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Background: The influx of new resident physicians has been shown to cause increased complications in academic institutions, named the "July effect." This study investigated if this effect is associated with liver transplants and if it affects patient or allograft outcomes after orthotopic liver transplantation (OLT)., Materials and Methods: The United Network of Organ Sharing or Organ Procurement and Transplantation Network database was queried. Cases were separated and coded by the month of transplant. The survival analysis was calculated by log-rank and Kaplan-Meier tests in SPSS version 15.0 (IBM Corporation, Chicago, IL)., Results: A total of 108,666 OLTs were analyzed through March 31, 2011. The mean short-term patient survivals at 30 d and 1 y were 94.3% and 85.2%, respectively. The mean long-term survivals at 3, 5, and 10 y were 77.6%, 72.1%, and 58.8%, respectively. The mean short-term allograft survivals at 30 d and 1 y were 90.6% and 79.4%, respectively. The mean long-term allograft survivals at 3, 5, and 10 y were 71.0%, 65.0%, and 51.5%, respectively. OLTs in the month of April had significantly improved patient and allograft survivals compared with those in the months of January, October, and December; OLTs in the month of December had significantly decreased patient and allograft survivals compared with those in the months of July and August., Conclusions: OLTs in the month of April had significantly improved outcomes, and OLTs in the month of December had significantly decreased outcomes. These months do not correlate with the beginning of new trainees; therefore, there is no July effect observed in liver transplant fellowship and resident training., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Use of donation after cardiac death (DCD) donors has been proposed as an effective way to expand the availability of hepatic allografts used in orthotopic liver transplantation (OLT); yet, there remains no consensus in the medical literature as to how to choose optimal recipients and donors based on available information., Methods: We queried the United Network of Organ Sharing/Organ Procurement and Transplantation Network database for hepatic DCD allografts used in OLT. As of March 31, 2011, 85,148 patients received hepatic allografts from donation-after-brain-death (DBD) donors, and 2351 patients received hepatic allografts from DCD donors. We performed survival analysis using log-rank and Kaplan-Meier tests. We performed univariate and multivariate analyses using the Cox proportional hazards model. All statistics were performed with SPSS 15.0., Results: Patients receiving hepatic DCD allografts had significantly worse survival compared with patients receiving hepatic DBD allografts. Pediatric patients who received a hepatic DCD allograft had similar survival to those who received a hepatic DBD allograft. The optimal recipient-related characteristics were age <50 y, International Normalized Ratio <2.0, albumin >3.5 gm/dL, and cold ischemia time <8 h; optimal donor-related characteristics included age <50 y and donor warm ischemia time <20 min., Conclusions: By identifying certain characteristics, the transplant clinician's decision-making process can be assisted so that similar survival outcomes after OLT can be achieved with the use of hepatic DCD allografts., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: Experience suggests transplanting whole liver allografts (WL) from donors weighing <6 kg portends a worse prognosis. Patient and allograft survivals of infants who underwent transplantation with livers from donors ≥6 kg, <6 kg, or technical variant allografts from deceased donors (TV) and those from living donors (LD) were compared., Methods: The United Network of Organ Sharing database was queried for infant orthotopic liver transplantation (≤2 y). Of 5976 orthotopic liver transplantations, 860 patients received TV from deceased donors, 534 received LD split allografts, 509 patients had WL from donors weighing <6 kg, and 4073 remaining patients had WL from donors weighing ≥6 kg. Kaplan-Meier method and log-rank tests were employed., Results: Patients who received WL from donors weighing <6 kg had survival mean of 13.9 y ± 177 d. Overall patient survivals were 76.7%, 71.4%, 68.4%, and 65.9% at 1, 3, 5, and 10 y. This is significantly worse compared with all other groups, both in patient and allograft survival (P ≤ 0.001). In patients whose donors ≥6 kg, overall patient survivals were 82.1%, 78.7%, 77.3%, and 75.4% at 1, 3, 5, and 10 y. Infants who received TV had patient survival of 87.8%, 84.7%, 82.7%, and 80.6% at 1, 3, 5, and 10 y. Infants who received LD allografts had patient survival of 92.4%, 90.7%, 89.6%, and 88.5% at 1, 3, 5, and 10 y., Conclusions: Smaller weight of the donor influences the infant patient outcome. Patients with allografts from donors weighing <6 kg have a worse prognosis compared with those who received TV and LD allografts and those whose donors weigh ≥6 kg. Patients who receive LD allografts had the best survival., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Caroli disease (CD) is characterized by dilation of the intrahepatic biliary tree, which may result in malignancy. Treatments include management of symptoms and hepatic resection to decrease disease burden. In patients with CD not amenable to these treatments, orthotopic liver transplantation (OLT) has been used. This study examines if OLT is a reasonable treatment for patients with CD., Materials and Methods: The United Network of Organ Sharing/Organ Procurement and Transplantation Network database between September 30, 1987 and March 31, 2011 was queried. Cases without patient or allograft survival time or without a diagnosis were excluded from analysis. Patients with CD were compared to patients with primary biliary cirrhosis (PBC), secondary biliary cirrhosis (BC), primary sclerosing cholangitis (PSC), and all indications for OLT. Survival analysis was performed by log-rank test and Kaplan-Meier., Results: One hundred forty patients with CD were compared to 4797 patients with PBC, 489 patients with secondary BC, 6033 patients with PSC, and 92,210 patients post-OLT. Patient and allograft survivals of CD patients at 1, 3, 5, and 10 y are, respectively, 88.5%, 83.4%, 80.9%, and 77.8%; and 81.2%, 74.8%, 70.6%, and 67.9%. CD patients have significantly improved patient and allograft survivals after OLT compared to patients with secondary BC (P = 0.003, P = 0.015) and all other patients undergoing OLT (P = 0.003, P = 0.026). There is a trend towards long-term improved patient and allograft survival in transplanted patients with CD compared to patients with PBC and PSC., Conclusions: These results suggest that OLT should be considered an effective treatment modality for patients with CD resulting in excellent long-term outcomes., (Copyright © 2012. Published by Elsevier Inc.)

Background: Angiostatin, a proteolytic fragment of plasminogen, is a potent inhibitor of angiogenesis. In vitro, angiostatin can be generated by pancreatic elastase proteolysis of plasminogen; however, in vivo, the enzymes responsible for angiostatin production are not known. A recent study demonstrates the involvement of a serine protease in angiostatin generation. In this study we sought to determine if the human pancreatic carcinoma cell line ASPC1 produced enzymatic activity capable of converting plasminogen to angiostatin and to determine if urokinase plasminogen activator (uPA) is involved in this system. Methods. ASPC1 cells were grown to near confluence in 20% FBS-RPMI. Media were changed to serum free and cells cultured for an additional 24 h. The serum free conditioned media (SFCM) was obtained. Angiostatin generation was determined by incubating 20 microg of human plasminogen with 100 microl of SFCM for 0, 3, 8, 12, 24, and 48 h. Plasminogen cleavage was assessed in the presence of the following protease inhibitors: pefabloc, aprotinin, phosphoramidon, leupeptin, and EDTA. The effect of uPA on angiostatin generation was determined by incubating plasminogen with antibody to uPA. Angiostatin generation was determined by Western blot., Results: Incubation of plasminogen with SFCM resulted in the generation of immunoreactive bands at 48 kDa corresponding to human angiostatin. Angiostatin generation by ASPC1 SFCM was time dependent; there was a significant decrease in the plasminogen substrate beginning at 3 h with complete conversion to angiostatin by 48 h. Enzymatic activity leading to angiostatin production was found to be due to a serine protease. Antibody to uPA effectively blocked angiostatin production by ASPC1 SFCM in a dose-dependent manner., Conclusion: Human pancreatic cancer cells express enzymatic activity which leads to the generation of angiostatin. Conversion of plasminogen to angiostatin is due to a serine protease. This serine protease is most likely uPA., (Copyright 1998 Academic Press.)