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Anouti A, Al Hariri M, VanWagner LB, Lee WM, Mufti A, Pedersen M, Shah J, Hanish S, Vagefi PA, Cotter TG, Patel MS. Early Graft Failure After Living-Donor Liver Transplant. Dig Dis Sci 2024; 69:1488-1495. [PMID: 38381224 DOI: 10.1007/s10620-024-08280-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Living-donor liver transplantation (LDLT) has been increasing in the USA. While data exist on longer-term patient and graft outcomes, a contemporary analysis of short-term outcomes is needed. AIM Evaluate short-term (30-day) graft failure rates and identify predictors associated with these outcomes. METHODS Adult (≥ 18) LDLT recipients from 01/2004 to 12/2021 were analyzed from the United States Scientific Registry of Transplant Recipients. Graft status at 30 days was assessed with graft failure defined as retransplantation or death. Comparison of continuous and categorical variables was performed and a multivariable logistic regression was used to identify risk factors of early graft failure. RESULTS During the study period, 4544 LDLTs were performed with a graft failure rate of 3.4% (155) at 30 days. Grafts from male donors (aOR: 0.63, CI 0.44-0.89), right lobe grafts (aOR: 0.40, CI 0.27-0.61), recipients aged > 60 years (aOR: 0.52, CI 0.32-0.86), and higher recipient albumin (aOR: 0.73, CI 0.57-0.93) were associated with superior early graft outcomes, whereas Asian recipient race (vs. White; aOR: 3.75, CI 1.98-7.10) and a history of recipient PVT (aOR: 2.7, CI 1.52-4.78) were associated with inferior outcomes. LDLTs performed during the most recent 2016-2021 period (compared to 2004-2009 and 2010-2015) resulted in significantly superior outcomes (aOR: 0.45, p < 0.001). CONCLUSION Our study demonstrates that while short-term adult LDLT graft failure is uncommon, there are opportunities for optimizing outcomes by prioritizing right lobe donation, improving candidate nutritional status, and careful pre-transplant risk assessment of candidates with known PVT. Notably, a period effect exists whereby increased LDLT experience in the most recent era correlated with improved outcomes.
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Affiliation(s)
- Ahmad Anouti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - William M Lee
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Arjmand Mufti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mark Pedersen
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jigesh Shah
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Steven Hanish
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Parsia A Vagefi
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar S Patel
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA.
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Anouti A, Patel MS, VanWagner LB, Lee WM, Asrani SK, Mufti AR, Rich NE, Vagefi PA, Shah JA, Kerr TA, Pedersen M, Hanish S, Singal AG, Cotter TG. Increasing practice and acceptable outcomes of high-MELD living donor liver transplantation in the USA. Liver Transpl 2024; 30:72-82. [PMID: 37490432 DOI: 10.1097/lvt.0000000000000228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
Recent deceased-donor allocation changes in the United States may have increased high-Model for End-Stage Liver Disease (MELD) living donor liver transplantation (LDLT); however, outcomes in these patients remain poorly defined. We aimed to examine the impact of the MELD score on LDLT outcomes. Using UNOS data (January 1, 2010-December 31, 2021), LDLT recipients were identified and stratified into low-MELD (<15), intermediate-MELD (15-24), and high-MELD (≥25) groups. We compared outcomes between MELD-stratified LDLT groups and between MELD-stratified LDLT and donation after brain death liver transplantation recipients. We used Kaplan-Meier analysis to compare graft survival rates and multivariable Cox proportional hazards modeling to identify factors associated with graft outcomes. Of 3558 LDLTs, 1605 (45.1%) were low-MELD, 1616 (45.4%) intermediate-MELD, and 337 (9.5%) high-MELD. Over the study period, the annual number of LDLTs increased from 282 to 569, and the proportion of high-MELD LDLTs increased from 3.9% to 7.7%. Graft survival was significantly higher in low-MELD versus high-MELD LDLT recipients (adjusted HR = 1.36, 95% CI: 1.03-1.79); however, 5-year survival exceeded 70.0% in both groups. We observed no significant difference in graft survival between high-MELD LDLT and high-MELD donation after brain death liver transplantation recipients (adjusted HR: 1.25, 95% CI:0.99-1.58), with a 5-year survival of 71.5% and 77.3%, respectively. Low LDLT center volume (<3 LDLTs/year) and recipient life support requirement were both associated with inferior graft outcomes among high-MELD LDLT recipients. While higher MELD scores confer graft failure risk in LDLT, high-MELD LDLT outcomes are acceptable with similar outcomes to MELD-stratified donation after brain death liver transplantation recipients. Future practice guidance should consider the expansion of LDLT recommendations to high-MELD recipients in centers with expertise to help reduce donor shortage.
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Affiliation(s)
- Ahmad Anouti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar S Patel
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - William M Lee
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Arjmand R Mufti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole E Rich
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parsia A Vagefi
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jigesh A Shah
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas A Kerr
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mark Pedersen
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Steven Hanish
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
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Hwang CS, Okoro E, Chaudhary U, Kadakia Y, Patel MS, Shah JA, Hanish S, Cheruku S, Lahsaei P, Huang N, Shi C, Vagefi PA, MacConmara MP. Controlling instability at reperfusion: Another benefit of normothermic machine perfusion using OCS liver. Liver Transpl 2023; 29:1249-1251. [PMID: 37144616 DOI: 10.1097/lvt.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/01/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Christine S Hwang
- Division of Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ejike Okoro
- Department of Anesthesia, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Yash Kadakia
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar S Patel
- Division of Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jigesh A Shah
- Division of Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Steven Hanish
- Division of Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sreekanth Cheruku
- Department of Anesthesia, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Peiman Lahsaei
- Department of Anesthesia, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Norman Huang
- Department of Anesthesia, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Chen Shi
- Department of Anesthesia, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parsia A Vagefi
- Division of Transplantation, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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4
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Anouti A, Patel MS, VanWagner LB, Lee WM, Fung JJ, Cholankeril G, Hwang CS, Mufti AR, Tujios S, Kerr T, Rich NE, Louissaint J, Desai DM, Vagefi PA, Hanish S, Shah J, Singal AG, Cotter TG. Biliary atresia and liver transplantation in the United States: A contemporary analysis. Liver Int 2023; 43:2198-2209. [PMID: 37548078 DOI: 10.1111/liv.15689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Biliary atresia (BA) remains the number one indication for paediatric liver transplantation (LT) worldwide but is an uncommon indication for older LT recipients. The impact of recent donor allocation changes, pervasive organ shortage and evolving LT practices on the BA LT population is unknown. METHODS We identified patients who underwent LT between January 2010 and December 2021 using the UNOS database. We compared clinical outcomes between patients with BA and those with non-BA cholestatic liver disease. Groups were stratified by age, <12 years (allocated via PELD system) and ≥12 years (allocated via MELD system). Waitlist outcomes were compared using competing-risk regression analysis, graft survival rates were compared using Kaplan-Meier time-to-event analysis and Cox proportional hazards modelling provided adjusted estimates. RESULTS There were 2754 BA LT waitlist additions and 2206 BA LTs (1937 <12 years [younger], 269 ≥12 years [older]). There were no differences in waitlist mortality between BA and non-BA cholestatic patients. Among BA LT recipients, there were 441 (20.0%) living-donor liver transplantations (LDLT) and 611 (27.7%) split deceased-donor LTs. Five-year graft survival was significantly higher among BA versus non-BA cholestatic patients in the older group (88.3% vs. 79.5%, p < .01) but not younger group (89.3% vs. 89.5%). Among BA LT recipients, improved graft outcomes were associated with LDLT (vs. split LT: HR: 2, 95% CI: 1.03-3.91) and higher transplant volume (volume >100 vs. <40 BA LTs: HR: 3.41, 95% CI: 1.87-6.2). CONCLUSION Liver transplant outcomes among BA patients are excellent, with LDLT and higher transplant centre volume associated with optimal graft outcomes.
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Affiliation(s)
- Ahmad Anouti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar S Patel
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - William M Lee
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - John J Fung
- Department of Surgery, University of Chicago Medicine Transplant Institute, Chicago, Illinois, USA
| | - George Cholankeril
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Christine S Hwang
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Arjmand R Mufti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shannan Tujios
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas Kerr
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole E Rich
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeremy Louissaint
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dev M Desai
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parsia A Vagefi
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Steven Hanish
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jigesh Shah
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
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5
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Kadakia Y, MacConmara M, Patel MS, Shah JA, de Gregorio Muniz L, Desai DM, Hanish S, Vagefi PA, Hwang CS. Normothermic Machine Perfusion in pediatric liver transplantation: A survey of attitudes and barriers. Pediatr Transplant 2022; 26:e14282. [PMID: 35445521 DOI: 10.1111/petr.14282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/03/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND NMP provides a superior strategy for the assessment and preservation of marginal donor livers and has demonstrated increased utilization and enhances organ quality when used in adult liver transplantation. We aimed to evaluate the interest of incorporating the use of NMP in pediatric liver transplantation. METHODS An anonymous online survey was distributed to pediatric transplant surgeons and hepatologists across the United States. Respondent demographic information, attitudes toward NMP in pediatric liver transplantation, and barriers to utilization were examined. RESULTS Thirty-two providers (18 transplant surgeons and 14 hepatologists) completed the survey, yielding a response rate of 64%. Half (50%) of respondents indicated prior exposure to NMP. Overall, 96% of respondents believed there was benefit to using NMP in pediatric liver transplantation. DCD (68%) and post-cross-clamp (75%) grafts were the greatest opportunity for NMP use. A role in splitting livers ex vivo (71%) was also seen as a potential major opportunity. Cost was perceived as a barrier to implementation (36%), followed by institutional factors (32%). Cost tolerance was significantly greater in respondents residing in OPTN regions with greater than median wait times (63% vs. 11% in OPTN regions with greater vs. shorter wait times, p = .010). CONCLUSIONS There is significant interest within the pediatric liver transplant community for NMP to expand the donor pool. Interest appears particularly strong in regions where wait times for suitable pediatric donors are prolonged.
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Affiliation(s)
- Yash Kadakia
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Malcolm MacConmara
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA.,TransMedics Inc., Andover, Massachusetts, USA
| | - Madhukar S Patel
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA
| | - Jigesh A Shah
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA
| | - Lucia de Gregorio Muniz
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA
| | - Dev M Desai
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA
| | - Steven Hanish
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA
| | - Parsia A Vagefi
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA
| | - Christine S Hwang
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Transplantation, Children's Medical Center, Dallas, Texas, USA
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6
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Hobeika MJ, Glazner R, Foley DP, Hanish S, Loss G, Quintini C, Eidbo E, Zollinger C, Ruterbories J, Lebovitz DJ, Axelrod D. A Step toward Standardization: Results of two National Surveys of Best Practices in Donation after Circulatory Death Liver Recovery and Recommendations from The American Society of Transplant Surgeons and Association of Organ Procurement Organizations. Clin Transplant 2020; 34:e14035. [DOI: 10.1111/ctr.14035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/28/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Mark J. Hobeika
- Department of Surgery Weill Cornell Medical College Houston Methodist Hospital Houston TX USA
| | | | - David P. Foley
- Department of Surgery School of Medicine and Public Health University of Wisconsin Madison WI USA
| | - Steven Hanish
- Department of Surgery University of Texas Southwestern Medical Center Dallas TX USA
| | - George Loss
- Department of Surgery Oschner Clinic Foundation New Orleans Louisiana USA
| | | | - Elling Eidbo
- Association of Organ Procurement Organizations Vienna VA USA
| | | | | | | | - David Axelrod
- Department of Surgery University of Iowa Carver College of Medicine Iowa City IA USA
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Chuong MD, Kaiser A, Khan F, Parikh P, Ben-Josef E, Crane C, Brunner T, Okumura T, Schreuder N, Bentzen SM, Gutierrez A, Mendez Romero A, Yoon SM, Sharma N, Kim TH, Kishi K, Moeslein F, Hoffe S, Schefter T, Hanish S, Scorsetti M, Apisarnthanarax S. Consensus Report From the Miami Liver Proton Therapy Conference. Front Oncol 2019; 9:457. [PMID: 31214502 PMCID: PMC6557299 DOI: 10.3389/fonc.2019.00457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022] Open
Abstract
An international group of 22 liver cancer experts from 18 institutions met in Miami, Florida to discuss the optimal utilization of proton beam therapy (PBT) for primary and metastatic liver cancer. There was consensus that PBT may be preferred for liver cancer patients expected to have a suboptimal therapeutic ratio from XRT, but that PBT should not be preferred for all patients. Various clinical scenarios demonstrating appropriateness of PBT vs. XRT were reviewed.
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Affiliation(s)
- Michael D Chuong
- Baptist Hospital of Miami, Miami Cancer Institute, Miami, FL, United States
| | - Adeel Kaiser
- University of Maryland Medical Center, Baltimore, MD, United States
| | - Fazal Khan
- Baptist Hospital of Miami, Miami Cancer Institute, Miami, FL, United States
| | - Parag Parikh
- Henry Ford Health System, Detroit, MI, United States
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Niek Schreuder
- Provision CARES Proton Therapy, Knoxville, TN, United States
| | - Søren M Bentzen
- University of Maryland Medical Center, Baltimore, MD, United States
| | - Alonso Gutierrez
- Baptist Hospital of Miami, Miami Cancer Institute, Miami, FL, United States
| | - Alejandra Mendez Romero
- Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands.,Holland Proton Treatment Center, Rotterdam, Netherlands
| | - Sang Min Yoon
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Navesh Sharma
- Department of Radiation Oncology, Pennsylvania State University, University Park, PA, United States
| | | | | | - Fred Moeslein
- Sarasota Memorial Hospital, Sarasota, FL, United States
| | - Sarah Hoffe
- Moffitt Cancer Center, Tampa, FL, United States
| | - Tracey Schefter
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Steven Hanish
- University of Maryland Medical Center, Baltimore, MD, United States
| | - Marta Scorsetti
- Department of Radiation Oncology, Humanitas University, Rozzano, Italy
| | - Smith Apisarnthanarax
- Department of Radiation Oncology, University of Washington, Seattle, WA, United States
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Brown SA, Axenfeld E, Stonesifer EG, Hutson W, Hanish S, Raufman JP, Urrunaga NH. Current and prospective therapies for acute liver failure. Dis Mon 2018; 64:493-522. [DOI: 10.1016/j.disamonth.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Thuluvath PJ, Thuluvath AJ, Hanish S, Savva Y. Liver transplantation in patients with multiple organ failures: Feasibility and outcomes. J Hepatol 2018; 69:1047-1056. [PMID: 30071241 DOI: 10.1016/j.jhep.2018.07.007] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [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: 04/17/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Multiple organ failures (OFs) are common in patients with cirrhosis, but the independent effect of the number or type of OFs on liver transplantation (LT) outcomes is not well defined. METHOD United Network for Organ Sharing data were analyzed from 2002 to 2016 for all adults listed for LT who received an LT within 30 days after listing. We estimated post-LT survival stratified by number and type of pre-transplant OFs before and after adjusting for confounding variables. RESULTS During the study period, 4,714 (4.1%) patients died and 19,375 (16.6%) patients were transplanted within 30 days of listing. One or more OF were more common in those who were transplanted (57.4%) compared to those without LT (9.5%). The probability of staying alive more than 30 days on the waiting list without LT decreased with increasing number of OFs; while 90% were alive without OF, only 20% were alive with two OFs, and 2-8% with three or more OFs. The interval between listing and transplantation decreased with an increase in OFs, and the median time to transplant after listing was only 4-5 days with three or more OFs. Although the risk of post-LT mortality increased with increasing number of OFs, the 90-day patient survival was 90% and one-year survival was 81% in the presence of 5-6 OFs. The number of OFs was an independent predictor of survival, but the maximum difference in one-year graft or patient survival between those without OF and those with 5-6 OFs was only 9%. Additionally, the type of OF had minimal impact on outcomes. CONCLUSIONS Liver transplantation is feasible with excellent outcomes, even in the presence of five or six OFs. LAY SUMMARY Multiple organ failures, ranging from 1-6, are common in hospitalized patients with cirrhosis. The survival without liver transplant is dismal in the presence of three or more organ failures. Small retrospective studies have shown that liver transplant is feasible with good outcomes even in the presence of multiple organ failures. In this study, using a large national dataset, we show that survival chances for more than 30 days in those with three or more organ failures are less than 8%. However, if a liver transplant is performed quickly, the survival chances are very high with one-year survival ranging from 84% with three organ failures to 81% with 5-6 organ failures.
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Affiliation(s)
- Paul J Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, United States; University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Avesh J Thuluvath
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Steven Hanish
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Yulia Savva
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, United States
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10
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Baig K, Fields R, Gaca J, Hanish S, Milton L, Koch W, Lawson J. A porcine Model of Intimal-Medial Hyperplasia in Polytetrafluoroethylene Arteriovenous Grafts. J Vasc Access 2018. [DOI: 10.1177/112972980300400306] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Vascular access polytetrafluoroethylene (PTFE) graft failure is a major cause of morbidity in the hemodialysis population. The most common cause of graft failure is thrombosis secondary to stenosis at the venous outflow tract. Venous outflow stenosis is characterized by intimal-medial hyperplasia. We have developed a porcine arteriovenous (AV) graft model that may be used to investigate this proliferative response and aid in the development of new therapies to prevent intimal-medial hyperplasia and improve graft patency. Methods Left carotid to right external jugular vein PTFE (6 mm) grafts were implanted in the necks of swine. Immediately following anatomosis, flow rates were recorded. In one group of animals (n = 4) the venous outflow tract was harvested after 7 days and morphometric analysis of intimal and medial area was performed. In a second group (n = 8) the graft patency was monitored until 28 days. Results All porcine PTFE fistula grafts were patent at 7 days and 100% patency was maintained until 14 days. After 28 days, 75% of the grafts failed due to thrombosis. The venous outflow tract developed a significant proliferative response. After 7 days the intimal and medial areas were 469 ± 9 μm2 and 875 ± 26 μm2 respectively. At 28 days the intimal and medial areas were 913 ± 55 μm2 and 1437 ± 182 μm2 respectively. Luminal flow rate of the venous outflow tract was reduced significantly (344 ± 11 ml/min at Day 0 to 129 ± 14 ml/min at Day 7, p < 0.05). Conclusions This porcine model rapidly, reliably and robustly reproduces the flow reducing stenosis and intimal-medial hyperplasia at the venous outflow tract of PTFE arteriovenous fistula. It represents a promising tool for investigating the mechanisms of intimal-medial hyperplasia, evaluating therapeutic interventions and new graft materials.
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Affiliation(s)
- K. Baig
- Department of Surgery, Duke University
Medical Center, Durham - USA
| | - R.C. Fields
- Department of Surgery, Duke University
Medical Center, Durham - USA
| | - J. Gaca
- Department of Surgery, Duke University
Medical Center, Durham - USA
| | - S. Hanish
- Department of Surgery, Duke University
Medical Center, Durham - USA
| | - L.G. Milton
- Department of Surgery, Duke University
Medical Center, Durham - USA
| | - W.J. Koch
- Department of Surgery, Duke University
Medical Center, Durham - USA
| | - J.H. Lawson
- Department of Surgery, Duke University
Medical Center, Durham - USA
- Department of Pathology, Duke
University Medical Center, Durham - USA
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Ahmad SB, Miller M, Hanish S, Bartlett ST, Hutson W, Barth RN, LaMattina JC. Sequential kidney-liver transplantation from the same living donor for lecithin cholesterol acyl transferase deficiency. Clin Transplant 2016; 30:1370-1374. [PMID: 27490864 DOI: 10.1111/ctr.12826] [Citation(s) in RCA: 8] [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] [Accepted: 07/22/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lecithin cholesterol acyl transferase (LCAT) deficiency is a rare autosomal recessive disorder of lipoprotein metabolism that results in end-stage renal disease (ESRD) necessitating transplantation. As LCAT is produced in the liver, combined kidney and liver transplantation was proposed to cure the clinical syndrome of LCAT deficiency. METHODS A 29-year-old male with ESRD secondary to LCAT deficiency underwent a sequential kidney-liver transplantation from the same living donor (LD). One year following the kidney transplant, auxiliary partial orthotopic liver transplant (APOLT) of a left lateral segment from the same donor was performed. RESULTS At 5 years follow-up, there have been no major complications, readmissions, or rejection episodes. Serum lipid abnormalities recurred within the first year, but liver and kidney allograft function remains intact. CONCLUSION Few cases of sequential transplantation from the same LD have been performed in adults. This is the first APOLT and multi-organ transplant performed for LCAT deficiency. Sequential organ transplant from the same LD for ESRD secondary to a metabolic disorder of the liver is feasible in adults and should be further investigated.
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Affiliation(s)
- Sarwat B Ahmad
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Michael Miller
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven Hanish
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen T Bartlett
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Hutson
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rolf N Barth
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John C LaMattina
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Udoji T, Berkowitz D, Bechara R, Hanish S, Subramanian R. The Use of Transtracheal Oxygen Therapy in the Management of Severe Hepatopulmonary Syndrome After Liver Transplantation. Transplant Proc 2013; 45:3316-9. [DOI: 10.1016/j.transproceed.2013.05.007] [Citation(s) in RCA: 3] [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] [Received: 04/19/2013] [Accepted: 05/09/2013] [Indexed: 11/29/2022]
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Patel SH, Kneuertz PJ, Delgado M, Kooby DA, Staley CA, El-Rayes BF, Kauh JS, Sarmiento JM, Hanish S, Cohen C, Farris AB, Maithel SK. Clinically Relevant Biomarkers to Select Patients for Targeted Inhibitor Therapy after Resection of Hepatocellular Carcinoma. Ann Surg Oncol 2011; 18:3384-90. [DOI: 10.1245/s10434-011-1775-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Indexed: 12/15/2022]
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Baig K, Fields RC, Gaca J, Hanish S, Milton LG, Koch WJ, Lawson JH. A porcine model of intimal-medial hyperplasia in polytetrafluoroethylene arteriovenous grafts. J Vasc Access 2003; 4:111-7. [PMID: 17639488] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
PURPOSE Vascular access polytetrafluoroethylene (PTFE) graft failure is a major cause of morbidity in the hemodialysis population. The most common cause of graft failure is thrombosis secondary to stenosis at the venous outflow tract. Venous outflow stenosis is characterized by intimal-medial hyperplasia. We have developed a porcine arteriovenous (AV) graft model that may be used to investigate this proliferative response and aid in the development of new therapies to prevent intimal-medial hyperplasia and improve graft patency. METHODS Left carotid to right external jugular vein PTFE (6 mm) grafts were implanted in the necks of swine. Immediately following anatomosis, flow rates were recorded. In one group of animals (n = 4) the venous outflow tract was harvested after 7 days and morphometric analysis of intimal and medial area was performed. In a second group (n = 8) the graft patency was monitored until 28 days. RESULTS All porcine PTFE fistula grafts were patent at 7 days and 100% patency was maintained until 14 days. After 28 days, 75% of the grafts failed due to thrombosis. The venous outflow tract developed a significant proliferative response. After 7 days the intimal and medial areas were 469 +/- 9 microm2 and 875 +/- 26 microm2 respectively. At 28 days the intimal and medial areas were 913 +/- 55 microm2 and 1437 +/- 182 microm2 respectively. Luminal flow rate of the venous outflow tract was reduced significantly (344 +/- 11 ml/min at Day 0 to 129 +/- 14 ml/min at Day 7, p < 0.05). CONCLUSIONS This porcine model rapidly, reliably and robustly reproduces the flow reducing stenosis and intimal-medial hyperplasia at the venous outflow tract of PTFE arteriovenous fistula. It represents a promising tool for investigating the mechanisms of intimal-medial hyperplasia, evaluating therapeutic interventions and new graft materials.
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Affiliation(s)
- K Baig
- Department of Surgery, Duke University Medical Center, Durham USA
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Olgin JE, Sih HJ, Hanish S, Jayachandran JV, Wu J, Zheng QH, Winkle W, Mulholland GK, Zipes DP, Hutchins G. Heterogeneous atrial denervation creates substrate for sustained atrial fibrillation. Circulation 1998; 98:2608-14. [PMID: 9843470 DOI: 10.1161/01.cir.98.23.2608] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heterogeneous electrophysiological properties, which may be due in part to autonomic innervation, are important in the maintenance of atrial fibrillation (AF). We hypothesized that heterogeneous sympathetic denervation with phenol would create a milieu for sustained AF. METHODS AND RESULTS After the determination of baseline inducibility, 15 dogs underwent atrial epicardial phenol application and 11 underwent a sham procedure. After 2 weeks of recovery, the animals had repeat attempts at inducing AF and effective refractory period (ERP) testing. Epicardial maps were obtained to determine local AF cycle lengths. ERPs were determined at baseline and during sympathetic, vagal, and simultaneous vagal/sympathetic stimulation. Dogs then underwent PET imaging with either a sympathetic ([11C]hydroxyephedrine, HED) or parasympathetic (5-[11C]methoxybenzovesamicol, MOBV) nerve label. None of the animals had sustained AF (>60 minutes) at baseline. None of the sham dogs and 14 of 15 phenol dogs had sustained AF at follow-up. Sites to which phenol was applied had a significantly shorter ERP (136+/-17.6 ms) than those same sites in the sham controls (156+/-19.1 ms) (P=0.01). Although there was no difference in the ERP change with either vagal or sympathetic stimulation alone between phenol and nonphenol sites, the percent decrease in ERP with simultaneous vagal/sympathetic stimulation was greater in the phenol sites (17+/-8%) than in the nonphenol sites (9+/-9%) (P=0.01). There was a significantly increased dispersion of refractoriness (21+/-6.4 ms in the sham versus 58+/-14 ms in the phenol dogs, P=0.01) as well as dispersion of AF cycle length (49+/-10 ms in the sham versus 105+/-12 ms in the phenol dogs, P=0.0001). PET images demonstrated defects of HED uptake in the areas of phenol application, with no defect of MOBV uptake. CONCLUSIONS Heterogeneous sympathetic atrial denervation with phenol facilitates sustained AF.
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Affiliation(s)
- J E Olgin
- Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Hanish S, Titov S, Kovacs R. 947-113 Aprotinin Produces Ion Channels in lipid Bilayers. J Am Coll Cardiol 1995. [DOI: 10.1016/0735-1097(95)92188-b] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Vitreous fluorophotometry was used to evaluate the integrity of the blood-retinal barrier to fluorescein in hooded rats. Streptozotocin-induced diabetes mellitus caused a breakdown of this barrier within ten days. Normalization of blood glucose levels with insulin significantly reduced (P less than .005) the increased permeability. This functional microangiopathy might prove to be the earliest detectable change in the retinal circulation in experimental diabetes.
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Waltman SR, Oestrich C, Krupin T, Hanish S, Ratzan S, Santiago J, Kilo C. Quantitative vitreous fluorophotometry. A sensitive technique for measuring early breakdown of the blood-retinal barrier in young diabetic patients. Diabetes 1978; 27:85-7. [PMID: 624444 DOI: 10.2337/diab.27.2.85] [Citation(s) in RCA: 80] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Vitreous and aqueous humor fluorescein concentrations were measured one hour after graded intravenous fluorescein was given to 20 juvenile diabetics, ages 20 to 40, with and without retinopathy, and to 12 controls of similar age. Vitreous fluorescein concentrations were significantly higher in diabetics, indicating breakdown of the blood-retinal barrier. Mean vitreous fluorescein values were 10.66 +/- 0.65 for the diabetics and 4.28 +/- 0.37 ng./ml. for the controls. Breakdown of the blood-retinal barrier was also confirmed in diabetics under the age of 20 without retinopathy. The blood-aqueous barrier was similarly altered in diabetics. Vitreous fluorophotometry quantitatively measures breakdown of the blood-retinal barrier, possibly the earliest detectable ocular vascular abnormality in juvenile diabetic patients.
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