1
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Soliman M, Rosenblatt R, Joshi M, Chung C, Mitry M, Oh K, Talenfeld A, Samstein B, Brown R, Halazun K, Fortune B, Charalel R. 3:27 PM Abstract No. 130 Hospitalization and complication rates following radiation segmentectomy versus microwave ablation for small hepatocellular carcinoma. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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2
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Joshi M, Rosenblatt R, Chung C, Mitry M, Soliman M, Oh K, Askin G, Talenfeld A, Samstein B, Brown R, Halazun K, Fortune B, Charalel R. Abstract No. 532 Comparative efficacy of transarterial embolization versus transarterial embolization plus microwave ablation for hepatocellular carcinoma 3 to 5 cm in size. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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3
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Chaudhry S, Bentley-Hibbert S, Stern J, Lobritto S, Martinez M, Vittorio J, Halazun K, Lee H, Emond J, Kato T, Samstein B, Griesemer A. Growth of liver allografts over time in pediatric transplant recipients. Pediatr Transplant 2018; 22:10.1111/petr.13104. [PMID: 29334158 PMCID: PMC5820167 DOI: 10.1111/petr.13104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 01/29/2023]
Abstract
The liver's capacity to grow in response to metabolic need is well known. However, long-term growth of liver allografts in pediatric recipients has not been characterized. A retrospective review of pediatric recipients at a single institution identified patients who had cross-sectional imaging at 1, 5, and 10 years post-transplant. Using volumetric calculations, liver allograft size was calculated and percent SLV were compared across the different time points; 18 patients ranging from 0.3 to 17.7 years old were identified that had imaging at 2 or more time points. Measured liver volumes increased by 59% after 5 years and 170% after 10 years. The measured liver volumes compared to calculated %SLV for these patients were 123 ± 37%, 97 ± 19%, and 118 ± 27% at 1, 5, and 10 years after transplant, respectively. Our data suggest that liver allografts in pediatric recipients increase along with overall growth, and reach SLVs for height and weight by 5 years post-transplantation. Additionally, as pediatric recipients grow, the livers appear to maintain appropriate SLV.
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Affiliation(s)
- S.G. Chaudhry
- Department of Surgery, Columbia University Medical Center, New York, NY
| | | | - J. Stern
- Columbia Center for Translational Immunology, Columbia University, College of Physicians and Surgeons, New York, NY
| | - S. Lobritto
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - M. Martinez
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - J. Vittorio
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - K.J. Halazun
- Department of Surgery, Weill-Cornell Medical Center, New York, NY
| | - H.T. Lee
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - J. Emond
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - T. Kato
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - B. Samstein
- Department of Surgery, Weill-Cornell Medical Center, New York, NY
| | - A. Griesemer
- Department of Surgery, Columbia University Medical Center, New York, NY
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4
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Halazun KJ, Rana AA, Fortune B, Quillin RC, Verna EC, Samstein B, Guarrera JV, Kato T, Griesemer AD, Fox A, Brown RS, Emond JC. No country for old livers? Examining and optimizing the utilization of elderly liver grafts. Am J Transplant 2018; 18:669-678. [PMID: 28960723 DOI: 10.1111/ajt.14518] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 04/06/2017] [Revised: 08/21/2017] [Accepted: 09/18/2017] [Indexed: 01/25/2023]
Abstract
Of the 1.6 million patients >70 years of age who died of stroke since 2002, donor livers were retrieved from only 2402 (0.15% yield rate). Despite reports of successful liver transplantation (LT) with elderly grafts (EG), advanced donor age is considered a risk for poor outcomes. Centers for Medicare and Medicaid Services definitions of an "eligible death" for donation excludes patients >70 years of age, creating disincentives to donation. We investigated utilization and outcomes of recipients of donors >70 through analysis of a United Network for Organ Sharing Standard Transplant Analysis and Research-file of adult LTs from 2002 to 2014. Survival analysis was conducted using Kaplan-Meier curves, and Cox regression was used to identify factors influencing outcomes of EG recipients. Three thousand one hundred four livers from donors >70, ≈40% of which were used in 2 regions: 2 (520/3104) and 9 (666/3104). Unadjusted survival was significantly worse among recipients of EG compared to recipients of younger grafts (P < .0001). Eight independent negative predictors of survival in recipients of EG were identified on multivariable analysis. Survival of low-risk recipients who received EG was significantly better than survival of recipients of younger grafts (P = .04). Outcomes of recipients of EG can therefore be optimized to equal outcomes of younger grafts. Given the large number of stroke deaths in patients >70 years of age, the yield rate of EGs can be maximized and disincentives removed to help resolve the organ shortage crisis.
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Affiliation(s)
- K J Halazun
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA.,Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - A A Rana
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - B Fortune
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - R C Quillin
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - E C Verna
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - B Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA.,Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - J V Guarrera
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - T Kato
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - A D Griesemer
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - A Fox
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - R S Brown
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY, USA.,Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - J C Emond
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
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5
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Najjar M, Campos BD, Samstein B, Halazun KJ. Intracaval Mass Discovered at the Time of Liver Procurement. Am J Transplant 2016. [DOI: 10.1111/ajt.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Najjar
- Department of Surgery; Columbia University Medical Center; New York NY
| | - B. D. Campos
- Emory Transplant Center; Emory University Hospital; Atlanta GA
| | - B. Samstein
- Division of Transplantation Surgery; Department of Surgery; Weill Cornell Medical Center; New York NY
| | - K. J. Halazun
- Division of Transplantation Surgery; Department of Surgery; Weill Cornell Medical Center; New York NY
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6
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Samstein B, Smith AR, Freise CE, Zimmerman M, Baker T, Othloff KM, Fisher RA, Merion RM. Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study. Am J Transplant 2016; 16:594-602. [PMID: 26461803 PMCID: PMC4733444 DOI: 10.1111/ajt.13479] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 02/16/2015] [Revised: 06/19/2015] [Accepted: 07/19/2015] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to explore long-term complications in recipients of deceased donor liver transplant (DDLT) and living donor liver transplant (LDLT) in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). We analyzed 471 DDLTs and 565 LDLTs from 1998 to 2010 that were followed up to 10 years for 36 categories of complications. Probabilities of complications and their resolutions were estimated using the Kaplan-Meier method, and predictors were tested in Cox proportional hazards models. Median follow-up for DDLT and LDLT was 4.19 and 4.80 years, respectively. DDLT recipients were more likely to have hepatocellular carcinoma and higher disease severity, including Model for End-Stage Liver Disease score. Complications occurring with higher probability in LDLT included biliary-related complications and hepatic artery thrombosis. In DDLT, ascites, intra-abdominal bleeding, cardiac complications and pulmonary edema were significantly more probable. Development of chronic kidney disease stage 4 or 5 was less likely in LDLT recipients (hazard ratio [HR] 0.41, p = 0.02). DDLT and LDLT had similar risk of grade 4 complications (HR 0.89, p = 0.60), adjusted for other risk factors. Once a complication occurred, the time to resolution did not differ between LDLT and DDLT. Future efforts should be directed toward reducing the occurrence of complications after liver transplantation.
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Affiliation(s)
- B Samstein
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - AR Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI,Arbor Research Collaborative for Health, Ann Arbor, MI
| | - CE Freise
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - M Zimmerman
- Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - T Baker
- Department of Surgery, Northwestern University, Chicago, IL
| | - KM Othloff
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - RA Fisher
- Division of Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - RM Merion
- Arbor Research Collaborative for Health, Ann Arbor, MI,Department of Surgery, University of Michigan, Ann Arbor, MI
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7
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Halazun KJ, Mathur AK, Rana AA, Massie AB, Mohan S, Patzer RE, Wedd JP, Samstein B, Subramanian RM, Campos BD, Knechtle SJ. One Size Does Not Fit All--Regional Variation in the Impact of the Share 35 Liver Allocation Policy. Am J Transplant 2016; 16:137-42. [PMID: 26561981 DOI: 10.1111/ajt.13500] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 11/21/2014] [Revised: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 01/25/2023]
Abstract
Allocation policies for liver transplantation underwent significant changes in June 2013 with the introduction of Share 35. We aimed to examine the effect of Share 35 on regional variation in posttransplant outcomes. We examined two patient groups from the United Network for Organ Sharing dataset; a pre-Share 35 group composed of patients transplanted between June 17, 2012, and June 17, 2013 (n = 5523), and a post-Share group composed of patients transplanted between June 18, 2013, and June 18, 2014 (n = 5815). We used Kaplan-Meier and Cox multivariable analyses to compare survival. There were significant increases in allocation Model for End-stage Liver Disease (MELD) scores, laboratory MELD scores, and proportions of patients in the intensive care unit and on mechanical, ventilated, or organ-perfusion support at transplant post-Share 35. We also observed a significant increase in donor risk index in this group. We found no difference on a national level in survival between patients transplanted pre-Share 35 and post-Share 35 (p = 0.987). Regionally, however, posttransplantation survival was significantly worse in the post-Share 35 patients in regions 4 and 10 (p = 0.008 and p = 0.04), with no significant differences in the remaining regions. These results suggest that Share 35 has been associated with transplanting "sicker patients" with higher MELD scores, and although no difference in survival is observed on a national level, outcomes appear to be concerning in some regions.
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Affiliation(s)
- K J Halazun
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY
| | - A K Mathur
- Department of Surgery and Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, AZ
| | - A A Rana
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - A B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - S Mohan
- Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY
| | - R E Patzer
- Emory Transplant Center, Emory University Hospital, Atlanta, GA
| | - J P Wedd
- Emory Transplant Center, Emory University Hospital, Atlanta, GA
| | - B Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY
| | - R M Subramanian
- Emory Transplant Center, Emory University Hospital, Atlanta, GA
| | - B D Campos
- Emory Transplant Center, Emory University Hospital, Atlanta, GA
| | - S J Knechtle
- Duke Transplant Center, Duke University Hospital, Durham, NC
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8
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Guarrera JV, Henry SD, Samstein B, Reznik E, Musat C, Lukose TI, Ratner LE, Brown RS, Kato T, Emond JC. Hypothermic machine preservation facilitates successful transplantation of "orphan" extended criteria donor livers. Am J Transplant 2015; 15:161-9. [PMID: 25521639 DOI: 10.1111/ajt.12958] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023]
Abstract
Hypothermic machine preservation (HMP) remains investigational in clinical liver transplantation. It is widely used to preserve kidneys for transplantation with improved results over static cold storage (SCS). At our center, we have used HMP in 31 adults receiving extended criteria donor (ECD) livers declined by the originating United Network for Organ Sharing region ("orphan livers"). These cases were compared to ECD SCS cases in a matched cohort study design. Livers were matched for donor age, recipient age, cold ischemic time, donor risk index and Model for End-Stage Liver Disease (MELD) score. HMP was performed for 3-7 h at 4-8 °C using our previously published protocol. Early allograft dysfunction rates were 19% in the HMP group versus 30% in the control group (p = 0.384). One-year patient survival was 84% in the HMP group versus 80% in the SCS group (p = NS). Post hoc analysis revealed significantly less biliary complications in the HMP group versus the SCS group (4 vs. 13, p = 0.016). Mean hospital stay was significantly shorter in the HMP group (13.64 ± 10.9 vs. 20.14 ± 11.12 days in the SCS group, p = 0.001). HMP provided safe and reliable preservation in orphan livers transplanted at our center.
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Affiliation(s)
- J V Guarrera
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY
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9
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Tanriover B, Mohan S, Cohen DJ, Radhakrishnan J, Nickolas TL, Stone PW, Tsapepas DS, Crew RJ, Dube GK, Sandoval PR, Samstein B, Dogan E, Gaston RS, Tanriover JN, Ratner LE, Hardy MA, Chvojka J, da Motta H, Devan J, Dytman SA, Díaz GA, Eberly B, Felix J, Fields L, Fiorentini GA, Gago AM, Gallagher H, Gran R, Harris DA, Higuera A, Hurtado K, Jerkins M, Kafka T, Kordosky M, Kulagin SA, Le T, Maggi G, Maher E, Manly S, Mann WA, Marshall CM, Martin Mari C, McFarland KS, McGivern CL, McGowan AM, Miller J, Mislivec A, Morfín JG, Muhlbeier T, Naples D, Nelson JK, Norrick A, Osta J, Palomino JL, Paolone V, Park J, Patrick CE, Perdue GN, Rakotondravohitra L, Ransome RD, Ray H, Ren L, Rodrigues PA, Savage DG, Schellman H, Schmitz DW, Simon C, Snider FD, Solano Salinas CJ, Tagg N, Valencia E, Velásquez JP, Walton T, Wolcott J, Zavala G, Zhang D, Ziemer BP. Kidneys at higher risk of discard: expanding the role of dual kidney transplantation. Am J Transplant 2014; 14:404-15. [PMID: 24472195 PMCID: PMC4058786 DOI: 10.1111/ajt.12553] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [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: 04/15/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 01/25/2023]
Abstract
Half of the recovered expanded criteria donor (ECD) kidneys are discarded in the United States. A new kidney allocation system offers kidneys at higher risk of discard, Kidney Donor Profile Index (KDPI)>85%, to a wider geographic area to promote broader sharing and expedite utilization. Dual kidney transplantation (DKT) based on the KDPI is a potential option to streamline allocation of kidneys which otherwise would have been discarded. To assess the clinical utility of the KDPI in kidneys at higher risk of discard, we analyzed the OPTN/UNOS Registry that included the deceased donor kidneys recovered between 2002 and 2012. The primary outcomes were allograft survival, patient survival and discard rate based on different KDPI categories (<80%, 80-90% and >90%). Kidneys with KDPI>90% were associated with increased odds of discard (OR=1.99, 95% CI 1.74-2.29) compared to ones with KDPI<80%. DKTs of KDPI>90% were associated with lower overall allograft failure (HR=0.74, 95% CI 0.62-0.89) and better patient survival (HR=0.79, 95% CI 0.64-0.98) compared to single ECD kidneys with KDPI>90%. Kidneys at higher risk of discard may be offered in the up-front allocation system as a DKT. Further modeling and simulation studies are required to determine a reasonable KDPI cutoff percentile.
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Affiliation(s)
- B. Tanriover
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,The Columbia University Renal Epidemiology (CURE) Group, Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,Corresponding author: Bekir Tanriover,
| | - S. Mohan
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,The Columbia University Renal Epidemiology (CURE) Group, Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - D. J. Cohen
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - J. Radhakrishnan
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - T. L. Nickolas
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY,The Columbia University Renal Epidemiology (CURE) Group, Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - P. W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | - D. S. Tsapepas
- Department of Pharmacy, New York Presbyterian Hospital, New York, NY
| | - R. J. Crew
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - G. K. Dube
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - P. R. Sandoval
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - B. Samstein
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - E. Dogan
- Division of Nephrology, Sutcu Imam University, Kahramanmaras, Turkey
| | - R. S. Gaston
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL
| | | | - L. E. Ratner
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - M. A. Hardy
- Renal and Pancreatic Transplantation, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - J Chvojka
- University of Rochester, Rochester, New York 14610, USA
| | - H da Motta
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - J Devan
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - S A Dytman
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - G A Díaz
- Sección Física, Departamento de Ciencias, Pontificia Universidad Católica del Perú, Apartado 1761, Lima, Peru
| | - B Eberly
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - J Felix
- Northwestern University, Evanston, Illinois 60208, USA
| | - L Fields
- Northwestern University, Evanston, Illinois 60208, USA
| | - G A Fiorentini
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - A M Gago
- Sección Física, Departamento de Ciencias, Pontificia Universidad Católica del Perú, Apartado 1761, Lima, Peru
| | - H Gallagher
- Physics Department, Tufts University, Medford, Massachusetts 02155, USA
| | - R Gran
- Department of Physics, University of Minnesota-Duluth, Duluth, Minnesota 55812, USA
| | - D A Harris
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Higuera
- Campus León y Campus Guanajuato, Universidad de Guanajuato, Lascurain de Retana No. 5, Col. Centro. Guanajuato 36000, Guanajuato, Mexico
| | - K Hurtado
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil and Universidad Nacional de Ingeniería, Apartado 31139 Lima, Peru
| | - M Jerkins
- Department of Physics, University of Texas, 1 University Station, Austin, Texas 78712, USA
| | - T Kafka
- Physics Department, Tufts University, Medford, Massachusetts 02155, USA
| | - M Kordosky
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - S A Kulagin
- Institute for Nuclear Research of the Russian Academy of Sciences, 117312 Moscow, Russia
| | - T Le
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | - G Maggi
- Departamento de Física, Universidad Técnica Federico Santa María, Avenida España 1680 Casilla 110-V, Valparaíso, Chile
| | - E Maher
- Massachusetts College of Liberal Arts, 375 Church Street, North Adams, Massachusetts 01247, USA
| | - S Manly
- University of Rochester, Rochester, New York 14610, USA
| | - W A Mann
- Physics Department, Tufts University, Medford, Massachusetts 02155, USA
| | - C M Marshall
- University of Rochester, Rochester, New York 14610, USA
| | | | - K S McFarland
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA and University of Rochester, Rochester, New York 14610, USA
| | - C L McGivern
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - A M McGowan
- University of Rochester, Rochester, New York 14610, USA
| | - J Miller
- Departamento de Física, Universidad Técnica Federico Santa María, Avenida España 1680 Casilla 110-V, Valparaíso, Chile
| | - A Mislivec
- University of Rochester, Rochester, New York 14610, USA
| | - J G Morfín
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T Muhlbeier
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - D Naples
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - J K Nelson
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - A Norrick
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - J Osta
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J L Palomino
- Centro Brasileiro de Pesquisas Físicas, Rua Dr. Xavier Sigaud 150, Urca, Rio de Janeiro, Rio de Janeiro 22290-180, Brazil
| | - V Paolone
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - J Park
- University of Rochester, Rochester, New York 14610, USA
| | - C E Patrick
- Northwestern University, Evanston, Illinois 60208, USA
| | - G N Perdue
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA and University of Rochester, Rochester, New York 14610, USA
| | | | - R D Ransome
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | - H Ray
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - L Ren
- Department of Physics and Astronomy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - P A Rodrigues
- University of Rochester, Rochester, New York 14610, USA
| | - D G Savage
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H Schellman
- Northwestern University, Evanston, Illinois 60208, USA
| | - D W Schmitz
- Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - C Simon
- Department of Physics and Astronomy, University of California, Irvine, Irvine, California 92697-4575, USA
| | - F D Snider
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - N Tagg
- Department of Physics, Otterbein University, 1 South Grove Street, Westerville, Ohio 43081, USA
| | - E Valencia
- Campus León y Campus Guanajuato, Universidad de Guanajuato, Lascurain de Retana No. 5, Col. Centro. Guanajuato 36000, Guanajuato, Mexico
| | - J P Velásquez
- Sección Física, Departamento de Ciencias, Pontificia Universidad Católica del Perú, Apartado 1761, Lima, Peru
| | - T Walton
- Department of Physics, Hampton University, Hampton, Virginia 23668, USA
| | - J Wolcott
- University of Rochester, Rochester, New York 14610, USA
| | - G Zavala
- Campus León y Campus Guanajuato, Universidad de Guanajuato, Lascurain de Retana No. 5, Col. Centro. Guanajuato 36000, Guanajuato, Mexico
| | - D Zhang
- Department of Physics, College of William & Mary, Williamsburg, Virginia 23187, USA
| | - B P Ziemer
- Department of Physics and Astronomy, University of California, Irvine, Irvine, California 92697-4575, USA
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10
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Samstein B, Cherqui D, Rotellar F, Griesemer A, Halazun KJ, Kato T, Guarrera J, Emond JC. Totally laparoscopic full left hepatectomy for living donor liver transplantation in adolescents and adults. Am J Transplant 2013; 13:2462-6. [PMID: 24034709 DOI: 10.1111/ajt.12360] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/20/2013] [Indexed: 01/25/2023]
Abstract
In recent years different minimal access strategies have been designed in order to perform living donor liver surgery for adult recipients with less morbidity. Techniques involve shortening the length of the incision with or without previous laparoscopic mobilization of the liver. Herein we present two cases of totally laparoscopic living donor left hepatectomy, with and without removal of the middle hepatic vein, respectively. We describe in detail the anatomical and technical aspects of the procedure focusing on relevant points to enhance safety.
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Affiliation(s)
- B Samstein
- Division of Abdominal Organ Transplantation, Department of Surgery, New York-Presbyterian Hospital/Columbia Presbyterian Medical Center, New York, NY
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11
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Pham HP, Hsu SX, Parker-Jones S, Samstein B, Diuguid D, Schwartz J. Recombinant activated factor VII in patients with acute liver failure with UNOS Status 1A: a single tertiary academic centre experience. Vox Sang 2013; 106:75-82. [PMID: 23815226 DOI: 10.1111/vox.12067] [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: 02/25/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Recombinant activated factor VII (rFVIIa) is often used in off-label indications, including many situations in which the patients are at risk of thrombosis. In this study, we retrospectively reviewed the use of rFVIIa in patients with acute liver failure - UNOS Status 1A (ALF-1A) to determine its efficacy and safety profile. MATERIALS AND METHODS Using the transplantation records, all adult patients with ALF-1A were identified from 6/2001 to 3/2009. From patients' medical charts, rFVIIa dose, blood component usage, short-term outcomes [length of intensive care unit (ICU) and hospital stay, ability to undergo orthotopic liver transplant (OLT) and in-hospital survival rate] and adverse events were examined. RESULTS Forty-two patients with ALF-1A were identified. Fifteen patients received rFVIIa with doses ranging between 24·4 μg/kg and 126·8 μg/kg. Three patients received two doses of rFVIIa. The age, baseline activated partial thromboplastin time (aPTT) and platelet (PLT) count were not statistically different between the group receiving rFVIIa versus the group that did not. However, the prothrombin time (PT) was significantly higher in the rFVIIa group. Although the rFVIIa group stayed in the ICU longer and required significant more blood products during admission, there was no statistical difference between the two groups in terms of length of hospital stay, ability to undergo OLT and survival rate. There was no increase in complications, including thrombosis, after receiving rFVIIa. CONCLUSION Recombinant activated factor VII (rFVIIa) appears to be safe in patients with ALF-1A, but to elucidate its full role, a randomized controlled trial would be ideal.
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Affiliation(s)
- H P Pham
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, NY, USA
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12
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Henry SD, Nachber E, Tulipan J, Stone J, Bae C, Reznik L, Kato T, Samstein B, Emond JC, Guarrera JV. Hypothermic machine preservation reduces molecular markers of ischemia/reperfusion injury in human liver transplantation. Am J Transplant 2012; 12:2477-86. [PMID: 22594953 DOI: 10.1111/j.1600-6143.2012.04086.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [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
Hypothermic machine perfusion (HMP) is in its infancy in clinical liver transplantation. Potential benefits include diminished preservation injury (PI) and improved graft function. Molecular data to date has been limited to extrapolation of animal studies. We analyzed liver tissue and serum collected during our Phase 1 trial of liver HMP. Grafts preserved with HMP were compared to static cold stored (SCS) transplant controls. Reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry and transmission electron microscopy (TEM) were performed on liver biopsies. Expression of inflammatory cytokines, adhesion molecules and chemokines, oxidation markers, apoptosis and acute phase proteins and the levels of CD68 positive macrophages in tissue sections were evaluated. RT-PCR of reperfusion biopsy samples in the SCS group showed high expression of inflammatory cytokines, adhesion molecules and chemokines, oxidative markers and acute phase proteins. This upregulation was significantly attenuated in livers that were preserved by HMP. Immunofluorescence showed larger numbers of CD68 positive macrophages in the SCS group when compared to the HMP group. TEM samples also revealed ultrastructural damage in the SCS group that was not seen in the HMP group. HMP significantly reduced proinflammatory cytokine expression, relieving the downstream activation of adhesion molecules and migration of leukocytes, including neutrophils and macrophages when compared to SCS controls.
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Affiliation(s)
- S D Henry
- Department of Surgery, Columbia University, Center for Liver Disease and Transplantation, New York, NY, USA
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13
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Abecassis MM, Fisher RA, Olthoff KM, Freise CE, Rodrigo DR, Samstein B, Kam I, Merion RM. Complications of living donor hepatic lobectomy--a comprehensive report. Am J Transplant 2012; 12:1208-17. [PMID: 22335782 PMCID: PMC3732171 DOI: 10.1111/j.1600-6143.2011.03972.x] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A wider application of living donor liver transplantation is limited by donor morbidity concerns. An observational cohort of 760 living donors accepted for surgery and enrolled in the Adult-to-Adult Living Donor Liver Transplantation cohort study provides a comprehensive assessment of incidence, severity and natural history of living liver donation (LLD) complications. Donor morbidity (assessed by 29 specific complications), predictors, time from donation to complications and time from complication onset to resolution were measured outcomes over a 12-year period. Out of the 760 donor procedures, 20 were aborted and 740 were completed. Forty percent of donors had complications (557 complications among 296 donors), mostly Clavien grades 1 and 2. Most severe counted by complication category; grade 1 (minor, n = 232); grade 2 (possibly life-threatening, n = 269); grade 3 (residual disability, n = 5) and grade 4 (leading to death, n = 3). Hernias (7%) and psychological complications (3%) occurred >1 year postdonation. Complications risk increased with transfusion requirement, intraoperative hypotension and predonation serum bilirubin, but did not decline with the increased center experience with LLD. The probability of complication resolution within 1 year was overall 95%, but only 75% for hernias and 42% for psychological complications. This report comprehensively quantifies LLD complication risk and should inform decision making by potential donors and their caregivers.
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Affiliation(s)
- M. M. Abecassis
- Comprehensive Transplant Center, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
,Corresponding author: Michael M. Abecassis,
| | - R. A. Fisher
- Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - K. M. Olthoff
- Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA
| | - C. E. Freise
- Department of Surgery, University of California, San Francisco, CA
| | - D. R. Rodrigo
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - B. Samstein
- Center for Liver Disease and Transplantation, Columbia University, New York, NY
| | - I. Kam
- Department of Surgery, University of Colorado, Denver, CO
| | - R. M. Merion
- Department of Surgery, University of Michigan, Ann Arbor, MI
,Arbor Research Collaborative for Health, Ann Arbor, MI
| | - A2ALL Study Group
- The A2ALL Study Group includes Northwestern University, Chicago, IL; University of California, Los Angeles, CA; University of California, San Francisco, CA; University of Colorado Health Sciences Center, Denver, CO; University of North Carolina, Chapel Hill, NC; Epidemiology and Clinical Trials Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD; University of Michigan, Ann Arbor, MI; Department of Surgery, Columbia Presbyterian Medical Center, New York, NY; University of Pennsylvania, Philadelphia, PA; Department of Internal Medicine, University of Virginia, Charlottesville, VA; Virginia Commonwealth University, Richmond, VA
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14
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Watkins AC, Vedula GV, Horan J, Dellicarpini K, Pak SW, Daly T, Samstein B, Kato T, Emond JC, Guarrera JV. The deceased organ donor with an "open abdomen": proceed with caution. Transpl Infect Dis 2012; 14:311-5. [PMID: 22283979 DOI: 10.1111/j.1399-3062.2011.00712.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 10/10/2011] [Accepted: 11/25/2011] [Indexed: 12/17/2022]
Abstract
In solid organ transplantation, the disparity between donor supply and patients awaiting transplant continues to increase. The organ shortage has led to relaxation of historic contraindications to organ donation. A large percentage of deceased organ donors have been subjected to traumatic injuries, which can often result in intervention that leads to abdominal packing and intensive care unit resuscitation. The donor with this "open abdomen" (OA) presents a situation in which the risk of organ utilization is difficult to quantify. There exists a concern for the potential of a higher risk for both bacterial and fungal infections, including multidrug-resistant (MDR) pathogens because of the prevalence of antibiotic use and critical illness in this population. No recommendations have been established for utilization of organs from these OA donors, because data are limited. Herein, we report a case of a 21-year-old donor who had sustained a gunshot wound to his abdomen, resulting in a damage-control laparotomy and abdominal packing. The donor subsequently suffered brain death, and the family consented to organ donation. A multiorgan procurement was performed with respective transplantation of the procured organs (heart, liver, and both kidneys) into 4 separate recipients. Peritoneal swab cultures performed at the time of organ recovery grew out MDR Pseudomonas aeruginosa on the day after procurement, subsequently followed by positive blood and sputum cultures as well. All 4 transplant recipients subsequently developed infections with MDR P. aeruginosa, which appeared to be donor-derived with similar resistance patterns. Appropriate antibiotic coverage was initiated in all of the patients. Although 2 of the recipients died, mortality did not appear to be clearly associated with the donor-derived infections. This case illustrates the potential infectious risk associated with organs from donors with an OA, and suggests that aggressive surveillance for occult infections should be pursued.
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Affiliation(s)
- A C Watkins
- Division of Abdominal Organ Transplantation, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Guarrera JV, Henry SD, Samstein B, Odeh-Ramadan R, Kinkhabwala M, Goldstein MJ, Ratner LE, Renz JF, Lee HT, Brown RS, Emond JC. Hypothermic machine preservation in human liver transplantation: the first clinical series. Am J Transplant 2010; 10:372-81. [PMID: 19958323 DOI: 10.1111/j.1600-6143.2009.02932.x] [Citation(s) in RCA: 390] [Impact Index Per Article: 27.9] [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
Hypothermic machine perfusion (HMP) is widely used to preserve kidneys for transplantation with improved results over cold storage (CS). To date, successful transplantation of livers preserved with HMP has been reported only in animal models. In this, the first prospective liver HMP study, 20 adults received HMP-preserved livers and were compared to a matched group transplanted with CS livers. HMP was performed for 3-7 h using centrifugal perfusion with Vasosol solution at 4-6 degrees C. There were no cases of primary nonfunction in either group. Early allograft dysfunction rates were 5% in the HMP group versus 25% in controls (p = 0.08). At 12 months, there were two deaths in each group, all unrelated to preservation or graft function. There were no vascular complications in HMP livers. Two biliary complications were observed in HMP livers compared with four in the CS group. Serum injury markers were significantly lower in the HMP group. Mean hospital stay was shorter in the HMP group (10.9 +/- 4.7 days vs. 15.3 +/- 4.9 days in the CS group, p = 0.006). HMP of donor livers provided safe and reliable preservation in this pilot case-controlled series. Further multicenter HMP trials are now warranted.
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Affiliation(s)
- J V Guarrera
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
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16
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Rana A, Hardy MA, Halazun KJ, Woodland DC, Ratner LE, Samstein B, Guarrera JV, Brown RS, Emond JC. Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transplant 2008; 8:2537-46. [PMID: 18945283 DOI: 10.1111/j.1600-6143.2008.02400.x] [Citation(s) in RCA: 318] [Impact Index Per Article: 19.9] [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
It is critical to balance waitlist mortality against posttransplant mortality. Our objective was to devise a scoring system that predicts recipient survival at 3 months following liver transplantation to complement MELD-predicted waitlist mortality. Univariate and multivariate analysis on 21,673 liver transplant recipients identified independent recipient and donor risk factors for posttransplant mortality. A retrospective analysis conducted on 30,321 waitlisted candidates reevaluated the predictive ability of the Model for End-Stage Liver Disease (MELD) score. We identified 13 recipient factors, 4 donor factors and 2 operative factors (warm and cold ischemia) as significant predictors of recipient mortality following liver transplantation at 3 months. The Survival Outcomes Following Liver Transplant (SOFT) Score utilized 18 risk factors (excluding warm ischemia) to successfully predict 3-month recipient survival following liver transplantation. This analysis represents a study of waitlisted candidates and transplant recipients of liver allografts after the MELD score was implemented. Unlike MELD, the SOFT score can accurately predict 3-month survival following liver transplantation. The most significant risk factors were previous transplantation and life support pretransplant. The SOFT score can help clinicians determine in real time which candidates should be transplanted with which allografts. Combined with MELD, SOFT can better quantify survival benefit for individual transplant procedures.
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Affiliation(s)
- A Rana
- Division of Abdominal Organ Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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17
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Guarrera JV, Nasr SH, Reverte CM, Samstein B, Brown T, Balachandran V, Samuels MJ, Kelly J, Hardy MA, Markowitz GS, D'Agati VD, Ratner LE. Microscopic Intrarenal Particles After Pulsatile Machine Preservation Do Not Adversely Affect Outcomes After Renal Transplantation. Transplant Proc 2006; 38:3384-7. [PMID: 17175278 DOI: 10.1016/j.transproceed.2006.10.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 07/22/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Our center has recently observed foreign carbohydrate-appearing particles (FP) on transplant postreperfusion biopsy specimens: (PRBx). METHODS To further characterize FPs, we reviewed all renal transplant RBx (30-45 minutes) performed between September 1, 2004 and December 3, 2005. Donor, preservation, and outcome variables were collected among patients with FP. RESULTS A total of 135 PRBx were performed (45 deceased donors [DD] and 90 live donors [LD]). Fifteen PRBx demonstrated FP. All 15 cases were DD kidneys that underwent machine perfusion (MP) on the Waters RM3 (Waters Medical Systems, Rochester, Minn, United States) with Belzer MP solution (Trans Med, Elk River, Minn, United States). Donor age was 39.8 +/- 15.7 years. Terminal creatinine level was 1.45 +/- 0.8 mg/dL. Two of 15 were flushed in situ with HTK solution (no starch). Cold ischemia time was 28.8 +/- 9.1 hours with 14.3 +/- 5.1 hours of MP. In 13 of 15 patients, perfusion parameters were excellent (flow > 100 mL; resistance < .35). CHARACTERISTICS OF FP: Particles were 10-30 mu and globular in shape. FP were not visible on hematoxylin and eosin stain, but stained strongly periodic acid-Schiff-(PAS) positive and were refractile under polarized light. FP were seen segmentally within glomerular capillaries in all cases and in peritubular capillaries in 3. In 11 of the 15 cases with FP, focal glomerular fibrin thrombi or intracapillary neutrophil margination was seen. Ten of 15 patients with FP had a biopsy within the first week with no identifiable FP. OUTCOMES Recipient age was 45.3 +/- 11.6 years. Eight patients (53.3%) had delayed graft function. Biopsy-proven rejection occurred in 3 patients (20%). Three-month creatinine level was 1.59 +/- 0.35 mg/dL. One graft was lost to early thrombosis in a patient with a hypercoagulable state and 1 patient died of sepsis at 2 months. All remaining 13 patients are alive with excellent graft function at a median follow-up of 6.7 months (range, 3-17 months). CONCLUSIONS Microscopic intrarenal particles may be seen on DD kidney PRBx after MP. These FPs likely originate from surgical gloves. FPs are too small to be captured by standard filters but clear spontaneously and do not have deleterious effects on renal function or outcomes.
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Affiliation(s)
- J V Guarrera
- Division of Abdominal Organ Transplantation, New York Presbyterian Hospital, New York, New York, USA
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Abstract
The application of xenotransplantation faces daunting immunological hurdles, some of which might be overcome with the induction of tolerance. Porcine organs transplanted into primates are subject to several types of rejection responses. Hyperacute rejection mediated by naturally occurring xenoreactive antibodies and complement can be overcome without tolerance. Acute vascular rejection and cellular rejection, however, may present important opportunities for immunological tolerance, and humoral rejection might be approached by various mechanisms including (i) clonal deletion, (ii) anergy, (iii) immune deviation, (iv) induction of immunoregulatory or suppressor cells, or (v) veto cells. B-cell tolerance, useful for preventing humoral rejection, might be approached through clonal anergy. It remains to be determined, however, whether tolerance induction is required for xenotransplantation and by which means the various mechanisms of tolerance can be applied in the setting of xenotransplantation. Regardless, the study of tolerance will surely expand understanding of the physiology and pathophysiology of the immune system.
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Affiliation(s)
- B Samstein
- Transplantation Biology, and the Department of Surgery, Medical Sciences Building 2-66, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Liver transplantation from living related donors was unthinkable until recently, when the safety of modern hepatic surgery became widely appreciated. The first step was the successful demonstration that parts of livers could be transplanted. This technique, termed reduced-size liver transplantation, evolved into reliable procedures to allow parents to donate small parts of their livers to small children. More recently, right hepatectomy, in which up to 70% of the liver is resected for donation, has been performed in adults. As the demand for liver transplantation continues to increase, the development of ethically sound, medically and surgically optimal programs for routine use of living donors has become essential. This chapter provides a broad overview of the evolution and current state of liver transplantation with living donors.
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Affiliation(s)
- B Samstein
- The Center for Liver Disease and Transplantation, New York Presbyterian Hospital, Columbia College of Physicians and Surgeons, New York, New York 10032
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Samstein B, Hoimes ML, Fan J, Frost RA, Gelato MC, Lang CH. IL-6 stimulation of insulin-like growth factor binding protein (IGFBP)-1 production. Biochem Biophys Res Commun 1996; 228:611-5. [PMID: 8920958 DOI: 10.1006/bbrc.1996.1705] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
TNF alpha and IL-1 beta have previously been shown to increase the IGFBP-1 concentration in plasma and liver under in vivo conditions. The present study demonstrates that another inflammatory cytokine, IL-6, also elevates a 30- to 32-kDa IGF binding protein in the plasma of mice. Moreover, IL-6 produced dose- and time-dependent increases in IGFBP-1 production by HepG2 cells. The maximal IL-6-induced increase in IGFBP-1 was comparable to that observed with dexamethasone, and this increase was attenuated by diltiazem or dantrolene, both of which are known to reduce the cytosolic Ca2+ concentration. Finally, incubation of HepG2 cells with TNF alpha or IL-1 beta also increased IGFBP-1 in a dose-dependent manner. These results demonstrate that IGFBP-1 production is mediated directly by proinflammatory cytokines and suggest that this mechanism may be important for the upregulation of IGFBP-1 seen in catabolic conditions associated with overexpression of these cytokines.
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Affiliation(s)
- B Samstein
- Department Surgery and Medicine/Endocrinology, State University of New York at Stony Brook 11794-8191, USA
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