28 results on '"Posner MP"'
Search Results
2. Center-level Variation in HLA-incompatible Living Donor Kidney Transplantation Outcomes.
- Author
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Jackson KR, Long J, Motter J, Bowring MG, Chen J, Waldram MM, Orandi BJ, Montgomery RA, Stegall MD, Jordan SC, Benedetti E, Dunn TB, Ratner LE, Kapur S, Pelletier RP, Roberts JP, Melcher ML, Singh P, Sudan DL, Posner MP, El-Amm JM, Shapiro R, Cooper M, Verbesey JE, Lipkowitz GS, Rees MA, Marsh CL, Sankari BR, Gerber DA, Wellen J, Bozorgzadeh A, Gaber AO, Heher E, Weng FL, Djamali A, Helderman JH, Concepcion BP, Brayman KL, Oberholzer J, Kozlowski T, Covarrubias K, Desai N, Massie AB, Segev DL, and Garonzik-Wang J
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- Adult, Female, Graft Rejection blood, Graft Rejection immunology, Graft Rejection mortality, Humans, Immunosuppressive Agents adverse effects, Male, Middle Aged, Quality Indicators, Health Care, Registries, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Graft Rejection prevention & control, Graft Survival drug effects, HLA Antigens immunology, Healthcare Disparities, Histocompatibility, Immunosuppressive Agents therapeutic use, Isoantibodies blood, Kidney Transplantation adverse effects, Kidney Transplantation mortality, Living Donors, Practice Patterns, Physicians'
- Abstract
Background: Desensitization protocols for HLA-incompatible living donor kidney transplantation (ILDKT) vary across centers. The impact of these, as well as other practice variations, on ILDKT outcomes remains unknown., Methods: We sought to quantify center-level variation in mortality and graft loss following ILDKT using a 25-center cohort of 1358 ILDKT recipients with linkage to Scientific Registry of Transplant Recipients for accurate outcome ascertainment. We used multilevel Cox regression with shared frailty to determine the variation in post-ILDKT outcomes attributable to between-center differences and to identify any center-level characteristics associated with improved post-ILDKT outcomes., Results: After adjusting for patient-level characteristics, only 6 centers (24%) had lower mortality and 1 (4%) had higher mortality than average. Similarly, only 5 centers (20%) had higher graft loss and 2 had lower graft loss than average. Only 4.7% of the differences in mortality (P < 0.01) and 4.4% of the differences in graft loss (P < 0.01) were attributable to between-center variation. These translated to a median hazard ratio of 1.36 for mortality and 1.34 of graft loss for similar candidates at different centers. Post-ILDKT outcomes were not associated with the following center-level characteristics: ILDKT volume and transplanting a higher proportion of highly sensitized, prior transplant, preemptive, or minority candidates., Conclusions: Unlike most aspects of transplantation in which center-level variation and volume impact outcomes, we did not find substantial evidence for this in ILDKT. Our findings support the continued practice of ILDKT across these diverse centers., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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3. Multimodality therapy and liver transplantation for hepatocellular carcinoma: a 14-year prospective analysis of outcomes.
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Ramanathan R, Sharma A, Lee DD, Behnke M, Bornstein K, Stravitz RT, Sydnor M, Fulcher A, Cotterell A, Posner MP, and Fisher RA
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- Aged, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Chemotherapy, Adjuvant, Disease-Free Survival, Female, Humans, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local, Niacinamide therapeutic use, Prospective Studies, Radiotherapy, Adjuvant, Risk Factors, Sorafenib, Time Factors, Treatment Outcome, Carcinoma, Hepatocellular therapy, Catheter Ablation adverse effects, Catheter Ablation mortality, Chemoembolization, Therapeutic adverse effects, Chemoembolization, Therapeutic mortality, Hepatectomy adverse effects, Hepatectomy mortality, Liver Neoplasms therapy, Liver Transplantation adverse effects, Liver Transplantation mortality, Niacinamide analogs & derivatives, Phenylurea Compounds therapeutic use, Protein Kinase Inhibitors therapeutic use, Radiopharmaceuticals therapeutic use, Yttrium Radioisotopes therapeutic use
- Abstract
Background: Hepatocellular carcinoma is a major cause of death among patients with cirrhosis. A standardized approach of multimodality therapy with intent-to-treat by transplantation for all patients with hepatocellular carcinoma was instituted at our transplant center in 1997. Data were prospectively collected to evaluate the impact of multimodality therapy on posttransplant patient survival, tumor recurrence, and patient survival without transplantation., Methods: All patients with hepatocellular carcinoma were eligible for multimodality therapy. Multimodality therapy consisted of hepatic resection, radiofrequency ablation, transarterial chemoembolization, transarterial chemoinfusion, yttrium-90 microsphere radioembolization, and sorafenib., Results: Approximately 715 patients underwent multimodality therapy; 231 patients were included in the intent-to-treat with transplantation arm, and 484 patients were treated with multimodality therapy or palliative therapy because of contraindications for transplantation. A 60.2% transplantation rate was achieved in the intent-to-treat with transplantation arm. Posttransplant survivals at 1 and 5 years were 97.1% and 72.5%, respectively. Tumor recurrence rates at 1, 3, and 5 years were 2.4%, 6.2%, and 11.6%, respectively. Patients with contraindications to transplant had increased 1- and 5-year survival from diagnosis with multimodality therapy compared with those not treated (73.1% and 46.5% versus 15.5% and 4.4%, P<0.0001)., Conclusions: Using multimodality therapy before liver transplantation for hepatocellular carcinoma achieved low recurrence rates and posttransplant survival equivalent to patients with primary liver disease without hepatocellular carcinoma. Multimodality therapy may help identify patients with less active tumor biology and result in improved disease-free survival and organ utilization.
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- 2014
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4. Identification of biomarkers to assess organ quality and predict posttransplantation outcomes.
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Scian MJ, Maluf DG, Archer KJ, Turner SD, Suh JL, David KG, King AL, Posner MP, Brayman KL, and Mas VR
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- Biomarkers, Glomerular Filtration Rate, Humans, Oligonucleotide Array Sequence Analysis, Proportional Hazards Models, Signal Transduction, Transplantation, Homologous, Kidney Transplantation, Tissue Donors, Transcriptome
- Abstract
Unlabelled: The increased disparity between organ supply and need has led to the use of extended criteria donors and donation after cardiac death donors with other comorbidities., Methods: We have examined the preimplantation transcriptome of 112 kidney transplant recipient samples from 100 deceased-donor kidneys by microarray profiling. Subject groups were segregated based on estimated glomerular filtration rate (eGFR) at 1 month after transplantation: the GFR-high group (n=74) included patients with eGFR 45 mL/min per 1.73 m(2), whereas the GFR-low group (n=35) included patients with eGFR 45 mL/min or less per 1.73 m(2)., Results: Gene expression profiling identified higher expression of 160 probe sets (140 genes) in the GFR-low group, whereas expression of 37 probe sets (33 genes) was higher in the GFR-high group (P<0.01, false discovery rate <0.2). Four genes (CCL5, CXCR4, ITGB2, and EGF) were selected based on fold change and P value and further validated using an independent set of samples. A random forest analysis identified three of these genes (CCL5, CXCR4, and ITGB2) as important predictors of graft function after transplantation., Conclusions: Inclusion of pretransplantation molecular gene expression profiles in donor quality assessment systems may provide the necessary information for better donor organ selection and function prediction. These biomarkers would further allow a more objective and complete assessment of procured renal allografts at pretransplantation time.
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- 2012
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5. En bloc kidney transplantation from pediatric donors: comparable outcomes with living donor kidney transplantation.
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Sharma A, Fisher RA, Cotterell AH, King AL, Maluf DG, and Posner MP
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- Adult, Body Weight, Cadaver, Child, Preschool, Female, Graft Survival, Humans, Infant, Kidney Transplantation adverse effects, Male, Middle Aged, Patient Selection, Retrospective Studies, Time Factors, Treatment Outcome, Kidney Transplantation methods, Living Donors, Tissue Donors
- Abstract
Background: En bloc kidneys from pediatric donors have been considered suboptimal for transplantation to adult recipients and their outcomes have rarely been compared with living donor kidney transplantation (LDKT). Traditionally, there has been hesitancy in transplanting en bloc kidneys from donors weighing less than 10 kg due to high risk of technical complications., Methods: Retrospective chart reviews were performed to compare outcomes after pediatric en bloc (n=20, mean donor weight 11.4 kg), standard criteria deceased (n=249), and living donor (n=215) kidney transplantation in adult recipients at our center. The outcomes after en bloc transplantation from young donors weighing less than or equal to 10 kg were compared with those from 11 to 15 kg donors., Results: The 5-year graft survival after en bloc, standard deceased, and LDKT were 92%, 70%, and 88%, respectively (P=ns). There were no vascular complications, and urine leak was seen in 1 of 20 en bloc transplants. The 1-year serum creatinine of 1.1±0.2 mg/dL in recipients from less than or equal to 10 kg donors was comparable with 0.9±0.5 mg/dL in 11 to 15 kg group (P=ns)., Conclusions: Excellent long-term outcome after pediatric en bloc kidney transplantation from donors weighing less than or equal to 15 kg are comparable with those after LDKT. By using meticulous surgical technique and judicious recipient selection criteria, technical graft losses can be minimized when using en bloc pediatric kidneys from donors weighing less than or equal to 10 kg. Use of pediatric en bloc kidneys should be encouraged continuously to address the problem of organ shortage.
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- 2011
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6. Gene expression changes are associated with loss of kidney graft function and interstitial fibrosis and tubular atrophy: diagnosis versus prediction.
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Scian MJ, Maluf DG, Archer KJ, Suh JL, Massey D, Fassnacht RC, Whitehill B, Sharma A, King A, Gehr T, Cotterell A, Posner MP, and Mas V
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- Adult, Aged, Atrophy, Fibrosis, Humans, Kidney metabolism, Kidney Tubules pathology, Middle Aged, Transplantation, Homologous, Gene Expression Profiling, Kidney pathology, Kidney Transplantation adverse effects
- Abstract
Background: Loss of kidney graft function due to interstitial fibrosis (IF) and tubular atrophy (TA) is the most common cause of kidney allograft loss., Methods: One hundred one allograft tissues (26 samples with IF/TA, 17 normal allografts, and an independent biopsy group collected at 3 month [n=34] posttransplantation) underwent microarray analysis to identify early detection/diagnostic biomarkers of IF/TA. Profiling of 24 allograft biopsies collected at or after 9-month posttransplantation (range 9-18 months) was used for validation. Three-month posttransplantation biopsies were classified as IF/TA nonprogressors (group 1) or progressors (group 2) using graft function and histology at 9-month posttransplantation., Results: We identified 2223 differentially expressed probe sets between IF/TA and normal allograft biopsies using a Bonferroni correction. Genes up-regulated in IF/TA were primarily involved in pathways related to T-cell activation, natural killer cell-mediated cytotoxicity, and programmed cell death. A least absolute shrinkage and selection operator model was derived from the differentially expressed probe sets, resulting in a final model that included 10 probe sets and had 100% training set accuracy. The N-fold crossvalidated error was 2.4% (sensitivity 95.8% and specificity 100%). When 3-month biopsies were tested using the model, all the samples were classified as normal. However, evaluating gene expression of the 3-month biopsies and fitting a new penalized model, 100% sensitivity was observed in classifying the samples as group1 or 2. This model was evaluated in the sample set collected at or after 9-month posttransplantation., Conclusions: An IF/TA gene expression signature was identified, and it was useful for diagnosis but not prediction. However, gene expression profiles at 3 months might predict IF/TA progression.
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- 2011
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7. Distinctive gene expression profiles characterize donor biopsies from HCV-positive kidney donors.
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Mas VR, Archer KJ, Suh L, Scian M, Posner MP, and Maluf DG
- Subjects
- Adult, Biopsy, Case-Control Studies, Cluster Analysis, Delayed Graft Function genetics, Delayed Graft Function immunology, Female, Gene Expression Regulation, Gene Regulatory Networks, Graft Survival genetics, Hepatitis C immunology, Humans, Immunity, Innate genetics, Inflammation genetics, Kidney immunology, Male, Middle Aged, Oligonucleotide Array Sequence Analysis, Polymerase Chain Reaction, Transplantation, Homologous, Treatment Outcome, Virginia, Donor Selection, Gene Expression Profiling methods, Hepatitis C genetics, Kidney chemistry, Kidney Transplantation immunology, RNA analysis, Tissue Donors supply & distribution
- Abstract
Background: Because of the shortage of organs for transplantation, procurement of kidneys from extended criteria donors is inevitable. Frequently, donors infected with hepatitis C virus (HCV) are used. To elucidate an initial compromise of molecular pathways in HCV graft, gene expression profiles were evaluated., Methods: Twenty-four donor allograft biopsies (n=12 HCV positive (+) and n=12 HCV negative (-)) were collected at preimplantation time and profiled using microarrays. Donors were age, race, gender, and cold and warm ischemia time matched between groups. Probe level data were read into the R programming environment using the affy Bioconductor package, and the robust multiarray average method was used to obtain probe set expression summaries. To identify probe sets exhibiting differential expression, a two sample t test was performed. Molecular and biologic functions were analyzed using Interaction Networks and Functional Analysis., Results: Fifty-eight probe sets were differentially expressed between HCV (+) versus HCV (-) donors (P<0.001). The molecular functions associated with the two top scored networks from the analysis of the differentially expressed genes were connective tissue development and function and tissue morphology (score 34), cell death, cell signaling, cellular assembly, and organization (score 32). Among the differentially affected top canonical pathways, we found the role of RIG1-like receptors in antiviral innate immunity (P<0.001), natural killer cell signaling (P=0.007), interleukin-8 signaling (P=0.048), interferon signaling (P=0.0 11; INFA21, INFGR1, and MED14), ILK signaling (P=0.001), and apoptosis signaling., Conclusions: A unique gene expression pattern was identified in HCV (+) kidney grafts. Innate immune system and inflammatory pathways were the most affected.
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- 2010
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8. Saphenous vein graft aneurysm after renal transplantation: a case report.
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Sharma A, King AL, Lee HM, and Posner MP
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- Adult, Creatinine blood, Glomerulosclerosis, Focal Segmental complications, Graft Rejection surgery, Humans, Iliac Artery surgery, Kidney Failure, Chronic etiology, Male, Postoperative Complications, Plastic Surgery Procedures, Reoperation, Saphenous Vein surgery, Treatment Outcome, Aneurysm diagnosis, Kidney Failure, Chronic surgery, Kidney Transplantation adverse effects, Saphenous Vein transplantation
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- 2010
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9. Hepatitis C virus infection and kidney transplantation: predictors of patient and graft survival.
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Maluf DG, Fisher RA, King AL, Gibney EM, Mas VR, Cotterell AH, Shiffman ML, Sterling RK, Behnke M, and Posner MP
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- Biopsy, Cadaver, Female, Fish Oils therapeutic use, Humans, Liver pathology, Liver virology, Living Donors, Male, Middle Aged, Tissue Donors, Treatment Outcome, Triglycerides blood, Graft Survival physiology, Hepatitis C complications, Kidney Failure, Chronic complications, Kidney Failure, Chronic surgery, Kidney Transplantation physiology
- Abstract
Background: The effect of hepatitis C virus (HCV) infection on patients undergoing kidney transplantation (KTx) is uncertain. This study aimed to evaluate the outcomes of our HCV+/end-stage renal disease (ESRD) patient population based on the therapeutic option including KTx or continuation in dialysis., Methods: KTx performed at Virginia Commonwealth University Hospital between January 2000 and December 2004 were tracked prospectively. Forty-three out of a total of 394 KTx patients included in the analysis were HCV+. A group of 52 contemporaneous HCV+/ESRD patients listed, but never transplanted, was also analyzed. HCV-negative transplanted patients were used as the control group., Results: Patient survival posttransplantation was 81.4% and 68.5% at 1 and 3 years in the HCV+ group, and 97.1% and 92.9% at 1 and 3 years in the HCV- group, respectively (P=0.001). Graft survival was 81.2% and 64.1% at 1 and 3 years in the HCV+ group, and 93.2% and 84.1% at 1 and 3 years posttransplantation in the HCV- group (P=0.01). Univariate analysis identified Knodell score as a predictor of mortality in HCV+ patients (P=0.04). Cox proportional hazards multivariate analysis identified deceased donor (P=0.02), previous kidney transplant (P=0.007), pretransplant diabetes (P=0.05), and Knodell Score (P=0.012) as predictors of patient mortality. Patient survival was superior in HCV+ patients undergoing KTx versus remaining on dialysis., Conclusions: Patients with ESRD/HCV+ benefit from KTx without achieving the excellent survival of HCV-/ESRD patients. Liver biopsy is a useful tool to identify advanced liver disease at pretransplantation time.
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- 2007
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10. Reasons for non-use of recovered kidneys: the effect of donor glomerulosclerosis and creatinine clearance on graft survival.
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Edwards EB, Posner MP, Maluf DG, and Kauffman HM
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- Aged, Aged, 80 and over, Biopsy, Cadaver, Cohort Studies, Female, Glomerulosclerosis, Focal Segmental pathology, Humans, Kidney metabolism, Kidney Transplantation standards, Kidney Transplantation statistics & numerical data, Male, Middle Aged, Multivariate Analysis, Outcome Assessment, Health Care, Predictive Value of Tests, Registries, Tissue and Organ Procurement, Creatinine metabolism, Glomerulosclerosis, Focal Segmental mortality, Graft Survival, Kidney pathology, Kidney Transplantation mortality
- Abstract
Background: In 2000, the United Network for Organ Sharing/Organ Procurement and Transplantation Network Registry reported 540 recovered kidneys were discarded because of biopsy results, and 210 were discarded because of poor organ function. We compared the percentage of glomerulosclerosis (GS) and creatinine clearance (CrCl) of both discarded and transplanted cadaveric kidneys and examined their effect on graft survival and function., Methods: The cohort consisted of all cadaveric kidneys (n= 3,444) with reported biopsy results between October 25, 1999 and December 31, 2001. Graft survival was calculated by univariate and multivariate models., Results: Fifty-one percent of discarded kidneys had GS of less than 20%, 27% had a CrCl greater than 80 mL/min, and 15% (129 kidneys) had both GS less than 20% and a CrCl of greater than 80 mL/min. Univariate analyses of kidneys with less than or equal to 20% GS revealed no difference in 1-year graft survival when the CrCl was greater than or less than or equal to 80 mL/min. When GS was greater than 20%, 1-year graft survival of kidneys with a CrCl of greater than 80 mL/min was significantly greater than that of kidneys with a CrCl of less than or equal to 80 mL/min. Multivariate results showed no significant difference in relative risk of graft loss with GS greater than 20% versus less than or equal to 20% when the CrCl was either 50 or 80 mL/min. With both GS less than or equal to 20% and greater than 20%, serum creatinine at 1 year was significantly lower in kidneys with CrCl greater 80 mL/min., Conclusions: Calculated donor CrCl does, and percentage GS on donor kidney biopsies does not, correlate well with 1-year graft survival and function, and percentage GS should not be used as the sole criterion for discarding recovered cadaveric kidneys.
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- 2004
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11. Hardikar syndrome: a case requiring liver transplantation.
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Maluf DG, Fisher RA, Fulcher AS, and Posner MP
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- Child, Preschool, Female, Humans, Liver pathology, Liver Diseases diagnosis, Magnetic Resonance Imaging, Syndrome, Abnormalities, Multiple, Hydronephrosis complications, Liver Diseases complications, Liver Diseases surgery, Liver Transplantation, Retinal Diseases complications
- Abstract
We report the case of a girl with Hardikar syndrome who underwent living-donor liver transplantation at 2 years of age. This disease, described in 1992, includes a constellation of abnormalities, such as cleft lip and palate, pigmentary retinopathy, and multiple tubular stenoses (e.g., bile ducts, ureters). Other system involvement is variable. Rotation anomalies of the gut and cardiac abnormalities are frequently present. Pathogenesis remains obscure. Our patient was delivered at 33 weeks of gestation by cesarean section, and was jaundiced, with low birth weight and height. On day 5 after birth, the patient underwent Ladd's surgery for intestinal malrotation. One month later, she developed pyelonephritis and urosepsis. She remained jaundiced and a liver biopsy revealed cirrhosis with regenerating nodules, portal chronic inflammation with bile duct proliferation, and lobular cholestasis. The patient underwent several corrective operations, and at 12 months of age she was diagnosed with Hardikar syndrome. She failed to thrive and had progressive cholestasis and jaundice, coagulation disorders, bilateral ureterostomies, repetitive urinary tract infections, bilateral cleft lip and palate, retinopathy, and gut malrotation. She received a liver transplant at 24 months of age from a living donor. She has had an excellent clinical outcome in liver function without further decline of growth and development.
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- 2002
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12. Prospective validation of quantitative polymerase chain reaction for management of cytomegalovirus disease in solid-organ transplant patients.
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Fisher RA, Saggi BH, Ferreira-Gonzalez A, Wolfe L, and Posner MP
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- Adolescent, Adult, Cytomegalovirus Infections drug therapy, Ganciclovir therapeutic use, Humans, Middle Aged, Prospective Studies, Cytomegalovirus Infections diagnosis, Kidney Transplantation adverse effects, Liver Transplantation adverse effects, Polymerase Chain Reaction methods, Viral Load
- Abstract
This study evaluates the utility of quantitative polymerase chain reaction (QPCR) to determine duration of treatment of transplant patients with human cytomegalovirus (HCMV) disease. Eighteen patients with HCMV disease were prospectively evaluated and followed for recurrence using a QPCR assay. We used plasma samples from which nucleic acid was extracted. Quantification was determined by using an internal standard that contained the same primer sequences as for HCMV. During treatment, weekly QPCR assays were performed. Patients were treated with HCMV immunoglobulin-G for a finite period, but intravenous ganciclovir was continued until less than 100 viral copies (vc) per mL was detectable. After cessation of therapy, patients were followed for 6 months with monthly clinical assessment and QPCR. No patient developed recurrence of HCMV at a mean follow-up of 16 months. This preliminary study suggests that the use of QPCR to assess viral load is useful in deciding the length of HCMV treatment with ganciclovir but requires further randomized validation.
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- 2002
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13. The interrelationship between portal and arterial blood flow after adult to adult living donor liver transplantation.
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Marcos A, Olzinski AT, Ham JM, Fisher RA, and Posner MP
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- Adult, Blood Flow Velocity, Body Weight, Cadaver, Hepatic Artery diagnostic imaging, Humans, Liver Transplantation diagnostic imaging, Liver Transplantation pathology, Living Donors, Portal Vein diagnostic imaging, Ultrasonography, Hepatic Artery physiology, Liver Circulation, Liver Transplantation physiology, Portal Vein physiology
- Abstract
Background: When adults are transplanted with segmental grafts, disparity between the size of the graft and the native organ is almost universal. These grafts presumably still receive all of the native portal inflow despite a reduced vascular bed and dramatically elevated blood flow may result. The hemodynamic changes after segmental transplantation in adults have not yet been studied and their clinical significance is unknown., Methods: Portal venous and hepatic arterial blood flow were measured intraoperatively in right lobe liver donors and recipients with electromagnetic flow probes. Postoperative evolution was monitored in recipients with ultrasonography., Results: Portal flow to the right lobe ranged from 601 to 1,102 ml/min before resection and from 1,257 to 2,362 ml/min after transplantation. There was a statistically significant linear correlation between the change in portal flow and graft to recipient body weight ratio. Arterial blood flow ranged from 213 to 460 ml/min before resection and from 60 to 300 ml/min after transplantation. Preoperative portal peak systolic velocity was uniformly around 10 cm/sec. Values on postoperative day 1 were increased to 30 cm/sec in recipients of cadaveric organs, to 50 cm/sec in recipients of organs with graft to recipient body weight ratios of more than 1.2%, and to 115 cm/sec in recipients of organs with ratios less than 0.9%. A decreasing tendency was universally observed. Arterial systolic velocity was inversely related to portal systolic velocity. Neither graft dysfunction nor vascular complications occurred., Conclusions: The hemodynamic pattern after right lobe transplantation is predictable and intraoperative measurements and ultrasonography are useful for monitoring. The size of the graft influences the magnitude of the hemodynamic changes.
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- 2000
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14. Selection and outcome of living donors for adult to adult right lobe transplantation.
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Marcos A, Fisher RA, Ham JM, Olzinski AT, Shiffman ML, Sanyal AJ, Luketic VA, Sterling RK, Olbrisch ME, and Posner MP
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- Adult, Biopsy, Follow-Up Studies, Hepatectomy, Humans, Liver pathology, Postoperative Complications, Liver Transplantation, Living Donors, Personnel Selection methods, Tissue and Organ Procurement
- Abstract
Background: The shortage of cadaveric livers has sparked an interest in adult-to-adult living donor transplantation. Right lobe donor hepatectomy is frequently required to obtain a graft of adequate size for adult recipients. Careful donor selection is necessary to minimize complications and assure a functional graft., Methods: A four-step evaluation protocol was used for donor selection and satisfactory results of all tests in each step were required before proceeding to the next. Donors were selected based on a battery of laboratory studies chosen to exclude unrecognized infection, liver disease, metabolic disorders, and conditions representing undue surgical risk. Imaging studies included ultrasonography, angiography, magnetic resonance imaging, and intraoperative cholangiography and ultrasonography. The information obtained from liver biopsy was used to correct the estimated graft mass for the degree of steatosis., Results: From March 1998 to August 1999, 126 candidates were evaluated for living donation. A total of 35 underwent donor right lobectomy with no significant complications. Forty percent of all donors that came to surgery were genetically unrelated to the recipient. A total of 69% of those evaluated were excluded. ABO incompatibility was the primary reason for exclusion after the first step (71%) and the presence of steatosis yielding an inadequate estimated graft mass after the second step (20%)., Conclusions: Donor selection limits the application of living donor liver transplantation in the adult population. Unrelated individuals increase the size of the donor pool. Right lobe hepatectomy can be performed safely in healthy adult liver donors. Preoperative liver biopsy is an essential part of the evaluation protocol, particularly when the estimated graft mass is marginal.
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- 2000
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15. Emergency adult to adult living donor liver transplantation for fulminant hepatic failure.
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Marcos A, Ham JM, Fisher RA, Olzinski AT, Shiffman ML, Sanyal AJ, Luketic VA, Sterling RK, and Posner MP
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- Adult, Emergencies, Hepatectomy, Hepatic Encephalopathy virology, Hepatitis B complications, Humans, Liver anatomy & histology, Liver Function Tests, Magnetic Resonance Imaging, Male, Nuclear Family, Tissue and Organ Harvesting, Hepatic Encephalopathy surgery, Liver Transplantation methods, Living Donors
- Abstract
Background: The high mortality rate associated with fulminant hepatic failure combined with the limited availability of cadaveric organs requires consideration of alternatives to conventional cadaveric transplantation. Use of the donor right lobe in adult-to-adult living donor transplantation holds promise in a variety of circumstances, including high-acuity situations., Methods: A 28-year-old male with fulminant hepatic failure secondary to hepatitis B was referred to our institution. He rapidly progressed to grade IV encephalopathy, and laboratory values were indicative of a poor prognosis without transplantation. He was listed for transplantation as UNOS status I. Three siblings were simultaneously evaluated for living liver donation. Following established protocols, we completed donor evaluation in less than 24 hr, and donor right lobectomy and living donor transplantation were performed within 36 hr of the recipient's admission to our center., Results: The donor surgery was uncomplicated, and the patient was discharged on postoperative day 4. The recipient experienced full recovery and was discharged home on postoperative day 14. Of note, the first offer for a cadaveric liver came more than 60 hr after living donor transplantation., Conclusions: Thorough donor workup can be completed in less than 24 hr without inappropriate abbreviation of the evaluation. Simultaneous workup of willing individuals prevents unnecessary delay. Living donor transplantation should be considered for patients with fulminant hepatic failure who are appropriate transplant candidates.
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- 2000
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16. Emergency portacaval shunt for control of hemorrhage from a parenchymal fracture after adult-to-adult living donor liver transplantation.
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Marcos A, Fisher RA, Ham JM, Olzinski AT, Shiffman ML, Sanyal AJ, Luketic VA, Sterling RK, and Posner MP
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- Adult, Female, Humans, Iatrogenic Disease, Liver Regeneration, Living Donors, Magnetic Resonance Imaging, Male, Middle Aged, Reoperation, Emergencies, Hemorrhage, Liver Diseases, Liver Transplantation, Portacaval Shunt, Surgical, Postoperative Complications
- Abstract
As more adults undergo transplantation with partial liver grafts, the unique features of these segments and their clinical significance will become apparent. A patient presented with life-threatening hemorrhage from an iatrogenic laceration to a right lobe graft 11 days after transplantation. The creation of a portacaval shunt effectively controlled the bleeding, allowing more elective replacement of the organ with another right lobe graft. The regeneration process combined with increased portal blood flow and relative outflow limitation may have set the stage for this complication. Any disruption of the liver parenchyma during transplantation should be securely repaired and followed cautiously. Portacaval shunting is an option for controlling hemorrhage from the liver in transplant recipients. The timely availability of a second organ was likely the ultimate determinant of survival for this patient.
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- 2000
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17. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation.
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Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA, Sterling RK, Fulcher AS, and Posner MP
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- Adult, Body Weight, Fatty Liver physiopathology, Humans, Liver pathology, Magnetic Resonance Imaging, Middle Aged, Postoperative Period, Prospective Studies, Liver physiopathology, Liver Regeneration, Liver Transplantation, Living Donors
- Abstract
Background: Regeneration of the liver to a predetermined size after resection or transplantation is a well described phenomenon, but the time course over which these events occur has not been well defined. It is not clear how initial liver mass, reperfusion, immunosuppression, or steatosis influence this process., Methods: Liver regeneration was assessed prospectively by volumetric magnetic resonance imaging (MRI) in living right lobe liver donors and the recipients of these grafts. Imaging was performed at regular intervals through 60 days after resection/transplantation, and liver mass was determined. Liver function tests and synthetic function were monitored throughout the study period in donors and recipients of these grafts as well as recipients of cadaveric grafts., Results: MRI consistently overestimated liver mass by a mean of 45 g (+/-65) (range 10-123). Donor liver mass increased by 101%, 110%, 115%, and 144% at 7, 14, 30, and 60 days after resection, respectively. Recipient liver mass increased by 87,101, 119, and 99% at 7, 14, 30, and 60 days after transplantation, respectively. Steatosis did not influence the degree of regeneration or graft function, nor was there a functional difference between grafts of >1% graft to recipient body weight ratio or <1%., Conclusions: MRI accurately determines right lobe mass. Most liver regeneration occurs in the 1st week after resection or transplantation, and the time course does not differ significantly in donors or recipients. The mass of the graft or remnant segment affects the duration of the regeneration process, with a smaller initial liver mass prolonging the course. Steatosis of <30% had no bearing on liver function or regeneration and, therefore, should not be an absolute criterion for exclusion of donors. A calculated graft to recipient body weight ratio of 0.8% is adequate for right lobe living donor liver transplantation.
- Published
- 2000
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18. Right lobe living donor liver transplantation.
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Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA, Sterling RK, and Posner MP
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- Adult, Biliary Tract Diseases etiology, Graft Survival physiology, Hepatectomy methods, Humans, Intestinal Obstruction etiology, Middle Aged, Pulmonary Atelectasis etiology, Survival Rate, Thrombophlebitis etiology, Liver, Liver Transplantation adverse effects, Liver Transplantation methods, Liver Transplantation mortality, Living Donors supply & distribution
- Abstract
Background: The shortage of livers for transplantation has prompted transplant centers to seek alternatives to conventional cadaveric liver transplantation. Left lateral segmentectomy from living donors has proven to be a safe operation for the donor with excellent results in the pediatric population. Left lobectomy, conceived to supply more tissue, still provides insufficient liver mass for an average size adult patient. Right lobectomy could supply a graft of adequate size., Methods: Donors were considered only after recipients were listed according to United Network for Organ Sharing (UNOS) criteria. Donor evaluation included liver biopsy, magnetic resonance imaging, and celiac and mesenteric angiography. The donor operation consisted of a right lobectomy uniformly performed throughout the series as described herein., Results: Twenty-five right lobe living donor liver transplants were performed between adults, with no significant complications in donors. Recipient and graft survival was 88%, with three recipient deaths secondary to uncontrolled sepsis in patients at high risk for liver transplant; all three had functioning grafts., Conclusions: Right lobe living donor liver transplantation poses challenges that require a meticulous surgical technique to minimize morbidity in the recipient. Right lobectomies for living donation can be performed safely with minimal risk to both donor and recipient although providing adequate liver mass for an average size adult patient.
- Published
- 1999
- Full Text
- View/download PDF
19. Intragraft cytokine expression and tolerance induction in rat renal allografts.
- Author
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Saggi BH, Fisher RA, Bu D, Tawes JW, Riley R, and Posner MP
- Subjects
- Animals, Cyclosporine therapeutic use, Cytokines biosynthesis, Gene Expression Regulation, Graft Rejection immunology, Immunosuppressive Agents therapeutic use, Interferon-gamma genetics, Interleukin-10 genetics, Interleukin-4 genetics, Polymerase Chain Reaction, Rats, Sirolimus therapeutic use, Transcription, Genetic, Transplantation, Homologous, Transplantation, Isogeneic, Cytokines genetics, Immunosuppression Therapy methods, Kidney Transplantation immunology
- Abstract
Background: Intragraft cytokine expression was evaluated in a model of renal transplantation. ACI and Lewis rats were used as donors and recipients, respectively, for heterotopic renal transplantation., Methods: Treated allograft rats (n=10) received a preoperative dose of rapamycin and cyclosporine, followed by 7 days of cyclosporine postoperatively. Isograft rats (n=5) and control allograft rats (n=4) received no immunosuppression. Sacrifice was performed after 120 days. Expression of interleukin (IL)-4, IL-10, and interferon-gamma (IFN-gamma) transcripts was determined with semiquantitative reverse transcriptase-polymerase chain reaction., Results: All treated allograft rats had normal function with 50% histologic rejection. All isografts had normal function. IL-4 and IL-10 were in greater density in allografts with normal histology, whereas IFN-gamma was only seen in allografts with cellular rejection. No IL-10 was seen in isografts, but IL-4 was detected in 3/5 isografts., Conclusions: We conclude that the lymphocyte population's elaboration of IL-4 and IL-10 is associated with tolerance, whereas the production of IFN-gamma and absence of IL-4 is associated with histology suggestive of acute cellular rejection.
- Published
- 1999
- Full Text
- View/download PDF
20. A prospective randomized trial of mycophenolate mofetil with neoral or tacrolimus after orthotopic liver transplantation.
- Author
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Fisher RA, Ham JM, Marcos A, Shiffman ML, Luketic VA, Kimball PM, Sanyal AJ, Wolfe L, Chodorov A, and Posner MP
- Subjects
- Adolescent, Adult, Aged, Cholesterol blood, Cytomegalovirus Infections prevention & control, Female, Graft Survival, Humans, Male, Middle Aged, Mycophenolic Acid administration & dosage, Prospective Studies, Risk Factors, Cyclosporine administration & dosage, Immunosuppressive Agents administration & dosage, Liver Transplantation adverse effects, Liver Transplantation immunology, Mycophenolic Acid analogs & derivatives, Tacrolimus administration & dosage
- Abstract
Background: The success of liver transplantation in this decade has become the stimulus to extend the donor and recipient pool. Reducing early posttransplant morbidity to maintain our success, as we expand our frontiers, has led us to focus on balanced testing of multidrug immunosuppression regimens., Methods: A prospective trial in orthotopic liver transplantation using Mycophenolate Mofetil and an identical steroid taper with randomization of patients to Neoral (N) or Tacrolimus (FK) is the basis of this report. This was an intent-to-treat study designed to compare the 6-month primary endpoints of rejection and infection and to compare the 6-month secondary endpoints of liver function, renal function, bone marrow function, hypertension, and serum cholesterol levels., Results: Ninety-seven patients completed the 6-month follow-up period (N=49, FK=48). The actual 6-month patient and graft survival rates were 98% and 94%, respectively. There was no difference in the number of patients with rejection episodes (N=11, FK=8) (P=0.61). There were 24 infections (3 cytomegalovirus) in the FK group and 30 infections (9 cytomegalovirus) in the N group. The cholesterol levels at 6 months were not significantly different (P=0.07) between the groups. The other secondary 6-month endpoints were not significantly different, except total bilirubin, which was lower in the FK arm (P=0.02)., Conclusions: The use of Mycophenolate Mofetil with N or FK and an identical steroid taper after orthotopic liver transplantation is associated with excellent graft and patient survival, and at 6 months, only 191% of the patients experienced rejection, with a 48% overall infection rate.
- Published
- 1998
- Full Text
- View/download PDF
21. Hepatocyte transplantation as a bridge to orthotopic liver transplantation in terminal liver failure.
- Author
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Strom SC, Fisher RA, Thompson MT, Sanyal AJ, Cole PE, Ham JM, and Posner MP
- Subjects
- Adult, Aged, Female, Humans, Infant, Intracranial Pressure, Male, Middle Aged, Prospective Studies, alpha 1-Antitrypsin analysis, Cell Transplantation, Liver cytology, Liver Failure surgery, Liver Transplantation
- Abstract
The limited donor organ supply has led to several bridging techniques to sustain patients with acute and subacute liver failure. We report here the prospective, controlled trial of transplanted isolated fresh and cryopreserved human hepatocytes as a bridge to orthotopic liver transplantation. Five hepatocyte transplant recipients with grade IV encephalopathy and multisystem organ failure and four patients of equal illness severity due to liver failure were studied. Medical therapy resulted in a significant (P<0.05), but not normal, fall in blood ammonia, and a significant (P<0.02) resolving biochemical marker of liver injury that did not improve cardiovascular or cerebral stability; this lead to death within 3 days in all control patients. The five hepatocyte-treated patients maintained normal cerebral perfusion and cardiac stability, with withdrawal of medical support for 2 to 10 days before orthotopic liver transplantation. Biochemical evidence of liver injury improved significantly (P=0.004) and blood ammonia levels decreased significantly (P=0.0005) to normal levels in the hepatocyte-treated patients. Three of five patients who successfully bridged to whole liver allograft transplant are alive, home, and normal with more than 20 months of follow-up. No infections or embolic or pulmonary complications resulted from intra-arterial splenic hepatocyte infusion. Specific antiprotease production in a patients with genetically deficient alpha-1-antitrypsin disease, and immunohistochemical and electron microscopic evidence of splenic "hepatization" are presented as evidence of the viability of hepatocyte splenic seeding. In conclusion, splenic transplantation of differentiated adult hepatocytes can control hyper-ammonemia, correct genetic defects in liver function, and bridge life to orthotopic liver transplantation in human liver failure.
- Published
- 1997
- Full Text
- View/download PDF
22. Analysis of functional renal allograft tolerance with single-dose rapamycin based induction immunosuppression.
- Author
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Goggins WC, Fisher RA, Dattilo JB, Cohen DS, Tawes JW, Dattilo MP, Babcock GF, Frede SE, Wakely PE Jr, and Posner MP
- Subjects
- Actins biosynthesis, Animals, Blood Urea Nitrogen, Creatinine blood, Cyclosporine therapeutic use, DNA Primers, Drug Therapy, Combination, Graft Rejection immunology, Graft Rejection pathology, Immune Tolerance, Immunosuppression Therapy methods, Interleukin-10 biosynthesis, Kidney Transplantation pathology, Kidney Transplantation physiology, Male, Polymerase Chain Reaction, Proteinuria, Rats, Rats, Inbred ACI, Rats, Inbred Lew, Sirolimus, Transplantation Chimera, Transplantation, Homologous, Transplantation, Isogeneic, Immunosuppressive Agents therapeutic use, Kidney Transplantation immunology, Polyenes therapeutic use
- Abstract
The induction of transplantation tolerance is one of the primary goals following solid organ transplantation. The combination of a single dose of rapamycin (RAPA) with a short course of cyclosporine (CsA) has been shown to induce transplantation tolerance in the nonfunctional rat heterotopic cardiac transplant model. The purpose of this study was to assess this effective induction protocol in a functional renal transplant model. Male ACI (RTl(a)) and Lewis (RT1(1)) rats were used as donor and recipients respectively. Allografts received a single RAPA dose of (1.5 mg/kg) combined with CsA (10 mg/kg) 12-14 hr prior to transplantation. CsA (5 mg/kg) was given daily on days +1 - +7. Untreated Lewis to Lewis isografts served as histological controls. Chimerism, assessed in recipient skin, and intragraft interleukin (IL) 10 expression was determined utilizing PCR and RT-PCR techniques respectively. Treated animals and isografts were sacrificed 120-130 days posttransplant for functional and histological evaluation. Allografts (n=9) were functionally tolerant with serum creatinine (0.77+/-0.1 vs. 0.88+/-0.1; P=0.275), blood urea nitrogen (37.6+/-4.6 vs. 23.3+/-1.9; P=0.123), and 24 hr protein excretion (27.0+/-4.4 vs. 17.9+/-5.2; P=0.131) similar to single kidney ACI controls. Histologically, 45% (4/9) allografts were indistinguishable from isografts with no evidence of rejection, and were considered immunologically tolerant. Donor/recipient chimerism was not detected. All immunologically tolerant allografts had evidence of intragraft IL-10 expression. Rejecting allografts and isografts did not express intragraft IL-10. This study confirms the efficacy of pre-engraftment single-dose RAPA combined with CsA in inducing true immunologic tolerance in this stringent functional renal transplant model. The expression of intragraft IL-10 in tolerant recipients suggests a Th-2 shift as the mechanism of tolerance in this model.
- Published
- 1997
- Full Text
- View/download PDF
23. The impact of a positive crossmatch upon outcome after liver transplantation.
- Author
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Goggins WC, Fisher RA, Kimball PM, Wolfe L, Hill BE, Pietruszka TD, Shiffman ML, Sanyal AJ, Luketic VA, Ham JM, and Posner MP
- Subjects
- Adult, Female, Flow Cytometry, Graft Rejection prevention & control, Graft Survival physiology, Humans, Male, Middle Aged, Muromonab-CD3 therapeutic use, Prospective Studies, Blood Grouping and Crossmatching methods, Liver Transplantation immunology, T-Lymphocytes, Cytotoxic pathology
- Abstract
Recent reports have shown that liver allografts transplanted against a positive lymphocytotoxic crossmatch (CDC+) are susceptible to an increased frequency of rejection, and decreases in patient and graft survival. The implication of a positive flow cytometric crossmatch (FCXM+) in liver transplantation remains controversial. The purpose of this study was to determine what impact a pretransplant IgG crossmatch due to CDC+ or FCXM+ had upon the clinical outcome following liver transplantation. Preoperative crossmatch status was determined prospectively in 110 consecutive liver transplants performed between July 1991 and January 1995. Allografts were divided into three groups: negative crossmatch (NXM), positive flow cytometric crossmatch FCXM+, and positive lymphocytotoxic crossmatch CDC+. Crossmatch status did not impact patient or graft survival. Actuarial patient survival was similar between groups at 12 months (88% vs. 95% vs. 92%, NXM vs. FCXM+ vs. CDC+) and 24 months (81% vs. 93% vs. 92%, NXM vs. FCXM+ vs. CDC+) (P=0.1938). Actuarial allograft survival was similar between groups at 12 months (76% vs. 93% vs. 85%, NXM vs. FCXM+ vs. CDC+) and 24 months (76% vs. 89% vs. 85%, NXM vs. FCXM+ vs. CDC+) (P=0.0738). CDC+ allografts had a significant increase in early rejection episodes compared with NXM (46% vs. 7%, CDC+ vs. NXM) (P=0.003) or FCXM+ allografts (46% vs. 10%, CDC+ vs. FCXM+) (P=0.006). CDC+ allografts experienced significantly more rejection episodes per year than NXM (53% vs. 20%, CDC+ vs. NXM) (P=0.015) or FCXM+ allografts (53% vs. 23%, CDC+ vs. FCXM+) (P=0.02). CDC+ allografts had a significant increase in numbers of additional nonconventional therapeutic interventions compared to NXM allografts (0.9+/-0.5 vs. 0.2+/-0.1, CDC+ vs. NXM) (P=0.039). The presence of cytotoxic antibodies pretransplantation is associated with increased incidences of early rejection, and rejection episodes per year. With careful monitoring and aggressive therapeutic interventions the presence of cytotoxic antibodies are not deleterious to patient or liver allograft survival.
- Published
- 1996
- Full Text
- View/download PDF
24. Biochemical and histologic evaluation of recurrent hepatitis C following orthotopic liver transplantation.
- Author
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Shiffman ML, Contos MJ, Luketic VA, Sanyal AJ, Purdum PP 3rd, Mills AS, Fisher RA, and Posner MP
- Subjects
- Adult, Alanine Transaminase blood, Alkaline Phosphatase blood, Bilirubin blood, Cholestasis etiology, Female, Graft Survival, Hepatitis C pathology, Humans, Male, Middle Aged, Necrosis, Hepatitis C diagnosis, Liver Transplantation pathology
- Abstract
It is well recognized that hepatitis recurs in virtually all patients who undergo orthotopic liver transplantation for cirrhosis secondary to chronic hepatitis C (HCV). The present report describes the biochemical and histologic findings of recurrent hepatitis in 25 such patients. One patient was found to have hepatocellular carcinoma at the time of OLT and was excluded from further analysis. All post-OLT laboratory values were reviewed. Liver biopsies were performed on protocol 6, 12, 24, and 36 months following OLT. Additional biopsies were performed as necessary to evaluate abnormalities in serum liver chemistries. A total of 104 biopsies was obtained; hepatitis consistent with recurrent HCV was present in 68 (65%). Other biopsy findings included cytomegalovirus hepatitis; acute, chronic, or resolving rejection; cholestasis with or without an underlying hepatitis; steatosis, and centrilobular necrosis. Histologic hepatitis appeared in all patients within 12 months following OLT. Despite these histologic findings, serum ALT was normal for prolonged periods in over 50% of such patients. In all cases this hepatitis was mild and did not progress over a mean follow-up of 22 months (maximum 44 months), as judged by Knodell histologic activity score (mean score: 4.0 +/- 0.3). Five patients developed cholestatic jaundice, far out of proportion to the degree of histologic hepatitis. In 2 patients this was secondary to chronic rejection. The other 3 patients had drug-induced cholestasis that resolved after various medications were discontinued. HCV did not contribute to graft dysfunction in any of the 24 patients. To date, our data suggest that post-OLT hepatitis in patients with preexisting HCV is a relatively benign process. Severe cholestatic jaundice in such patients is not secondary to HCV, and should stimulate a search for other possible causes of graft dysfunction. The long-term consequences of recurrent HCV following hepatic transplantation remain to be determined.
- Published
- 1994
25. Hepatic lidocaine metabolism and complications of cirrhosis. Implications for assessing patient priority for hepatic transplantation.
- Author
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Shiffman ML, Fisher RA, Sanyal AJ, Edinboro LE, Luketic VA, Purdum PP 3rd, Raymond P, and Posner MP
- Subjects
- Adult, Aged, Contraindications, Humans, Lidocaine analogs & derivatives, Lidocaine blood, Liver Cirrhosis epidemiology, Liver Function Tests, Middle Aged, Risk Factors, Time Factors, Lidocaine metabolism, Liver metabolism, Liver Cirrhosis complications, Liver Transplantation
- Abstract
The number of patients awaiting hepatic transplantation continues to exceed organ donation. As a result, many liver transplant candidates will develop life-threatening complications of their liver disease and not survive the pretransplant waiting period. Recent studies have demonstrated that hepatic lidocaine metabolism into monoethylglycinexylidide (MEG-X) can predict pretransplant survival. The present study was performed to determine if MEG-X could also predict pretransplant complications and thereby be useful in stratifying persons being evaluated for hepatic transplantation. A total of 57 patients with biopsy-proven cirrhosis underwent MEG-X testing. Of 57 patients, 30 (53%) developed life-threatening complications of their liver disease--i.e., variceal bleeding, grade II hepatic encephalopathy or worse, and spontaneous bacterial peritonitis. MEG-X values were greater in persons without complications of liver disease than in persons with complications (25.7 +/- 2.9 versus 14.7 +/- 1.4 ng/ml, respectively). No patients with MEG-X greater than 30 ng/ml developed a major complication. No significant difference in any of the standard liver function tests existed between persons who developed complications and patients who did not. In this group of 57 patients, 4 (7%) died from complications of cirrhosis. Mean MEG-X for patients who died (5.5 +/- 1.6 ng/ml) was significantly less (P < 0.05) than observed for other patient groups. All patients who died had MEG-X values below 10 ng/ml. This suggests that MEG-X testing could be an extremely useful test in the evaluation of patients for hepatic transplantation by identifying persons at increased risk for developing complications of chronic liver disease.
- Published
- 1993
- Full Text
- View/download PDF
26. Use of extracorporeal membrane oxygenation for adult respiratory distress syndrome following cadaveric renal transplantation.
- Author
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Greenfield DT, Posner MP, Lofland GK, and Wechsler AS
- Subjects
- Adult, Cadaver, Humans, Male, Muromonab-CD3 therapeutic use, Extracorporeal Membrane Oxygenation, Kidney Transplantation adverse effects, Respiratory Distress Syndrome therapy
- Published
- 1993
- Full Text
- View/download PDF
27. Pretransplant warm B cell antibodies in recipients of primary and retransplanted cadaver renal allografts.
- Author
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Posner MP, Mohanakumar T, Rhodes CL, McGeorge MB, Mendez-Picon G, Goldman MH, and Lee HM
- Subjects
- Autoantibodies immunology, Graft Survival, Humans, Kidney Failure, Chronic therapy, B-Lymphocytes immunology, Kidney Transplantation
- Abstract
Eighty-four recipients of cadaveric renal allografts were retrospectively crossmatched for donor-specific pretransplant B cell antibody. Of these, 28 were found to be positive for the antibody and 56 were negative. Actuarial survival analysis over six years revealed a slightly better graft survival overall in the B-cell-negative group as compared with the B-cell-positive group (P less than 0.07). These patients were further subgrouped into those who received primary transplants and those who were retransplanted. Fifty-four percent of the B-cell-positive group (15/28) consisted of retransplants, and only 13% (7/56) of the B-cell-negative group were retransplants. When considering primary transplants only, B-cell-negative and B-cell-positive groups had similar graft survival rates (P less than 0.25). When retransplants only were considered, the graft survivals of the B-cell-positive and B-cell-negative groups were comparable (P less than 0.32). The most significant differences were observed when comparing the B-cell-positive primary transplant group with the B-cell-positive retransplanted group. The primary transplants fared consistently better at all time intervals (P less than .007). Conversely, when primary and retransplants in the B-cell-negative group were compared, no differences were noted (P less than 0.29). Our results suggest that the identification of pretransplant B-cell antibodies may be indicative of a poorer allograft survival prognosis in patients who have been previously transplanted.
- Published
- 1984
- Full Text
- View/download PDF
28. The importance of the Lewis system in cadaver renal transplantation.
- Author
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Posner MP, McGeorge MB, Mendez-Picon G, Mohanakumar T, and Lee HM
- Subjects
- Black People, Graft Survival, Humans, Prospective Studies, White People, Kidney Transplantation, Lewis Blood Group Antigens immunology
- Abstract
Previous reports have suggested that Lewis (Le) antigens may exert a significant effect on cadaver renal allograft (CRA) survival, especially in black recipients in whom there is a higher frequency of Le-negative phenotypes. We review our experience with this problem in 70 donor-recipient pairs of CRA who underwent prospective Le typing and received conventional immunosuppression between 1980 and 1983. Recipient typing alone yielded the following graft survival (GS) and patient survival (PS) at 2 years by life table analysis: (a+,b;-) (n = 12) 51% GS, 93% PS; (a-, b+) (n = 44) 57% GS, 88% PS; and (a-,b-) (n = 14) 51% GS, 93% PS(P-ns for GS, PS). Recipient racial characteristics did not effect ultimate graft survival, as whites and blacks had similar two-year GS in all phenotypic groups. When Le matching was considered, no significant differences in one-year graft survivals could be ascertained between Le-matched and Le-mismatched donor-recipient pairs, and this effect persisted despite stratification for race and HLA-A,B and DR histoincompatibilities. In light of these results, we do not recommend using Lewis compatibility as a criterion for donor selection in cadaver renal allografting, as this substantially increases the difficulty in finding suitable matches, especially in the (a-,b-) recipient group.
- Published
- 1986
- Full Text
- View/download PDF
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