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Azar JH, Evans JP, Sikorski MH, Chakravarthy KB, McKenney S, Carmody I, Zeng C, Teodorescu R, Song NJ, Hamon JL, Bucci D, Velegraki M, Bolyard C, Weller KP, Reisinger SA, Bhat SA, Maddocks KJ, Denlinger N, Epperla N, Gumina RJ, Vlasova AN, Oltz EM, Saif LJ, Chung D, Woyach JA, Shields PG, Liu SL, Li Z, Rubinstein MP. Selective suppression of de novo SARS-CoV-2 vaccine antibody responses in patients with cancer on B cell-targeted therapy. JCI Insight 2023; 8:e163434. [PMID: 36749632 PMCID: PMC10070099 DOI: 10.1172/jci.insight.163434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
We assessed vaccine-induced antibody responses to the SARS-CoV-2 ancestral virus and Omicron variant before and after booster immunization in 57 patients with B cell malignancies. Over one-third of vaccinated patients at the pre-booster time point were seronegative, and these patients were predominantly on active cancer therapies such as anti-CD20 monoclonal antibody. While booster immunization was able to induce detectable antibodies in a small fraction of seronegative patients, the overall booster benefit was disproportionately evident in patients already seropositive and not receiving active therapy. While ancestral virus- and Omicron variant-reactive antibody levels among individual patients were largely concordant, neutralizing antibodies against Omicron tended to be reduced. Interestingly, in all patients, including those unable to generate detectable antibodies against SARS-CoV-2 spike, we observed comparable levels of EBV- and influenza-reactive antibodies, demonstrating that B cell-targeting therapies primarily impair de novo but not preexisting antibody levels. These findings support rationale for vaccination before cancer treatment.
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Affiliation(s)
- Joseph H. Azar
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - John P. Evans
- Center for Retrovirus Research
- Department of Veterinary Biosciences
- Molecular, Cellular and Developmental Biology Program
| | - Madison H. Sikorski
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Karthik B. Chakravarthy
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Selah McKenney
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Ian Carmody
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Cong Zeng
- Center for Retrovirus Research
- Department of Veterinary Biosciences
| | - Rachael Teodorescu
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - No-Joon Song
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Jamie L. Hamon
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Donna Bucci
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Maria Velegraki
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Chelsea Bolyard
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Kevin P. Weller
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Sarah A. Reisinger
- The Ohio State University Comprehensive Cancer Center – James, The James Cancer Hospital
| | - Seema A. Bhat
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Kami J. Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Nathan Denlinger
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Narendranath Epperla
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Richard J. Gumina
- Department of Internal Medicine, Division of Cardiovascular Medicine; and
| | - Anastasia N. Vlasova
- Center for Food Animal Health, Animal Sciences Department, Ohio Agricultural Research and Development Center, College of Food, Agricultural and Environmental Sciences, The Ohio State University, Columbus, Ohio, USA
- Veterinary Preventive Medicine Department, College of Veterinary Medicine, The Ohio State University, Wooster, Ohio, USA
- Viruses and Emerging Pathogens Program, Infectious Diseases Institute
| | - Eugene M. Oltz
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
- Department of Microbial Infection and Immunity; and
| | - Linda J. Saif
- Center for Food Animal Health, Animal Sciences Department, Ohio Agricultural Research and Development Center, College of Food, Agricultural and Environmental Sciences, The Ohio State University, Columbus, Ohio, USA
- Veterinary Preventive Medicine Department, College of Veterinary Medicine, The Ohio State University, Wooster, Ohio, USA
- Viruses and Emerging Pathogens Program, Infectious Diseases Institute
| | - Dongjun Chung
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A. Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Peter G. Shields
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Shan-Lu Liu
- Center for Retrovirus Research
- Department of Veterinary Biosciences
- Viruses and Emerging Pathogens Program, Infectious Diseases Institute
- Department of Microbial Infection and Immunity; and
| | - Zihai Li
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Mark P. Rubinstein
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
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Núñez KG, Sandow T, Fort D, Patel J, Hibino M, Carmody I, Cohen AJ, Thevenot P. Baseline Alpha-Fetoprotein, Alpha-Fetoprotein-L3, and Des-Gamma-Carboxy Prothrombin Biomarker Status in Bridge to Liver Transplant Outcomes for Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13194765. [PMID: 34638251 PMCID: PMC8507524 DOI: 10.3390/cancers13194765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary An abnormal alpha-fetoprotein (AFP) test is often associated with hepatocellular carcinoma (HCC) development, although as many as 40% of HCC diagnoses are made in the absence of an abnormal AFP test. In Japan and other Asian countries, Lens culinaris agglutinin-reactive AFP fraction (AFP-L3) and des-gamma-carboxy prothrombin (DCP) are used in combination with AFP for HCC diagnosis. Combined testing with all three biomarkers increases early diagnosis in addition to providing a patient-specific profile of HCC aggressiveness. The utility of AFP, AFP-L3, and DCP for HCC prognosis in the bridge to liver transplantation has not been established. The goal of this study is to define prognosis to first-line HCC treatment and the risk of progression prior to liver transplantation associated with biomarker profile at diagnosis. Biomarker profiling may have future implications in precision therapeutic management of HCC as a bridge to transplantation. Abstract The biomarkers α-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP fraction (AFP-L3), and des-γ-carboxy prothrombin (DCP) have emerging implications in hepatocellular carcinoma (HCC) surveillance, overall prognosis, and post-surgical recurrence risk. This retrospective study investigated treatment and bridge to liver transplant (LT) prognosis associated with AFP, AFP-L3%, and DCP biomarker profiles prior to liver-directed therapy (LDT). In a 140-patient cohort, each biomarker was associated with HCC progression risk using the established thresholds of AFP > 20 ng/mL, AFP-L3 > 15%, and DCP > 7.5 ng/mL. Over 60% of the cohort expressed at least one biomarker at baseline. Although most biomarker-positive patients expressed the clinical standard AFP (57/87), only 32% were positive for AFP alone. Biomarker accumulation increased HCC progression risk but was not associated with demographic factors or preserved liver function. Biomarker triple negative patients had smaller index HCC (p = 0.003), decreased multifocal burden (p = 0.010), and a higher objective response rate (ORR, 62% compared to 46%, p = 0.011). Expressing all three biomarkers at baseline was associated with dismal first-line ORR (12%) with a median time to progression (TTP) of only 181 days post-LDT. Patients with triple negative status for the HCC biomarkers AFP, AFP-L3%, and DCP have the highest first-line ORR with < 5% HCC progression 1-year post-LDT. Biomarker profiling can establish baseline prognosis for identifying optimal bridge to LT and downstaging to LT candidates with triple negative biomarker status and providing an ideal post-LDT target as a compliment to radiographic response.
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Affiliation(s)
- Kelley G. Núñez
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
| | - Tyler Sandow
- Department of Radiology, Ochsner Health, New Orleans, LA 70121, USA;
| | - Daniel Fort
- Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA 70121, USA;
| | - Jai Patel
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
| | - Mina Hibino
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
| | - Ian Carmody
- Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA 70121, USA;
| | - Ari J. Cohen
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
- Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA 70121, USA;
- Faculty of Medicine, The University of Queensland, New Orleans, LA 70121, USA
| | - Paul Thevenot
- Institute of Translational Research, Ochsner Health, New Orleans, LA 70121, USA; (K.G.N.); (J.P.); (M.H.); (A.J.C.)
- Correspondence:
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Bohorquez H, Bugeaud E, Bzowej N, Scheuermann J, Hand J, Bruce D, Carmody I, Cohen A, Joshi S, Seal J, Sonnier D, Therapondos G, Girgrah N, Anders S, Loss GE. Liver Transplantation Using Hepatitis C Virus-Viremic Donors Into Hepatitis C Virus-Aviremic Recipients as Standard of Care. Liver Transpl 2021; 27:548-557. [PMID: 37160040 DOI: 10.1002/lt.25925] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/08/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
Liver transplantation (LT) using allografts from hepatitis C virus (HCV)-viremic/nucleic acid testing-positive donors' (DNAT+) organs into HCV-aviremic recipients (rHCV-) has been limited owing to nearly universal HCV transmission and concerns regarding availability, safety, and efficacy post-LT with direct-acting antiviral (DAA) therapy. We report our experience of LT using DNAT+ organs into rHCV- as a routine standard of care. Following verification of DAA access, absence of critical drug-drug interactions (DDIs) with DAAs, and informed consent, allocated DNAT+ organs were offered to patients on the waiting list for LT irrespective of recipient HCV status. Between June 2018 and December 2019, 292/339 rHCV- received an LT. Forty-seven patients were excluded from analysis because of recipient HCV viremia, refusal to receive DNAT+ organs, or inability to receive DAA therapy post-LT. Of these 292 patients, 61 rHCV- received DNAT+ livers (study group), and 231 rHCV- received DNAT- (aviremic donors [nuclear acid test-negative donors]) livers (control group). Recipient and donor characteristics as well as 1-year post-LT patient and graft survival were similar between groups. In the study group, 4 patients died, and 1 patient required retransplantation within the first year post-LT (all unrelated to HCV); 56 patients received DAA therapy, with a median time from LT to the start of DAA treatment of 66.9 days (interquartile range [IQR], 36-68.5), and 51 patients completed DAA treatment, all achieving sustained virologic response for 12 or more weeks (SVR-12) (1 patient required retreatment owing to relapse following initial DAA therapy). No patients had evidence of fibrosing cholestatic hepatitis or extrahepatic manifestations of HCV. This report indicates that transplantation of DNAT+ livers into rHCV- and subsequent DAA therapy is associated with clinical outcomes comparable to those achieved with DNAT- allografts.
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Affiliation(s)
- Humberto Bohorquez
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA.,Ochsner Clinical School of Medicine, University of Queensland, New Orleans, LA
| | - Emily Bugeaud
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA
| | - Natalie Bzowej
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA
| | | | - Jonathan Hand
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA
| | - David Bruce
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA
| | - Ian Carmody
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA.,Ochsner Clinical School of Medicine, University of Queensland, New Orleans, LA
| | - Ari Cohen
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA.,Ochsner Clinical School of Medicine, University of Queensland, New Orleans, LA
| | - Shobha Joshi
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA.,Ochsner Clinical School of Medicine, University of Queensland, New Orleans, LA
| | - John Seal
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA
| | - Dennis Sonnier
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA
| | - George Therapondos
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA.,Ochsner Clinical School of Medicine, University of Queensland, New Orleans, LA
| | - Nigel Girgrah
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA.,Ochsner Clinical School of Medicine, University of Queensland, New Orleans, LA
| | - Stephanie Anders
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA
| | - George E Loss
- Ochsner Health, Ochsner Multi-Organ Transplant Institute, New Orleans, LA.,Ochsner Clinical School of Medicine, University of Queensland, New Orleans, LA
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Nicolau-Raducu R, Cohen AJ, Bokhari A, Bohorquez H, Bruce D, Carmody I, Bugeaud E, Seal J, Sonnier D, Nossaman B, Loss G. Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients. Clin Transplant 2017; 31. [PMID: 28856732 DOI: 10.1111/ctr.13097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 08/17/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Early allograft dysfunction (EAD) is a well-defined clinical syndrome that reflects overall graft function within the first week after transplant. The aim of this study was to further refine the definition for EAD. METHOD In this study, 1124 patients were included for analysis. Logistic regression was performed to identify markers of liver injury associated with 6-month patient and graft failure. RESULTS Recursive partitioning identified cut-points for ALT/AST > 3000/6000 IU/dL observed within first week, with bilirubin ≥ 10 mg/dL and INR ≥ 1.6 on postoperative day 7 for the revised EAD model. The incidence of updated EAD was 15% (164/1124). Multivariable analysis identified eight risk factors associated with EAD: % macrosteatosis, donor location, donor weight, nonheart beating donors, type of organ transplanted, recipient-associated hepatocellular carcinoma, severity of postreperfusion syndrome, and the amount of transfused fresh frozen plasma. In the presence of EAD, the incidence of post-transplant renal replacement therapy and dialysis dependence increases. There was a significant association of the presence of EAD with 6-month mortality (12% vs 3%) and 6-month graft failure (8% vs 1%). CONCLUSION Higher AST/ALT level needed as cutoff in comparison with the old EAD definition.
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Affiliation(s)
| | - Ari J Cohen
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Amjad Bokhari
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Humberto Bohorquez
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - David Bruce
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Ian Carmody
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Emily Bugeaud
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - John Seal
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Dennis Sonnier
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Bobby Nossaman
- Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - George Loss
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
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5
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Nicolau-Raducu R, Occhipinti E, Marshall T, Koveleskie J, Ganier D, Evans B, Daly W, Fish B, Cohen AJ, Reichman TW, Bruce D, Bohorquez H, Seal J, Ahmed E, Carmody I, Loss G, Rayburn J, Nossaman B. Thromboprophylaxis With Heparin During Orthotopic Liver Transplantation: Comparison of Hepcon HMS Plus and Anti-Xa Assays for Low-Range Heparin. J Cardiothorac Vasc Anesth 2017; 31:575-581. [DOI: 10.1053/j.jvca.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Indexed: 11/11/2022]
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Reichman TW, Fiorello B, Carmody I, Bohorquez H, Cohen A, Seal J, Bruce D, Loss GE. Using on-site liver 3-D reconstruction and volumetric calculations in split liver transplantation. Hepatobiliary Pancreat Dis Int 2016; 15:587-592. [PMID: 27919847 DOI: 10.1016/s1499-3872(16)60155-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to an in situ division of the donor liver. METHODS Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathfinder Scout© liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively. RESULTS The average predicted weight of the grafts from the adult donors obtained from an in situ split procedure were 1130 g (930-1458 g) for the extended right lobe donors and 312 g (222-396 g) for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the extended right grafts and the left lateral segment grafts. The predicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts, respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft weight. CONCLUSIONS On-site volumetric assessment of donors provides useful information for the planning of an in situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.
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Affiliation(s)
- Trevor W Reichman
- Ochsner Multi-Organ Transplant Institute, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Reichman TW, Therapondos G, Serrano MS, Seal J, Evers-Meltzer R, Bohorquez H, Cohen A, Carmody I, Ahmed E, Bruce D, Loss GE. “Weighing the risk”: Obesity and outcomes following liver transplantation. World J Hepatol 2015; 7:1484-1493. [PMID: 26085908 PMCID: PMC4462687 DOI: 10.4254/wjh.v7.i11.1484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/23/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023] Open
Abstract
Obesity is on the rise worldwide. As a result, unprecedented rates of patients are presenting with end stage liver disease in the setting of non-alcoholic fatty liver disease (NAFLD) and are requiring liver transplantation. There are significant concerns that the risk factors associated with obesity and the metabolic syndrome might have a detrimental effect on the long term outcomes following liver transplantation. In general, short term patient and graft outcomes for both obese and morbidly obese patients are comparable with that of non-obese patients, however, several studies report an increase in peri-operative morbidity and increased length of stay. Continued studies documenting the long-term outcomes from liver transplantation are needed to further examine the risk of recurrent disease (NAFLD) and also further define the role risk factors such cardiovascular disease might play long term. Effective weight reduction in the post liver transplant setting may mitigate the risks associated with the metabolic syndrome long-term.
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Seal JB, Bohorquez H, Reichman T, Kressel A, Ghanekar A, Cohen A, McGilvray ID, Cattral MS, Bruce D, Greig P, Carmody I, Grant D, Selzner M, Loss G. Thrombolytic protocol minimizes ischemic-type biliary complications in liver transplantation from donation after circulatory death donors. Liver Transpl 2015; 21:321-8. [PMID: 25545787 DOI: 10.1002/lt.24071] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [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: 06/03/2014] [Revised: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 12/31/2022]
Abstract
Liver transplantation (LT) with donation after circulatory death (DCD) donors has been associated with a high rate of ischemic-type biliary strictures (ITBSs) and inferior graft survival. To investigate the impact of an intraoperative tissue plasminogen activator (tPA) on outcomes following DCD LT, we conducted a retrospective analysis of DCD LT at the Toronto General Hospital (TGH) and the Ochsner Medical Center (OMC). Between 2009 and 2013, 85 DCD LTs were performed with an intraoperative tPA injection (n = 30 at TGH, n = 55 at OMC), and they were compared with 33 DCD LTs without a tPA. Donor and recipient characteristics were similar in the 2 groups. There was no significant difference in the intraoperative packed red blood cell transfusion requirement (3.2 ± 3.4 versus 3.1 ± 2.3 U, P = 0.74). Overall, biliary strictures occurred less commonly in the tPA-treated group (16.5% versus 33.3%, P = 0.07) with a much lower rate of diffuse intrahepatic strictures (3.5% versus 21.2%, P = 0.005). After 1 and 3 years, the tPA group versus the non-tPA group had superior patient survival (97.6% versus 87.0% and 92.7% versus 79.7%, P = 0.016) and graft survival (96.4% versus 69.7% and 90.2% versus 63.6%, P < 0.001). In conclusion, a tPA injection into the hepatic artery during DCD LT reduces ITBSs and improves graft and patient survival without increasing the risk for bleeding.
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Affiliation(s)
- John B Seal
- Multi-Organ Transplant Program, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
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9
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Chandra PK, Gunduz F, Hazari S, Kurt R, Panigrahi R, Poat B, Bruce D, Cohen AJ, Behorquez HE, Carmody I, Loss G, Balart LA, Wu T, Dash S. Impaired expression of type I and type II interferon receptors in HCV-associated chronic liver disease and liver cirrhosis. PLoS One 2014; 9:e108616. [PMID: 25265476 PMCID: PMC4180933 DOI: 10.1371/journal.pone.0108616] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/22/2014] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Chronic Hepatitis C Virus (HCV)-infected patients with liver cirrhosis (LC) respond poorly to interferon-alpha (IFN-α) and ribavirin (RBV) combination therapy, but the reason for this is unclear. We previously reported that HCV-infection induces endoplasmic reticulum (ER) stress and autophagy response that selectively down regulates the type I IFN-α receptor-1 (IFNAR1) and RBV transporters (CNT1 and ENT1), leading to IFN-α/RBV resistance. The goal of this study is to verify whether an increase in ER stress and autophagy response is also associated with the reduced expression of IFNAR1 and RBV transporters in chronic HCV-infected patients. METHODS Primary human hepatocytes (PHH) were infected with cell culture grown HCV particles (JFH-ΔV3-Rluc). HCV replication was confirmed by the detection of viral RNA by RT-qPCR and HCV-core protein by Western blotting. The ER stress and autophagy response and expression of IFN receptors and RBV transporters in HCV infected PHH and liver tissues derived from patients were measured by Western blotting. RESULT HCV infection of PHH showed impaired expression of IFNAR1, IFNγR1 (Type II IFN receptor) and RBV transporters but not IL10Rβ (Type III IFN-λ receptor). ER stress markers (BiP, IRE1α and peIF2α) and autophagy response (LC3II, Beclin 1 and ATG5) were induced in HCV infected chronic liver disease (CLD) and LC patients. Liver biopsies (CLD) show a 50% reduced expression of IFNAR1 and RBV transporters. Furthermore, the expression of IFNAR1 and RBV transporters was impaired in almost all LC patients. CONCLUSION HCV infection induces ER stress and autophagy response in infected PHH and chronically infected liver tissues. The expression of IFNAR1, IFNγR1 and RBV transporters were significantly impaired in CLD and cirrhotic livers. Our study provides a potential explanation for the reduced response rate of IFN-α and RBV combination therapy in HCV infected patients with liver cirrhosis.
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Affiliation(s)
- Partha K. Chandra
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Feyza Gunduz
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Sidhartha Hazari
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ramazan Kurt
- Department of Medicine, Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Rajesh Panigrahi
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Bret Poat
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - David Bruce
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Ari J. Cohen
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Humberto E. Behorquez
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Ian Carmody
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - George Loss
- Transplant Surgery Section, Ochsner Medical Center, New Orleans, Louisiana, United States of America
| | - Luis A. Balart
- Department of Medicine, Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Tong Wu
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Srikanta Dash
- Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- Department of Medicine, Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America
- * E-mail:
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Kressel A, Therapondos G, Bohorquez H, Borg B, Bruce D, Carmody I, Cohen A, Girgrah N, Joshi S, Reichman T, Loss GE. Excellent liver retransplantation outcomes in hepatitis C-infected recipients. Clin Transplant 2013; 27:E512-20. [DOI: 10.1111/ctr.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2013] [Indexed: 12/15/2022]
Affiliation(s)
- A. Kressel
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - G. Therapondos
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - H. Bohorquez
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - B. Borg
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - D. Bruce
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - I. Carmody
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - A. Cohen
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - N. Girgrah
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - S. Joshi
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - T. Reichman
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
| | - G. E. Loss
- Multi-organ Transplant Institute; Ochsner Medical Center; New Orleans; LA; USA
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11
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Tang ZY, Loss G, Carmody I, Cohen AJ. TIMP-3 Ameliorates Hepatic Ischemia/Reperfusion Injury Through Inhibition of Tumor Necrosis Factor-Alpha-Converting Enzyme Activity in Rats. Transplantation 2006; 82:1518-23. [PMID: 17164725 DOI: 10.1097/01.tp.0000243381.41777.c7] [Citation(s) in RCA: 24] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tumor necrosis factor (TNF)-alpha and its receptors play a critical role in the inflammatory cascade after hepatic ischemia/reperfusion injury. TNF-alpha converting enzyme (TACE) or disintegrin and metalloproteinase (ADAM)-17 is a metalloproteinase disintegrin that specifically cleaves precursor TNF-alpha to its mature form and is involved in the ectodomain shedding of TNF receptors. The regulation of TACE is poorly understood and its role in liver injury and/or regeneration is unknown. METHODS Male Wistar rats were subjected to 10 or 30 min of partial warm hepatic ischemia followed by 3 to 24 hr of reperfusion. Serum and/or hepatic TACE, TNF-alpha, TNF receptor 1 (TNFR1), and interleukin (IL)-6 levels were assessed by enzyme-linked immunosorbent assay, real-time reverse-transcriptase polymerase chain reaction, and/or Western blot. RESULTS Low levels of TACE were detected in normal liver tissue. Both 10 and 30 min warm ischemia resulted in a rise in TACE expression which peaked six hr after reperfusion. TNF-alpha, TNFR1, and IL-6 levels were up-regulated in a pattern similar to TACE messenger RNA (mRNA) levels. Moreover, selective inhibition of TACE activity by specific inhibitor tissue inhibitor of metalloproteinase (TIMP)-3 at dosages of 100 or 1000 ng/kg body weight showed significant decrease of circulating TNF-alpha and serum alanine transferase (ALT) levels and histological improvement of hepatic ischemia/reperfusion injuries. CONCLUSIONS TACE expression and its activity, as measured by increases in TNF-alpha, TNFR1, and IL-6 levels, are increased following hepatic ischemia/reperfusion injury, implying that TACE plays an important role in hepatic ischemia/reperfusion injury. Amelioration of hepatic ischemia/reperfusion injury after inhibition of TACE activity by TIMP-3 suggests that TACE inhibition may play an important role in preventing liver ischemia/reperfusion injury warranting further experimental and clinical study.
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Affiliation(s)
- Zhen-Ya Tang
- Transplantation Research Laboratory, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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12
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Abstract
Seventy-five thousand Americans develop organ failure each year. Fifteen percent of those on the list for transplantation die while waiting. Several possible mechanisms to expand the organ pool are being pursued including the use of extended criteria donors, living donation, and split deceased donor transplants. Cadaveric organ splitting results from improved understanding of the surgical anatomy of the liver derived from Couinaud. Early efforts focused on reduced-liver transplantation (RLT) reported by both Bismuth and Broelsch in the mid-1980s. These techniques were soon modified to create both a left lateral segment graft appropriate for a pediatric recipient and a right trisegment for an appropriately sized adult. Techniques of split liver transplantation (SLT) were also modified to create living donor liver transplantation. Pichlmayr and Bismuth reported successful split liver transplantation in 1989 and Emond reported a larger series of nine split procedures in 1990. Broelsch and Busuttil described a technical modification in which the split was performed in situ at the donor institution with surgical division completed in the heart beating cadaveric donor. In situ splitting reduces cold ischemia, simplifies identification of biliary and vascular structures, and reduces reperfusion hemorrhage. However, in situ splits require specialized skills, prolonged operating room time, and increased logistical coordination at the donor institution. At UCLA over 120 in situ splits have been performed and this technique is the default when an optimal donor is available. Split liver transplantation now accounts for 10% of adult transplantations at UCLA and 40% of pediatric transplantations.
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Affiliation(s)
- H Yersiz
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7054, USA.
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13
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Savar A, Carmody I, Hiatt JR, Busuttil RW. Laparoscopic bile duct injuries: management at a tertiary liver center. Am Surg 2004; 70:906-9. [PMID: 15529848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Bile duct injury is a rare but morbid complication of laparoscopic cholecystectomy (LC). This study was undertaken to evaluate the management of 20 patients with bile duct injuries during LC who were referred to a tertiary center with expertise in hepatobiliary surgery and liver transplantation. Sixteen (80%) were female. Mean age was 44 (range 13-70) years. Half of the injuries were distal (Bismuth I), and nearly half were diagnosed at LC. Reoperative repair was attempted in 30 per cent. Mean interval between injury and operation was 6.55 months (range 0 to 36 months). Eighteen patients underwent Roux-en-Y hepaticojejunostomy (HJ). Of the two patients who did not undergo HJ (both Bismuth I), one was treated with transhepatic cholangiography only, and one died of multiorgan failure. There were four minor complications and one late reoperation for stricture. We conclude that bile duct injury after LC is successfully managed in a tertiary center by a hepatobiliary-liver transplant team. Principles of management include anatomic definition of injury, control of sepsis, staged approach involving interventional radiology, and operative techniques refined in liver transplantation including magnification, fine sutures, selective use of internal stent, and liver biopsy.
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Affiliation(s)
- Aaron Savar
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7054, USA
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14
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Savar A, Carmody I, Hiatt JR, Busuttil RW. Laparoscopic Bile Duct Injuries: Management at a Tertiary Liver Center. Am Surg 2004. [DOI: 10.1177/000313480407001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bile duct injury is a rare but morbid complication of laparoscopic cholecystectomy (LC). This study was undertaken to evaluate the management of 20 patients with bile duct injuries during LC who were referred to a tertiary center with expertise in hepatobiliary surgery and liver transplantation. Sixteen (80%) were female. Mean age was 44 (range 13–70) years. Half of the injuries were distal (Bismuth I), and nearly half were diagnosed at LC. Reoperative repair was attempted in 30 per cent. Mean interval between injury and operation was 6.55 months (range 0 to 36 months). Eighteen patients underwent Roux-en-Y hepaticojejunostomy (HJ). Of the two patients who did not undergo HJ (both Bismuth I), one was treated with transhepatic cholangiography only, and one died of multiorgan failure. There were four minor complications and one late reoperation for stricture. We conclude that bile duct injury after LC is successfully managed in a tertiary center by a hepatobiliary-liver transplant team. Principles of management include anatomic definition of injury, control of sepsis, staged approach involving interventional radiology, and operative techniques refined in liver transplantation including magnification, fine sutures, selective use of internal stent, and liver biopsy.
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Affiliation(s)
- Aaron Savar
- From the Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ian Carmody
- From the Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan R. Hiatt
- From the Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ronald W. Busuttil
- From the Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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15
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Carmody I, Busuttil RW. Treatment of Hepatic Artery Thrombosis After Orthotopic Liver Transplantation. Asian J Surg 2004. [DOI: 10.1016/s1015-9584(09)60036-1] [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: 10/19/2022] Open
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Abstract
OBJECTIVE To explore putative cytoprotective functions of biliverdin during hepatic ischemia/reperfusion (I/R) injury in rat models. MATERIAL AND METHODS Male Sprague Dawley (SD) rat livers were harvested and stored for 24 hours at 4 degrees C in University of Wisconsin (UW) solution (n=18), and then perfused with blood for 2 hours on an isolated rat liver perfusion apparatus equipped for temperature (37 degrees C), pressure (13 cm H2O), and pH (7.3) maintenance. Biliverdin was added to the blood at concentrations of 10 and 50 micromol in two groups of six animals. Portal vein blood flow, bile production, and GOT/GPT levels were assessed serially. At the conclusion of the experiment, liver samples were collected for histologic evaluation using Suzuki criteria. RESULTS BV exerted protective effects against liver I/R injury. Adjunctive biliverdin improved portal venous blood flow (mL/min/g) from the beginning of reperfusion (1.33+/-0.17 versus 0.98+/-0.15; P<.001) and increased bile production (mL/g) as compared with the control group (3.40 versus 1.88; P<.003). I/R-induced hepatocellular damage as measured by GOT/GPT release (IU/L) was diminished in the biliverdin group (91 versus 171 and 46 versus 144, respectively; P<.0001). Improved liver function by biliverdin was accompanied by preservation of the histologic structure as assessed by Suzuki criteria (3.7+/-1.4 versus 6.8+/-0.8 in untreated controls; P<.005). CONCLUSIONS Biliverdin attenuates the ischemia/early reperfusion injury of rat liver grafts as assessed by hemodynamics, function, enzyme analysis, and histology. This study provides the rationale for novel therapeutic approaches using biliverdin to maximize the organ donor pool through the safer use of liver transplants despite prolonged periods of cold ischemia.
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Affiliation(s)
- C Fondevila
- Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Asensio JA, Forno W, Roldán G, Petrone P, Rojo E, Ceballos J, Wang C, Costaglioli B, Romero J, Tillou A, Carmody I, Shoemaker WC, Berne TV. Visceral vascular injuries. Surg Clin North Am 2002; 82:1-20, xix. [PMID: 11905939 DOI: 10.1016/s0039-6109(03)00138-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article deals with injuries to the celiac trunk, superior and inferior mesenteric arterial injuires. Surgical approaches and physiological implications of interruption of the mesenteric arterial circulation are addressed in detail. Surgical techniques for the management of these injuries and the need for second look operations are also examined.
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Affiliation(s)
- Juan A Asensio
- Trauma Surgery Service A, Division of Trauma Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, 90033, USA
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