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Hashem M, Medhat MA, Abdeltawab D, Makhlouf NA. Expanding the liver donor pool worldwide with hepatitis C infected livers, is it the time? World J Transplant 2024; 14:90382. [DOI: 10.5500/wjt.v14.i2.90382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/29/2024] [Accepted: 04/12/2024] [Indexed: 06/13/2024] Open
Abstract
Liver transplantation (LT) provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma. Despite the increasing number of liver transplants performed each year, the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and mortality. Living donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT candidates. Nevertheless, further strategies can be implemented to increase the pool of potential donors in deceased donor LT, such as reducing the rate of organ discards. Utilizing hepatitis C virus (HCV) seropositive liver grafts is one of the expanded donor organ criteria. A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative recipients. Direct-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in transplantation. The American Society of Transplantation advises against performing transplants from HCV-infected liver donors (D+) into HCV-negative recipient (R-) unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such transplants. Proper selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is important. National and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.
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Affiliation(s)
- Mai Hashem
- Fellow of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515, Egypt
| | - Mohammed A Medhat
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Doaa Abdeltawab
- Department of Tropical Medicine and Gastroenterology, Al-Rajhi Liver Hospital, Assiut University, Assiut 71515, Egypt
| | - Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Elbeshbeshy H, Modi N, Patel T, Matthews I, Kampert T, Lee J, Okeke R, Caliskan Y, Fleetwood V, Varma C, Gabris B, Bastani B, Abu Al Rub F, Guenette A, Befeler A, Agbim U, Desai R, Alsabbagh E, Qureshi K, Schnitzler M, Lentine KL, Randall HB, Nazzal M. Outcomes of kidney, liver, and simultaneous liver and kidney transplants from hepatitis c infected donors to hepatitis c naïve recipients: A large single center experience. Clin Transplant 2024; 38:e15161. [PMID: 37842872 DOI: 10.1111/ctr.15161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND With the introduction of direct-acting antiviral therapies (DAAs), the non-use rate of hepatitis C virus (HCV)-positive donor organs (D+) has decreased significantly. We present the donor, recipient, and transplant allograft characteristics, along with recipient outcomes, in one of the largest cohorts of HCV-D+ transplants into HCV-naïve recipients (R-). METHODS Charts of HCV D+/R- kidney (KT), liver (LT), and simultaneous liver-kidney (SLKT) transplant recipients between January 2019 and July 2022 were reviewed. Primary outcomes of interest included waitlist times and 1-year graft failure. Secondary outcomes included hospital and intensive care unit length of stay, post-transplant complications, effectiveness of DAA therapy, and characteristics of patients who relapsed from initial DAA therapy. RESULTS Fifty-five HCV D+/R- transplants at our center [42 KT (26 nucleic acid testing positive [NAT+], 16 NAT-), 12 LT (eight NAT+, four NAT-), and one SLKT (NAT+)] had a median waitlist time of 69 days for KT, 87 days for LT, and 15 days for SLKT. There were no graft failures at 1 year. All viremic recipients were treated with a 12-week course of DAAs, of which 100% achieved end of treatment response (EOTR)-85.7% (n = 30) achieved sustained virologic response (SVR) and 14.3% relapsed (n = 5; four KT, one LT). All relapsed recipients were retreated and achieved SVR. The most common post-transplantation complications include BK virus infection (n = 9) for KT and non-allograft infections (n = 4) for LT. CONCLUSIONS Our study has demonstrated no graft failures or recipient deaths at 1 year, and despite a 14.3% relapse rate, we achieved 100% SVR. Complications rates of D+/R- appeared comparable to national D-/R- complication rates. Further studies comparing D+/R- to D-/R- outcomes are needed.
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Affiliation(s)
- Hany Elbeshbeshy
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Neal Modi
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Twinkle Patel
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Ian Matthews
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Timothy Kampert
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jaenic Lee
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Raymond Okeke
- Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Yasar Caliskan
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Vidyaratna Fleetwood
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Chintalapati Varma
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Brittney Gabris
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Bahar Bastani
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Fadee Abu Al Rub
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Alexis Guenette
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Alex Befeler
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Uchenna Agbim
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Roshani Desai
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Eyad Alsabbagh
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Kamran Qureshi
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Mark Schnitzler
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Henry B Randall
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Mustafa Nazzal
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
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Torres-Díaz JA, Jasso-Baltazar EA, Toapanta-Yanchapaxi L, Aguirre-Valadez J, Martínez-Matínez L, Sánchez-Cedillo A, Aguirre-Villarreal D, García-Juárez I. Hepatitis C virus-positive donors in HCV-negative recipients in liver transplantation: Is it possible in Mexico? REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:392-403. [PMID: 38097433 DOI: 10.1016/j.rgmxen.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/30/2023] [Indexed: 01/01/2024]
Abstract
Hepatitis C virus (HCV) infection is a worldwide public health problem associated with significant morbidity and mortality. In the context of liver transplantation, the demand for organs continues to exceed the supply, prompting the consideration of using organs from HCV-positive donors in HCV-negative recipients. The introduction of direct-acting antivirals (DAAs), which have demonstrated great efficacy in eradicating the virus, has made transplantation of organs from donors with HCV infection possible. The present article provides a brief review of the current evidence on the use of organs from HCV-infected patients.
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Affiliation(s)
- J A Torres-Díaz
- Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E A Jasso-Baltazar
- Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - L Toapanta-Yanchapaxi
- Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Departamento de Gastroenterología, Hospital Ángeles Pedregal, Mexico City, Mexico
| | - J Aguirre-Valadez
- Departamento de Gastroenterología, Hospital Ángeles Pedregal, Mexico City, Mexico
| | - L Martínez-Matínez
- Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Sánchez-Cedillo
- Departamento de trasplante, Hospital General de México, Mexico City, Mexico
| | - D Aguirre-Villarreal
- Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - I García-Juárez
- Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Awan RU, Rashid S, Nabeel A, Samant H. Fibrosing Cholestatic Hepatitis Masquerading Acute Rejection in Hepatitis C Virus-Positive Donor Liver Graft. ACG Case Rep J 2023; 10:e01058. [PMID: 37235000 PMCID: PMC10208711 DOI: 10.14309/crj.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Fibrosing cholestatic hepatitis is a rare complication that manifests in patients receiving organ transplantation from seropositive (hepatitis C virus or hepatitis B virus) donors. We report a rare case of such a phenomenon in the immediate post-transplant period.
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Affiliation(s)
| | - Shazia Rashid
- Department of Gastroenterology and Hepatology, Louisiana State University, Shreveport, LA
| | - Ambreen Nabeel
- Department of Medicine, Ochsner Rush Health System, Meridian, MS
| | - Hrishikesh Samant
- Department of Gastroenterology and Hepatology, Ochsner Health System, New Orleans, LA
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Snyder HS, Wiegel JJ, Khalil K, Summers BB, Tan T, Jonchhe S, Kaiser TE. A systematic review of direct acting antiviral therapies in hepatitis C virus-negative liver transplant recipients of hepatitis C-viremic donors. Pharmacotherapy 2022; 42:905-920. [PMID: 36373198 DOI: 10.1002/phar.2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
The introduction of safe and highly effective direct acting antivirals (DAAs) has significantly improved hepatitis C virus (HCV) treatment outcomes after transplant. The solid organ transplant community has sought to identify strategies aimed at increasing the donor pool including the utilization of HCV-viremic organs in HCV-negative recipients. We will review the existing literature to evaluate DAA use for the treatment of HCV viremia post-liver transplant in patients who receive HCV-viremic allografts. A PubMed search was conducted and references for each study were also reviewed to identify additional articles. Randomized controlled trials, cohort studies, case series, and case reports were included if: published in English language, evaluated DAA treatment outcomes after liver only or simultaneous liver-kidney transplantation with HCV-viremic allografts in HCV-negative recipients, and had full-text article availability. Our review included 16 studies and 2 case reports. The majority of liver transplant recipients were treated with a pangenotypic DAA for 12 weeks with a heterogeneous median time to initiation (range 1.7-118 days). Sustained virologic response was assessed in 253 liver transplant patients with 99.6% achieving cure with minimal DAA-attributed adverse drug events. There were 23 reported episodes of rejection, 12 deaths, and 1 graft loss among all studies. Treatment with DAA after transplantation of HCV-viremic livers into HCV-negative recipients appears to be safe and effective; however, long-term outcomes remain unknown. Transplant pharmacists play a key role in the development of center-specific protocols to optimize post-transplant outcomes in this unique patient population.
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Affiliation(s)
- Heather S Snyder
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA
| | - Joshua J Wiegel
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin, USA
| | - Karen Khalil
- NYU Langone Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Bryant B Summers
- Department of Pharmacy, Henry Ford Health System, Detroit, Michigan, USA
| | - Teresa Tan
- Department of Pharmaceutical Services, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Srijana Jonchhe
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
| | - Tiffany E Kaiser
- Department of Medicine, Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA
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Willingness of Kidney and Liver Transplant Candidates to Receive HCV-Infected Organs. J Surg Res 2022; 278:342-349. [PMID: 35667277 DOI: 10.1016/j.jss.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Transplantation of organs exposed to hepatitis C virus (HCV) into uninfected patients has yielded excellent outcomes and more widespread adoption may lead to fewer discarded organs and more transplants. Patient perceptions may shed light on acceptability and likely the uptake of HCV+/HCV- transplantation, gaps in understanding, and perceived benefits/risks. METHODS We surveyed 435 uninfected kidney and liver transplant candidates at four centers about their attitude towards HCV-infected organs. RESULTS The percentage of patients willing to accept HCV-infected organs increased from 58% at baseline, to 86% following education about HCV, direct-acting antiviral agents (DAAs), and HCV+/HCV- transplantation benefits/risks. More willingness to accept an organ from an intravenous drug user (P < 0.001), age >50 y old (P = 0.02), longer waiting time (P = 0.02), more trust in the transplant system (P = 0.03), and previous awareness of DAAs (P = 0.04) were associated with higher willingness to accept an HCV-infected organ. The most important reasons for accepting an HCV-infected organ were a decrease in waiting time (65%), lower mortality and morbidity risk while on the waiting list (63%), effectiveness of DAAs (54%), and a quicker return to higher functional status (51%). CONCLUSIONS Presenting patients with information about HCV+/HCV- transplantation in small doses that are calibrated to account for varying levels of health and numerical literacy is recommended.
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Kuntzen C, Bagha Z. The Use of Hepatitis C Virus-Positive Organs in Hepatitis C Virus-Negative Recipients. Clin Liver Dis 2022; 26:291-312. [PMID: 35487612 DOI: 10.1016/j.cld.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use of hepatitis C virus (HCV) -positive organs in HCV-negative recipients with posttransplant antiviral treatment has increasingly been studied since the introduction of new direct-acting antivirals. This article reviews existing experience in liver and kidney transplant. Fifteen studies with 218 HCV D+/R- liver transplants, with 182 from viremic donors, show a sustained viral response for 12 weeks (SVR12) rate of 99.5%. Nine studies involving 204 HCV donor-positive recipient-negative kidney transplant recipients had an SVR12 rate of 99.5%. Complications are infrequent. Preemptive treatment in kidney transplant of for only 4 weeks or even 4 days showed surprising success rates.
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Affiliation(s)
- Christian Kuntzen
- Hofstra University at Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Zohaib Bagha
- Hofstra University at Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
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8
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Richter BI, Parent B, Lonze BE. The Moral Necessity to Increase Access to HCV+ Transplants With Early Treatment for HCV-naive Patients. Transplantation 2022; 106:236-238. [PMID: 34342960 DOI: 10.1097/tp.0000000000003898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Benjamin I Richter
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY
| | - Brendan Parent
- Division of Medical Ethics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Bonnie E Lonze
- Transplant Institute, New York University Langone Health, New York, NY
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Clinical and Financial Implications of 2 Treatment Strategies for Donor-derived Hepatitis C Infections. Transplant Direct 2021; 7:e762. [PMID: 34514117 PMCID: PMC8425828 DOI: 10.1097/txd.0000000000001222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022] Open
Abstract
Transplanting hepatitis C viremic donor organs into hepatitis C virus (HCV)-negative recipients is becoming increasingly common; however, practices for posttransplant direct-acting antiviral (DAA) treatment vary widely. Protracted insurance authorization processes for DAA therapy often lead to treatment delays.
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Raasikh T, Jamali T, Flores A, Cotton RT, Ramanathan V, Tan HP, Hernaez R. Systematic review: hepatitis C viraemic allografts to hepatitis C-negative recipients in solid organ transplantation. Aliment Pharmacol Ther 2021; 54:571-582. [PMID: 34265111 DOI: 10.1111/apt.16508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/14/2021] [Accepted: 06/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given the success of direct-acting antivirals (DAAs) in treating hepatitis C (HCV), interest is growing in utilizing solid organs from allografts with active HCV to expand donor availability. AIM To review post-transplant outcomes and patient survival in HCV-negative recipients receiving solid organ transplants (SOT) from viraemic, that is, HCV+/NAT+ (nucleic acid testing) allografts. METHODS A literature search was conducted on PubMed and EMBASE from 01/01/2007 to 4/17/2021 for articles matching eligibility criteria. Two authors independently screened titles and abstracts. Disagreements were solved by a third independent reviewer. Methodological quality assessment was done using a modified Newcastle-Ottawa scale (NOS). Data synthesis was done qualitatively using median, ranges and percentages. RESULTS Thirty-five studies were included (or 852 SOTs): 343 kidney, 233 heart, 204 liver, and 72 lung transplants from viraemic allografts. Of the recipients eligible for sustained virological response at 12 weeks (SVR12) calculation, 100% achieved cure from HCV. No deaths/graft failures were reported to be related to HCV transmission. Seven SOT recipients had viral relapse, with all seven patients treated successfully. Four patients developed fibrosing cholestatic hepatitis with complete resolution post-treatment. CONCLUSIONS Transplanting viraemic organs into uninfected individuals can become the standard of care for patients who do not have contraindications to DAAs.
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Affiliation(s)
- Taaj Raasikh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Taher Jamali
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Avegail Flores
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ronald T Cotton
- Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Venkat Ramanathan
- Division of Nephrology and Solid-Organ Transplantation, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Henkie P Tan
- Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, VA Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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