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Ragni MV, Callis J, Daoud N, Hu B, Manuel M, Santos J, Schwartz J, Friedman KD, Kouides P, Kuriakose P, Leavitt AD, Lim MY, Machin N, Recht M, Chrisentery-Singleton T. Observational cohort study of long-term outcomes of liver transplantation in haemophilia. Haemophilia 2024; 30:87-97. [PMID: 38111071 DOI: 10.1111/hae.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Gene therapy is now a reality for individuals with haemophilia, yet little is known regarding the quality-of-life impact of factor correction. As few data exist, and recognizing the analogy to liver transplantation (OLTX), we identified OLTX+ and OLTX- men in the ATHNdataset to compare post-OLTX factor VIII and IX on quality of life (QoL) by Haem-A-QoL and PROMIS-29. METHODS OLTX- were matched to OLTX+ by age, race, and haemophilia type and severity. Deidentified demographic data, including post-transplant factor levels, genotype and target joint disease were analysed by descriptive statistics. Haem-A-Qol and PROMIS-29 were compared in OLTX+ and OLTX- by student's t-test and univariate regression models. RESULTS Of 86 people with haemophilia A (HA) or haemophilia B (HB) cared for at 10 haemophilia treatment centers (HTCs), 21 (24.4%) OLTX+ and 65 (75.6%) OLTX- were identified. OLTX+ and OLTX- had a similar frequency of target joint disease (p = .806), HA genotypes, null versus non-null (p = .696), and HIV infection (p = .316). At a median 9.2 years post-OLTX, median FVIII, .63 IU/mL [IQR 0.52-0.97] and FIX, .91 IU/mL [IQR .63-1.32], Haem-A-QoL, PROMIS-29, and HOT scores were comparable. Severe HA/HB had lower post-OLTX 'dealing with haemophilia' scores (p = .022) and higher 'sports and leisure' (p = .010) and 'view of yourself' scores (p = .024) than OLTX+ non-severe participants. Non-caucasian OLTX+ had significantly lower scores in sports and leisure (p = .042), future expectations (p = .021) and total score (p = .010). CONCLUSION Nine years after OLTX, QoL is comparable to OLTX-, but significantly better in OLTX+ with severe than non-severe disease and in caucasians than non-caucasians.
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Affiliation(s)
- Margaret V Ragni
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, and Hemophilia Center of Western PA, Pittsburgh, Pennsylvania, USA
| | - Jessica Callis
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Nabil Daoud
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Brian Hu
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Matthew Manuel
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | - Jarren Santos
- American Thrombosis Hemostasis Network, Rochester, New York, USA
| | | | | | - Peter Kouides
- Mary M. Gooley Hemophilia Center, Rochester, New York, USA
| | - Philip Kuriakose
- Henry Ford Health System Bleeding and Thrombosis Center, Detroit, Michigan, USA
| | - Andrew D Leavitt
- San Francisco Hemophilia Treatment Center, University of California, San Francisco, California, USA
| | - Ming Y Lim
- Utah Center for Bleeding and Clotting Disorders, Salt Lake City, Utah, USA
| | - Nicoletta Machin
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, and Hemophilia Center of Western PA, Pittsburgh, Pennsylvania, USA
| | - Michael Recht
- American Thrombosis Hemostasis Network, Rochester, New York, USA
- Yale University Medical Center, New Haven, Connecticut, USA
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Yoshimoto-Haramura T, Hidaka M, Hasegawa K, Suzumura K, Takemura N, Hama N, Mizuno T, Nomi T, Kobayashi T, Sano K, Yokomizo H, Nitta H, Kurata M, Hasegawa Y, Nagayama M, Tani M, Fukumoto T, Ohta M, Hayashi H, Taniguchi H, Ishino S, Aihara T, Murase T, Tsuchida A, Shimamura T, Marubashi S, Kaneko J, Hara T, Matsushima H, Soyama A, Endo T, Eguchi S. National survey of hepatobiliary and pancreatic surgery in hemophilia patients in Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:385-393. [PMID: 34726831 DOI: 10.1002/jhbp.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Approximately 8300 hemophiliacs are registered in Japan, but no comprehensive reports on hepatobiliary and pancreatic surgery (HBPS) have been conducted. This report investigates the current status of HPBS in hemophilia patients in Japan. METHODS The subjects were hemophiliac patients seen between January 1 2007, and December 31 2017, at facilities participating in this study among the facilities for performing high-difficulty cases nationwide designated by the Japanese Society for HBPS. A retrospective examination of short-term outcomes in 49 cases was conducted to assess patient background, disease, surgical procedure, and complications. RESULTS The types of hemophilia were A: 43 cases, B: four cases, and von Willebrand disease: two cases (hemophilia severity: mild 32, moderate seven, severe 10). The target malignant diseases for surgery were hepatocellular carcinoma (HCC) in 20 cases, intrahepatic cholangiocellular carcinoma (CCC) in four cases, combined HCC-CCC in two cases, hilar CCC in two cases, and pancreatic cancer in four cases. As for the surgical procedure, limited resection (subsegmentectomy and partial hepatectomy) was performed in 16 cases of HCC even with normal liver function tests. Pancreaticoduodenectomy and distal pacreatectomy were performed for pancreatic cancers as in the standard procedure. Postoperative complications were postoperative bleeding in two cases after hepatectomy and one after pancreatectomy in one case. When compared with Japanese National Clinical Data base, the complication rates after hepatectomy and pancreatectomy were not conspicuous in hemophilic patients. CONCLUSIONS As long as they are performed in qualified centers, complication rate is not increased in hemophilic patients undergoing HBPS.
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Affiliation(s)
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Kazuhiro Suzumura
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuyuki Takemura
- Department of Surgery National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoki Hama
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeo Nomi
- Department of Surgery, Nara Medical University, Kashihara-shi, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Itabashi-Ku, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Masanao Kurata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Minoru Nagayama
- Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta Tsukiniwa-Cho, Otsu, Japan
| | - Takumi Fukumoto
- Department of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Departments of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Hironori Hayashi
- Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Hiroki Taniguchi
- Department of Surgery, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Shinichiro Ishino
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsukasa Aihara
- Department of Surgery, Meiwa Hospital, Nishinomiya, Japan
| | - Takaaki Murase
- Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tsuyoshi Shimamura
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Takanobu Hara
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hajime Matsushima
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoyuki Endo
- Department of Hematology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Isfordink CJ, van Erpecum KJ, van der Valk M, Mauser-Bunschoten EP, Makris M. Viral hepatitis in haemophilia: historical perspective and current management. Br J Haematol 2021; 195:174-185. [PMID: 33955555 DOI: 10.1111/bjh.17438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The introduction of clotting factor concentrates has substantially improved the lives of people with clotting factor deficiencies. Unfortunately, the transmission of blood-borne viral infections through these plasma-derived products led to a huge epidemic of human immunodeficiency virus and viral hepatitis in people with haemophilia (PWH). In a significant proportion of PWH exposed to these viruses, the ensuing decades-long chronic infection resulted in excess morbidity and mortality. Fortunately, developments in the safety of blood products, as well as vaccination and highly effective antiviral treatments have improved the prospects of PWH. The present article reviews the background of the viral hepatitis epidemic in PWH, the natural history of hepatitis B and C infections and their long-term management.
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Affiliation(s)
- Cas J Isfordink
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien P Mauser-Bunschoten
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Eguchi S, Soyama A, Hara T, Hidaka M, Ono S, Adachi T, Hamada T, Kugiyama T, Ito S, Kanetaka K, Maekawa T, Sekino M, Hara T, Nagai K, Miyazaki Y. Packing procedure effective for liver transplantation in hemophilic patients with HIV/HCV coinfection. Surg Today 2020; 50:1314-1317. [PMID: 32572584 DOI: 10.1007/s00595-020-02051-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/17/2020] [Indexed: 01/23/2023]
Abstract
We herein report an effective procedure for liver transplantation (LT) for severe cirrhotic patients with hemophilia. Three hemophilic patients suffering from liver cirrhosis due to human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection underwent deceased donor LT in our institute. Basic clotting parameters were measured and evaluated during LT to determine the optimal packing procedure. All patients were treated with a gauze packing procedure to ensure stable hemostasis in relation to hemophilia during the peri-transplant period. The graft function of all patients recovered well upon gauze removal (depacking) procedure and the patients were finally discharged to home. The administration of clotting factor was discontinued on day 3 after deceased donor LT. No infectious complications occurred in any of the 3 patients. This technique could be an option for achieving successful LT in these patients. Cooperation between transplant surgeons and anesthesiologists can make this challenging operation possible.
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Affiliation(s)
- Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takanobu Hara
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinichiro Ono
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Hamada
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tota Kugiyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sinichiro Ito
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuji Maekawa
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Motohiro Sekino
- Intensive Care Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Intensive Care Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasushi Miyazaki
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
- Department of Hematology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Shibata R, Orii R, Ako R. Anesthesia management of arthroscopic ankle arthrodesis for a hemophilia patient after living-donor liver transplantation. Intractable Rare Dis Res 2019; 8:56-59. [PMID: 30881860 PMCID: PMC6409122 DOI: 10.5582/irdr.2018.01127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hemophilia is an X-linked recessive inherited coagulation disorder. We report the anesthesia management of a hemophilia patient who underwent arthroscopic ankle arthrodesis after living-donor liver transplantation due to cirrhosis. The 35-year-old male patient with hemophilia B was diagnosed with cirrhosis due to hepatitis C virus at the age of 23 years and underwent biologically-related partial liver transplantation at the age of 29 years. As a result, the activity of factor IX activity became normal and blood product treatment became unnecessary, but the patient required long-term immunosuppression. Perioperative coagulation factor activity monitoring was performed and an immunosuppressive drug that had been preoperatively administered were continued. General anesthesia was administered by inhalation. There was no significant fluctuation in perioperative factor IX activity. This case illustrates that even in patients with hemophilia B after living-donor liver transplantation undergoing an orthopedic surgical procedure, anesthesia management can safely be performed without perioperative coagulation factor replacement.
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Affiliation(s)
- Reiko Shibata
- Department of Anesthesia, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Address correspondence to:Dr. Reiko Shibata, Department of Anesthesia, Research Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo 108-8639, Japan. E-mail:
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Ragni MV, Humar A, Stock PG, Blumberg EA, Eghtesad B, Fung JJ, Stosor V, Nissen N, Wong MT, Sherman KE, Stablein DM, Barin B. Hemophilia Liver Transplantation Observational Study. Liver Transpl 2017; 23:762-768. [PMID: 27935212 PMCID: PMC5449207 DOI: 10.1002/lt.24688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/20/2016] [Indexed: 01/13/2023]
Abstract
Hepatitis C virus (HCV) infection is the leading cause of liver disease in hemophilia patients. In those with human immunodeficiency virus (HIV)/HCV coinfection, the rate of liver disease progression is greater than in HCV monoinfected individuals. Despite antiretroviral therapy, which slows HCV liver disease progression, some require transplantation. Whether transplant outcomes are worse in hemophilic (H) rather than nonhemophilic (NH) candidates is unknown. In order to determine rates and predictors of pretransplant and posttransplant survival, we conducted a retrospective observational study using United Network for Organ Sharing national transplant registry data, comparing HCV+ H and NH candidates. We identified 2502 HCV+ liver transplant candidates from 8 US university-based transplant centers, between January 1, 2004 to December 31, 2010, including 144 HIV+ (6%) and 2358 HIV-; 36 H (1%) and 2466 NH; 1213 (48%) transplanted and 1289 not transplanted. Other than male predominance and younger age, each were P < 0.001. Baseline data were comparable between H and NH. In univariate analysis, 90-day pretransplant mortality was associated with higher baseline Model for End-Stage Liver Disease (MELD; hazard ratio [HR] = 1.15; P < 0.001), lower baseline platelet count (HR = 0.9 per 25,000/µL; P = 0.04), and having HIV/HCV+ hemophilia (P = 0.003). In multivariate analysis, pretransplant mortality was associated with higher MELD (P < 0.001) and was significantly greater in HIV+ than HIV- groups (P = 0.001). However, it did not differ between HIV+ H and NH (HR = 1.7; P = 0.36). Among HIV/HCV+, posttransplant mortality was similar between H and NH, despite lower CD4 in H (P = 0.04). In conclusion, this observational study confirms that hemophilia per se does not have a specific influence on transplant outcomes and that HIV infection increases the risk of mortality in both H and NH patients. Liver Transplantation 23 762-768 2017 AASLD.
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Affiliation(s)
- Margaret V. Ragni
- Division Hematology/Oncology, University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh, PA
| | - Abhinav Humar
- Division of Transplant Surgery, Starzl Transplant Institute, University of Pittsburgh
| | - Peter G. Stock
- Division of Transplant Surgery, University of California, San Francisco, CA
| | - Emily A. Blumberg
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bijan Eghtesad
- Transplant Center and Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - John J. Fung
- Transplant Center and Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Nicholas Nissen
- Division Transplant Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael T. Wong
- Division of Transplant Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Kenneth E. Sherman
- Division of Digestive Disorders, University of Cincinnati, Cincinnati OH
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