lunsford
- Department of Surgery, Division of Transplant and HPB Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - R. Cutler Quillin
- Department of Surgery, Division of Transplantation, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Abbas Rana
- Department of Surgery, Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Vatche G. Agopian
- Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Center, Pfleger Liver Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Grace S. Lee-Riddle
- Department of Surgery, Division of Transplant and HPB Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Daniela Markovic
- Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Center, Pfleger Liver Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Flavio Paterno
- Department of Surgery, Division of Transplant and HPB Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Adam D. Griesemer
- Department of Surgery, Transplant Institute, NYU Langone Medical Center, New York, New York, USA
| | - Arpit Amin
- Department of Surgery, Division of Transplant and HPB Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Diane Alonso
- Department of Transplant, Intermountain Medical Center, Murray, Utah, USA
| | - Juan P. Rocca
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Daniel Borja-Cacho
- Department of Surgery, Division of Transplantation, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Roberto Hernandez-Alejandro
- Department of Surgery, Division of Transplantation and Hepatobiliary Surgery, University of Rochester, Rochester, New York, USA
| | - John J. Fung
- Department of Surgery, Section of Abdominal Organ Transplantation, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Shawn J. Pelletier
- Department of Surgery, Division of Transplantation Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shimul A. Shah
- Department of Surgery, Division of Transplantation, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James V. Guarrera
- Department of Surgery, Division of Transplant and HPB Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Bailey RE, Pugliesi RA, Borja-Cacho D, Borhani AA. Imaging Evaluation of the Living Liver Donor: A Systems-Based Approach. Radiol Clin North Am 2023; 61:771-784. [PMID: 37495286 DOI: 10.1016/j.rcl.2023.03.002] [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] [Indexed: 07/28/2023]
Abstract
Liver transplant is the definitive treatment of end-stage liver disease and early hepatocellular carcinoma. The number of liver transplant surgeries done is highly affected by the number and availability of deceased donor organs. Living donor liver transplantation has emerged as an alternative source of donors, increasing the availability of organs for transplant. Many factors must be considered when choosing living donor candidates to maintain a high level of donor safety and organ survival. To that end, potential donors undergo a rigorous pre-donation workup.
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Affiliation(s)
- Ryan E Bailey
- Department of Radiology, Section of Body Imaging, Northwestern University, Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA
| | - Rosa Alba Pugliesi
- Department of Radiology, Section of Body Imaging, Northwestern University, Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA
| | - Daniel Borja-Cacho
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA.
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Steggerda JA, Ladner DP, Kim IK, Wisel SA, Borja-Cacho D. A Retrospective Evaluation of Changing Health Characteristics Amongst Deceased Organ Donors in the United States. Transplant Proc 2023; 55:251-262. [PMID: 36870869 DOI: 10.1016/j.transproceed.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The availability of suitable donor organs remains a limiting factor to performing life-saving transplant operations. This study evaluates changes in the health of the donor population and its influence on organ use in the United States. METHODS A retrospective analysis was performed using the OPTN STAR data file from 2005 to 2019. Three donor eras were defined: 1) 2005 to 2009, 2) 2010 to 2014, and 3) 2015 to 2019. The primary outcome was donor use, defined as transplantation of at least one solid organ. Descriptive analyses were performed, and associations of donor use were examined with multivariable logistic regression models. P values <.01 were considered significant. RESULTS The cohort included 132,783 potential donors of which 124,729 (93.9%) were used for transplantation. Donor median age was 42 years (interquartile range 26-54), 53,566 (40.3%) were female, and 88,209 (66.4%) were White, 21,834 (16.4%) were black, and 18,509 (13.9%) were Hispanic. Compared with donors from Eras 1 and 2, donors in Era 3 were younger (P < .001), had higher body mass index (BMI) (P < .001), increased rates of diabetes mellitus (DM) (P < .001), hepatitis C virus (HCV) positivity (P < .001) and more comorbidities (P < .001). Multivariable modeling found donor BMI, DM, hypertension, and HCV status as health factors significantly associated with donor use. Compared with Era 1, there was increased use in Era 3 of donors with BMI ≥30 kg/m2, DM, hypertension, HCV-positive status, and donors with ≥3 comorbidities. CONCLUSIONS Despite an increasing prevalence of chronic health problems in the donor population, donors with multiple comorbid conditions are more likely to be used for transplantation in recent years.
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Affiliation(s)
- Justin A Steggerda
- Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California; Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Daniela P Ladner
- Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois; Northwestern University Transplant Outcomes Research Collaborative (NUTORC0), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Irene K Kim
- Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California; Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Steven A Wisel
- Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California; Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel Borja-Cacho
- Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois
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4
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Thuluvath AJ, Siddiqui O, Lai JC, Peipert J, Levitsky J, Daud A, Mazumder NR, Flores AM, Borja-Cacho D, Caicedo JC, Loftus C, Wong R, Mroczek D, Ladner DP. Personality Traits in Patients With Cirrhosis Are Different From Those of the General Population and Impact Likelihood of Liver Transplantation. Transplantation 2023; 107:420-428. [PMID: 36173424 PMCID: PMC10294608 DOI: 10.1097/tp.0000000000004304] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Personality traits influence clinical outcomes in chronic diseases, but their impact in cirrhosis is unknown. We studied the personality of patients with cirrhosis undergoing liver transplant (LT) evaluation and determined their correlation to clinical outcomes. METHODS A multicenter' prospective study of adult patients undergoing LT evaluation was performed from January 2018 to October 2019. The "Big Five" personality traits of conscientiousness, extraversion, openness, neuroticism, and agreeableness plus agency were assessed with the Midlife Development Inventory Personality Scale and compared with the general population. Frailty was assessed with the Liver Frailty Index. RESULTS Two hundred sixty-three LT candidates were enrolled. Twenty-four percent had hepatitis C virus, 25% nonalcoholic steatohepatitis, and 25% ethyl alcohol (mean model for end-stage liver disease = 15.7). Compared with the general population, LT candidates had higher openness (3.1 versus 2.9; P < 0.001), extraversion (3.2 versus 3.1; P < 0.001), agreeableness (3.5 versus 3.4; P = 0.04), agency (2.9 versus 2.6; P < 0.001), neuroticism (2.2 versus 2.1; P = 0.001), and lower conscientiousness (3.3 versus 3.4; P = 0.007). Patients with higher conscientiousness were more likely to receive an LT (HR = 2.76; P = 0.003). CONCLUSIONS Personality traits in LT candidates differ significantly from the general population, with higher conscientiousness associated with a higher likelihood of receiving a transplant.
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Affiliation(s)
- Avesh J. Thuluvath
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Osama Siddiqui
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA
| | - John Peipert
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Josh Levitsky
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Amna Daud
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nikhilesh R. Mazumder
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Anne-Marie Flores
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel Borja-Cacho
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
| | - Juan C. Caicedo
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
| | - Corinne Loftus
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Randi Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA
| | - Dan Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Psychology, Weinberg College of Arts & Sciences, Northwestern University, Evanston, IL
| | - Daniela P. Ladner
- Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
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Swersky A, Borja-Cacho D, Deitch Z, Thornburg B, Salem R. Portal Vein Recanalization-Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS) Facilitates Liver Transplantation in Cirrhotic Patients with Occlusive Portal Vein Thrombosis. Semin Intervent Radiol 2023; 40:38-43. [PMID: 37152801 PMCID: PMC10159708 DOI: 10.1055/s-0043-1764409] [Citation(s) in RCA: 1] [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] [Indexed: 05/09/2023]
Abstract
Portal vein thrombosis (PVT) is a heterogeneous condition with multiple possible etiologies and to varying degrees has historically limited candidacy for liver transplant (LT) in the cirrhotic patient population due to resultant difficulties in constructing a robust portal vein anastomosis. While intraoperative approaches to managing PVT are well-described, methods which approximate normal portal physiology are not always feasible depending on the extent of PVT, and other nonphysiologic techniques are linked with substantial morbidity and poor long-term outcomes. Portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) creation is an efficacious method of restoring physiologic portal flow in cirrhotic patients prior to LT allowing for end-to-end PV anastomosis, and is the product of decades-long institutional expertise in TIPS/LT and the support of a multidisciplinary liver tumor board. To follow is a review of the pertinent pathophysiology of PVT in cirrhosis, the rationale leading to the development and subsequent evolution of the PVR-TIPS procedure, technical lessons learned, and a summary of outcomes to date.
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Affiliation(s)
- Adam Swersky
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Bartley Thornburg
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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6
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Talwar A, Varghese J, Knight GM, Katariya N, Caicedo JC, Dietch Z, Borja-Cacho D, Ladner D, Christopher D, Baker T, Abecassis M, Mouli S, Desai K, Riaz A, Thornburg B, Salem R. Preoperative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation. Hepatol Commun 2022; 6:1803-1812. [PMID: 35220693 PMCID: PMC9234680 DOI: 10.1002/hep4.1914] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 11/09/2022] Open
Abstract
High-grade portal vein thrombosis (PVT) is often considered to be a technically challenging scenario for liver transplantation (LT) and in some centers a relative contraindication. This study compares patients with chronic obliterative PVT who underwent portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) and subsequent LT to those with partial nonocclusive PVT who underwent LT without an intervention. This institutional review board-approved study analyzed 49 patients with cirrhosis with PVT from 2000 to 2020 at our institution. Patients were divided into two groups, those that received PVR-TIPS due to anticipated surgical challenges from chronic obliterative PVT and those who did not because of partial PVT. Demographic data and long-term outcomes were compared. A total of 35 patients received PVR-TIPS while 14 did not, with all receiving LT. Patients with PVR-TIPS had a higher Yerdel score and frequency of cavernoma than those that did not. PVR-TIPS was effective in decreasing portosystemic gradient (16 down to 8 mm HG; p < 0.05). Both groups allowed for end-to-end anastomoses in >90% of cases. However, veno-veno bypass was used significantly more in patients who did not receive PVR-TIPS. Additionally, patients without PVR-TIPS required significantly more intraoperative red blood cells. Overall survival was not different between groups. PVR-TIPS demonstrated efficacy in resolving PVT and allowed for end-to-end portal vein anastomoses. PVR-TIPS is a viable treatment option for chronic obliterative PVT with or without cavernoma that simplifies the surgical aspects of LT.
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Affiliation(s)
- Abhinav Talwar
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Jeffrey Varghese
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Gabriel M Knight
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Nitin Katariya
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Juan-Carlos Caicedo
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Zach Dietch
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Daniel Borja-Cacho
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Daniella Ladner
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Derrick Christopher
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Talia Baker
- Department of SurgeryDivision of Transplant SurgeryUniversity of ChicagoChicagoIllinoisUSA
| | - Michael Abecassis
- Department of SurgeryDivision of Transplant SurgeryUniversity of ArizonaTucsonArizonaUSA
| | - Samdeep Mouli
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Kush Desai
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Ahsun Riaz
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Bart Thornburg
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Riad Salem
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
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7
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Bushara O, Alhalel J, Sanders J, Azad H, Cerri T, Zafer S, Guo K, Zhao L, Daud A, Borja-Cacho D, Caicedo-Ramirez JC. Single Center Experience with Incidence, Impact and Predictors of Biliary Complications in Donation After Circulatory Death Liver Transplantation. Prog Transplant 2022; 32:252-260. [PMID: 35702045 DOI: 10.1177/15269248221107039] [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] [Indexed: 11/16/2022]
Abstract
Introduction: Utilizing allografts from donors after cardiac death (DCD) has improved organ availability, and DCD livers comprise a growing proportion of transplantations. However, it has been suggested that DCD transplantations have worse outcomes. Research Questions: We aimed to characterize outcomes in a large cohort of DCD transplantations, identify trends in outcomes over time, and identify factors associated with the development of biliary complications. Design: We conducted an observational retrospective cohort study of patients receiving DCD liver allografts within a large academic teaching hospital with a high transplantation volume. Consecutive patients who underwent Type III DCD liver transplantation from 2006-2016 were included in our cohort. Re-transplantations and multi-organ transplant recipients were excluded. Results: Ninety-six type III DCD transplantations occurred between 2006-2016. We report a 1one-year patient survival of 90.6% (87) and a 5five-year patient survival of 69.8% (67). Twenty-nine (30.2%) patients experienced any biliary complication in the first year following discharge, with 17 (17.7%) experiencing ischemic cholangiopathy. Five-year patient (P = 0.04) and graft (P = 0.005) survival improved over time. Post-operative biliary complications experienced during index admission and prior to discharge were found to be associated with the development of biliary complications (P = 0.005) and ischemic cholangiopathy (P = 0.01) following discharge. Conclusion: Our data suggested that outcomes using DCD allografts have improved, however biliary complications remain a significant issue in DCD transplantation. Patients who experienced post-operative biliary complications during index admission may require more frequent screening to allow the initiation of earlier treatment for biliary complications.
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Affiliation(s)
- Omar Bushara
- 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Alhalel
- 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jes Sanders
- Department of Surgery, 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hooman Azad
- 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Thomas Cerri
- 97174Rosalind Franklin Medical School, Chicago, IL, USA
| | - Salmaan Zafer
- 97174Rosalind Franklin Medical School, Chicago, IL, USA
| | - Kexin Guo
- Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Lihui Zhao
- Department of Preventive Medicine, 12244Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amna Daud
- 209825Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Daniel Borja-Cacho
- 209825Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Juan C Caicedo-Ramirez
- 209825Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
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8
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Talwar A, Varghese J, Knight G, Katariya N, Caicedo-Ramirez J, Dietch Z, Borja-Cacho D, Ladner D, Christopher D, Baker T, Abecassis M, Mouli S, Desai K, Riaz A, Thornburg B, Salem R. Abstract No. 184 Pre-operative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic, obliterative portal vein thrombosis: outcomes following liver transplantation. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.265] [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: 11/15/2022] Open
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9
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Schlegel A, van Reeven M, Croome K, Parente A, Dolcet A, Widmer J, Meurisse N, De Carlis R, Hessheimer A, Jochmans I, Mueller M, van Leeuwen OB, Nair A, Tomiyama K, Sherif A, Elsharif M, Kron P, van der Helm D, Borja-Cacho D, Bohorquez H, Germanova D, Dondossola D, Olivieri T, Camagni S, Gorgen A, Patrono D, Cescon M, Croome S, Panconesi R, Carvalho MF, Ravaioli M, Caicedo JC, Loss G, Lucidi V, Sapisochin G, Romagnoli R, Jassem W, Colledan M, De Carlis L, Rossi G, Di Benedetto F, Miller CM, van Hoek B, Attia M, Lodge P, Hernandez-Alejandro R, Detry O, Quintini C, Oniscu GC, Fondevila C, Malagó M, Pirenne J, IJzermans JNM, Porte RJ, Dutkowski P, Taner CB, Heaton N, Clavien PA, Polak WG, Muiesan P. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation. J Hepatol 2022; 76:371-382. [PMID: 34655663 DOI: 10.1016/j.jhep.2021.10.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. METHODS Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. RESULTS Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. CONCLUSIONS Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups and to provide a valid comparator cohort for future clinical trials. LAY SUMMARY The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2,219 liver transplantations following controlled DCD donation in 17 centres worldwide. Donor and recipient combinations with higher risk had significantly worse outcomes. However, the use of novel organ perfusion technology helped high-risk patients achieve similar outcomes as the benchmark cohort.
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Affiliation(s)
- Andrea Schlegel
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, United Kingdom; Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland; Hepatobiliary Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Marjolein van Reeven
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery, Rotterdam, the Netherlands
| | - Kristopher Croome
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 United States
| | - Alessandro Parente
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, United Kingdom
| | - Annalisa Dolcet
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Jeannette Widmer
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland; HPB Surgery and Liver Transplantation, Royal Free Hospital London, United Kingdom
| | - Nicolas Meurisse
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Amelia Hessheimer
- General & Digestive Surgery, Hospital Clínic Barcelona, Barcelona, Spain; CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ina Jochmans
- Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; Abdominal Transplant Surgery, Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Matteo Mueller
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
| | - Otto B van Leeuwen
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Amit Nair
- Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, NY, USA
| | - Koji Tomiyama
- Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, NY, USA
| | - Ahmed Sherif
- Department of Transplant Surgery, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, United Kingdom
| | - Mohamed Elsharif
- HPB and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Philipp Kron
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland; HPB and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Danny van der Helm
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel Borja-Cacho
- Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Humberto Bohorquez
- Multi-Organ Transplant Institute, University of Queensland School and the Ochsner Clinical School, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Desislava Germanova
- Department of abdominal surgery, Unit of hepato-biliary surgery and abdominal transplantation, CUB Erasme Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan 20122, Italy
| | - Tiziana Olivieri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andre Gorgen
- Multi-Organ Transplant Program, Division of General Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Damiano Patrono
- General Surgery 2U-Liver Transplant Unit, Department of Surgery, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sarah Croome
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 United States
| | - Rebecca Panconesi
- Hepatobiliary Unit, Careggi University Hospital, University of Florence, Florence, Italy; General Surgery 2U-Liver Transplant Unit, Department of Surgery, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Matteo Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Juan Carlos Caicedo
- Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - George Loss
- Multi-Organ Transplant Institute, University of Queensland School and the Ochsner Clinical School, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Valerio Lucidi
- Department of abdominal surgery, Unit of hepato-biliary surgery and abdominal transplantation, CUB Erasme Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | | | - Renato Romagnoli
- General Surgery 2U-Liver Transplant Unit, Department of Surgery, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Wayel Jassem
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Michele Colledan
- Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy; Università di Milano-Bicocca, Milano, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giorgio Rossi
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan 20122, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Charles M Miller
- Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Magdy Attia
- HPB and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Peter Lodge
- HPB and Transplant Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium
| | - Cristiano Quintini
- Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gabriel C Oniscu
- Department of Transplant Surgery, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, United Kingdom
| | - Constantino Fondevila
- General & Digestive Surgery, Hospital Clínic Barcelona, Barcelona, Spain; CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Massimo Malagó
- HPB Surgery and Liver Transplantation, Royal Free Hospital London, United Kingdom
| | - Jacques Pirenne
- Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; Abdominal Transplant Surgery, Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan N M IJzermans
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery, Rotterdam, the Netherlands
| | - Robert J Porte
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
| | - C Burcin Taner
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 United States
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland
| | - Wojciech G Polak
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery, Rotterdam, the Netherlands
| | - Paolo Muiesan
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, United Kingdom; Hepatobiliary Unit, Careggi University Hospital, University of Florence, Florence, Italy; General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan 20122, Italy.
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Bhatti S, Lizaola-Mayo B, Al-Shoha M, Garcia-Saenz-de-Sicilia M, Habash F, Ayoub K, Karr M, Ahmed Z, Borja-Cacho D, Duarte-Rojo A. Use of Computed Tomography Coronary Calcium Score for Coronary Artery Disease Risk Stratification During Liver Transplant Evaluation. J Clin Exp Hepatol 2022; 12:319-328. [PMID: 35535104 PMCID: PMC9077224 DOI: 10.1016/j.jceh.2021.08.015] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background End-stage liver disease (ESLD) is not considered a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, lifestyle characteristics commonly associated with increased ASCVD risk are highly prevalent in ESLD. Emerging literature shows a high burden of asymptomatic coronary artery disease (CAD) in patients with ESLD and a high ASCVD risk in liver transplantation (LT) recipients. Coronary artery calcium score (CAC) is a noninvasive test providing reliable CAD risk stratification. We implemented an LT evaluation protocol with CAC playing a central role in triaging and determining the need for further CAD assessment. Here, we inform our results from this early experience. Methods Patients with ESLD referred for LT evaluation were prospectively studied. We compared accuracy of CAC against that of CAD risk factors/scores, troponin I, dobutamine stress echocardiogram (DSE), and single-photon emission computed tomography (SPECT) to detect coronary stenosis ≥70 (CAD ≥ 70) per left heart catheterization (LHC). Thirty-day post-LT cardiac outcomes were also analyzed. Results One hundred twenty-four of 148 (84%) patients underwent CAC, 106 (72%) DSE/SPECT, and 50 (34%) LHC. CAC ≥ 400 was found in 35 (28%), 100 to 399 in 17 (14%), and <100 in 72 (58%). LHC identified CAD ≥ 70% in 8 of 29 (28%), 2 of 9 (22%), and 0 of 4, respectively. Two acute coronary syndromes occurred after LT in a patient with CAC 811 (CAD < 70%), and one with CAC 347 (CAD ≥ 70%). No patients with CAC < 100 presented with acute coronary syndrome after LT. When using CAD ≥ 70% as primary endpoint of LT evaluation, CAC ≥ 346 was the only test showing predictive usefulness (negative predictive value 100%). Conclusions CAC is a promising tool to guide CAD risk stratification and need for LHC during LT evaluation. Patients with a CAC < 100 can safely undergo LT without the need for LHC or cardiac stress testing, whereas a CAC < 346 accurately rules out significant CAD stenosis (≥70%) on LHC, outperforming other CAD risk-stratification strategies.
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Key Words
- ACS, Acute coronary syndromes
- ALD, alcoholic liver disease
- ASCVD, Atherosclerotic cardiovascular disease
- ASCVD, atherosclerosis cardiovascular disease risk
- BMI, Body mass index
- CABG, Coronary angioplasty bypass surgery
- CAC, Coronary calcium score
- CAD, Coronary artery disease
- CKD, chronic kidney disease
- DSE/SPECT, Dobutamine stress echocardiogram or single-photon emission computed tomography
- ESLD, End-stage liver disease
- HCV, hepatitis C virus
- IQR, Interquartile range
- LCx, left circumflex
- LHC, Left heart catheterization
- LT, liver transplantation
- MELD, model for end stage liver disease
- MESA, Multi-Ethnic Study of Atherosclerosis
- METs, Metabolic equivalents
- NPV, negative predictive value
- OM, obtuse marginal
- OPTN, Organ Procurement and Transplantation Network
- PCI, Percutaneous coronary intervention
- PDA, posterior descending artery
- POBA, plain old balloon angioplasty
- PPV, positive predictive value
- RCA, right coronary artery
- RI, ramus intermedius
- ROC, Receiver operating characteristic
- RPL, right posterolateral
- SD, Standard deviation
- VT, Ventricular tachycardia
- agatston score
- angiogram
- cardiac stress test
- cirrhosis
- end-stage liver disease
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Affiliation(s)
- Sabha Bhatti
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Blanca Lizaola-Mayo
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, United States
| | - Mohammad Al-Shoha
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | | | - Fuad Habash
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Karam Ayoub
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Michael Karr
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Zubair Ahmed
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
| | - Daniel Borja-Cacho
- Division of Transplant Surgery, Northwestern University, 676 N Saint Clair, Chicago, IL, 60611, United States
| | - Andres Duarte-Rojo
- Division of Cardiology, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #567, Little Rock, AR, 70205, United States
- Thomas E. Starzl Transplantation Institute and Division of Gastroenterology, Hepatology and Nutrition; University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA, 15213, United States
- Address for correspondence: Andres Duarte-Rojo, MD, MS, DSc, Starzl Transplantation Institute and Center for Liver Diseases, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA, 15213, United States. Tel.: +1 412 647-1170; fax: +1 412 647 9268
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11
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Steggerda JA, Son AY, Pozo ME, Pawale A, Reynolds AS, Desai K, Galvez-Lima D, Herborn J, DeWolf A, Ladner D, Caicedo JC, Katariya N, Borja-Cacho D. Re-appropriation of a right anterior thoracotomy approach to portal-systemic bypass for liver transplantation in a patient with complete superior vena cava occlusion. Transplantation Reports 2021. [DOI: 10.1016/j.tpr.2021.100086] [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: 11/26/2022] Open
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12
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Gabr A, Kulik L, Mouli S, Riaz A, Ali R, Desai K, Mora RA, Ganger D, Maddur H, Flamm S, Boike J, Moore C, Thornburg B, Alasadi A, Baker T, Borja-Cacho D, Katariya N, Ladner DP, Caicedo JC, Lewandowski RJ, Salem R. Liver Transplantation Following Yttrium-90 Radioembolization: 15-Year Experience in 207-Patient Cohort. Hepatology 2021; 73:998-1010. [PMID: 32416631 DOI: 10.1002/hep.31318] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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] [Received: 01/31/2020] [Revised: 03/31/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Radioembolization (yttrium-90 [Y90]) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver-directed therapy to curative liver transplantation (LT). In this study, we report long-term outcomes of LT for patients with HCC who were bridged/downstaged by Y90. APPROACH AND RESULTS Patients undergoing LT following Y90 between 2004 and 2018 were included, with staging by United Network for Organ Sharing (UNOS) tumor-node-metastasis criteria at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM), and time-to-recurrence, were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Univariate and multivariate analyses were performed using a log-rank test and Cox proportional-hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with a median time to LT of 7.5 months [interquartile range, 4.4-10.3]. A total of 169 patients were bridged, whereas 38 were downstaged to LT. Respectively, 94 (45%), 60 (29%), and 53 (26%) patients showed complete, extensive, and partial tumor necrosis on histopathology. Three-year, 5-year, and 10-year OS rates were 84%, 77%, and 60%, respectively. Twenty-four patients developed recurrence, with a median RFS of 120 (95% confidence interval, 69-150) months. DSM at 3, 5, and 10 years was 6%, 11%, and 16%, respectively. There were no differences in OS/RFS for patients who were bridged or downstaged. RFS was higher in patients with complete/extensive versus partial tumor necrosis (P < 0.0001). For patients with UNOS T2 treated during the study period, 5.2% dropped out because of disease progression. CONCLUSIONS Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment before LT.
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Affiliation(s)
- Ahmed Gabr
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Laura Kulik
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Samdeep Mouli
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ahsun Riaz
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Rehan Ali
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Kush Desai
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ronald A Mora
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Daniel Ganger
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Haripriya Maddur
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Steven Flamm
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Justin Boike
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Christopher Moore
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Bartley Thornburg
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ali Alasadi
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Talia Baker
- Department of SurgeryDivision of TransplantationUniversity of ChicagoChicagoIL
| | - Daniel Borja-Cacho
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Nitin Katariya
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Daniela P Ladner
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Juan Carlos Caicedo
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Robert J Lewandowski
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL.,Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Riad Salem
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL.,Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
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Gordon AC, Gupta AN, Gabr A, Thornburg BG, Kulik LM, Ganger DR, Maddur H, Flamm SL, Boike JR, Moore CM, Borja-Cacho D, Christopher DA, Katariya NN, Ladner DP, Caicedo-Ramirez JC, Riaz A, Salem R, Lewandowski RJ. Safety and Efficacy of Segmental Yttrium-90 Radioembolization for Hepatocellular Carcinoma after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol 2021; 32:211-219. [PMID: 33349507 DOI: 10.1016/j.jvir.2020.09.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate safety and efficacy of segmental yttrium-90 (Y90) radioembolization for hepatocellular carcinoma (HCC) after transjugular intrahepatic portosystemic shunt (TIPS) placement. The hypothesis was liver sparing segmental Y90 for HCC after TIPS would provide high antitumor response with a tolerable safety profile. MATERIALS AND METHODS This single-arm retrospective study included 39 patients (16 women, 23 men) with ages 49-81 years old who were treated with Y90. Child-Pugh A/B liver dysfunction was present in 72% (28/39) with a median Model for End-stage Liver Disease score of 18 (95% confidence interval, 16.4-19.4). Primary outcomes were clinical and biochemical toxicities and antitumor imaging response by World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria. Secondary outcomes were orthotopic liver transplantation (OLT), time to progression (TTP), and overall survival (OS) estimates by the Kaplan-Meier method. RESULTS The 30-day mortality was 0%. Grade 3+ clinical adverse events and grade 3+ hyperbilirubinemia occurred in 5% (2/39) and 0% (0/39), respectively. Imaging response was achieved in 58% (22/38, WHO criteria) and 74% (28/38, EASL criteria), respectively. Median TTP was 16.1 months for any cause and 27.5 months for primary index lesions. OLT was completed in 88% (21/24) of listed patients at a median time of 6.1 months (range, 0.9-11.7 months). Median OS was 31.6 months and 62.9 months censored and uncensored to OLT, respectively. CONCLUSIONS Segmental Y90 for HCC appears safe and efficacious in patients after TIPS. Preserved transplant eligibility suggests that Y90 is a useful tool for bridging these patients to liver transplantation.
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Affiliation(s)
- Andrew C Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Aakash N Gupta
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahmed Gabr
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Bartley G Thornburg
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Laura M Kulik
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois; Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Daniel R Ganger
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Haripriya Maddur
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Steven L Flamm
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Justin R Boike
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Christopher M Moore
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel Borja-Cacho
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Derrick A Christopher
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Nitin N Katariya
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Daniela P Ladner
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Juan C Caicedo-Ramirez
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois; Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois; Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.
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14
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Meek J, Fletcher S, Gauss CH, Bezold S, Borja-Cacho D, Meek M. Temporary Balloon Occlusion for Hepatic Arterial Flow Redistribution during Yttrium-90 Radioembolization. J Vasc Interv Radiol 2019; 30:1201-1206. [DOI: 10.1016/j.jvir.2019.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/03/2018] [Accepted: 01/02/2019] [Indexed: 11/25/2022] Open
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Meek J, Fletcher S, Bezold S, Borja-Cacho D, Meek M. Abstract No. 534 Temporary balloon occlusion for hepatic arterial flow redistribution during Y90 radioembolization: a novel technique for treatment of centrally located hepatic tumors. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.579] [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] Open
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Pandey S, Rhodes-Clark B, Borja-Cacho D, Jethava Y, Harville T. P159 High-resolution HLA-typing can confirm diagnosis of graft versus host disease after orthotopic liver-transplantation. Hum Immunol 2016. [DOI: 10.1016/j.humimm.2016.07.224] [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: 11/26/2022]
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Syed F, Lam Q, Maharjan N, Portilla D, Smeds MR, Borja-Cacho D. Diagnosis and successful surgical management of posterior nutcracker syndrome in a patient with loin pain hematuria. J Ark Med Soc 2015; 111:254-256. [PMID: 25966600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The syndrome of loin pain hematuria in the absence of stones is poorly understood but must be considered in the differential diagnosis for patients with clinical manifestations resembling nephrolithiasis. A 22-year-old white female with a 4-year history of left flank pain and hematuria underwent an extensive workup with normal renal ultrasound and cystourethroscopies. CT scan and MRI revealed a retro-aortic left renal vein. Posterior nutcracker syndrome was considered the most likely diagnosis. The patient underwent a left laparoscopic nephrectomy with auto-transplantation in the right iliac fossa. She developed azotemia shortly after, which resolved and since then has become asymptomatic.
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Borja-Cacho D, Tamayo G, Noreen H, Krefting P, Maurer D, Dunn TB. 25-OR Desensitization and living donor kidney transplant using a novel induction regimen without rejection. Hum Immunol 2011. [DOI: 10.1016/j.humimm.2011.07.270] [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: 10/17/2022]
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Maurer D, Noreen H, Krefting P, Borja-Cacho D, Tamayo G, Dunn TB. 109-P An approach to monitoring desensitization in a patient with a naturally-occurring interfering substance. Hum Immunol 2011. [DOI: 10.1016/j.humimm.2011.07.134] [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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Jasinski P, Zwolak P, Terai K, Vogel RI, Borja-Cacho D, Dudek AZ. MT477 acts in tumor cells as an AURKA inhibitor and strongly induces NRF-2 signaling. Anticancer Res 2011; 31:1181-1187. [PMID: 21508363] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The novel compound thiopyrano [2,3-c]quinoline (MT477) has been shown to exhibit antitumor activity in both in vitro and in vivo studies. The present study examined the expression levels of 10,000 genes and how they changed after MT477 treatment in three cancer cell lines: H226, MDA231 and MiaPaCa-2. Materials and Methods/ RESULTS Molecular function analysis revealed changes in genes involved in cell death, cell-cycle progression and cellular growth and proliferation in all three cancer cell lines. Canonical pathway analysis showed the involvement of the NRF2-mediated oxidative stress response, glucocorticoid, p53, RXR-VDR, G(1)/S checkpoint regulation, ERK, SAPK/JNK and JAS/Stat signaling. Analysis of 234 kinases and phosphatases using a kinase inhibition assay demonstrated a strong inhibitory effect for MAPK14 (104 ± 2%), AMPK A2/B1/G1 (89%) and FGR (83 ± 2%). AURKA was inhibited at 77 ± 1%. MiaPaCa-2 tumor xenograft studies showed a 49.5 ±1 4.8% inhibitory effect in mice treated with 100 μg/kg MT477 compared to untreated mice (p=0.0021). CONCLUSION MT477 induces molecular mechanisms related to cell death, survival, and inhibition of cellular growth in vitro and in vivo.
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Affiliation(s)
- Piotr Jasinski
- Department of Medicine,University of Minnesota, Minneapolis, MN 55455, USA
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Dunn TB, Borja-Cacho D, Chinnakotla S, Finger E, Tamayo G, Verghese P, Kim Y, Manivel C, Kandaswamy R, Matas A, Pruett T, Noreen H, Krefting P, Maurer D. High immunologic risk living donor kidney transplant using bortezomib in a novel induction regimen without acute antibody mediated rejection. Clin Transpl 2011:381-387. [PMID: 22755435] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Desensitization therapies have been used with modest success in kidney transplantation. Some candidates, however, have such great breadth and depth of anti-HLA antibodies that they remain incompatible with potential donors. Bortezomib has been used without much success in desensitization regimens, but we hypothesized that its use during induction may be helpful in targeting antibody production by long-lived plasma cells. This report describes a high-risk positive crossmatch son-to-mother transplant that was performed after desensitization. The induction immunosuppression was supplemented with bortezomib. Pre- and post-transplant immunosuppression, antibody monitoring, biopsy data, and the clinical course are described in detail. Following transplant, the patient had excellent early graft function. Serial biopsies did not reveal acute antibody mediated rejection. Despite excellent graft function, the patient underwent withdrawal of care and died due to complications of calciphylaxis and deconditioning. This case details the first report of bortezomib used as part of induction therapy in solid organ transplant. Donor specific antibody production remained stable after transplant, with near complete abrogation of class I specificities. There were no bortezomib-related complications.
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Affiliation(s)
- Ty B Dunn
- Divisions of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Borja-Cacho D, Henderson WG, Al-Refaie WB. Assessment of ACS NSQIP’s Predictive Ability for Adverse Events After Major Cancer Surgery. Ann Surg Oncol 2010. [DOI: 10.1245/s10434-010-1464-7] [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: 11/18/2022]
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Dudeja V, Chugh RK, Sangwan V, Mujumdar N, Borja-Cacho D, Dawra RK, Vickers SM. SIRT1 downregulation: A novel therapeutic strategy for pancreatobiliary cancers. J Am Coll Surg 2010. [DOI: 10.1016/j.jamcollsurg.2010.06.333] [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: 10/19/2022]
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Mujumdar N, MacKenzie T, Dudeja V, Chugh R, Antonoff M, Borja-Cacho D, Sangwan V, Dawra R, Vickers SM, Saluja AK. Triptolide induces cell death in pancreatic cancer cells by apoptotic and autophagic pathways. Gastroenterology 2010; 139:598-608. [PMID: 20434451 PMCID: PMC3587769 DOI: 10.1053/j.gastro.2010.04.046] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 04/07/2010] [Accepted: 04/22/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Pancreatic adenocarcinoma, among the most lethal human malignancies, is resistant to current chemotherapies. We previously showed that triptolide inhibits the growth of pancreatic cancer cells in vitro and prevents tumor growth in vivo. This study investigates the mechanism by which triptolide kills pancreatic cancer cells. METHODS Cells were treated with triptolide and viability and caspase-3 activity were measured using colorimetric assays. Annexin V, propidium iodide, and acridine orange staining were measured by flow cytometry. Immunofluorescence was used to monitor the localization of cytochrome c and Light Chain 3 (LC3) proteins. Caspase-3, Atg5, and Beclin1 levels were down-regulated by exposing cells to their respective short interfering RNA. RESULTS We show that triptolide induces apoptosis in MiaPaCa-2, Capan-1, and BxPC-3 cells and induces autophagy in S2-013, S2-VP10, and Hs766T cells. Triptolide-induced autophagy has a pro-death effect, requires autophagy-specific genes, atg5 or beclin1, and is associated with the inactivation of the Protein kinase B (Akt)/mammalian target of Rapamycin/p70S6K pathway and the up-regulation of the Extracellular Signal-Related Kinase (ERK)1/2 pathway. Inhibition of autophagy in S2-013 and S2-VP10 cells results in cell death via the apoptotic pathway whereas inhibition of both autophagy and apoptosis rescues cell death. CONCLUSIONS This study shows that triptolide kills pancreatic cancer cells by 2 different pathways. It induces caspase-dependent apoptotic death in MiaPaCa-2, Capan-1, and BxPC-3, and induces caspase-independent autophagic death in metastatic cell lines S2-013, S2-VP10, and Hs766T, thereby making it an attractive chemotherapeutic agent against a broad spectrum of pancreatic cancers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ashok K. Saluja
- Address for Correspondence: Ashok K Saluja, Ph.D., Professor and Vice Chair, Department of Surgery, University of Minnesota, MMC 195, 420 Delaware Street SE, Minneapolis, , Phone: 612- 624-8108, Fax: 612-624-8909
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Borja-Cacho D, Parsons HM, Habermann EB, Rothenberger DA, Henderson WG, Al-Refaie WB. Assessment of ACS NSQIP’s Predictive Ability for Adverse Events After Major Cancer Surgery. Ann Surg Oncol 2010; 17:2274-82. [DOI: 10.1245/s10434-010-1176-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Indexed: 01/03/2023]
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Antonoff MB, Chugh R, Skube SJ, Dudeja V, Borja-Cacho D, Clawson KA, Vickers SM, Saluja AK. Role of Hsp-70 in triptolide-mediated cell death of neuroblastoma. J Surg Res 2010; 163:72-8. [PMID: 20638672 DOI: 10.1016/j.jss.2010.04.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 04/01/2010] [Accepted: 04/19/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Our recent work demonstrated that treatment of neuroblastoma with triptolide causes apoptotic cell death in vitro and decreases tumor size in vivo. Triptolide therapy has been associated with reduced expression of Hsp-70, suggesting a mechanism of cell killing involving Hsp-70 inhibition. The principal objective of this study was to investigate the role of Hsp-70 in triptolide-mediated cell death in neuroblastoma. MATERIALS AND METHODS Neuroblastoma cells were transfected with Hsp-70-specific siRNA. Viability, caspase activity, and phosphatidylserine externalization were subsequently measured. An orthotopic, syngeneic murine tumor model was developed, and randomized mice received daily injections of triptolide or vehicle. At 21 d, mice were sacrificed. Immunohistochemisty was used to characterize Hsp-70 levels in residual tumors, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed to identify cells undergoing apoptosis. RESULTS Targeted silencing of Hsp-70 with siRNA significantly decreased cellular viability, augmented caspase-3 activity, and resulted in increased annexin-V staining. These effects parallel those findings obtained following treatment with triptolide. Residual tumors from triptolide-treated mice showed minimal staining with Hsp-70 immunohistochemistry, while control tumors stained prominently. Tumors from treated mice demonstrated marked staining with the TUNEL assay, while control tumors showed no evidence of apoptosis. CONCLUSIONS Use of siRNA to suppress Hsp-70 expression in neuroblastoma resulted in apoptotic cell death, similar to the effects of triptolide. Residual tumors from triptolide-treated mice expressed decreased levels of Hsp-70 and demonstrated significant apoptosis. These findings support the hypothesis that Hsp-70 inhibition plays a significant role in triptolide-mediated neuroblastoma cell death.
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Affiliation(s)
- Mara B Antonoff
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Clawson KA, Borja-Cacho D, Antonoff MB, Saluja AK, Vickers SM. Triptolide and TRAIL combination enhances apoptosis in cholangiocarcinoma. J Surg Res 2010; 163:244-9. [PMID: 20691980 DOI: 10.1016/j.jss.2010.03.067] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 03/25/2010] [Accepted: 03/30/2010] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cholangiocarcinoma originates from bile duct epithelial cells in the intrahepatic and extrahepatic biliary system. We recently observed that triptolide (a diterpenoid triepoxide) is effective in inducing apoptosis in pancreatic tumors. Death receptors 4 and 5 are overexpressed in several cancer types, and their activation by tumor-necrosis factor-related apoptosis-inducing ligand (TRAIL) induces cell death. The principal objective of this study was to determine the effects of combination therapy with TRAIL and triptolide in cholangiocarcinoma. MATERIALS AND METHODS Two cholangiocarcinoma cell lines were incubated with various doses of triptolide and TRAIL, alone and in combination; cell viability was assessed at 24 and 48 h. Annexin-V staining and caspase-3 activity were measured after 24 h of triptolide, TRAIL or combination treatment. Western blots assessed protein levels of poly(ADP-ribose) polymerase (PARP) and X-linked inhibitor of apoptosis (XIAP). RESULTS Combination treatment using TRAIL and triptolide decreased cell viability in all cell lines at 48 h, with greater cell killing than that which was observed with either drug alone. This decrease in viability was associated with increases in annexin-V staining and caspase-3 activity. Western blot analysis demonstrated increases in PARP cleavage and decreases in XIAP expression that were dose-dependent. CONCLUSIONS TRAIL and triptolide in combination decreased cell viability and enhanced apoptosis. Furthermore, Western blot analysis suggests that triptolide sensitizes cells to TRAIL-induced apoptotic cell death by inhibiting expression of XIAP, a protein known to inhibit apoptosis. Our results demonstrate that combination of TRAIL and triptolide enhance apoptosis in cholangiocarcinoma cell lines.
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Affiliation(s)
- Kimberly A Clawson
- Department of Surgery, Division of Basic and Translational Research, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Dudeja V, Chugh R, Bezek H, Skube S, Mujumdar N, Yokoyama Y, Borja-Cacho D, Rajinder D, Vickers S, Saluja A. SIRT1 Gene Silencing: A Potential Therapeutic Strategy for Pancreatic Cancer. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.461] [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: 12/01/2022]
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Borja-Cacho D, Yokoyama Y, Chugh RK, Mujumdar NR, Dudeja V, Clawson KA, Dawra RK, Saluja AK, Vickers SM. TRAIL and triptolide: an effective combination that induces apoptosis in pancreatic cancer cells. J Gastrointest Surg 2010; 14:252-60. [PMID: 20013316 PMCID: PMC4194070 DOI: 10.1007/s11605-009-1065-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/29/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An emerging therapy in oncology is the induction of apoptotic cell death through anti-death receptor therapy. However, pancreatic cancer is resistant to apoptosis including anti-death receptor therapy. We have previously described how triptolide decreases resistance to apoptosis in pancreatic cancer cells in vitro and in vivo. We hypothesized that triptolide decreases tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) resistance in pancreatic cancer cells. The aim of this study was to evaluate the effects that combined therapy with TRAIL and triptolide have on different parameters of apoptosis. METHODS Four different pancreatic cancer cell lines were exposed to triptolide, TRAIL, or a combination of both drugs. We assessed the effects that combined therapy with TRAIL and triptolide has on cell viability, apoptosis, caspase-3 and caspase-9 activities, and poly(ADP)-ribose polymerase cleavage. RESULTS Pancreatic cancer cells were resistant to TRAIL therapy; however, combined therapy with triptolide and TRAIL significantly decreased the cell viability in all the cell lines and increased apoptotic cell death as a result of caspase-3 and caspase-9 activation. CONCLUSIONS Pancreatic cancer is highly resistant to anti-death receptor therapy, but combined therapy with TRAIL and triptolide is an effective therapy that induces apoptotic cell death in pancreatic cancer cells.
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Clawson K, Borja-Cacho D, Antonoff M, Saluja A, Vickers S. Triptolide and Trail Combination Enhances Cell Death via Apoptosis in Cholangiocarcinoma Cells. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.463] [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: 11/26/2022]
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Jasinski P, Zwolak P, Terai K, Borja-Cacho D, Dudek AZ. PKC-alpha inhibitor MT477 slows tumor growth with minimal toxicity in in vivo model of non-Ras-mutated cancer via induction of apoptosis. Invest New Drugs 2009; 29:33-40. [DOI: 10.1007/s10637-009-9330-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/16/2009] [Indexed: 11/29/2022]
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Vergara-Fernandez O, Zeron-Medina J, Mendez-Probst C, Salgado-Nesme N, Borja-Cacho D, Sanchez-Guerrero J, Medina-Franco H. Acute abdominal pain in patients with systemic lupus erythematosus. J Gastrointest Surg 2009. [PMID: 19415401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. METHODS We conducted a prospective study of patients admitted to the ER with AAP and SLE in an 11-year period. Demographic, diagnostic, and treatment data were recorded. Systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), and APACHE II Score were analyzed. The main outcome variables were morbidity and mortality within 30 days of admission. RESULTS Seventy-three patients were included. Ninety-three percent were female. Most common causes of AAP were: pancreatitis (29%), intestinal ischemia (16%), gallbladder disease (15%), and appendicitis (14%). Most causes of AAP in patients with LES were not related to the disease. APACHE II score > 12 was statistically associated with the diagnosis of intestinal ischemia compared to other causes. No relationship was observed between SLEDAI and outcome. Furthermore, this index did not have impact on diagnosis or decision making. Overall morbidity was 57% and overall mortality 11%. On multivariate analysis, only APACHE II > 12 was associated with mortality (P = 0.0001). CONCLUSION This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these etiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.
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Affiliation(s)
- Omar Vergara-Fernandez
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga No. 15, Col. Seccion XVI Tlalpan, Mexico City, CP, 14000, Mexico.
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Vergara-Fernandez O, Zeron-Medina J, Mendez-Probst C, Salgado-Nesme N, Borja-Cacho D, Sanchez-Guerrero J, Medina-Franco H. Acute abdominal pain in patients with systemic lupus erythematosus. J Gastrointest Surg 2009; 13:1351-7. [PMID: 19415401 DOI: 10.1007/s11605-009-0897-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 02/11/2009] [Accepted: 04/15/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. METHODS We conducted a prospective study of patients admitted to the ER with AAP and SLE in an 11-year period. Demographic, diagnostic, and treatment data were recorded. Systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus international collaboration clinics damage index (SLICC/DI), and APACHE II Score were analyzed. The main outcome variables were morbidity and mortality within 30 days of admission. RESULTS Seventy-three patients were included. Ninety-three percent were female. Most common causes of AAP were: pancreatitis (29%), intestinal ischemia (16%), gallbladder disease (15%), and appendicitis (14%). Most causes of AAP in patients with LES were not related to the disease. APACHE II score > 12 was statistically associated with the diagnosis of intestinal ischemia compared to other causes. No relationship was observed between SLEDAI and outcome. Furthermore, this index did not have impact on diagnosis or decision making. Overall morbidity was 57% and overall mortality 11%. On multivariate analysis, only APACHE II > 12 was associated with mortality (P = 0.0001). CONCLUSION This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these etiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.
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Affiliation(s)
- Omar Vergara-Fernandez
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga No. 15, Col. Seccion XVI Tlalpan, Mexico City, CP, 14000, Mexico.
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Antonoff M, Borja-Cacho D, Chugh R, Sorenson B, Saltzman D, Saluja A, Vickers S. 73. Triptolide Therapy for Neuroblastoma Decreases Cell Viability in Vitro and Inhibits Tumor Growth in Vivo. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.087] [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: 10/21/2022]
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Borja-Cacho D, Jensen EH, Saluja AK, Buchsbaum DJ, Vickers SM. Molecular targeted therapies for pancreatic cancer. Am J Surg 2008; 196:430-41. [PMID: 18718222 DOI: 10.1016/j.amjsurg.2008.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 04/30/2008] [Accepted: 04/30/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pancreatic cancer cells express different mutations that increase the aggressiveness and confer resistance to conventional chemotherapy and radiotherapy. Molecules that selectively bind and inhibit these mutations are effective in other solid tumors and are now emerging as a complementary therapy in pancreatic cancer. The objective of this review is to describe the effect of drugs that inhibit specific mutations present in pancreatic cancer with special emphasis on clinical trials. DATA SOURCES We reviewed the English-language literature (MedLine) addressing the role of drugs that target mutations present in pancreatic cancer. Both preclinical and clinical studies were included. CONCLUSIONS Preclinical evidence supports the combination of conventional approved therapies plus drugs that block epidermal growth factor receptor and vascular growth endothelial factor or induce apoptosis. However, most of the current clinical evidence is limited to small phase I trials evaluating the toxicity and safety of these regimens. The results of additional randomized trials that are still undergoing will clarify the role of these drugs in pancreatic cancer.
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Dudeja V, Chugh R, Skube S, Yokoyama Y, Borja-Cacho D, Zwolak P, Antonoff MB, Dawara R, Vickers SM, Saluja AK. Silencing of heat shock factor 1: A potential therapeutic strategy for pancreatic cancer. J Am Coll Surg 2008. [DOI: 10.1016/j.jamcollsurg.2008.06.029] [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: 10/21/2022]
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Zwolak P, Borja-Cacho D, Phillips P, Dudeja V, Dawra RK, Talukdar R, Chugh RK, Dudek AZ, Vickers SM, Saluja AK. 55. Myricetin a Novel Natural Antineoplastic Agent Decreases Progression of Human Pancreatic Cancer Via Inhibition of Akt Kinase and Erk Pathways. J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.063] [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: 11/29/2022]
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Dudeja V, Chugh R, Yokoyama Y, Talukdar R, Borja-Cacho D, Zwolak P, Dawara R, Vickers SM, Saluja AK. QS309. Inhibition of Heat Shock Factor 1: A Potential Therapeutic Strategy in the Treatment of Pancreatic Cancer. J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.561] [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: 10/22/2022]
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Zwolak P, Borja-Cacho D, Phillips P, Dudeja V, Dawra RK, Talukdar R, Chugh RK, Dudek AZ, Vickers SM, Saluja AK. P32. Myricetin a Novel Natural Antineoplastic Agent Decreases Progression of Human Pancreatic Cancer Via Inhibition of Akt Kinase and ERK Pathways. J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.742] [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: 10/22/2022]
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Borja-Cacho D, Zwolak P, Dudeja V, Dawra RK, Ankeny JS, Talukdar R, Chugh RK, Vickers SM, Saluja AK. QS308. HSP70 Inhibition Sensitizes to TRAIL Induced Apoptotic Cell Death in Pancreatic Cancer Cells. J Surg Res 2008. [DOI: 10.1016/j.jss.2007.12.560] [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: 11/26/2022]
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Phillips PA, Dudeja V, McCarroll JA, Borja-Cacho D, Dawra RK, Grizzle WE, Vickers SM, Saluja AK. Triptolide induces pancreatic cancer cell death via inhibition of heat shock protein 70. Cancer Res 2007; 67:9407-16. [PMID: 17909050 DOI: 10.1158/0008-5472.can-07-1077] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pancreatic cancer is highly resistant to current chemotherapy agents. We therefore examined the effects of triptolide (a diterpenoid triepoxide) on pancreatic cancer growth and local-regional tumor spread using an orthotopic model of pancreatic cancer. We have recently shown that an increased level of HSP70 in pancreatic cancer cells confers resistance to apoptosis and that inhibiting HSP70 induces apoptosis in these cells. In addition, triptolide was recently identified as part of a small molecule screen, as a regulator of the human heat shock response. Therefore, our aims were to examine the effects of triptolide on (a) pancreatic cancer cells by assessing viability and apoptosis, (b) pancreatic cancer growth and local invasion in vivo, and (c) HSP70 levels in pancreatic cancer cells. Incubation of PANC-1 and MiaPaCa-2 cells with triptolide (50-200 nmol/L) significantly reduced cell viability, but had no effect on the viability of normal pancreatic ductal cells. Triptolide induced apoptosis (assessed by Annexin V, caspase-3, and terminal nucleotidyl transferase-mediated nick end labeling) and decreased HSP70 mRNA and protein levels in both cell lines. Triptolide (0.2 mg/kg/d for 60 days) administered in vivo decreased pancreatic cancer growth and significantly decreased local-regional tumor spread. The control group of mice had extensive local invasion into adjacent organs, including the spleen, liver, kidney, and small intestine. Triptolide causes pancreatic cancer cell death in vitro and in vivo by induction of apoptosis and its mechanism of action is mediated via the inhibition of HSP70. Triptolide is a potential therapeutic agent that can be used to prevent the progression and metastases of pancreatic cancer.
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Affiliation(s)
- Phoebe A Phillips
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55488, USA
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Phillips P, Borja-Cacho D, Dudeja V, McCarroll J, Dawra R, Grizzle W, Vickers S, Saluja A. Triptolide a potential therapeutic candidate for pancreatic cancer. J Am Coll Surg 2007. [DOI: 10.1016/j.jamcollsurg.2007.06.235] [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: 11/16/2022]
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Mercado MA, Borja-Cacho D, Domínguez I, Maravilla EC, Sánchez N, Zavaleta-Martínez E, Ramírez-Muciño A, Barajas-Olivas A, Arceo-Olaiz R. An unusual cause of bilioenteric anastomotic dysfunction after iatrogenic bile duct injury. Ann Hepatol 2006; 5:120-2. [PMID: 16807520] [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
Roux en Y hepatojejunostomy is the surgery of choice for bile duct repair. Anastomotical dysfunction after reconstruction has several etiopathologies. Besides technical factors, ischemia of the duct is responsible for late obstruction. Bile colonization with secondary stones and sludge can also be identified as a cause. An unusual cause of anastomotical dysfunction secondary to ascaris biliary infestation after biliary reconstruction is reported herein. The patient had intermittent cholangitis and eosinophilia. At operation, the worm was found obstructing the anastomosis.
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Affiliation(s)
- Miguel Angel Mercado
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico.
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Mercado MA, Orozco H, Chan C, Quezada C, Barajas-Olivas A, Borja-Cacho D, Sánchez-Fernandez N. Bile duct growing factor: an alternate technique for reconstruction of thin bile ducts after iatrogenic injury. J Gastrointest Surg 2006; 10:1164-9. [PMID: 16966037 DOI: 10.1016/j.gassur.2006.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 04/06/2006] [Indexed: 01/31/2023]
Abstract
A variant of bilioenteric anastomosis, laterolateral hepatojejunostomy, is described in which the opened anterior aspect of the common hepatic duct and left hepatic duct is anastomosed to a Roux jejunal limb. This technique is specially designed for thin, injured bile ducts in which a conventional anastomosis is difficult due to the small diameter of the ducts. A wide anastomosis is obtained, leaving the posterior wall as a conduit for bile, ensuring an adequate anastomotic diameter.
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Affiliation(s)
- Miguel Angel Mercado
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico.
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