1
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McDermott C, Ertreo M, Jha R, Ko J, Fernandez S, Desale S, Fishbein T, Satoskar R, Winslow E, Smith C, Hsu CC. Risk factors for bleeding hepatocellular adenoma in a United States cohort. Liver Int 2022; 42:224-232. [PMID: 34687281 DOI: 10.1111/liv.15087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/20/2021] [Accepted: 10/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Known risk factors for hepatocellular adenoma (HCA) bleeding are size >5 cm, growth rate, visible vascularity, exophytic lesions, β-catenin and Sonic Hedgehog activated HCAs. Most studies are based on European cohorts. The objective of this study is to identify additional risk factors for HCA bleeding in a US cohort. METHODS Retrospective chart review was performed on patients diagnosed with HCA on magnetic resonance imaging (n = 184) at an academic tertiary institution. Clinical, pathological, and imaging data were collected. Primary outcomes measured were HCA bleeding and malignancy. Statistical analysis was performed with SAS 9.4 using Chi-Square, Fisher's exact test, sample t test, non-parametric Wilcoxon test, and logistic regression. RESULTS After excluding patients whose pathology showed focal nodular hyperplasia and non-adenoma lesions, follow-up data were available for 167 patients. 16% experienced microscopic or macroscopic bleeding and 1.2% had malignancy. HCA size predicted bleeding (P < .0001) and no patients with lesion size <1.8 cm bled. In unadjusted analysis, hepatic adenomatosis (≥10 lesions) trended towards 2.8-fold increased risk of bleeding. Of patients with a single lesion that bled, 77% bled from a lesion >5 cm. In patients with multiple HCAs that bled, 50% bled from lesions <5 cm. In patients with multiple adenomas, size (P = .001) independently predicted bleeding and hepatic steatosis trended towards increased risk of bleeding (P = .05). CONCLUSIONS In a large US cohort, size predicted increased risk of HCA bleeding while hepatic adenomatosis trended towards increased risk of bleeding. In patients with multiple HCAs, size predicted bleeding and hepatic steatosis trended toward increased risk of bleeding.
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Affiliation(s)
- Chelsea McDermott
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Marco Ertreo
- Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Reena Jha
- Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Jimin Ko
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | | | - Sameer Desale
- MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Thomas Fishbein
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Rohit Satoskar
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Emily Winslow
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Coleman Smith
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Medicine, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Christine C Hsu
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Medicine, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
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2
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Jenkins M, Satoskar R. Ascites After Liver Transplantation. Clin Liver Dis (Hoboken) 2021; 17:317-319. [PMID: 33968396 PMCID: PMC8087930 DOI: 10.1002/cld.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Michelle Jenkins
- Transplant InstituteMedStar Georgetown University HospitalWashingtonDC
| | - Rohit Satoskar
- Transplant InstituteMedStar Georgetown University HospitalWashingtonDC
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3
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Hawksworth J, Llore N, Holzner ML, Radkani P, Meslar E, Winslow E, Satoskar R, He R, Jha R, Haddad N, Fishbein T. Robotic Hepatectomy Is a Safe and Cost-Effective Alternative to Conventional Open Hepatectomy: a Single-Center Preliminary Experience. J Gastrointest Surg 2021; 25:825-828. [PMID: 33001352 DOI: 10.1007/s11605-020-04793-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/06/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Jason Hawksworth
- MedStar Georgetown Transplant Institute, 2 PHC, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA. .,Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Nathaly Llore
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Matthew L Holzner
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Pejman Radkani
- MedStar Georgetown Transplant Institute, 2 PHC, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
| | - Erin Meslar
- MedStar Georgetown Transplant Institute, 2 PHC, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
| | - Emily Winslow
- MedStar Georgetown Transplant Institute, 2 PHC, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
| | - Rohit Satoskar
- MedStar Georgetown Transplant Institute, 2 PHC, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
| | - Ruth He
- Lombardi Cancer Center, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Reena Jha
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Nadim Haddad
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Thomas Fishbein
- MedStar Georgetown Transplant Institute, 2 PHC, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC, 20007, USA
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4
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Safren L, McNamara M, Bekeny J, Huang J, Satoskar R, Schlomp CIV, De Marchi L, Srichai-Parsia M. ASSOCIATION OF INTRAPULMONARY VASCULAR DILATATIONS IN LIVER TRANSPLANT CANDIDATES WITH POST-TRANSPLANT MORTALITY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32401-3] [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: 11/25/2022]
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5
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Thompson J, Jones N, Al‐Khafaji A, Malik S, Reich D, Munoz S, MacNicholas R, Hassanein T, Teperman L, Stein L, Duarte‐Rojo A, Malik R, Adhami T, Asrani S, Shah N, Gaglio P, Duddempudi A, Borg B, Jalan R, Brown R, Patton H, Satoskar R, Rossi S, Parikh A, ElSharkawy A, Mantry P, Sher L, Wolf D, Hart M, Landis C, Wigg A, Habib S, McCaughan G, Colquhoun S, Henry A, Bedard P, Landeen L, Millis M, Ashley R, Frank W, Henry A, Stange J, Subramanian R. Extracorporeal cellular therapy (ELAD) in severe alcoholic hepatitis: A multinational, prospective, controlled, randomized trial. Liver Transpl 2018; 24:380-393. [PMID: 29171941 PMCID: PMC5873437 DOI: 10.1002/lt.24986] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [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: 05/23/2017] [Revised: 09/30/2017] [Accepted: 10/10/2017] [Indexed: 12/14/2022]
Abstract
Severe alcoholic hepatitis (sAH) is associated with a poor prognosis. There is no proven effective treatment for sAH, which is why early transplantation has been increasingly discussed. Hepatoblastoma-derived C3A cells express anti-inflammatory proteins and growth factors and were tested in an extracorporeal cellular therapy (ELAD) study to establish their effect on survival for subjects with sAH. Adults with sAH, bilirubin ≥8 mg/dL, Maddrey's discriminant function ≥ 32, and Model for End-Stage Liver Disease (MELD) score ≤ 35 were randomized to receive standard of care (SOC) only or 3-5 days of continuous ELAD treatment plus SOC. After a minimum follow-up of 91 days, overall survival (OS) was assessed by using a Kaplan-Meier survival analysis. A total of 203 subjects were enrolled (96 ELAD and 107 SOC) at 40 sites worldwide. Comparison of baseline characteristics showed no significant differences between groups and within subgroups. There was no significant difference in serious adverse events between the 2 groups. In an analysis of the intent-to-treat population, there was no difference in OS (51.0% versus 49.5%). The study failed its primary and secondary end point in a population with sAH and with a MELD ranging from 18 to 35 and no upper age limit. In the prespecified analysis of subjects with MELD < 28 (n = 120), ELAD was associated with a trend toward higher OS at 91 days (68.6% versus 53.6%; P = .08). Regression analysis identified high creatinine and international normalized ratio, but not bilirubin, as the MELD components predicting negative outcomes with ELAD. A new trial investigating a potential benefit of ELAD in younger subjects with sufficient renal function and less severe coagulopathy has been initiated. Liver Transplantation 24 380-393 2018 AASLD.
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Affiliation(s)
| | | | | | - Shahid Malik
- University of Pittsburgh Medical CenterPittsburghPA
| | | | | | | | - Tarek Hassanein
- Southern California Gastrointestinal and Liver CentersCoronadoCA
| | | | | | | | - Raza Malik
- Beth Israel Deaconess Medical CenterBostonMA
| | | | | | | | | | | | - Brian Borg
- University of Mississippi Medical CenterJacksonMS
| | | | - Robert Brown
- Columbia University Medical CenterNew York CityNY
| | - Heather Patton
- University of California, San Diego Medical CenterSan DiegoCA
| | | | | | - Amay Parikh
- Rutgers University Medical CenterNew BrunswickNJ
| | - Ahmed ElSharkawy
- Queen Elizabeth Hospital/University of BirminghamBirminghamUnited Kingdom
| | | | - Linda Sher
- University of Southern CaliforniaLos AngelesCA
| | | | | | | | - Alan Wigg
- Flinders Medical Centre, AdelaideBedford ParkSouth AustraliaAustralia
| | | | | | | | | | | | | | | | | | | | | | - Jan Stange
- Vital Therapies Inc.San DiegoCA,Center for Internal Medicine, University of RostockRostockGermany
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6
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Ordway SM, Singla MB, Young PE, Satoskar R, Kwok RM. Factors influencing decisions about a career in hepatology: A survey of gastroenterology fellows. Hepatol Commun 2018; 1:347-353. [PMID: 29404464 PMCID: PMC5721393 DOI: 10.1002/hep4.1040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/13/2017] [Revised: 03/26/2017] [Accepted: 04/12/2017] [Indexed: 12/03/2022] Open
Abstract
Despite an unmet need for hepatologists in the United States, every year transplant hepatology (TH) fellowship positions remain unfilled. To address this, we investigated factors that influence trainee decisions about pursuing a career in hepatology. We invited current gastroenterology (GI) and TH fellows from all Accreditation Council for Graduate Medical Education‐accredited programs for the academic year 2014‐2015 to participate in an online survey about factors influencing decisions to train in hepatology. The same paper‐based survey was distributed at a nationally recognized GI board review course. The survey was completed by 180 participants of which 91% were current GI or TH fellows and 24% were not aware of the pilot 3‐year combined GI and TH training program. A majority of respondents (57%) reported that a shorter time (3 versus 4 years) to become board certification eligible would influence their decisions to pursue TH. The most common reasons for not pursuing hepatology were less endoscopy time (67%), additional length of training (64%), and lack of financial compensation (44%). Personal satisfaction (66%), management of complex multisystem disease (60%), and long‐term relationships with patients (57%) were the most attractive factors. Sixty‐one percent of participants reported having a mentor, and 94% of those with mentors reported that their mentors influenced their career decisions. Conclusion: We have identified several factors that affect fellows' decision to pursue TH. Shorter training, increased financial compensation, and increased endoscopy time are potentially modifiable factors that may increase the number of trainees seeking careers in hepatology and help alleviate the deficit of hepatologists. (Hepatology Communications 2017;1:347–353)
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Affiliation(s)
- Sarah M Ordway
- Department of Internal Medicine Walter Reed National Military Medical Center Bethesda MD
| | - Manish B Singla
- Division of Gastroenterology/Hepatology, Department of Internal MedicineWalter Reed National Military Medical Center Bethesda MD
| | - Patrick E Young
- Division of Gastroenterology/Hepatology, Department of Internal MedicineWalter Reed National Military Medical Center Bethesda MD
| | - Rohit Satoskar
- Medstar Georgetown Transplant Institute Medstar Georgetown University Washington DC
| | - Ryan M Kwok
- Division of Gastroenterology/Hepatology, Department of Internal MedicineWalter Reed National Military Medical Center Bethesda MD
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7
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Nookala AU, Crismale J, Schiano T, Te H, Ahn J, Robertazzi S, Rodigas C, Satoskar R, Kc M, Hassan M, Smith C. Direct-acting antiviral regimens are safe and effective in the treatment of hepatitis C in simultaneous liver-kidney transplant recipients. Clin Transplant 2018; 32:e13198. [PMID: 29323755 DOI: 10.1111/ctr.13198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/07/2018] [Indexed: 01/17/2023]
Abstract
Hepatitis C (HCV) remains the single most common etiology of end-stage liver disease leading to simultaneous liver/kidney transplant (SLKT) and has worse post-transplant survival compared to non-HCV patients. We aim to assess the effectiveness and tolerance of the all-oral direct-acting antiviral (DAA) agents with or without ribavirin (RBV) in the treatment of HCV recurrence post-SLKT. Thirty-four patients were studied retrospectively, composed predominantly of treatment-naïve (73.5%) non-Caucasian (61.8%) males (82.4%) infected with genotype 1a (64.7%). 94.1% reached a sustained virologic response (SVR) after 24 weeks (32/34 patients), without difference between 12 and 24 weeks of therapy. 64.7% had no clinical side effects. Three deaths occurred, all unrelated to treatment. One patient had liver rejection; tacrolimus was increased and prednisone was initiated while HCV treatment was continued and the patient ultimately achieved SVR. No liver graft losses. No kidney rejection or losses. We demonstrated that DAA combinations with or without RBV result in a remarkable SVR rate and tolerated in the majority of the studied SLKT patients. It is safe to wait to treat until post-kidney transplant and therefore increase the donor pool for these patients. Our cohort is ethnically diverse, making our results generalizable.
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Affiliation(s)
| | | | | | - Helen Te
- University of Chicago Medicine, Chicago, IL, USA
| | - Joseph Ahn
- Oregon Health and Sciences University, Portland, OR, USA
| | | | - Colleen Rodigas
- MedStar Georgetown Transplant Institute, Washington, DC, USA
| | - Rohit Satoskar
- MedStar Georgetown Transplant Institute, Washington, DC, USA
| | - Mandip Kc
- University of Minnesota, Minneapolis, MN, USA
| | | | - Coleman Smith
- MedStar Georgetown Transplant Institute, Washington, DC, USA
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8
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Morales AL, Liriano-Ward L, Tierney A, Sang M, Lalos A, Hassan M, Nair V, Schiano T, Satoskar R, Smith C. Ledipasvir/sofosbuvir is effective and well tolerated in postkidney transplant patients with chronic hepatitis C virus. Clin Transplant 2017; 31. [PMID: 28239909 DOI: 10.1111/ctr.12941] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 12/16/2022]
Abstract
Patients with end-stage renal diseases on hemodialysis have a high prevalence of hepatitis C infection (HCV). In most patients, treatment for HCV is delayed until postrenal transplant. We assessed the effectiveness and tolerance of ledipasvir/sofosbuvir (LDV/SOF) in 32 postkidney transplant patients infected with HCV. The group was composed predominantly of treatment-naïve (75%) African American (68.75%) males (75%) infected with genotype 1a (62.5%). Most patients received a deceased donor kidney graft (78.1%). A 96% sustained viral response (SVR) was reported (27/28 patients). One patient relapsed. One patient with baseline graft dysfunction developed borderline rejection. No graft loss was reported. Six HIV-coinfected patients were included in our analysis. Five of these patients achieved SVR 12. There were four deaths, and one of the deaths was in the HIV group. None of the deaths were attributed to therapy. Coinfected patients tolerated therapy well with no serious adverse events. Serum creatinine remained stable at baseline, end of therapy, and last follow-up, (1.351±.50 mg/dL; 1.406±.63 mg/dL; 1.290±.39 mg/dL, respectively). In postkidney transplant patients with HCV infection with or without coinfection with HIV, a combination of LDV/SOF was well tolerated and effective.
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Affiliation(s)
- Amilcar L Morales
- Transplant Hepatology Service, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Luz Liriano-Ward
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amber Tierney
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Michelle Sang
- Transplant Hepatology Service, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Alexander Lalos
- Transplant Hepatology Service, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Mohamed Hassan
- Division of Gastroenterology Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Vinay Nair
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas Schiano
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rohit Satoskar
- Transplant Hepatology Service, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Coleman Smith
- Transplant Hepatology Service, Medstar Georgetown University Hospital, Washington, DC, USA
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9
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Kwok RM, Ahn J, Schiano TD, Te HS, Potosky DR, Tierney A, Satoskar R, Robertazzi S, Rodigas C, Lee Sang M, Wiegel J, Patel N, Gripshover J, Hassan MA, Branch A, Smith CI. Sofosbuvir plus ledispasvir for recurrent hepatitis C in liver transplant recipients. Liver Transpl 2016; 22:1536-1543. [PMID: 27543748 DOI: 10.1002/lt.24614] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 06/03/2016] [Accepted: 08/08/2016] [Indexed: 12/14/2022]
Abstract
Hepatitis C virus (HCV) recurrence after liver transplantation (LT) is associated with worse outcomes. The combination of ledipasvir (LDV) and sofosbuvir (SOF) has been approved for HCV treatment after LT, but there are limited data on the effectiveness and safety of LDV/SOF in the "real-world" setting. This multicenter study is the largest report to date on the effectiveness and safety of LDV/SOF in the post-LT setting. A total of 204 patients (72% male, 68% Caucasian, 66% genotype [GT] 1a, 21% METAVIR F3-F4, 49% treatment-experienced) were treated with LDV/SOF. The mean duration from LT to treatment initiation was 4.8 years. The overall sustained virological response rate 12 weeks after completion of therapy (SVR12) was 96%. Patients treated with 8 or 12 weeks of LDV/SOF without RBV experienced an SVR12 rate of 100% and 96%, respectively. Calcineurin inhibitors were used in 89% of patients, and 32% of patients underwent adjustment in immunosuppression during treatment. One episode of mild rejection, responsive to an increase in immunosuppression dosage, was observed. There was no graft loss attributed to HCV treatment. Four deaths occurred unrelated to HCV treatment, and no significant serious adverse events were documented. In conclusion, SOF and LDV with or without RBV for 8, 12, or 24 weeks in post-LT patients was effective and safe with a high SVR12 rate across a spectrum of GTs and stages of fibrosis. Liver Transplantation 22 1536-1543 2016 AASLD.
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Affiliation(s)
- Ryan M Kwok
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC.
| | - Joseph Ahn
- Oregon Health and Science University, Portland, OR
| | - Thomas D Schiano
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Mount Sinai Medical Center, New York, NY
| | - Helen S Te
- Center for Liver Diseases, Department of Medicine, The University of Chicago Medical Center, Chicago, IL
| | - Darryn R Potosky
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Amber Tierney
- University of Minnesota Medical School, Minneapolis, MN
| | - Rohit Satoskar
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC
| | - Suzanne Robertazzi
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC
| | - Colleen Rodigas
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC
| | - Michelle Lee Sang
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC
| | | | - Neal Patel
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Mount Sinai Medical Center, New York, NY
| | - Janet Gripshover
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - Andrea Branch
- Division of Liver Diseases and Recanati-Miller Transplant Institute, Mount Sinai Medical Center, New York, NY
| | - Coleman I Smith
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC
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10
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Gabrielson A, Wu Y, Wang H, Jiang J, Kallakury B, Gatalica Z, Reddy S, Kleiner D, Fishbein T, Johnson L, Island E, Satoskar R, Banovac F, Jha R, Kachhela J, Feng P, Zhang T, Tesfaye A, Prins P, Loffredo C, Marshall J, Weiner L, Atkins M, He AR. Intratumoral CD3 and CD8 T-cell Densities Associated with Relapse-Free Survival in HCC. Cancer Immunol Res 2016; 4:419-30. [PMID: 26968206 DOI: 10.1158/2326-6066.cir-15-0110] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 01/06/2016] [Indexed: 12/12/2022]
Abstract
Immune cells that infiltrate a tumor may be a prognostic factor for patients who have had surgically resected hepatocellular carcinoma (HCC). The density of intratumoral total (CD3(+)) and cytotoxic (CD8(+)) T lymphocytes was measured in the tumor interior and in the invasive margin of 65 stage I to IV HCC tissue specimens from a single cohort. Immune cell density in the interior and margin was converted to a binary score (0, low; 1, high), which was correlated with tumor recurrence and relapse-free survival (RFS). In addition, the expression of programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) was correlated with the density of CD3(+) and CD8(+) cells and clinical outcome. High densities of both CD3(+) and CD8(+) T cells in both the interior and margin, along with corresponding Immunoscores, were significantly associated with a low rate of recurrence (P = 0.007) and a prolonged RFS (P = 0.002). In multivariate logistic regression models adjusted for vascular invasion and cellular differentiation, both CD3(+) and CD8(+) cell densities predicted recurrence, with odds ratios of 5.8 [95% confidence interval (CI), 1.6-21.8] for CD3(+) and 3.9 (95% CI, 1.1-14.1) for CD8(+) Positive PD-L1 staining was correlated with high CD3 and CD8 density (P = 0.024 and 0.005, respectively) and predicted a lower rate of recurrence (P = 0.034), as well as prolonged RFS (P = 0.029). Immunoscore and PD-L1 expression, therefore, are useful prognostic markers in patients with HCC who have undergone primary tumor resection. Cancer Immunol Res; 4(5); 419-30. ©2016 AACR.
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Affiliation(s)
- Andrew Gabrielson
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Yunan Wu
- First Hospital of Hunan University of Chinese Medicine, Changsha City, Hunan Province, People's Republic of China
| | - Hongkun Wang
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Jiji Jiang
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Bhaskar Kallakury
- Department of Pathology, Georgetown University Hospital, Washington, District of Columbia
| | | | | | - David Kleiner
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Thomas Fishbein
- Medstar Transplant Institute, Georgetown University Hospital, Washington, District of Columbia
| | - Lynt Johnson
- Department of Surgery, Georgetown University Hospital, Washington, District of Columbia
| | - Eddie Island
- Medstar Transplant Institute, Georgetown University Hospital, Washington, District of Columbia
| | - Rohit Satoskar
- Medstar Transplant Institute, Georgetown University Hospital, Washington, District of Columbia
| | - Filip Banovac
- Department of Radiology, Georgetown University Hospital, Washington, District of Columbia
| | - Reena Jha
- Department of Radiology, Georgetown University Hospital, Washington, District of Columbia
| | - Jaydeep Kachhela
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Perry Feng
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Tiger Zhang
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Anteneh Tesfaye
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Petra Prins
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Christopher Loffredo
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - John Marshall
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Louis Weiner
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Michael Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia
| | - Aiwu Ruth He
- Georgetown Lombardi Comprehensive Cancer Center, Division of Hematology and Oncology, Washington, District of Columbia.
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11
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Sosin M, Nassif SR, Girlanda R, Desai CS, Satoskar R, Kallakury B, Cermak T, Fishbein T. Isolated peritoneal donor-related plasmacytoma 3 years after liver transplantation: a case report. Am J Transplant 2014; 14:472-6. [PMID: 24373189 DOI: 10.1111/ajt.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/15/2013] [Accepted: 10/19/2013] [Indexed: 01/25/2023]
Abstract
Organ transplantation carries a risk of disease transmission from donor to recipient, primarily infection or malignancy. Although donors are thoroughly screened, donor-related malignancies are reported to occur in 0.01% of solid organ transplants. Plasma cell neoplasm, to the best of our knowledge, has not been reported as a donor-transmitted malignancy in liver transplantation. We describe a liver transplant from a donor with unrecognized plasmacytoma requiring retransplantation. Three years after the first transplant a single peritoneal mass was detected on surveillance imaging and radically excised; HLA phenotyping confirmed the mass to be an isolated extra-medullary plasmacytoma of chimeric donor and recipient origin.
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Affiliation(s)
- M Sosin
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC
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12
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Satoskar R, Reau N. Potential consequences of healthcare recommendations: a focus on the U.S. Preventive Services Task Force. Hepatology 2013; 58:422-7. [PMID: 23460345 DOI: 10.1002/hep.26349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/07/2013] [Accepted: 02/15/2013] [Indexed: 12/20/2022]
Abstract
UNLABELLED Healthcare guidelines and recommendations have broad-reaching impact. They serve as the evidence to enforce medical testing by establishing a bar for standard of care through their intrinsic credibility but also by affecting reimbursement. In this article, we discuss the various organizations in the United States that develop healthcare policy and guidelines. We focus on the recent recommendations for hepatitis C virus (HCV) screening put forward by these agencies and the potential effect of these documents. Additional discussion is provided on the recent draft HCV screening recommendations provided by the United States Preventive Services Task Force (USPSTF), comparison of these to the Centers for Disease Control and Prevention (CDC) guidelines, and professional societies' response to these. CONCLUSION As written, the USPSTF recommendations may reduce physician adoption of HCV screening in the 1945-1965 birth cohort as advocated by the CDC. Conflicting guidelines may further confuse providers and the public. This will ultimately hinder recognition of chronic HCV in an otherwise easily identifiable, high prevalence group, allowing progression of disease at a time when therapeutic advances make cure a realistic opportunity for many.
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Affiliation(s)
- Rohit Satoskar
- Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA.
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13
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Hawksworth JS, Rosen-Bronson S, Island E, Girlanda R, Guerra JF, Valdiconza C, Kishiyama K, Christensen KD, Kozlowski S, Kaufman S, Little C, Shetty K, Laurin J, Satoskar R, Kallakury B, Fishbein TM, Matsumoto CS. Successful isolated intestinal transplantation in sensitized recipients with the use of virtual crossmatching. Am J Transplant 2012; 12 Suppl 4:S33-42. [PMID: 22947089 DOI: 10.1111/j.1600-6143.2012.04238.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We evaluated virtual crossmatching (VXM) for organ allocation and immunologic risk reduction in sensitized isolated intestinal transplantation recipients. All isolated intestine transplants performed at our institution from 2008 to 2011 were included in this study. Allograft allocation in sensitized recipients was based on the results of a VXM, in which the donor-specific antibody (DSA) was prospectively evaluated with the use of single-antigen assays. A total of 42 isolated intestine transplants (13 pediatric and 29 adult) were performed during this time period, with a median follow-up of 20 months (6-40 months). A sensitized (PRA ≥ 20%) group (n = 15) was compared to a control (PRA < 20%) group (n = 27) to evaluate the efficacy of VXM. With the use of VXM, 80% (12/15) of the sensitized patients were transplanted with a negative or weakly positive flow-cytometry crossmatch and 86.7% (13/15) with zero or only low-titer (≤ 1:16) DSA. Outcomes were comparable between sensitized and control recipients, including 1-year freedom from rejection (53.3% and 66.7% respectively, p = 0.367), 1-year patient survival (73.3% and 88.9% respectively, p = 0.197) and 1-year graft survival (66.7% and 85.2% respectively, p = 0.167). In conclusion, a VXM strategy to optimize organ allocation enables sensitized patients to successfully undergo isolated intestinal transplantation with acceptable short-term outcomes.
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Affiliation(s)
- J S Hawksworth
- Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
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14
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Desai AP, Reau N, Reddy KG, Te HS, Mohanty S, Satoskar R, DeVoss A, Jensen D. Persistent spontaneous bacterial peritonitis: a common complication in patients with spontaneous bacterial peritonitis and a high score in the model for end-stage liver disease. Therap Adv Gastroenterol 2012; 5:275-83. [PMID: 22973414 PMCID: PMC3437533 DOI: 10.1177/1756283x11417037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Spontaneous bacterial peritonitis (SBP) is associated with a high mortality rate. After antibiotic therapy, improvement in fluid polymorphonuclear (PMN) cell count is expected within 2 days. However, our institution recognized cases unresponsive to standard treatment. METHODS To study these recalcitrant cases, we completed a retrospective chart review of patients admitted for SBP to the University of Chicago from 2002 to 2007. SBP was defined by an ascitic PMN cell count ≥250/ml. RESULTS Of 55 patients with SBP, 15 did not show improvement in fluid PMN cell count to below 250/ml with standard treatment, leading to a prevalence of 27%. The patients with persistent SBP were younger than those with nonpersistent SBP [mean (SD) 51.80 (9.84) compared with 58.13 (8.79); p = 0.0253]. Persistent SBP had a higher serum ascites albumin gradient (SAAG) [median (Q1, Q3) 1.85 (1.50, 2.41) compared with 1.10 (0.60, 1.60)] and a higher score in the model for end-stage liver disease (MELD) [mean (SD) 27.98 (8.09) compared with 22.22 (8.10)] than nonpersistent SBP patients; p = 0.027 and p = 0.023, respectively. In addition, persistent SBP patients were more likely to have a positive ascitic fluid culture than nonpersistent SBP patients [odds ratio (OR) (95% CI) 4.33 (1.21, 15.47); p = 0.024]. Importantly, in-hospital mortality in the persistent SBP group was 40%, compared with 22.5% in the nonpersistent SBP group [OR = 2.30 (0.64, 8.19); p = 0.20]. CONCLUSIONS The risk of persistent SBP is nearly 40% in patients with MELD score >25, SAAG >1.5 or positive ascitic fluid culture. Furthermore, patients who develop persistent SBP tend to experience a higher mortality rate. This study underscores the importance of further examination of this vulnerable population.
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Affiliation(s)
- Archita P. Desai
- Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Nancy Reau
- Center for Liver Diseases, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 7120, Chicago, IL 60637, USA
| | - K. Gautham Reddy
- Section of Gastroenterology, Center for Liver Diseases, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Helen S. Te
- Section of Gastroenterology, Center for Liver Diseases, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Smruti Mohanty
- Section of Gastroenterology, Center for Liver Diseases, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Rohit Satoskar
- Georgetown Transplant Institute, Georgetown University Medical Center, Washington, DC, USA
| | - Amanda DeVoss
- Section of Gastroenterology, Center for Liver Diseases, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Donald Jensen
- Section of Gastroenterology, Center for Liver Diseases, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
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15
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Te HS, Dasgupta KA, Cao D, Satoskar R, Mohanty SR, Reau N, Millis JM, Jensen DM. Use of immune function test in monitoring immunosuppression in liver transplant recipients. Clin Transplant 2012; 26:826-32. [DOI: 10.1111/j.1399-0012.2012.01632.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2011] [Indexed: 12/19/2022]
Affiliation(s)
- Helen S. Te
- Center for Liver Diseases; University of Chicago Medical Center; Chicago; IL; USA
| | - Kathleen A. Dasgupta
- Section of Transplant Surgery; University of Chicago Medical Center; Chicago; IL; USA
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago; IL; USA
| | - Rohit Satoskar
- Institute of Transplant; Georgetown University Medical Center; Washington; DC; USA
| | - Smruti R. Mohanty
- Center for Liver Diseases; University of Chicago Medical Center; Chicago; IL; USA
| | - Nancy Reau
- Center for Liver Diseases; University of Chicago Medical Center; Chicago; IL; USA
| | - James Michael Millis
- Section of Transplant Surgery; University of Chicago Medical Center; Chicago; IL; USA
| | - Donald M. Jensen
- Center for Liver Diseases; University of Chicago Medical Center; Chicago; IL; USA
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16
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Te HS, Dasgupta KA, Cao D, Satoskar R, Mohanty SR, Reau N, Millis JM, Jensen DM. Use of immune function test in monitoring immunosuppression in liver transplant recipients. Clin Transplant 2012. [PMID: 22554357 DOI: 10.1111/j.1399-0012.2012.01632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Immune function test (Immuknow™) is a measure of cell-mediated immunity based on peripheral CD4+ T cell adenosine triphosphate activity (desired range, 225-525 ng/mL). We evaluated the role of immune function test (IFT) in monitoring and adjustment of immunosuppression in orthotopic liver transplant (OLT) recipients. A total of 289 IFTs were obtained from 171 patients from March 2007 to June 2008. Graft/patient status was classified as stable, serious infection, or malignancy. IFT levels were analyzed with duration of follow-up after OLT, graft/patient status, and the presence of hepatitis C (HCV) infection. The mean age was 54±14 yr, with 62% men. The median follow-up was 65 (2-249) months. Mean IFT levels were significantly lower in patients who were <24 months than in those≥24 months post-OLT (220±19.5 vs. 257±11.3 ng/mL, p=0.03). Clinically stable patients had higher IFT levels than those with serious infection or malignancy (254±11.1 vs. 162.5±23.9, p<0.001). HCV-infected patients had lower IFT levels than uninfected patients (206.7±15.7 vs. 273±12.0 ng/mL, p<0.001). Immunosuppression was reduced in 58 patients with IFT levels<225 ng/mL, and 90% maintained stable graft function after a median follow-up of 22 (1-39) months. IFT may be a useful tool in monitoring and lowering of immunosuppression in long-term OLT recipients.
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Affiliation(s)
- Helen S Te
- Center for Liver Diseases, University of Chicago Medical Center, Chicago, IL 60637, USA.
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17
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Agrawal N, Parajuli S, Zhao P, Satoskar R, Laurin J, Azumi N, Matsumoto C, Shetty K. Liver transplantation in the management of hepatic epithelioid hemangioendothelioma: a single-center experience and review of the literature. Transplant Proc 2012; 43:2647-50. [PMID: 21911139 DOI: 10.1016/j.transproceed.2011.06.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/03/2011] [Indexed: 12/12/2022]
Abstract
Hepatic epitheliod hemangioendothelioma (HEHE) is a rare tumor of vascular origin with unpredictable malignant potential. We describe our experience with four biopsy-proven HEHE cases that were considered for orthotopic liver transplant (OLT). Three patients had preserved hepatic function and despite extensive disease burden did not develop disease progression while awaiting OLT. We were able to utilize the review process allowed by United Network of Organ Sharing to obtain additional priority for OLT for these patients. This led to expedited organ allocation and excellent post-OLT outcomes.
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Affiliation(s)
- N Agrawal
- Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC 20007, USA
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18
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Reau N, Satoskar R, Te H, DeVoss A, Elsen C, Reddy G, Mohanty S, Jensen D. Evaluation of early null response to pegylated interferon and ribavirin as a predictor of therapeutic nonresponse in patients undergoing treatment for chronic hepatitis C. Am J Gastroenterol 2011; 106:452-8. [PMID: 21063395 DOI: 10.1038/ajg.2010.424] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Early viral kinetics accurately predicts sustained virological response (SVR) in genotype 1 patients with hepatitis C virus (HCV) undergoing therapy with pegylated interferon (PEG) and ribavirin (RBV). No baseline factor has a stronger predictive role. Early identification of patients unlikely to respond is equally important, allowing early treatment modification or discontinuation. The aim of this study was to determine whether 4-week null response (eNR) correlates directly with 12-week null response and inversely with SVR. METHODS A retrospective analysis of HCV patients treated at our institution was done. Patients were classified based on a 4-week viral log decline compared with baseline: <1 log, ≥ 1 log, <2 log, ≥ 2 log, <3 log, ≥ 3 log without rapid virological response (RVR) and with RVR. eNR was defined as less than a 1 log change from baseline. RESULTS A total of 159 patients had quantitative HCV-RNA PCR at treatment week 4, of whom 24% (38) experienced eNR. In all, 22 (58%) of the eNR patients were African American, 58% male, 32% cirrhotic, average age 53 years (range 36-71), 89% (33) genotype 1, and average baseline viral load was 5.9261 log (range 3.1492-7.3025). On-treatment response demonstrated failure to attain early virological response (EVR; 2-log decline at week 12) in 50% (19) and partial EVR (pEVR) in 39% (15). Three (8%) patients with eNR achieved SVR. In our patient population, eNR had 92% negative predictive value (confidence interval 83.5-100%) for SVR and was the strongest single predictor for treatment failure, including the baseline factors genotype and viral load. CONCLUSIONS eNR is strongly associated with null response or pEVR and accurately predicts failure to attain SVR. Consideration should be made to discontinue or modify therapy in patients with eNR who receive the appropriate weight-based PEG/RBV.
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Affiliation(s)
- Nancy Reau
- University of Chicago Medical Center, Center for Liver Disease, Chicago, Illinois 60637, USA.
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19
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Mezhir JJ, Mullane KM, Zarling J, Satoskar R, Pai RK, Roggin KK. Successful nonoperative management of gastrointestinal mucormycosis: novel therapy for invasive disease. Surg Infect (Larchmt) 2010; 10:447-51. [PMID: 19485785 DOI: 10.1089/sur.2008.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Invasive opportunistic fungal infections caused by agents of Mucorales that involve the gastrointestinal tract are uncommon but aggressive. These ubiquitous fungal spores typically are inhaled and can germinate in immunocompromised hosts. Standard therapy for invasive mucormycosis includes parenteral amphotericin B (AMB) in combination with radical debridement of infected tissues. Early diagnosis and treatment are of paramount importance. Unfortunately, long-term survival is poor owing to the prohibitive morbidity and mortality rates associated with the medical and surgical therapies. Posaconazole is a novel, extended-spectrum triazole oral antifungal agent with documented success in the treatment of patients with invasive mucormycosis. METHODS Case report and literature review. RESULTS A 50-year-old man presented with invasive mucormycosis of the lower esophagus, stomach, and liver, resulting in gastrointestinal hemorrhage. The infection did not respond to AMB but was treated successfully with a combination of posaconazole and liposomal AMB (LAMB) without surgical debridement. CONCLUSIONS To our knowledge, this is the first reported case of extensive gastric and intrahepatic mucormycosis that responded to combination posaconazole and LAMB without surgical debridement. This approach may be an alternative to surgery in patients who are precluded from extensive surgical intervention.
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Affiliation(s)
- James J Mezhir
- Department of Surgery, Section of General Surgery, University of Chicago, Chicago, Illinois 60637, USA
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Abstract
Therapy for chronic hepatitis C has improved dramatically over the past 20 years. Unfortunately, approximately 50% of those treated do not have a durable response to therapy. Non-responders and relapsers after previous interferon-based therapy are particularly challenging with regard to clinical management. This article provides a general overview of the treatment of hepatitis C and reviews present data regarding management of patients with chronic hepatitis C who are non-responders or relapsers after previous treatment. The review ends with the authors' opinion regarding present management of non-responders and relapsers and future emerging therapies.
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Affiliation(s)
- Rohit Satoskar
- Center for Liver Diseases, University of Chicago, Section of Gastroenterology, 5841 S. Maryland, MC7120, Chicago, IL 60637, USA
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21
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Joshi JV, Gupta KC, Hazari KT, Gokral J, Pohujani S, Satoskar R. Salivary antipyrine half-life during injectable progestagen contraception. Clin Pharmacokinet 1986; 11:171-5. [PMID: 3956050 DOI: 10.2165/00003088-198611020-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Antipyrine pharmacokinetics were studied in 6 healthy women before and 2, 8 and 12 weeks after administering the injectable progestagen (progestin), norethisterone (norethindrone) enanthate 200mg intramuscularly. Additionally, antipyrine kinetics in 5 women who had previously used the injectable contraceptive for 8 to 14 months were compared with values obtained in 14 non-users. Antipyrine was measured in saliva using a spectrophotometric method, following an oral dose of 18 mg/kg bodyweight. In the 6 women studied prospectively the mean salivary antipyrine half-life was 14.91 +/- 1.5 hours (SEM) before administering the injection, and 13.56 +/- 0.73 at 2 weeks, 15.13 +/- 1.86 at 8 weeks and 15.21 +/- 2.46 hours at 12 weeks after the injection. The mean antipyrine half-life in the 5 long term users of injectable progestagen was 14.21 +/- 2.53 hours compared with 13.66 +/- 0.98 hours in non-users. The results of this study suggest that - in contrast to published data on combined oral contraceptives - neither short nor long term use of parenteral norethisterone enanthate in Indian women is associated with significant alterations in antipyrine clearance.
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