Author: "Pratima Sharma" / Topic: humans - Searchworks@Jio Institute Digital Library Search Results

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1. Intraoperative risk factors of acute kidney injury after liver transplantation

Author: Rachel J. Berkowitz, Milo C. Engoren, Graciela Mentz, Pratima Sharma, Sathish S. Kumar, Ryan Davis, Sachin Kheterpal, Christopher J. Sonnenday, and Nicholas J. Douville
Subjects: Adult, Transplantation, Postoperative Complications, Hepatology, Renal Dialysis, Risk Factors, Humans, Surgery, Acute Kidney Injury, Liver Transplantation, Retrospective Studies
Abstract: Acute kidney injury (AKI) is one of the most common complications of liver transplantation (LT). We examined the impact of intraoperative management on risk for AKI following LT. In this retrospective observational study, we linked data from the electronic health record with standardized transplant outcomes. Our primary outcome was stage 2 or 3 AKI as defined by Kidney Disease Improving Global Outcomes guidelines within the first 7 days of LT. We used logistic regression models to test the hypothesis that the addition of intraoperative variables, including inotropic/vasopressor administration, transfusion requirements, and hemodynamic markers improves our ability to predict AKI following LT. We also examined the impact of postoperative AKI on mortality. Of the 598 adult primary LT recipients included in our study, 43% (n = 255) were diagnosed with AKI within the first 7 postoperative days. Several preoperative and intraoperative variables including (1) electrolyte/acid-base balance disorder (International Classification of Diseases, Ninth Revision codes 253.6 or 276.x and International Classification of Diseases, Tenth Revision codes E22.2 or E87.x, where x is any digit; adjusted odds ratio [aOR], 1.917, 95% confidence interval [CI], 1.280-2.869; p = 0.002); (2) preoperative anemia (aOR, 2.612; 95% CI, 1.405-4.854; p = 0.002); (3) low serum albumin (aOR, 0.576; 95% CI, 0.410-0.808; p = 0.001), increased potassium value during reperfusion (aOR, 1.513; 95% CI, 1.103-2.077; p = 0.01), and lactate during reperfusion (aOR, 1.081; 95% CI, 1.003-1.166; p = 0.04) were associated with posttransplant AKI. New dialysis requirement within the first 7 days postoperatively predicted the posttransplant mortality. Our study identified significant association between several potentially modifiable variables with posttransplant AKI. The addition of intraoperative data did not improve overall model discrimination.
Published: 2022
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2. Equitable Access to Liver Transplant: Bridging the Gaps in the Social Determinants of Health

Author: Andrew Scott, Hannah Lee, Pratima Sharma, AnnMarie Liapakis, Russell Rosenblatt, Keri E Lunsford, and Julius M. Wilder
Subjects: Telemedicine, Bridging (networking), Social Determinants of Health, media_common.quotation_subject, Racism, Health Services Accessibility, Nursing, Political science, Pandemic, Humans, Social determinants of health, Healthcare Disparities, Policy Making, Disadvantage, media_common, Health Equity, Hepatology, SARS-CoV-2, Liver Diseases, COVID-19, Quality Improvement, United States, Liver Transplantation, Outreach, Socioeconomic Factors, Public Health, Implicit bias
Abstract: The COVID-19 pandemic and social justice movement have highlighted the impact of social determinants of health (SDOH) and structural racism in the United States on both access to care and patient outcomes. With the evaluation for liver transplantation being a highly subjective process, there are multiple ways for SDOH to place vulnerable patients at a disadvantage. This policy corner focuses on three different methods to reverse the deleterious effects of SDOH-identify and reduce implicit bias, expand and optimize telemedicine, and improve community outreach.
Published: 2021
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3. Assessment of donor quality and risk of graft failure after liver transplantation: The ID

Author: Sumeet K, Asrani, Giovanna, Saracino, Anji, Wall, James F, Trotter, Giuliano, Testa, Ruben, Hernaez, Pratima, Sharma, Allison, Kwong, Srikanta, Banerjee, and Gregory, McKenna
Subjects: End Stage Liver Disease, Tissue and Organ Procurement, Graft Survival, Humans, Tissue Donors, Liver Transplantation, Donor Selection, Retrospective Studies
Abstract: Accurate assessment of donor quality at the time of organ offer for liver transplantation candidates may be inadequately captured by the donor risk index (DRI). We sought to develop and validate a novel objective and simple model to assess donor risk using donor level variables available at the time of organ offer. We utilized national data from candidates undergoing primary LT (2013-2019) and assessed the prediction of graft failure 1 year after LT. The final components were donor Insulin-dependent diabetes mellitus, Donor type (DCD or DBD), cause of Death = CVA, serum creatinine, Age, height, and weight (length). The ID
Published: 2022

4. The prevalence and impact of pre-existing sleep disorder diagnoses and objective sleep parameters in patients hospitalized for COVID-19

Author: Pratima Sharma, Cathy Goldstein, Jonathan P. Troost, Emily C. Somers, Gita Gupta, Louise M. O'Brien, Helen J Burgess, Muneer Rizvydeen, Jonathan L. Golob, and Deirdre A. Conroy
Subjects: Adult, Sleep Wake Disorders, Pulmonary and Respiratory Medicine, Michigan, Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Cohort Studies, Hospitals, University, Prevalence, medicine, Humans, In patient, Medical diagnosis, Mechanical ventilation, Sleep disorder, business.industry, COVID-19, medicine.disease, Scientific Investigations, Sleep in non-human animals, Hospitalization, Obstructive sleep apnea, Treatment Outcome, Neurology, Neurology (clinical), business
Abstract: STUDY OBJECTIVES: Obstructive sleep apnea and other sleep disorders overlap with comorbidities associated with poor outcomes related to severe acute respiratory syndrome coronavirus 2 infection. However, the prevalence of obstructive sleep apnea among patients hospitalized for COVID-19 and relationship to outcomes is poorly characterized, and the relevance of other sleep disorders remains unknown. The objective of this study was to identify the prevalence of pre-existing sleep disorders and association with outcomes related to severe COVID-19 illness. METHODS: Patients with severe acute respiratory syndrome coronavirus 2 infection admitted to the University of Michigan Hospital System were included. Electronic medical records were queried for sleep disorders diagnostic codes. Data were extracted from polysomnography and home sleep testing in a subgroup with previous diagnostic testing at our center. Logistic regression was used to examine the association of sleep disorders with mechanical ventilation requirement, treatment with vasopressors, and death and Cox proportional hazards regression for time to discharge. RESULTS: Among n = 572 adult patients hospitalized for COVID-19, 113 (19.8%) patients had obstructive sleep apnea, 4 patients had central sleep apnea (0.7%), 5 had hypoventilation (0.9%), 63 had insomnia (11.0%), and 22 had restless legs syndrome or periodic limb movements disorder (3.9%). After adjusting for age, sex, body mass index, and race, no significant relationship was apparent between sleep disorders diagnoses or indices of sleep-disordered breathing severity and outcomes. CONCLUSIONS: This is the first study to determine the prevalence of obstructive sleep apnea and other sleep disorders in a well-characterized cohort of patients hospitalized for COVID-19. Once hospitalized, a significant contribution of sleep disorders to outcomes was not identified. Therefore, future evaluations should focus on earlier outcomes, such as infection or clinical manifestations after exposure to severe acute respiratory syndrome coronavirus 2. CITATION: Goldstein CA, Rizvydeen M, Conroy DA, et al. The prevalence and impact of pre-existing sleep disorder diagnoses and objective sleep parameters in patients hospitalized for COVID-19. J Clin Sleep Med. 2021;17(5):1039–1050.
Published: 2021
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5. Renal Outcomes After Simultaneous Liver‐Kidney Transplantation: Results from the US Multicenter Simultaneous Liver‐Kidney Transplantation Consortium

Author: Min Zhang, Zhiyu Sui, Giuseppe Cullaro, Jasmine Sinha, Elizabeth C. Verna, Yuval A. Patel, Randi Wong, Pratima Sharma, Jennifer Jo, Kara Walter, Lisa B. VanWagner, Scott W. Biggins, Aaron Schluger, Jennifer C. Lai, Pranab Barman, and John C. Magee
Subjects: Kidney Disease, medicine.medical_treatment, 030230 surgery, Liver transplantation, Kidney, Hepatitis, Cohort Studies, Liver disease, 0302 clinical medicine, Risk Factors, Interquartile range, Liver Disease, Graft Survival, Hazard ratio, Middle Aged, Treatment Outcome, Liver, Female, 030211 gastroenterology & hepatology, Adult, medicine.medical_specialty, Adolescent, Clinical Sciences, Renal and urogenital, Renal function, Article, 03 medical and health sciences, Clinical Research, Internal medicine, Diabetes mellitus, medicine, Humans, Renal Insufficiency, Chronic, Retrospective Studies, Transplantation, Hepatology, business.industry, Prevention, Patient Selection, Organ Transplantation, medicine.disease, Kidney Transplantation, United States, Liver Transplantation, Good Health and Well Being, Surgery, Digestive Diseases, business, Kidney disease
Abstract: Simultaneous liver-kidney transplantation (SLKT) is increasingly common in the United States. However, little is known about the renal-related outcomes following SLKT, which are essential to maximize the health of these allografts. We examined the factors impacting renal function following SLKT. This is an observational multicenter cohort study from the US Multicenter SLKT Consortium consisting of recipients of SLKT aged ≥18years of transplantations performed between February 2002 and June 2017 at 6 large US centers in 6 different United Network for Organ Sharing regions. The primary outcome was incident post-SLKT stage 4-5 chronic kidney disease (CKD) defined as
Published: 2021
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6. Impact of medical eligibility criteria and OPTN policy on simultaneous liver kidney allocation and utilization

Author: Ashwani K. Singal, Yong‐Fang Kuo, Paul Kwo, Nadim Mahmud, Pratima Sharma, and Mitra K. Nadim
Subjects: Adult, Transplantation, Policy, Tissue and Organ Procurement, Liver, Humans, Kidney Diseases, Kidney, Kidney Transplantation, Article
Abstract: BACKGROUND: Organ Procurement and Transplantation Network (OPTN) implemented medical eligibility and safety-net policy on 8/10/17 to optimize simultaneous liver-kidney (SLK) utilization. We examined impact of this policy on SLK listings and number of kidneys used within 1-yr. of receiving liver transplantation (LT) alone. METHODS AND RESULTS: OPTN database (08/10/14–06/12/20) on adults (N = 66 709) without previous transplant stratified candidates to listings for SLK or LT alone with pre-LT renal dysfunction at listing (eGFR < 30 mL/min or on dialysis). Outcomes were compared for pre (08/10/14–08/09/17) vs. post (08/10/17–06/12/20) policy era. SLK listings decreased in post vs. pre policy era (8.7% vs. 9.6%; P < .001), with 22% reduced odds of SLK listing in the postpolicy era, with a decrease in all OPTN regions except regions 6 and 8, which showed an increase. Among LT-alone recipients with pre-LT renal dysfunction (N = 3272), cumulative 1-year probability was higher in post vs. prepolicy period for dialysis (5.6% vs. 2.3%; P < .0001), KT listing (11.4% vs. 2.0%; P < .0001), and KT (3.7% vs. .25%; P < .0001). Sixty-seven (2.4%) kidneys were saved in post policy era, with 18.1%, 16.6%, 4.3%, and 2.9% saving from regions 7, 2, 11, and 1, respectively. CONCLUSION: Medical eligibility and safety-net OPTN policy resulted in decreased SLK use and improved access to LT alone among those with pre-LT renal dysfunction. Although decreased in postpolicy era, regional variation of SLK listings remains. In spite of increased use of KT within 1-year of receiving LT alone under safety net, less number of kidneys were used without impact on patient survival in postpolicy era.
Published: 2022
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7. Burden of early hospitalization after simultaneous liver-kidney transplantation: Results from the US Multicenter SLKT Consortium

Author: Pratima Sharma, Jiaheng Xie, Leyi Wang, Min Zhang, John Magee, Adeline Answine, Pranab Barman, Jennifer Jo, Jasmine Sinha, Aaron Schluger, Gabriel J. Perreault, Kara E. Walters, Giuseppe Cullaro, Randi Wong, Natalia Filipek, Scott W. Biggins, Jennifer C. Lai, Lisa B. VanWagner, Elizabeth C. Verna, and Yuval A. Patel
Subjects: Adult, Male, Transplantation, Hepatology, Graft Survival, Sodium, Middle Aged, Kidney Transplantation, Severity of Illness Index, Liver Transplantation, Cohort Studies, End Stage Liver Disease, Hospitalization, Treatment Outcome, Humans, Surgery, Female, Retrospective Studies
Abstract: The burden of early hospitalization (within 6 months) following simultaneous liver-kidney transplant (SLKT) is not known. We examined risk factors associated with early hospitalization after SLKT and their impact on patient mortality conditional on 6-month survival. We used data from the US Multicenter SLKT Consortium cohort study of all adult SLKT recipients between 2002 and 2017 who were discharged alive following SLKT. We used Poisson regression to model rates of early hospitalizations after SLKT. Cox regression was used to identify risk factors associated with mortality conditional on survival at 6 months after SLKT. Median age (N = 549) was 57.7 years (interquartile range [IQR], 50.6-63.9) with 63% males and 76% Whites; 33% had hepatitis C virus, 20% had non-alcohol-associated fatty liver disease, 23% alcohol-associated liver disease, and 24% other etiologies. Median body mass index (BMI) and Model for End-Stage Liver Disease-sodium scores were 27.2 kg/m
Published: 2022

8. Management of cardiac diseases in liver transplant recipients: Comprehensive review and multidisciplinary practice-based recommendations

Author: Manhal Izzy, Brett E. Fortune, Marina Serper, Nicole Bhave, Andrew deLemos, Juan F. Gallegos-Orozco, Cesar Guerrero-Miranda, Shelley Hall, Matthew E. Harinstein, Maria G. Karas, Michael Kriss, Nicholas Lim, Maryse Palardy, Deirdre Sawinski, Emily Schonfeld, Anil Seetharam, Pratima Sharma, Jose Tallaj, Darshana M. Dadhania, and Lisa B. VanWagner
Subjects: Heart Failure, Transplantation, Risk Factors, Non-alcoholic Fatty Liver Disease, Immunology and Allergy, Humans, Pharmacology (medical), Risk Assessment, Transplant Recipients, Liver Transplantation
Abstract: Cardiac diseases are one of the most common causes of morbidity and mortality following liver transplantation (LT). Prior studies have shown that cardiac diseases affect close to one-third of liver transplant recipients (LTRs) long term and that their incidence has been on the rise. This rise is expected to continue as more patients with advanced age and/or non-alcoholic steatohepatitis undergo LT. In view of the increasing disease burden, a multidisciplinary initiative was developed to critically review the existing literature (between January 1, 1990 and March 17, 2021) surrounding epidemiology, risk assessment, and risk mitigation of coronary heart disease, arrhythmia, heart failure, and valvular heart disease and formulate practice-based recommendations accordingly. In this review, the expert panel emphasizes the importance of optimizing management of metabolic syndrome and its components in LTRs and highlights the cardioprotective potential for the newer diabetes medications (e.g., sodium glucose transporter-2 inhibitors) in this high-risk population. Tailoring the multidisciplinary management of cardiac diseases in LTRs to the cardiometabolic risk profile of the individual patient is critical. The review also outlines numerous knowledge gaps to pave the road for future research in this sphere with the ultimate goal of improving clinical outcomes.
Published: 2022

9. Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care

Author: Anjana A. Pillai, Michael Kriss, David P. Al‐Adra, Ryan M. Chadha, Melissa M. Cushing, Khashayar Farsad, Brett E. Fortune, Aaron S. Hess, Robert Lewandowski, Mitra K. Nadim, Trevor Nydam, Pratima Sharma, Constantine J. Karvellas, and Nicolas Intagliata
Subjects: Transplantation, Hemostasis, Hepatology, Liver Diseases, Humans, Surgery, Blood Coagulation Disorders, Hemostatics, Liver Transplantation
Abstract: Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies and society guidance address this emerging paradigm and offer recommendations to assist with hemostatic management in patients with liver disease. However, patients undergoing LT are unique and diverse, often with unstable disease that requires specialized approaches. Our aim is to provide a focused review of hemostatic management of the LT patient, distinguish unique aspects of the three main phases of care (before LT, perioperative, and after LT), and identify knowledge gaps and critical areas of future research.
Published: 2022

10. Temporal Trends and Evolving Outcomes After Simultaneous Liver-Kidney Transplantation: Results from the US SLKT Consortium

Author: Aaron Schluger, Jennifer Jo, Randi Wong, Scott W. Biggins, Jennifer C. Lai, Pranab Barman, John C. Magee, Yuval A. Patel, Elizabeth C. Verna, Jasmine Rassiwala, Lisa B. VanWagner, Kara Walter, Giuseppe Cullaro, and Pratima Sharma
Subjects: medicine.medical_specialty, Kidney Disease, medicine.medical_treatment, Clinical Sciences, Renal and urogenital, Bioengineering, Liver transplantation, Kidney, Article, Oral and gastrointestinal, chemistry.chemical_compound, Clinical Research, Internal medicine, Medicine, Humans, Retrospective Studies, Creatinine, Assistive Technology, Transplantation, Hepatology, business.industry, Proportional hazards model, Liver Disease, Graft Survival, Organ Transplantation, medicine.disease, Kidney Transplantation, United States, Liver Transplantation, Good Health and Well Being, chemistry, Liver, Cohort, Surgery, Hemodialysis, business, Digestive Diseases, Body mass index, Kidney disease
Abstract: We aimed to understand the contemporary changes in the characteristics and the determinants of outcomes among simultaneous liver-kidney transplantation (SLKT) recipients at 6 liver transplantation centers in the United States. We retrospectively enrolled SLKT recipients between 2002 and 2017 in the US Multicenter SLKT Consortium. We analyzed time-related trends in recipient characteristics and outcomes with linear regression and nonparametric methods. Clustered Cox regression determined the factors associated with 1-year and overall survival. We enrolled 572 patients. We found significant changes in the clinical characteristics of SLKT recipients: as compared with 2002, recipients in 2017 were older (59 versus 52years; P&nbsp
Published: 2021

11. Intraoperative risk factors of acute kidney injury following liver transplantation

Author: Rachel J. Berkowitz, Milo C. Engoren, Graciela Mentz, Pratima Sharma, Sathish S. Kumar, Ryan Davis, Sachin Kheterpal, Christopher J. Sonnenday, and Nicholas J. Douville
Subjects: Transplantation, Hepatology, Risk Factors, Humans, Surgery, Acute Kidney Injury, Liver Transplantation, Retrospective Studies
Published: 2022
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12. The Risk Factors of Cerebral Palsy among the Children Attending a Children's Hospital

Author: Tulashi Adhikari, Mishra, Sarala, Shrestha, Bina, Prajapati Manandhar, and Pratima, Sharma
Subjects: Male, Nepal, Pregnancy, Risk Factors, Case-Control Studies, Cerebral Palsy, Humans, Female, Child, Hospitals
Abstract: Cerebral Palsy is a disorder of movement and posture caused by nonprogressive abnormal brain function. It is a lifelong condition and one of the most common causes of physical disability in children. The objective of this study was to find out the risk factors associated with cerebral palsy among children.A case control study was carried out among 330 children where cases and controls were taken in the ratio of 1:2. Cases included children diagnosed with cerebral palsy and attending neurological out-patient department of a Children's Hospital in Kathmandu, Nepal and control included children not having cerebral palsy and attending medical out-patient department of the same hospital for other medical problems. The data were collected from November 29, 2017 to May 20, 2018 by using a pretested interview schedule. The findings were analyzed using frequency, percentage, mean, standard deviation and chi square test and odds ratio.Findings revealed that about one-fourth (24.5%) cases were diagnosed to have CP within one year of age. In terms of sex majority (63.6%) of the cases were male and majority were the first born children. Findings also revealed that infection during pregnancy (OR:2.9, CI: 1.1-7.5), family history of cerebral palsy (OR:5.6, CI: 1.4-21.8), instrumental delivery (OR: 10.9, CI:2.3-50.6), not crying immediately after birth (OR: 17.3, CI: 8.6-34.6), were significantly associated with cerebral palsy.Most of the identified risk factors are preventable and controllable through proper antenatal and skilled intranatal care. Thus, every pregnant woman should receive proper care during pregnancy as well as during delivery for the prevention of the identified risk factors.
Published: 2021

13. Health Related Quality of Life of Children with Congenital Heart Disease Attending at Tertiary Level Hospital

Author: Tulashi Adhikari Mishra and Pratima Sharma
Subjects: Adult, Heart Defects, Congenital, Heart Septal Defects, Ventricular, Male, Pediatrics, medicine.medical_specialty, Adolescent, Heart disease, Cross-sectional study, Disease, Shahid, Interviews as Topic, Tertiary Care Centers, Nonprobability sampling, Nepal, Surveys and Questionnaires, medicine, Humans, Tertiary level, Child, Health related quality of life, business.industry, Age Factors, Infant, Newborn, Infant, General Medicine, medicine.disease, Socioeconomic Factors, Child, Preschool, Failure to thrive, Quality of Life, Educational Status, Female, medicine.symptom, business, Maternal Age
Abstract: Background: Congenital heart disease is one of the common congenital anomaly among the children affecting growth and development of the child and increasing susceptibility of the child to failure to thrive. The objective of the study is to find out the overall health related quality of life of children with congenital heart disease.Methods: A descriptive cross sectional study was carried out among 150 children with congenital heart disease attending in the pediatric out-patient department of Shahid Gangalal National Heart Centre, Bansbari, Kathmandu. The data was collected within the period of 2017/07/16 to 2017/08/16 using purposive sampling technique. Data was collected through interview technique using semi structured questionnaire. Collected data were entered in Statistical Package for Social Science 16 version and analyzed by using descriptive and inferential statistics.Results: The study findings revealed that more than half (52.7%) of the children had satisfactory overall health related quality of life. Health related quality of life is significantly associated with age group of the child (p=0.018), and education of mother (p=0.017)).Conclusions: It can be concluded that more than half of the children tends to have satisfactory overall health related quality of life.Ventricular septal defect is the commonest congenital heart disease. The health related quality of life of children with congenital heart disease tends to be better among those with educated mother and increasing age of the children. Therefore, awareness raising of mothers related to disease condition and care of children with congenital heart disease through mass media or proper intervention program might help to promote the quality of life of children with congenital heart disease. Keywords: Congenital heart disease; health related quality of life.
Published: 2019
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14. Limited Progress in Hepatorenal Syndrome (HRS) Reversal and Survival 2002–2018: A Systematic Review and Meta-Analysis

Author: Mary Thomson, Anna S. Lok, Elliot B. Tapper, Pratima Sharma, and Arthur C. Taylor
Subjects: Adult, Male, medicine.medical_specialty, Hepatorenal Syndrome, Physiology, Dopamine, Midodrine, Plasma Substitutes, Octreotide, law.invention, Norepinephrine, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Hepatorenal syndrome, Randomized controlled trial, law, Albumins, Internal medicine, Humans, Vasoconstrictor Agents, Medicine, Survival rate, Randomized Controlled Trials as Topic, business.industry, Gastroenterology, Middle Aged, medicine.disease, Anti-Bacterial Agents, Survival Rate, Treatment Outcome, 030220 oncology & carcinogenesis, Meta-analysis, Regression Analysis, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, business, Terlipressin, Complication, medicine.drug
Abstract: Type 1 hepatorenal syndrome (HRS) is a fatal complication of cirrhosis. Treatments trend toward HRS reversal, but few show clear mortality benefit. We sought to quantify the progress—or lack thereof—in improving outcomes of type 1 HRS over time. We performed a systematic review and meta-analysis for randomized controlled trials (RCTs) comparing type 1 HRS outcomes including (a) overall survival (liver transplant-free survival if reported) and (b) HRS reversal. Each study arm was analyzed separately to look at changes in outcomes over time. RCTs published comparing medical treatments for type 1 HRS were searched using several databases through July 31, 2019. Fourteen RCTs (28 arms) involving 778 participants enrolled between 2002 and 2018 were included. Twelve RCTs measured HRS reversal. In conjunction with albumin (or plasma expander), the most common medications used were terlipressin (13 arms), antibiotics (7), norepinephrine (6), dopamine (4), and midodrine/octreotide (3). Pooled survival rate was 34.6% (95% CI 26.4–43.8), and pooled HRS reversal rate was 42.8% (95% CI 34.2–51.9). Regression analyzing the incremental effect of the year the RCT was initiated showed that more recent studies were not associated with improved survival (OR 1.02, 95% CI 0.94–1.11, p = 0.66) or HRS reversal rates (OR 1.03, 95% CI 0.96–1.11, p = 0.41). There was no survival improvement when RCTs with endpoints assessed ≤ or > 1 month were analyzed separately with respective OR of 1.07 (95% CI 0.95–1.20, p = 0.26) and 0.97 (95% CI 0.85–1.12, p = 0.70). Outcomes have not improved for patients with type 1 HRS since 2002. There is a need to improve prevention and treatment of type 1 HRS.
Published: 2019
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15. Simultaneous Liver-Kidney Transplantation Following Standardized Medical Eligibility Criteria and Creation of the Safety Net: Less Appears to Be More

Author: Dempsey L. Hughes and Pratima Sharma
Subjects: Transplantation, medicine.medical_specialty, Hepatology, business.industry, Safety net, medicine.medical_treatment, Liver transplantation, Kidney, Kidney Transplantation, Article, Liver Transplantation, Text mining, Liver, medicine, Simultaneous liver kidney, Humans, Surgery, Intensive care medicine, business
Abstract: Historically in the United States, kidneys for simultaneous liver-kidney transplantation (SLKT) candidates were allocated with livers, prioritizing SLKT recipients over much of the kidney waiting list. A 2017 change in policy delineated renal function criteria for SLKT and implemented a safety net for kidney-after-liver transplantation. We compared the use and outcomes of SLKT and kidney-after-liver transplant with the 2017 policy. United Network for Organ Sharing Standard Transplant Analysis and Research files were used to identify adults who received liver transplantations (LT) from August 10, 2007 to August 10, 2012; from August 11, 2012 to August 10, 2017; and from August 11, 2017 to June 12, 2019. LT recipients with end-stage renal disease (ESRD) were defined by dialysis requirement or estimated glomerular filtration rate
Published: 2021

16. Optimizing the Selection of Patients for Simultaneous Liver-Kidney Transplant

Author: Pratima Sharma and Khurram Bari
Subjects: medicine.medical_specialty, Waiting Lists, Renal function, Kidney, Kidney transplant, Severity of Illness Index, End Stage Liver Disease, 03 medical and health sciences, 0302 clinical medicine, Model for End-Stage Liver Disease, medicine, Simultaneous liver kidney, Humans, Intensive care medicine, Selection (genetic algorithm), Retrospective Studies, Hepatology, business.industry, Patient Selection, Kidney Transplantation, Transplantation, surgical procedures, operative, Waiting list, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business
Abstract: Simultaneous liver-kidney transplantation has increased significantly in the Model for End Stage Liver Disease era. The transplantation policy has evolved significantly since the implementation of allocation based on the Model for End Stage Liver Disease. Current policy takes into account the medical eligibility criteria for simultaneous liver-kidney transplantation listing. It also provides a safety net option and prioritizes kidney transplant after liver transplant recipients who are unlikely to recover their renal function within 60 to 365 days after liver transplant alone. This review seeks to understand the underlying challenges in carefully selecting the candidates while optimizing the patient selection.
Published: 2021

17. Terlipressin and the Treatment of Hepatorenal Syndrome: How the CONFIRM Trial Moves the Story Forward

Author: Juan Carlos Q. Velez, Pratima Sharma, Nithin Karakala, Kevin R. Regner, Justin M. Belcher, Raymond T. Chung, Mitra K. Nadim, Hrs-Harmony study investigators, Guadalupe Garcia-Tsao, Samir M. Parikh, Luis A. Juncos, Douglas A. Simonetto, Hani M. Wadei, Andrew S. Allegretti, and Xavier Vela Parada
Subjects: Male, Mean arterial pressure, Vasopressin, medicine.medical_specialty, Hepatorenal Syndrome, Lypressin, law.invention, Randomized controlled trial, Hepatorenal syndrome, law, medicine, Clinical endpoint, Humans, Vasoconstrictor Agents, Intensive care medicine, Adverse effect, business.industry, Acute kidney injury, Acute Kidney Injury, medicine.disease, Treatment Outcome, Nephrology, Female, Terlipressin, business, medicine.drug
Abstract: Hepatorenal syndrome (HRS) is a form of acute kidney injury (AKI) occurring in patients with advanced cirrhosis and is associated with significant morbidity and mortality. The pathophysiology underlying HRS begins with increasing portal pressures leading to the release of vasodilatory substances that result in pooling blood in the splanchnic system and a corresponding reduction in effective circulating volume. Compensatory activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system and release of arginine vasopressin serve to defend mean arterial pressure but at the cost of severe constriction of the renal vasculature, leading to a progressive, often fulminant form of AKI. There are no approved treatments for HRS in the United States, but multiple countries, including much of Europe, use terlipressin, a synthetic vasopressin analogue, as a first-line therapy. CONFIRM (A Multi-Center, Randomized, Placebo Controlled, Double-Blind Study to Confirm Efficacy and Safety of Terlipressin in Subjects With Hepatorenal Syndrome Type 1), the third randomized trial based in North America evaluating terlipressin, met its primary end point of showing greater rates of HRS reversal in the terlipressin arm. However, due to concerns about the apparent increased rates of respiratory adverse events and a lack of evidence for mortality benefit, terlipressin was not approved by the Food and Drug Administration (FDA). We explore the history of regulatory approval for terlipressin in the United States, examine the results from CONFIRM and the concerns they raised, and consider the future role of terlipressin in this critical clinical area of continued unmet need.
Published: 2021

18. The value of open-source clinical science in pandemic response

Author: Ali Abbas, Sheryl Ann Abdukahil, Nurul Najmee Abdulkadir, Ryuzo Abe, Laurent Abel, Lara Absil, Subhash Acharya, Andrew Acker, Shingo Adachi, Elisabeth Adam, Diana Adrião, Saleh Al Ageel, Shakeel Ahmed, Quratul Ain, Kate Ainscough, Tharwat Aisa, Ali Ait Hssain, Younes Ait Tamlihat, Takako Akimoto, Ernita Akmal, Eman Al Qasim, Razi Alalqam, Tanvir Alam, Tala Al-dabbous, Senthilkumar Alegesan, Cynthia Alegre, Marta Alessi, Beatrice Alex, Kévin Alexandre, Abdulrahman Al-Fares, Huda Alfoudri, Imran Ali, Naseem Ali Shah, Kazali Enagnon Alidjnou, Jeffrey Aliudin, Qabas Alkhafajee, Clotilde Allavena, Nathalie Allou, Aneela Altaf, João Alves, João Melo Alves, Rita Alves, Maria Amaral, Nur Amira, Heidi Ammerlaan, Phoebe Ampaw, Roberto Andini, Claire Andrejak, Andrea Angheben, François Angoulvant, Séverine Ansart, Sivanesen Anthonidass, Massimo Antonelli, Carlos Alexandre Antunes de Brito, Kazi Rubayet Anwar, Ardiyan Apriyana, Yaseen Arabi, Irene Aragao, Rajeshwari Arali, Francisco Arancibia, Carolline Araujo, Antonio Arcadipane, Patrick Archambault, Lukas Arenz, Jean-Benoît Arlet, Christel Arnold-Day, Ana Aroca, Lovkesh Arora, Rakesh Arora, Elise Artaud-Macari, Diptesh Aryal, Motohiro Asaki, Angel Asensio, Elizabeth Ashley, Muhammad Ashraf, Sheharyar Ashraf, Mohammad Asim, Jean Baptiste Assie, Amirul Asyraf, Anika Atique, AM Udara Lakshan Attanyake, Johann Auchabie, Hugues Aumaitre, Adrien Auvet, Laurène Azemar, Cecile Azoulay, Benjamin Bach, Delphine Bachelet, Claudine Badr, Nadia Baig, J. Kenneth Baillie, J Kevin Baird, Erica Bak, Agamemnon Bakakos, Nazreen Abu Bakar, Andriy Bal, Mohanaprasanth Balakrishnan, Valeria Balan, Firouzé Bani-Sadr, Renata Barbalho, Nicholas Yuri Barbosa, Wendy S. Barclay, Saef Umar Barnett, Michaela Barnikel, Helena Barrasa, Audrey Barrelet, Cleide Barrigoto, Marie Bartoli, Cheryl Bartone, Joaquín Baruch, Mustehan Bashir, Romain Basmaci, Muhammad Fadhli Hassin Basri, Diego Bastos, Denise Battaglini, Jules Bauer, Diego Fernando Bautista Rincon, Denisse Bazan Dow, Alexandra Bedossa, Ker Hong Bee, Sylvie Behilill, Albertus Beishuizen, Aleksandr Beljantsev, David Bellemare, Anna Beltrame, Beatriz Amorim Beltrão, Marine Beluze, Nicolas Benech, Lionel Eric Benjiman, Dehbia Benkerrou, Suzanne Bennett, Luís Bento, Jan-Erik Berdal, Delphine Bergeaud, Hazel Bergin, José Luis Bernal Sobrino, Giulia Bertoli, Lorenzo Bertolino, Simon Bessis, Adam Betz, Sybille Bevilcaqua, Karine Bezulier, Amar Bhatt, Krishna Bhavsar, Isabella Bianchi, Claudia Bianco, Farah Nadiah Bidin, Moirangthem Bikram Singh, Felwa Bin Humaid, Mohd Nazlin Bin Kamarudin, François Bissuel, Patrick Biston, Laurent Bitker, Pablo Blanco-Schweizer, Catherine Blier, Frank Bloos, Mathieu Blot, Lucille Blumberg, Filomena Boccia, Laetitia Bodenes, Alice Bogaarts, Debby Bogaert, Anne-Hélène Boivin, Pierre-Adrien Bolze, François Bompart, Aurelius Bonfasius, Diogo Borges, Raphaël Borie, Hans Martin Bosse, Elisabeth Botelho-Nevers, Lila Bouadma, Olivier Bouchaud, Sabelline Bouchez, Dounia Bouhmani, Damien Bouhour, Kévin Bouiller, Laurence Bouillet, Camile Bouisse, Anne-Sophie Boureau, John Bourke, Maude Bouscambert, Aurore Bousquet, Jason Bouziotis, Bianca Boxma, Marielle Boyer-Besseyre, Maria Boylan, Fernando Augusto Bozza, Matthew Brack, Axelle Braconnier, Cynthia Braga, Timo Brandenburger, Filipa Brás Monteiro, Luca Brazzi, Dorothy Breen, Patrick Breen, Stephen Brett, Kathy Brickell, Tessa Broadley, Alex Browne, Shaunagh Browne, Nicolas Brozzi, Marjolein Brusse-Keizer, Nina Buchtele, Christian Buesaquillo, Polina Bugaeva, Marielle Buisson, Erlina Burhan, Aidan Burrell, Ingrid G. Bustos, Denis Butnaru, André Cabie, Susana Cabral, Eder Caceres, Cyril Cadoz, Mia Callahan, Kate Calligy, Jose Andres Calvache, João Cam, Valentine Campana, Paul Campbell, Josie Campisi, Cecilia Canepa, Mireia Cantero, Pauline Caraux-Paz, Sheila Cárcel, Chiara Simona Cardellino, Filipa Cardoso, Filipe Cardoso, Nelson Cardoso, Sofia Cardoso, Simone Carelli, Nicolas Carlier, Thierry Carmoi, Gayle Carney, Chloe Carpenter, Inês Carqueja, Marie-Christine Carret, François Martin Carrier, Ida Carroll, Gail Carson, Ed Carton, Maire-Laure Casanova, Mariana Cascão, Siobhan Casey, José Casimiro, Bailey Cassandra, Silvia Castañeda, Nidyanara Castanheira, Guylaine Castor-Alexandre, Henry Castrillón, Ivo Castro, Ana Catarino, François-Xavier Catherine, Paolo Cattaneo, Roberta Cavalin, Giulio Giovanni Cavalli, Alexandros Cavayas, Adrian Ceccato, Minerva Cervantes-Gonzalez, Anissa Chair, Catherine Chakveatze, Adrienne Chan, Meera Chand, Christelle Chantalat Auger, Jean-Marc Chapplain, Julie Chas, Mobin Chaudary, Jonathan Samuel Chávez Iñiguez, Anjellica Chen, Yih-Sharng Chen, Matthew Pellan Cheng, Antoine Cheret, Thibault Chiarabini, Julian Chica, Suresh Kumar Chidambaram, Leong Chin-Tho, Catherine Chirouze, Davide Chiumello, Hwa Jin Cho, Sung-Min Cho, Bernard Cholley, Marie-Charlotte Chopin, Ting Soo Chow, Yock Ping Chow, Hiu Jian Chua, Jonathan Chua, Jose Pedro Cidade, José Miguel Cisneros Herreros, Barbara Wanjiru Citarella, Anna Ciullo, Emma Clarke, Jennifer Clarke, Rolando Claure Del Granado, Sara Clohisey, J. Perren Cobb, Necsoi Coca, Cassidy Codan, Caitriona Cody, Alexandra Coelho, Megan Coles, Gwenhaël Colin, Michael Collins, Sebastiano Maria Colombo, Pamela Combs, Jennifer Connolly, Marie Connor, Anne Conrad, Sofía Contreras, Elaine Conway, Graham S. Cooke, Mary Copland, Hugues Cordel, Amanda Corley, Sarah Cormican, Sabine Cornelis, Alexander Daniel Cornet, Arianne Joy Corpuz, Andrea Cortegiani, Grégory Corvaisier, Emma Costigan, Camille Couffignal, Sandrine Couffin-Cadiergues, Roxane Courtois, Stéphanie Cousse, Rachel Cregan, Charles Crepy D'Orleans, Sabine Croonen, Gloria Crowl, Jonathan Crump, Claudina Cruz, Juan Luis Cruz Berm, Jaime Cruz Rojo, Marc Csete, Alberto Cucino, Ailbhe Cullen, Caroline Cullen, Matthew Cummings, Gerard Curley, Elodie Curlier, Colleen Curran, Paula Custodio, Ana da Silva Filipe, Charlene Da Silveira, Al-Awwab Dabaliz, Andrew Dagens, Darren Dahly, Heidi Dalton, Jo Dalton, Seamus Daly, Federico D'Amico, Nick Daneman, Corinne Daniel, Emmanuelle A Dankwa, Jorge Dantas, Frédérick D’Aragon, Mark de Boer, Gillian de Loughry, Diego de Mendoza, Etienne De Montmollin, Rafael Freitas de Oliveira França, Ana Isabel de Pinho Oliveira, Rosanna De Rosa, Thushan de Silva, Peter de Vries, Jillian Deacon, David Dean, Alexa Debard, Bianca DeBenedictis, Marie-Pierre Debray, Nathalie DeCastro, William Dechert, Lauren Deconninck, Romain Decours, Eve Defous, Isabelle Delacroix, Eric Delaveuve, Karen Delavigne, Nathalie M. Delfos, Ionna Deligiannis, Andrea Dell'Amore, Christelle Delmas, Pierre Delobel, Corine Delsing, Elisa Demonchy, Emmanuelle Denis, Dominique Deplanque, Pieter Depuydt, Mehul Desai, Diane Descamps, Mathilde Desvallée, Santi Dewayanti, Alpha Diallo, Sylvain Diamantis, André Dias, Priscila Diaz, Rodrigo Diaz, Juan Jose Diaz Diaz, Kévin Didier, Jean-Luc Diehl, Wim Dieperink, Jérôme Dimet, Vincent Dinot, Fara Diop, Alphonsine Diouf, Yael Dishon, Devika Dixit, Félix Djossou, Annemarie B. Docherty, Helen Doherty, Arjen M Dondorp, Andy Dong, Christl A. Donnelly, Maria Donnelly, Chloe Donohue, Sean Donohue, Yoann Donohue, Ciara Doran, Peter Doran, Céline Dorival, Eric D'Ortenzio, James Joshua Douglas, Renee Douma, Nathalie Dournon, Triona Downer, Joanne Downey, Mark Downing, Tom Drake, Aoife Driscoll, Murray Dryden, Claudio Duarte Fonseca, Vincent Dubee, François Dubos, Alexandre Ducancelle, Toni Duculan, Susanne Dudman, Abhijit Duggal, Paul Dunand, Jake Dunning, Mathilde Duplaix, Emanuele Durante-Mangoni, Lucian Durham III, Bertrand Dussol, Juliette Duthoit, Xavier Duval, Anne Margarita Dyrhol-Riise, Sim Choon Ean, Marco Echeverria-Villalobos, Siobhan Egan, Carla Eira, Mohammed El Sanharawi, Subbarao Elapavaluru, Brigitte Elharrar, Jacobien Ellerbroek, Philippine Eloy, Tarek Elshazly, Iqbal Elyazar, Isabelle Enderle, Tomoyuki Endo, Chan Chee Eng, Ilka Engelmann, Vincent Enouf, Olivier Epaulard, Martina Escher, Mariano Esperatti, Hélène Esperou, Marina Esposito-Farese, João Estevão, Manuel Etienne, Nadia Ettalhaoui, Anna Greti Everding, Mirjam Evers, Isabelle Fabre, Marc Fabre, Amna Faheem, Arabella Fahy, Cameron J. Fairfield, Zul Fakar, Pedro Faria, Ahmed Farooq, Jeremy J. Farrar, Nataly Farshait, Hanan Fateena, Arie Zainul Fatoni, Karine Faure, Raphaël Favory, Mohamed Fayed, Niamh Feely, Laura Feeney, Jorge Fernandes, Marília Fernandes, Susana Fernandes, François-Xavier Ferrand, Eglantine Ferrand Devouge, Joana Ferrão, Mário Ferraz, Benigno Ferreira, Sílvia Ferreira, Ricard Ferrer-Roca, Nicolas Ferriere, Céline Ficko, Claudia Figueiredo-Mello, Juan Fiorda, Thomas Flament, Clara Flateau, Tom Fletcher, Letizia Lucia Florio, Brigid Flynn, Deirdre Flynn, Claire Foley, Jean Foley, Victor Fomin, Tatiana Fonseca, Patricia Fontela, Simon Forsyth, Denise Foster, Giuseppe Foti, Erwan Fourn, Robert A. Fowler, Dr Marianne Fraher, Diego Franch-Llasat, Christophe Fraser, John F. Fraser, Marcela Vieira Freire, Ana Freitas Ribeiro, Caren Friedrich, Ricardo Fritz, Stéphanie Fry, Nora Fuentes, Masahiro Fukuda, Valérie Gaborieau, Rostane Gaci, Massimo Gagliardi, Jean-Charles Gagnard, Nathalie Gagné, Amandine Gagneux-Brunon, Sérgio Gaião, Linda Gail Skeie, Phil Gallagher, Elena Gallego Curto, Carrol Gamble, Yasmin Gani, Arthur Garan, Rebekha Garcia, Noelia García Barrio, Julia Garcia-Diaz, Esteban Garcia-Gallo, Navya Garimella, Denis Garot, Valérie Garrait, Basanta Gauli, Nathalie Gault, Aisling Gavin, Anatoliy Gavrylov, Alexandre Gaymard, Johannes Gebauer, Eva Geraud, Louis Gerbaud Morlaes, Nuno Germano, praveen kumar ghisulal, Jade Ghosn, Marco Giani, Carlo Giaquinto, Jess Gibson, Tristan Gigante, Morgane Gilg, Elaine Gilroy, Guillermo Giordano, Michelle Girvan, Valérie Gissot, Judy Gitahi, Gezy Giwangkancana, Daniel Glikman, Petr Glybochko, Eric Gnall, Geraldine Goco, François Goehringer, Siri Goepel, Jean-Christophe Goffard, Jin Yi Goh, Jonathan Golob, Rui Gomes, Kyle Gomez, Joan Gómez-Junyent, Marie Gominet, Alicia Gonzalez, Patricia Gordon, Anthony Gordon, Isabelle Gorenne, Laure Goubert, Cécile Goujard, Tiphaine Goulenok, Margarite Grable, Jeronimo Graf, Edward Wilson Grandin, Pascal Granier, Giacomo Grasselli, Lorenzo Grazioli, Christopher A. Green, Courtney Greene, William Greenhalf, Segolène Greffe, Domenico Luca Grieco, Matthew Griffee, Fiona Griffiths, Ioana Grigoras, Albert Groenendijk, Anja Grosse Lordemann, Heidi Gruner, Yusing Gu, Fabio Guarracino, Jérémie Guedj, Martin Guego, Dewi Guellec, Anne-Marie Guerguerian, Daniela Guerreiro, Romain Guery, Anne Guillaumot, Laurent Guilleminault, Maisa Guimarães de Castro, Thomas Guimard, Marieke Haalboom, Daniel Haber, Hannah Habraken, Ali Hachemi, Nadir Hadri, Olena Haidash, Saeeda Haider, Fakhir Haidri, Sheeba Hakak, Adam Hall, Matthew Hall, Sophie Halpin, Ansley Hamer, Raph Hamers, Rebecca Hamidfar, Terese Hammond, Lim Yuen Han, Rashan Haniffa, Kok Wei Hao, Hayley Hardwick, Ewen M. Harrison, Janet Harrison, Samuel Bernard Ekow Harrison, Alan Hartman, Junaid Hashmi, Madiha Hashmi, Muhammad Hayat, Ailbhe Hayes, Leanne Hays, Jan Heerman, Lars Heggelund, Ross Hendry, Martina Hennessy, Aquiles Henriquez, Maxime Hentzien, Fivzia Herekar, Jaime Hernandez-Montfort, Daniel Herr, Andrew Hershey, Liv Hesstvedt, Astarini Hidayah, Dawn Higgins, Eibhilin Higgins, Grainne HigginsOKeeffe, Rita Hinchion, Samuel Hinton, Hiroaki Hiraiwa, Hikombo Hitoto, Antonia Ho, Yi Bin Ho, Alexandre Hoctin, Isabelle Hoffmann, Wei Han Hoh, Oscar Hoiting, Rebecca Holt, Jan Cato Holter, Peter Horby, Juan Pablo Horcajada, Koji Hoshino, Kota Hoshino, Ikram Houas, Catherine L. Hough, Stuart Houltham, Jimmy Ming-Yang Hsu, Jean-Sébastien Hulot, Iqbal Hussain, Samreen Ijaz, Hajnal-Gabriela Illes, Patrick Imbert, Mohammad Imran, Rana Imran Sikander, Hugo Inácio, Carmen Infante Dominguez, Yun Sii Ing, Elias Iosifidis, Mariachiara Ippolito, Sarah Isgett, Palliya Guruge Pramodya Ishani Ishani, Tiago Isidoro, Nadiah Ismail, Margaux Isnard, Junji Itai, Asami Ito, Daniel Ivulich, Danielle Jaafar, Salma Jaafoura, Julien Jabot, Clare Jackson, Nina Jamieson, Pierre Jaquet, Waasila Jassat, Coline Jaud-Fischer, Stéphane Jaureguiberry, Jeffrey Javidfar, Issrah Jawad, Denise Jaworsky, Devachandran Jayakumar, Florence Jego, Anilawati Mat Jelani, Synne Jenum, Ruth Jimbo-Sotomayor, van der Palen Job, Ong Yiaw Joe, Ruth N. Jorge García, Cédric Joseph, Mark Joseph, Swosti Joshi, Mercé Jourdain, Philippe Jouvet, Jennifer June, Anna Jung, Hanna Jung, Dafsah Juzar, Ouifiya Kafif, Florentia Kaguelidou, Neerusha Kaisbain, Thavamany Kaleesvran, Sabina Kali, Alina Kalicinska, Smaragdi Kalomoiri, Saima Kamal, Muhammad Aisar Ayadi Kamaluddin, Zul Amali Che Kamaruddin, Nadiah Kamarudin, Darshana Hewa Kandamby, Chris Kandel, Kong Yeow Kang, Ravi Kant, Darakhshan Kanwal, Dyah Kanyawati, Bipin Karki, Pratap Karpayah, Todd Karsies, Christiana Kartsonaki, Daisuke Kasugai, Anant Kataria, Kevin Katz, Aasmine Kaur, Simreen Kaur Johal, Tatsuya Kawasaki, Christy Kay, Hannah Keane, Seán Keating, Paul Kellam, Andrea Kelly, Aoife Kelly, Claire Kelly, Niamh Kelly, Sadie Kelly, Yvelynne Kelly, Maeve Kelsey, Ryan Kennedy, Kalynn Kennon, Maeve Kernan, Younes Kerroumi, Sharma Keshav, Evelyne Kestelyn, Imrana Khalid, Osama Khalid, Antoine Khalil, Coralie Khan, Irfan Khan, Sushil Khanal, Michelle E Kho, Denisa Khoo, Ryan Khoo, Saye Khoo, Nasir Khoso, Khor How Kiat, Yuri Kida, Peter Kiiza, Anders Benjamin Kildal, Jae Burm Kim, Antoine Kimmoun, Detlef Kindgen-Milles, Alexander King, Nobuya Kitamura, Paul Klenerman, Rob Klont, Gry Kloumann Bekken, Stephen Knight, Robin Kobbe, Chamira Kodippily, Malte Kohns Vasconcelos, Sabin Koirala, Mamoru Komatsu, Volkan Korten, Caroline Kosgei, Arsène Kpangon, Karolina Krawczyk, Sudhir Krishnan, Vinothini Krishnan, Oksana Kruglova, Ashok Kumar, Deepali Kumar, Ganesh Kumar, Mukesh Kumar, Pavan Kumar Vecham, Dinesh Kuriakose, Ethan Kurtzman, Neurinda Permata Kusumastuti, Demetrios Kutsogiannis, Galyna Kutsyna, Konstantinos Kyriakoulis, Marie Lachatre, Marie Lacoste, John G. Laffey, Marie Lagrange, Fabrice Laine, Olivier Lairez, Sanjay Lakhey, Antonio Lalueza, Marc Lambert, François Lamontagne, Marie Langelot-Richard, Vincent Langlois, Eka Yudha Lantang, Marina Lanza, Cédric Laouénan, Samira Laribi, Delphine Lariviere, Stéphane Lasry, Naveed Latif, Odile Launay, Didier Laureillard, Yoan Lavie-Badie, Andy Law, Cassie Lawrence, Teresa Lawrence, Minh Le, Clément Le Bihan, Cyril Le Bris, Georges Le Falher, Lucie Le Fevre, Quentin Le Hingrat, Marion Le Maréchal, Soizic Le Mestre, Gwenaël Le Moal, Vincent Le Moing, Hervé Le Nagard, Paul Le Turnier, Ema Leal, Marta Leal Santos, Biing Horng Lee, Heng Gee Lee, James Lee, Su Hwan Lee, Todd C. Lee, Yi Lin Lee, Gary Leeming, Bénédicte Lefebvre, Laurent Lefebvre, Benjamin Lefevre, Sylvie LeGac, Jean-Daniel Lelievre, François Lellouche, Adrien Lemaignen, Véronique Lemee, Anthony Lemeur, Gretchen Lemmink, Ha Sha Lene, Jenny Lennon, Rafael León, Marc Leone, Michela Leone, Quentin Lepiller, François-Xavier Lescure, Olivier Lesens, Mathieu Lesouhaitier, Amy Lester-Grant, Bruno Levy, Yves Levy, Claire Levy-Marchal, Katarzyna Lewandowska, Erwan L'Her, Gianluigi Li Bassi, Janet Liang, Ali Liaquat, Geoffrey Liegeon, Kah Chuan Lim, Wei Shen Lim, Chantre Lima, Bruno Lina, Lim Lina, Andreas Lind, Guillaume Lingas, Sylvie Lion-Daolio, Samantha Lissauer, Keibun Liu, Marine Livrozet, Patricia Lizotte, Antonio Loforte, Navy Lolong, Leong Chee Loon, Diogo Lopes, Dalia Lopez-Colon, Anthony L. Loschner, Paul Loubet, Bouchra Loufti, Guillame Louis, Silvia Lourenco, Lara Lovelace-Macon, Lee Lee Low, Marije Lowik, Jia Shyi Loy, Jean Christophe Lucet, Carlos Lumbreras Bermejo, Carlos M. Luna, Olguta Lungu, Liem Luong, Nestor Luque, Dominique Luton, Nilar Lwin, Ruth Lyons, Olavi Maasikas, Oryane Mabiala, Samual MacDonald, Sarah MacDonald, Moïse Machado, Gabriel Macheda, Juan Macias Sanchez, Jai Madhok, Guillermo Maestro de la Calle, Rafael Mahieu, Sophie Mahy, Ana Raquel Maia, Lars S. Maier, Mylène Maillet, Thomas Maitre, Maximilian Malfertheiner, Nadia Malik, Paddy Mallon, Fernando Maltez, Denis Malvy, Victoria Manda, Jose M. Mandei, Laurent Mandelbrot, Frank Manetta, Kishore Mangal, Julie Mankikian, Edmund Manning, Aldric Manuel, Ceila Maria Sant`Ana Malaque, Daniel Marino, Flávio Marino, Samuel Markowicz, Charbel Maroun Eid, Ana Marques, Catherine Marquis, Brian Marsh, Laura Marsh, Megan Marshal, John Marshall, Celina Turchi Martelli, Dori-Ann Martin, Emily Martin, Guillaume Martin-Blondel, Alessandra Martinelli, Ignacio Martin-Loeches, Martin Martinot, Alejandro Martin-Quiros, Ana Martins, João Martins, Nuno Martins, Caroline Martins Rego, Gennaro Martucci, Olga Martynenko, Eva Miranda Marwali, Marsilla Marzukie, Juan Fernado Masa Jimenez, David Maslove, Phillip Mason, Sabina Mason, Sobia Masood, Basri Mat Nor, Moshe Matan, Henrique Mateus Fernandes, Meghena Mathew, Daniel Mathieu, Mathieu Mattei, Romans Matulevics, Laurence Maulin, Michael Maxwell, Javier Maynar, Thierry Mazzoni, Lisa Mc Sweeney, Lorraine McAndrew, Colin McArthur, Aine McCarthy, Anne McCarthy, Colin McCloskey, Rachael McConnochie, Sherry McDermott, Sarah E. McDonald, Aine McElroy, Samuel McElwee, Victoria McEneany, Natalie McEvoy, Allison McGeer, Chris McKay, Johnny McKeown, Kenneth A. McLean, Paul McNally, Bairbre McNicholas, Elaine McPartlan, Edel Meaney, Cécile Mear-Passard, Maggie Mechlin, Maqsood Meher, Omar Mehkri, Ferruccio Mele, Luis Melo, Kashif Memon, Joao Joao Mendes, Ogechukwu Menkiti, Kusum Menon, France Mentré, Alexander J. Mentzer, Emmanuelle Mercier, Noémie Mercier, Antoine Merckx, Mayka Mergeay-Fabre, Blake Mergler, Laura Merson, António Mesquita, Osama Metwally, Agnès Meybeck, Dan Meyer, Alison M. Meynert, Vanina Meysonnier, Amina Meziane, Mehdi Mezidi, Giuliano Michelagnoli, Céline Michelanglei, Isabelle Michelet, Efstathia Mihelis, Vladislav Mihnovit, Hugo Miranda-Maldonado, Nor Arisah Misnan, Nik Nur Eliza Mohamed, Tahira Jamal Mohamed, Asma Moin, David Molina, Elena Molinos, Brenda Molloy, Mary Mone, Agostinho Monteiro, Claudia Montes, Giorgia Montrucchio, Sarah Moore, Shona C. Moore, Lina Morales Cely, Lucia Moro, Diego Rolando Morocho Tutillo, Ben Morton, Catherine Motherway, Ana Motos, Hugo Mouquet, Clara Mouton Perrot, Julien Moyet, Caroline Mudara, Aisha Kalsoom Mufti, Ng Yong Muh, Dzawani Muhamad, Jimmy Mullaert, Fredrik Muller, Karl Erik Müller, Daniel Munblit, Syed Muneeb, Nadeem Munir, Laveena Munshi, Aisling Murphy, Lorna Murphy, Marlène Murris, Srinivas Murthy, Himed Musaab, Gugapriyaa Muyandy, Dimitra Melia Myrodia, Namra N, Dave Nagpal, Alex Nagrebetsky, Mangala Narasimhan, Nageswaran Narayanan, Rashid Nasim Khan, Alasdair Nazerali-Maitland, Nadège Neant, Holger Neb, Nikita A Nekliudov, Erni Nelwan, Raul Neto, Emily Neumann, Bernardo Neves, Pauline Yeung Ng, Anthony Nghi, Duc Nguyen, Orna Ni Choileain, Niamh Ni Leathlobhair, Alistair Nichol, Prompak Nitayavardhana, Stephanie Nonas, Nurul Amani Mohd Noordin, Marion Noret, Nurul Faten Izzati Norharizam, Lisa Norman, Alessandra Notari, Mahdad Noursadeghi, Karolina Nowicka, Adam Nowinski, Saad Nseir, Jose I Nunez, Nurnaningsih Nurnaningsih, Elsa Nyamankolly, Fionnuala O Brien, Annmarie O'Callaghan, Giovanna Occhipinti, Derbrenn OConnor, Max O'Donnell, Tawnya Ogston, Takayuki Ogura, Tak-Hyuk Oh, Sophie O'Halloran, Katie O'Hearn, Shinichiro Ohshimo, Agnieszka Oldakowska, João Oliveira, Larissa Oliveira, Piero L. Olliaro, Conar O'Neil, David S.Y. Ong, Jee Yan Ong, Wilna Oosthuyzen, Anne Opavsky, Peter Openshaw, Saijad Orakzai, Claudia Milena Orozco-Chamorro, Andrés Orquera, Jamel Ortoleva, Javier Osatnik, Linda O'Shea, Miriam O'Sullivan, Siti Zubaidah Othman, Nadia Ouamara, Rachida Ouissa, Clark Owyang, Eric Oziol, H M Upulee Pabasara, Maïder Pagadoy, Justine Pages, Amanda Palacios, Mario Palacios, Massimo Palmarini, Giovanna Panarello, Prasan Kumar Panda, Hem Paneru, Lai Hui Pang, Mauro Panigada, Nathalie Pansu, Aurélie Papadopoulos, Rachael Parke, Melissa Parker, Briseida Parra, Vieri Parrini, Taha Pasha, Jérémie Pasquier, Bruno Pastene, Fabian Patauner, Junaid Patel, Mohan Dass Pathmanathan, Luís Patrão, Patricia Patricio, Juliette Patrier, Lisa Patterson, Rajyabardhan Pattnaik, Christelle Paul, Mical Paul, Jorge Paulos, William A. Paxton, Jean-François Payen, Kalaiarasu Peariasamy, Miguel Pedrera Jiménez, Giles J. Peek, Florent Peelman, Nathan Peiffer-Smadja, Vincent Peigne, Mare Pejkovska, Paolo Pelosi, Ithan D. Peltan, Rui Pereira, Daniel Perez, Luis Periel, Thomas Perpoint, Antonio Pesenti, Vincent Pestre, Lenka Petrou, Ventzislava Petrov-Sanchez, Frank Olav Pettersen, Gilles Peytavin, Scott Pharand, Michael Piagnerelli, Walter Picard, Olivier Picone, Maria de Piero, Carola Pierobon, Djura Piersma, Carlos Pimentel, Raquel Pinto, Catarina Pires, Isabelle Pironneau, Lionel Piroth, Riinu Pius, Simone Piva, Laurent Plantier, Daniel Plotkin, Hon Shen Png, Julien Poissy, Ryadh Pokeerbux, Maria Pokorska-Spiewak, Sergio Poli, Georgios Pollakis, Diane Ponscarme, Jolanta Popielska, Andra-Maris Post, Douwe F. Postma, Pedro Povoa, Diana Póvoas, Jeff Powis, Sofia Prapa, Sébastien Preau, Christian Prebensen, Jean-Charles Preiser, Anton Prinssen, Mark G. Pritchard, Gamage Dona Dilanthi Priyadarshani, Lucia Proença, Sravya Pudota, Oriane Puéchal, Bambang Pujo Semedi, Mathew Pulicken, Matteo Puntoni, Gregory Purcell, Luisa Quesada, Vilmaris Quinones-Cardona, Víctor Quirós González, Else Quist-Paulsen, Mohammed Quraishi, Maia Rabaa, Christian Rabaud, Ebenezer Rabindrarajan, Aldo Rafael, Marie Rafiq, Gabrielle Ragazzo, Ahmad Kashfi Haji Ab Rahman, Rozanah Abd Rahman, Arsalan Rahutullah, Fernando Rainieri, Giri Shan Rajahram, Nipunie Rajapakse, Azrina Ralib, Nagarajan Ramakrishnan, Kollengode Ramanathan, Ahmad Afiq Ramli, Blandine Rammaert, Grazielle Viana Ramos, Asim Rana, Rajavardhan Rangappa, Ritika Ranjan, Christophe Rapp, Aasiyah Rashan, Thalha Rashan, Ghulam Rasheed, Menaldi Rasmin, Indrek Rätsep, Cornelius Rau, Tharmini Ravi, Ali Raza, Andre Real, Stanislas Rebaudet, Sarah Redl, Brenda Reeve, Ali Rehan, Attaur Rehman, Liadain Reid, Dag Henrik Reikvam, Renato Reis, Jordi Rello, Jonathan Remppis, Martine Remy, Hongru Ren, Hanna Renk, Liliana Resende, Anne-Sophie Resseguier, Matthieu Revest, Oleksa Rewa, Luis Felipe Reyes, Tiago Reyes, Maria Ines Ribeiro, David Richardson, Denise Richardson, Laurent Richier, Siti Nurul Atikah Ahmad Ridzuan, Jordi Riera, Ana L Rios, Asgar Rishu, Patrick Rispal, Karine Risso, Maria Angelica Rivera Nuñez, Nicholas Rizer, Doug Robb, Chiara Robba, André Roberto, Stephanie Roberts, David L. Robertson, Olivier Robineau, Ferran Roche-Campo, Paola Rodari, Simão Rodeia, Julia Rodriguez Abreu, Bernhard Roessler, Claire Roger, Pierre-Marie Roger, Emmanuel Roilides, Amanda Rojek, Juliette Romaru, Roberto Roncon-Albuquerque Jr, Mélanie Roriz, Manuel Rosa-Calatrava, Michael Rose, Dorothea Rosenberger, Andrea Rossanese, Matteo Rossetti, Bénédicte Rossignol, Patrick Rossignol, Stella Rousset, Carine Roy, Benoît Roze, Desy Rusmawatiningtyas, Clark D. Russell, Maeve Ryan, Maria Ryan, Steffi Ryckaert, Aleksander Rygh Holten, Isabela Saba, Sairah Sadaf, Musharaf Sadat, Valla Sahraei, Maximilien Saint-Gilles, Pranya Sakiyalak, Nawal Salahuddin, Leonardo Salazar, Jodat Saleem, Gabriele Sales, Stéphane Sallaberry, Charlotte Salmon Gandonniere, Hélène Salvator, Olivier Sanchez, Xavier Sánchez Choez, Kizy Sanchez de Oliveira, Angel Sanchez-Miralles, Vanessa Sancho-Shimizu, Gyan Sandhu, Zulfiqar Sandhu, Pierre-François Sandrine, Oana Sandulescu, Marlene Santos, Shirley Sarfo-Mensah, Bruno Sarmento Banheiro, Iam Claire E. Sarmiento, Benjamine Sarton, Sree Satyapriya, Rumaisah Satyawati, Egle Saviciute, Raymond Savio, Parthena Savvidou, Yen Tsen Saw, Justin Schaffer, Tjard Schermer, Arnaud Scherpereel, Marion Schneider, Stephan Schroll, Michael Schwameis, Gary Schwartz, Janet T. Scott, James Scott-Brown, Nicholas Sedillot, Tamara Seitz, Jaganathan Selvanayagam, Mageswari Selvarajoo, Caroline Semaille, Malcolm G. Semple, Rasidah Bt Senian, Eric Senneville, Claudia Sepulveda, Filipa Sequeira, Tânia Sequeira, Ary Serpa Neto, Pablo Serrano Balazote, Ellen Shadowitz, Syamin Asyraf Shahidan, Mohd Shahnaz Hasan, Mohammad Shamsah, Anuraj Shankar, Shaikh Sharjeel, Pratima Sharma, Catherine A. Shaw, Victoria Shaw, Haixia Shi, Nisreen Shiban, Mohiuddin Shiekh, Takuya Shiga, Nobuaki Shime, Hiroaki Shimizu, Keiki Shimizu, Naoki Shimizu, Nahoko Shindo, Sally Shrapnel, Hoi Ping Shum, Nassima Si Mohammed, Ng Yong Siang, Jeanne Sibiude, Atif Siddiqui, Louise Sigfrid, Piret Sillaots, Catarina Silva, Maria Joao Silva, Rogério Silva, Benedict Sim Lim Heng, Wai Ching Sin, Budha Charan Singh, Punam Singh, Pompini Agustina Sitompul, Karisha Sivam, Vegard Skogen, Sue Smith, Benjamin Smood, Coilin Smyth, Michelle Smyth, Morgane Snacken, Dominic So, Tze Vee Soh, Monserrat Solis, Joshua Solomon, Tom Solomon, Emily Somers, Agnès Sommet, Myung Jin Song, Rima Song, Tae Song, Jack Song Chia, Michael Sonntagbauer, Azlan Mat Soom, Alberto Sotto, Edouard Soum, Ana Chora Sousa, Marta Sousa, Maria Sousa Uva, Vicente Souza-Dantas, Alexandra Sperry, Elisabetta Spinuzza, B. P. Sanka Ruwan Sri Darshana, Shiranee Sriskandan, Sarah Stabler, Thomas Staudinger, Stephanie-Susanne Stecher, Trude Steinsvik, Ymkje Stienstra, Birgitte Stiksrud, Eva Stolz, Amy Stone, Adrian Streinu-Cercel, Anca Streinu-Cercel, Samantha Strudwick, Ami Stuart, David Stuart, Decy Subekti, Gabriel Suen, Jacky Y. Suen, Prasanth Sukumar, Asfia Sultana, Charlotte Summers, Dubravka Supic, Deepashankari Suppiah, Magdalena Surovcová, Suwarti Suwarti, Andrey A Svistunov, Sarah Syahrin, Konstantinos Syrigos, Jaques Sztajnbok, Konstanty Szuldrzynski, Shirin Tabrizi, Fabio S. Taccone, Lysa Tagherset, Shahdattul Mawarni Taib, Ewa Talarek, Sara Taleb, Jelmer Talsma, Maria Lawrensia Tampubolon, Kim Keat Tan, Le Van Tan, Yan Chyi Tan, Clarice Tanaka, Hiroyuki Tanaka, Taku Tanaka, Hayato Taniguchi, Hussain Tanveer, Huda Taqdees, Arshad Taqi, Coralie Tardivon, Pierre Tattevin, M Azhari Taufik, Hassan Tawfik, Richard S. Tedder, Tze Yuan Tee, João Teixeira, Sofia Tejada, Marie-Capucine Tellier, Sze Kye Teoh, Vanessa Teotonio, François Téoulé, Pleun Terpstra, Olivier Terrier, Nicolas Terzi, Hubert Tessier-Grenier, Adrian Tey, Alif Adlan Mohd Thabit, Zhang Duan Tham, Suvintheran Thangavelu, Vincent Thibault, Simon-Djamel Thiberville, Benoît Thill, Jananee Thirumanickam, Shaun Thompson, David Thomson, Emma C. Thomson, Surain Raaj Thanga Thurai, Duong Bich Thuy, Ryan S. Thwaites, Paul Tierney, Vadim Tieroshyn, Peter S Timashev, Jean-François Timsit, Bharath Kumar Tirupakuzhi Vijayaraghavan, Noémie Tissot, Jordan Zhien Yang Toh, Maria Toki, Timo Tolppa, Kristian Tonby, Sia Loong Tonnii, Antoni Torres, Margarida Torres, Rosario Maria Torres Santos-Olmo, Hernando Torres-Zevallos, Michael Towers, Tony Trapani, Damien Traynor, Théo Treoux, Huynh Trung Trieu, Swagata Tripathy, Cécile Tromeur, Ioannis Trontzas, Tiffany Trouillon, Jeanne Truong, Christelle Tual, Sarah Tubiana, Helen Tuite, Jean-Marie Turmel, Lance C.W. Turtle, Anders Tveita, Pawel Twardowski, Makoto Uchiyama, PG Ishara Udayanga, Andrew Udy, Roman Ullrich, Zubair Umer, Alberto Uribe, Asad Usman, Cristinava Vajdovics, Luís Val-Flores, Ana Luiza Valle, Amélie Valran, Stijn Van de Velde, Marcel van den Berge, Machteld van der Feltz, Paul van der Valk, Nicky Van Der Vekens, Peter Van der Voort, Sylvie Van Der Werf, Marlice van Dyk, Laura van Gulik, Jarne Van Hattem, Steven van Lelyveld, Carolien van Netten, Gitte Van Twillert, Ilonka van Veen, Noémie Vanel, Henk Vanoverschelde, Pooja Varghese, Michael Varrone, Shoban Raj Vasudayan, Charline Vauchy, Helen Vaughan, Shaminee Veeran, Aurélie Veislinger, Sebastian Vencken, Sara Ventura, Annelies Verbon, José Ernesto Vidal, César Vieira, Deepak Vijayan, Joy Ann Villanueva, Judit Villar, Pierre-Marc Villeneuve, Andrea Villoldo, Nguyen Van Vinh Chau, Benoit Visseaux, Hannah Visser, Chiara Vitiello, Harald Vonkeman, Fanny Vuotto, Noor Hidayu Wahab, Suhaila Abdul Wahab, Nadirah Abdul Wahid, Marina Wainstein, Wan Fadzlina Wan Muhd Shukeri, Chih-Hsien Wang, Steven Anthony Webb, Jia Wei, Katharina Weil, Tan Pei Wen, Sanne Wesselius, T. Eoin West, Murray Wham, Bryan Whelan, Nicole White, Paul Henri Wicky, Aurélie Wiedemann, Surya Otto Wijaya, Keith Wille, Suzette Willems, Virginie Williams, Evert-Jan Wils, Ng Wing Yiu, Calvin Wong, Teck Fung Wong, Xin Ci Wong, Yew Sing Wong, Gan Ee Xian, Lim Saio Xian, Kuan Pei Xuan, Ioannis Xynogalas, Sophie Yacoub, Siti Rohani Binti Mohd Yakop, Masaki Yamazaki, Yazdan Yazdanpanah, Nicholas Yee Liang Hing, Cécile Yelnik, Chian Hui Yeoh, Stephanie Yerkovich, Toshiki Yokoyama, Hodane Yonis, Obada Yousif, Saptadi Yuliarto, Akram Zaaqoq, Marion Zabbe, Kai Zacharowski, Masliza Zahid, Maram Zahran, Nor Zaila Binti Zaidan, Maria Zambon, Miguel Zambrano, Alberto Zanella, Konrad Zawadka, Nurul Zaynah, Hiba Zayyad, Alexander Zoufaly, David Zucman, ESTACA'Lab ( ESTACA'Lab ), École Supérieure des Techniques Aéronautiques et de Construction Automobile (ESTACA), Laboratoire d’Ingénierie Circulation Transport et Éco-gestion des systèmes énergétiques pour les transports (LICIT-Eco7), École Nationale des Travaux Publics de l'État (ENTPE)-Université Gustave Eiffel, St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University [New York], Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Department of Mathematics and Statistics, Wichita State University, Indo-French Center for Groundwater Research (IFCGR), Bureau de Recherches Géologiques et Minières (BRGM) (BRGM)-National Geophysical Research Institute [Hyderabad] (NGRI), National Geophysical Research Institute [Hyderabad] (NGRI), Department of Zoology [Rawalpindi, Pakistan], Pir Mehr Ali Shah Arid Agriculture University = PMAS-Arid Agriculture University Rawalpindi (AAUR), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Génétique Moléculaire des Virus à ARN - Molecular Genetics of RNA Viruses (GMV-ARN (UMR_3569 / U-Pasteur_2)), Institut Pasteur [Paris] (IP)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Centre National de Référence des virus des infections respiratoires (dont la grippe) - National Reference Center Virus Influenzae [Paris] (CNR - laboratoire coordonnateur), Institut Pasteur [Paris] (IP)-Université Paris Cité (UPCité), Abbas A., Abdukahil S.A., Abdulkadir N.N., Abe R., Abel L., Absil L., Acharya S., Acker A., Adachi S., Adam E., Adriao D., Ageel S.A., Ahmed S., Ain Q., Ainscough K., Aisa T., Ait Hssain A., Ait Tamlihat Y., Akimoto T., Akmal E., Al Qasim E., Alalqam R., Alam T., Al-dabbous T., Alegesan S., Alegre C., Alessi M., Alex B., Alexandre K., Al-Fares A., Alfoudri H., Ali I., Ali Shah N., Alidjnou K.E., Aliudin J., Alkhafajee Q., Allavena C., Allou N., Altaf A., Alves J., Alves J.M., Alves R., Amaral M., Amira N., Ammerlaan H., Ampaw P., Andini R., Andrejak C., Angheben A., Angoulvant F., Ansart S., Anthonidass S., Antonelli M., Antunes de Brito C.A., Anwar K.R., Apriyana A., Arabi Y., Aragao I., Arali R., Arancibia F., Araujo C., Arcadipane A., Archambault P., Arenz L., Arlet J.-B., Arnold-Day C., Aroca A., Arora L., Arora R., Artaud-Macari E., Aryal D., Asaki M., Asensio A., Ashley E., Ashraf M., Ashraf S., Asim M., Assie J.B., Asyraf A., Atique A., Attanyake A.U.L., Auchabie J., Aumaitre H., Auvet A., Azemar L., Azoulay C., Bach B., Bachelet D., Badr C., Baig N., Baillie J.K., Baird J.K., Bak E., Bakakos A., Bakar N.A., Bal A., Balakrishnan M., Balan V., Bani-Sadr F., Barbalho R., Barbosa N.Y., Barclay W.S., Barnett S.U., Barnikel M., Barrasa H., Barrelet A., Barrigoto C., Bartoli M., Bartone C., Baruch J., Bashir M., Basmaci R., Basri M.F.H., Bastos D., Battaglini D., Bauer J., Bautista Rincon D.F., Bazan Dow D., Bedossa A., Bee K.H., Behilill S., Beishuizen A., Beljantsev A., Bellemare D., Beltrame A., Beltrao B.A., Beluze M., Benech N., Benjiman L.E., Benkerrou D., Bennett S., Bento L., Berdal J.-E., Bergeaud D., Bergin H., Bernal Sobrino J.L., Bertoli G., Bertolino L., Bessis S., Betz A., Bevilcaqua S., Bezulier K., Bhatt A., Bhavsar K., Bianchi I., Bianco C., Bidin F.N., Bikram Singh M., Bin Humaid F., Bin Kamarudin M.N., Bissuel F., Biston P., Bitker L., Blanco-Schweizer P., Blier C., Bloos F., Blot M., Blumberg L., Boccia F., Bodenes L., Bogaarts A., Bogaert D., Boivin A.-H., Bolze P.-A., Bompart F., Bonfasius A., Borges D., Borie R., Bosse H.M., Botelho-Nevers E., Bouadma L., Bouchaud O., Bouchez S., Bouhmani D., Bouhour D., Bouiller K., Bouillet L., Bouisse C., Boureau A.-S., Bourke J., Bouscambert M., Bousquet A., Bouziotis J., Boxma B., Boyer-Besseyre M., Boylan M., Bozza F.A., Brack M., Braconnier A., Braga C., Brandenburger T., Bras Monteiro F., Brazzi L., Breen D., Breen P., Brett S., Brickell K., Broadley T., Browne A., Browne S., Brozzi N., Brusse-Keizer M., Buchtele N., Buesaquillo C., Bugaeva P., Buisson M., Burhan E., Burrell A., Bustos I.G., Butnaru D., Cabie A., Cabral S., Caceres E., Cadoz C., Callahan M., Calligy K., Calvache J.A., Cam J., Campana V., Campbell P., Campisi J., Canepa C., Cantero M., Caraux-Paz P., Carcel S., Cardellino C.S., Cardoso F., Cardoso N., Cardoso S., Carelli S., Carlier N., Carmoi T., Carney G., Carpenter C., Carqueja I., Carret M.-C., Carrier F.M., Carroll I., Carson G., Carton E., Casanova M.-L., Cascao M., Casey S., Casimiro J., Cassandra B., Castaneda S., Castanheira N., Castor-Alexandre G., Castrillon H., Castro I., Catarino A., Catherine F.-X., Cattaneo P., Cavalin R., Cavalli G.G., Cavayas A., Ceccato A., Cervantes-Gonzalez M., Chair A., Chakveatze C., Chan A., Chand M., Chantalat Auger C., Chapplain J.-M., Chas J., Chaudary M., Chavez Iniguez J.S., Chen A., Chen Y.-S., Cheng M.P., Cheret A., Chiarabini T., Chica J., Chidambaram S.K., Chin-Tho L., Chirouze C., Chiumello D., Cho H.J., Cho S.-M., Cholley B., Chopin M.-C., Chow T.S., Chow Y.P., Chua H.J., Chua J., Cidade J.P., Cisneros Herreros J.M., Citarella B.W., Ciullo A., Clarke E., Clarke J., Claure Del Granado R., Clohisey S., Cobb J.P., Coca N., Codan C., Cody C., Coelho A., Coles M., Colin G., Collins M., Colombo S.M., Combs P., Connolly J., Connor M., Conrad A., Contreras S., Conway E., Cooke G.S., Copland M., Cordel H., Corley A., Cormican S., Cornelis S., Cornet A.D., Corpuz A.J., Cortegiani A., Corvaisier G., Costigan E., Couffignal C., Couffin-Cadiergues S., Courtois R., Cousse S., Cregan R., Crepy D'Orleans C., Croonen S., Crowl G., Crump J., Cruz C., Cruz Berm J.L., Cruz Rojo J., Csete M., Cucino A., Cullen A., Cullen C., Cummings M., Curley G., Curlier E., Curran C., Custodio P., da Silva Filipe A., Da Silveira C., Dabaliz A.-A., Dagens A., Dahly D., Dalton H., Dalton J., Daly S., D'Amico F., Daneman N., Daniel C., Dankwa E.A., Dantas J., D'Aragon F., de Boer M., de Loughry G., de Mendoza D., De Montmollin E., de Oliveira Franca R.F., de Pinho Oliveira A.I., De Rosa R., de Silva T., de Vries P., Deacon J., Dean D., Debard A., DeBenedictis B., Debray M.-P., DeCastro N., Dechert W., Deconninck L., Decours R., Defous E., Delacroix I., Delaveuve E., Delavigne K., Delfos N.M., Deligiannis I., Dell'Amore A., Delmas C., Delobel P., Delsing C., Demonchy E., Denis E., Deplanque D., Depuydt P., Desai M., Descamps D., Desvallee M., Dewayanti S., Diallo A., Diamantis S., Dias A., Diaz P., Diaz R., Diaz Diaz J.J., Didier K., Diehl J.-L., Dieperink W., Dimet J., Dinot V., Diop F., Diouf A., Dishon Y., Dixit D., Djossou F., Docherty A.B., Doherty H., Dondorp A.M., Dong A., Donnelly C.A., Donnelly M., Donohue C., Donohue S., Donohue Y., Doran C., Doran P., Dorival C., D'Ortenzio E., Douglas J.J., Douma R., Dournon N., Downer T., Downey J., Downing M., Drake T., Driscoll A., Dryden M., Duarte Fonseca C., Dubee V., Dubos F., Ducancelle A., Duculan T., Dudman S., Duggal A., Dunand P., Dunning J., Duplaix M., Durante-Mangoni E., Durham III L., Dussol B., Duthoit J., Duval X., Dyrhol-Riise A.M., Ean S.C., Echeverria-Villalobos M., Egan S., Eira C., El Sanharawi M., Elapavaluru S., Elharrar B., Ellerbroek J., Eloy P., Elshazly T., Elyazar I., Enderle I., Endo T., Eng C.C., Engelmann I., Enouf V., Epaulard O., Escher M., Esperatti M., Esperou H., Esposito-Farese M., Estevao J., Etienne M., Ettalhaoui N., Everding A.G., Evers M., Fabre I., Fabre M., Faheem A., Fahy A., Fairfield C.J., Fakar Z., Faria P., Farooq A., Farrar J.J., Farshait N., Fateena H., Fatoni A.Z., Faure K., Favory R., Fayed M., Feely N., Feeney L., Fernandes J., Fernandes M., Fernandes S., Ferrand F.-X., Ferrand Devouge E., Ferrao J., Ferraz M., Ferreira B., Ferreira S., Ferrer-Roca R., Ferriere N., Ficko C., Figueiredo-Mello C., Fiorda J., Flament T., Flateau C., Fletcher T., Florio L.L., Flynn B., Flynn D., Foley C., Foley J., Fomin V., Fonseca T., Fontela P., Forsyth S., Foster D., Foti G., Fourn E., Fowler R.A., Fraher D.M., Franch-Llasat D., Fraser C., Fraser J.F., Freire M.V., Freitas Ribeiro A., Friedrich C., Fritz R., Fry S., Fuentes N., Fukuda M., Gaborieau V., Gaci R., Gagliardi M., Gagnard J.-C., Gagne N., Gagneux-Brunon A., Gaiao S., Gail Skeie L., Gallagher P., Gallego Curto E., Gamble C., Gani Y., Garan A., Garcia R., Garcia Barrio N., Garcia-Diaz J., Garcia-Gallo E., Garimella N., Garot D., Garrait V., Gauli B., Gault N., Gavin A., Gavrylov A., Gaymard A., Gebauer J., Geraud E., Gerbaud Morlaes L., Germano N., ghisulal P.K., Ghosn J., Giani M., Giaquinto C., Gibson J., Gigante T., Gilg M., Gilroy E., Giordano G., Girvan M., Gissot V., Gitahi J., Giwangkancana G., Glikman D., Glybochko P., Gnall E., Goco G., Goehringer F., Goepel S., Goffard J.-C., Goh J.Y., Golob J., Gomes R., Gomez K., Gomez-Junyent J., Gominet M., Gonzalez A., Gordon P., Gordon A., Gorenne I., Goubert L., Goujard C., Goulenok T., Grable M., Graf J., Grandin E.W., Granier P., Grasselli G., Grazioli L., Green C.A., Greene C., Greenhalf W., Greffe S., Grieco D.L., Griffee M., Griffiths F., Grigoras I., Groenendijk A., Grosse Lordemann A., Gruner H., Gu Y., Guarracino F., Guedj J., Guego M., Guellec D., Guerguerian A.-M., Guerreiro D., Guery R., Guillaumot A., Guilleminault L., Guimaraes de Castro M., Guimard T., Haalboom M., Haber D., Habraken H., Hachemi A., Hadri N., Haidash O., Haider S., Haidri F., Hakak S., Hall A., Hall M., Halpin S., Hamer A., Hamers R., Hamidfar R., Hammond T., Han L.Y., Haniffa R., Hao K.W., Hardwick H., Harrison E.M., Harrison J., Harrison S.B.E., Hartman A., Hashmi J., Hashmi M., Hayat M., Hayes A., Hays L., Heerman J., Heggelund L., Hendry R., Hennessy M., Henriquez A., Hentzien M., Herekar F., Hernandez-Montfort J., Herr D., Hershey A., Hesstvedt L., Hidayah A., Higgins D., Higgins E., HigginsOKeeffe G., Hinchion R., Hinton S., Hiraiwa H., Hitoto H., Ho A., Ho Y.B., Hoctin A., Hoffmann I., Hoh W.H., Hoiting O., Holt R., Holter J.C., Horby P., Horcajada J.P., Hoshino K., Houas I., Hough C.L., Houltham S., Hsu J.M.-Y., Hulot J.-S., Hussain I., Ijaz S., Illes H.-G., Imbert P., Imran M., Imran Sikander R., Inacio H., Infante Dominguez C., Ing Y.S., Iosifidis E., Ippolito M., Isgett S., Ishani P.G.P.I., Isidoro T., Ismail N., Isnard M., Itai J., Ito A., Ivulich D., Jaafar D., Jaafoura S., Jabot J., Jackson C., Jamieson N., Jaquet P., Jassat W., Jaud-Fischer C., Jaureguiberry S., Javidfar J., Jawad I., Jaworsky D., Jayakumar D., Jego F., Jelani A.M., Jenum S., Jimbo-Sotomayor R., Job V.D.P., Joe O.Y., Jorge Garcia R.N., Joseph C., Joseph M., Joshi S., Jourdain M., Jouvet P., June J., Jung A., Jung H., Juzar D., Kafif O., Kaguelidou F., Kaisbain N., Kaleesvran T., Kali S., Kalicinska A., Kalomoiri S., Kamal S., Kamaluddin M.A.A., Kamaruddin Z.A.C., Kamarudin N., Kandamby D.H., Kandel C., Kang K.Y., Kant R., Kanwal D., Kanyawati D., Karki B., Karpayah P., Karsies T., Kartsonaki C., Kasugai D., Kataria A., Katz K., Kaur A., Kaur Johal S., Kawasaki T., Kay C., Keane H., Keating S., Kellam P., Kelly A., Kelly C., Kelly N., Kelly S., Kelly Y., Kelsey M., Kennedy R., Kennon K., Kernan M., Kerroumi Y., Keshav S., Kestelyn E., Khalid I., Khalid O., Khalil A., Khan C., Khan I., Khanal S., Kho M.E., Khoo D., Khoo R., Khoo S., Khoso N., Kiat K.H., Kida Y., Kiiza P., Kildal A.B., Kim J.B., Kimmoun A., Kindgen-Milles D., King A., Kitamura N., Klenerman P., Klont R., Kloumann Bekken G., Knight S., Kobbe R., Kodippily C., Kohns Vasconcelos M., Koirala S., Komatsu M., Korten V., Kosgei C., Kpangon A., Krawczyk K., Krishnan S., Krishnan V., Kruglova O., Kumar A., Kumar D., Kumar G., Kumar M., Kumar Vecham P., Kuriakose D., Kurtzman E., Kusumastuti N.P., Kutsogiannis D., Kutsyna G., Kyriakoulis K., Lachatre M., Lacoste M., Laffey J.G., Lagrange M., Laine F., Lairez O., Lakhey S., Lalueza A., Lambert M., Lamontagne F., Langelot-Richard M., Langlois V., Lantang E.Y., Lanza M., Laouenan C., Laribi S., Lariviere D., Lasry S., Latif N., Launay O., Laureillard D., Lavie-Badie Y., Law A., Lawrence C., Lawrence T., Le M., Le Bihan C., Le Bris C., Le Falher G., Le Fevre L., Le Hingrat Q., Le Marechal M., Le Mestre S., Le Moal G., Le Moing V., Le Nagard H., Le Turnier P., Leal E., Leal Santos M., Lee B.H., Lee H.G., Lee J., Lee S.H., Lee T.C., Lee Y.L., Leeming G., Lefebvre B., Lefebvre L., Lefevre B., LeGac S., Lelievre J.-D., Lellouche F., Lemaignen A., Lemee V., Lemeur A., Lemmink G., Lene H.S., Lennon J., Leon R., Leone M., Lepiller Q., Lescure F.-X., Lesens O., Lesouhaitier M., Lester-Grant A., Levy B., Levy Y., Levy-Marchal C., Lewandowska K., L'Her E., Li Bassi G., Liang J., Liaquat A., Liegeon G., Lim K.C., Lim W.S., Lima C., Lina B., Lina L., Lind A., Lingas G., Lion-Daolio S., Lissauer S., Liu K., Livrozet M., Lizotte P., Loforte A., Lolong N., Loon L.C., Lopes D., Lopez-Colon D., Loschner A.L., Loubet P., Loufti B., Louis G., Lourenco S., Lovelace-Macon L., Low L.L., Lowik M., Loy J.S., Lucet J.C., Lumbreras Bermejo C., Luna C.M., Lungu O., Luong L., Luque N., Luton D., Lwin N., Lyons R., Maasikas O., Mabiala O., MacDonald S., Machado M., Macheda G., Macias Sanchez J., Madhok J., Maestro de la Calle G., Mahieu R., Mahy S., Maia A.R., Maier L.S., Maillet M., Maitre T., Malfertheiner M., Malik N., Mallon P., Maltez F., Malvy D., Manda V., Mandei J.M., Mandelbrot L., Manetta F., Mangal K., Mankikian J., Manning E., Manuel A., Maria Sant`Ana Malaque C., Marino D., Marino F., Markowicz S., Maroun Eid C., Marques A., Marquis C., Marsh B., Marsh L., Marshal M., Marshall J., Martelli C.T., Martin D.-A., Martin E., Martin-Blondel G., Martinelli A., Martin-Loeches I., Martinot M., Martin-Quiros A., Martins A., Martins J., Martins N., Martins Rego C., Martucci G., Martynenko O., Marwali E.M., Marzukie M., Masa Jimenez J.F., Maslove D., Mason P., Mason S., Masood S., Mat Nor B., Matan M., Mateus Fernandes H., Mathew M., Mathieu D., Mattei M., Matulevics R., Maulin L., Maxwell M., Maynar J., Mazzoni T., Mc Sweeney L., McAndrew L., McArthur C., McCarthy A., McCloskey C., McConnochie R., McDermott S., McDonald S.E., McElroy A., McElwee S., McEneany V., McEvoy N., McGeer A., McKay C., McKeown J., McLean K.A., McNally P., McNicholas B., McPartlan E., Meaney E., Mear-Passard C., Mechlin M., Meher M., Mehkri O., Mele F., Melo L., Memon K., Mendes J.J., Menkiti O., Menon K., Mentre F., Mentzer A.J., Mercier E., Mercier N., Merckx A., Mergeay-Fabre M., Mergler B., Merson L., Mesquita A., Metwally O., Meybeck A., Meyer D., Meynert A.M., Meysonnier V., Meziane A., Mezidi M., Michelagnoli G., Michelanglei C., Michelet I., Mihelis E., Mihnovit V., Miranda-Maldonado H., Misnan N.A., Mohamed N.N.E., Mohamed T.J., Moin A., Molina D., Molinos E., Molloy B., Mone M., Monteiro A., Montes C., Montrucchio G., Moore S., Moore S.C., Morales Cely L., Moro L., Morocho Tutillo D.R., Morton B., Motherway C., Motos A., Mouquet H., Mouton Perrot C., Moyet J., Mudara C., Mufti A.K., Muh N.Y., Muhamad D., Mullaert J., Muller F., Muller K.E., Munblit D., Muneeb S., Munir N., Munshi L., Murphy A., Murphy L., Murris M., Murthy S., Musaab H., Muyandy G., Myrodia D.M., N N., Nagpal D., Nagrebetsky A., Narasimhan M., Narayanan N., Nasim Khan R., Nazerali-Maitland A., Neant N., Neb H., Nekliudov N.A., Nelwan E., Neto R., Neumann E., Neves B., Ng P.Y., Nghi A., Nguyen D., Ni Choileain O., Ni Leathlobhair N., Nichol A., Nitayavardhana P., Nonas S., Noordin N.A.M., Noret M., Norharizam N.F.I., Norman L., Notari A., Noursadeghi M., Nowicka K., Nowinski A., Nseir S., Nunez J.I., Nurnaningsih N., Nyamankolly E., O Brien F., O'Callaghan A., Occhipinti G., OConnor D., O'Donnell M., Ogston T., Ogura T., Oh T.-H., O'Halloran S., O'Hearn K., Ohshimo S., Oldakowska A., Oliveira J., Oliveira L., Olliaro P.L., O'Neil C., Ong D.S.Y., Ong J.Y., Oosthuyzen W., Opavsky A., Openshaw P., Orakzai S., Orozco-Chamorro C.M., Orquera A., Ortoleva J., Osatnik J., O'Shea L., O'Sullivan M., Othman S.Z., Ouamara N., Ouissa R., Owyang C., Oziol E., Pabasara H.M.U., Pagadoy M., Pages J., Palacios A., Palacios M., Palmarini M., Panarello G., Panda P.K., Paneru H., Pang L.H., Panigada M., Pansu N., Papadopoulos A., Parke R., Parker M., Parra B., Parrini V., Pasha T., Pasquier J., Pastene B., Patauner F., Patel J., Pathmanathan M.D., Patrao L., Patricio P., Patrier J., Patterson L., Pattnaik R., Paul C., Paul M., Paulos J., Paxton W.A., Payen J.-F., Peariasamy K., Pedrera Jimenez M., Peek G.J., Peelman F., Peiffer-Smadja N., Peigne V., Pejkovska M., Pelosi P., Peltan I.D., Pereira R., Perez D., Periel L., Perpoint T., Pesenti A., Pestre V., Petrou L., Petrov-Sanchez V., Pettersen F.O., Peytavin G., Pharand S., Piagnerelli M., Picard W., Picone O., de Piero M., Pierobon C., Piersma D., Pimentel C., Pinto R., Pires C., Pironneau I., Piroth L., Pius R., Piva S., Plantier L., Plotkin D., Png H.S., Poissy J., Pokeerbux R., Pokorska-Spiewak M., Poli S., Pollakis G., Ponscarme D., Popielska J., Post A.-M., Postma D.F., Povoa P., Povoas D., Powis J., Prapa S., Preau S., Prebensen C., Preiser J.-C., Prinssen A., Pritchard M.G., Priyadarshani G.D.D., Proenca L., Pudota S., Puechal O., Pujo Semedi B., Pulicken M., Puntoni M., Purcell G., Quesada L., Quinones-Cardona V., Quiros Gonzalez V., Quist-Paulsen E., Quraishi M., Rabaa M., Rabaud C., Rabindrarajan E., Rafael A., Rafiq M., Ragazzo G., Rahman A.K.H.A., Rahman R.A., Rahutullah A., Rainieri F., Rajahram G.S., Rajapakse N., Ralib A., Ramakrishnan N., Ramanathan K., Ramli A.A., Rammaert B., Ramos G.V., Rana A., Rangappa R., Ranjan R., Rapp C., Rashan A., Rashan T., Rasheed G., Rasmin M., Ratsep I., Rau C., Ravi T., Raza A., Real A., Rebaudet S., Redl S., Reeve B., Rehan A., Rehman A., Reid L., Reikvam D.H., Reis R., Rello J., Remppis J., Remy M., Ren H., Renk H., Resende L., Resseguier A.-S., Revest M., Rewa O., Reyes L.F., Reyes T., Ribeiro M.I., Richardson D., Richier L., Ridzuan S.N.A.A., Riera J., Rios A.L., Rishu A., Rispal P., Risso K., Rivera Nunez M.A., Rizer N., Robb D., Robba C., Roberto A., Roberts S., Robertson D.L., Robineau O., Roche-Campo F., Rodari P., Rodeia S., Rodriguez Abreu J., Roessler B., Roger C., Roger P.-M., Roilides E., Rojek A., Romaru J., Roncon-Albuquerque Jr R., Roriz M., Rosa-Calatrava M., Rose M., Rosenberger D., Rossanese A., Rossetti M., Rossignol B., Rossignol P., Rousset S., Roy C., Roze B., Rusmawatiningtyas D., Russell C.D., Ryan M., Ryckaert S., Rygh Holten A., Saba I., Sadaf S., Sadat M., Sahraei V., Saint-Gilles M., Sakiyalak P., Salahuddin N., Salazar L., Saleem J., Sales G., Sallaberry S., Salmon Gandonniere C., Salvator H., Sanchez O., Sanchez Choez X., Sanchez de Oliveira K., Sanchez-Miralles A., Sancho-Shimizu V., Sandhu G., Sandhu Z., Sandrine P.-F., Sandulescu O., Santos M., Sarfo-Mensah S., Sarmento Banheiro B., Sarmiento I.C.E., Sarton B., Satyapriya S., Satyawati R., Saviciute E., Savio R., Savvidou P., Saw Y.T., Schaffer J., Schermer T., Scherpereel A., Schneider M., Schroll S., Schwameis M., Schwartz G., Scott J.T., Scott-Brown J., Sedillot N., Seitz T., Selvanayagam J., Selvarajoo M., Semaille C., Semple M.G., Senian R.B., Senneville E., Sepulveda C., Sequeira F., Sequeira T., Serpa Neto A., Serrano Balazote P., Shadowitz E., Shahidan S.A., Shahnaz Hasan M., Shamsah M., Shankar A., Sharjeel S., Sharma P., Shaw C.A., Shaw V., Shi H., Shiban N., Shiekh M., Shiga T., Shime N., Shimizu H., Shimizu K., Shimizu N., Shindo N., Shrapnel S., Shum H.P., Si Mohammed N., Siang N.Y., Sibiude J., Siddiqui A., Sigfrid L., Sillaots P., Silva C., Silva M.J., Silva R., Sim Lim Heng B., Sin W.C., Singh B.C., Singh P., Sitompul P.A., Sivam K., Skogen V., Smith S., Smood B., Smyth C., Smyth M., Snacken M., So D., Soh T.V., Solis M., Solomon J., Solomon T., Somers E., Sommet A., Song M.J., Song R., Song T., Song Chia J., Sonntagbauer M., Soom A.M., Sotto A., Soum E., Sousa A.C., Sousa M., Sousa Uva M., Souza-Dantas V., Sperry A., Spinuzza E., Sri Darshana B.P.S.R., Sriskandan S., Stabler S., Staudinger T., Stecher S.-S., Steinsvik T., Stienstra Y., Stiksrud B., Stolz E., Stone A., Streinu-Cercel A., Strudwick S., Stuart A., Stuart D., Subekti D., Suen G., Suen J.Y., Sukumar P., Sultana A., Summers C., Supic D., Suppiah D., Surovcova M., Suwarti S., Svistunov A.A., Syahrin S., Syrigos K., Sztajnbok J., Szuldrzynski K., Tabrizi S., Taccone F.S., Tagherset L., Taib S.M., Talarek E., Taleb S., Talsma J., Tampubolon M.L., Tan K.K., Tan L.V., Tan Y.C., Tanaka C., Tanaka H., Tanaka T., Taniguchi H., Tanveer H., Taqdees H., Taqi A., Tardivon C., Tattevin P., Taufik M.A., Tawfik H., Tedder R.S., Tee T.Y., Teixeira J., Tejada S., Tellier M.-C., Teoh S.K., Teotonio V., Teoule F., Terpstra P., Terrier O., Terzi N., Tessier-Grenier H., Tey A., Thabit A.A.M., Tham Z.D., Thangavelu S., Thibault V., Thiberville S.-D., Thill B., Thirumanickam J., Thompson S., Thomson D., Thomson E.C., Thurai S.R.T., Thuy D.B., Thwaites R.S., Tierney P., Tieroshyn V., Timashev P.S., Timsit J.-F., Tirupakuzhi Vijayaraghavan B.K., Tissot N., Toh J.Z.Y., Toki M., Tolppa T., Tonby K., Tonnii S.L., Torres A., Torres M., Torres Santos-Olmo R.M., Torres-Zevallos H., Towers M., Trapani T., Traynor D., Treoux T., Trieu H.T., Tripathy S., Tromeur C., Trontzas I., Trouillon T., Truong J., Tual C., Tubiana S., Tuite H., Turmel J.-M., Turtle L.C.W., Tveita A., Twardowski P., Uchiyama M., Udayanga P.I., Udy A., Ullrich R., Umer Z., Uribe A., Usman A., Vajdovics C., Val-Flores L., Valle A.L., Valran A., Van de Velde S., van den Berge M., van der Feltz M., van der Valk P., Van Der Vekens N., Van der Voort P., Van Der Werf S., van Dyk M., van Gulik L., Van Hattem J., van Lelyveld S., van Netten C., Van Twillert G., van Veen I., Vanel N., Vanoverschelde H., Varghese P., Varrone M., Vasudayan S.R., Vauchy C., Vaughan H., Veeran S., Veislinger A., Vencken S., Ventura S., Verbon A., Vidal J.E., Vieira C., Vijayan D., Villanueva J.A., Villar J., Villeneuve P.-M., Villoldo A., Vinh Chau N.V., Visseaux B., Visser H., Vitiello C., Vonkeman H., Vuotto F., Wahab N.H., Wahab S.A., Wahid N.A., Wainstein M., Wan Muhd Shukeri W.F., Wang C.-H., Webb S.A., Wei J., Weil K., Wen T.P., Wesselius S., West T.E., Wham M., Whelan B., White N., Wicky P.H., Wiedemann A., Wijaya S.O., Wille K., Willems S., Williams V., Wils E.-J., Wing Yiu N., Wong C., Wong T.F., Wong X.C., Wong Y.S., Xian G.E., Xian L.S., Xuan K.P., Xynogalas I., Yacoub S., Yakop S.R.B.M., Yamazaki M., Yazdanpanah Y., Yee Liang Hing N., Yelnik C., Yeoh C.H., Yerkovich S., Yokoyama T., Yonis H., Yousif O., Yuliarto S., Zaaqoq A., Zabbe M., Zacharowski K., Zahid M., Zahran M., Zaidan N.Z.B., Zambon M., Zambrano M., Zanella A., Zawadka K., Zaynah N., Zayyad H., Zoufaly A., Zucman D., NIHR, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Abbas, A., Abdukahil, S. 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B., Asyraf, A., Atique, A., Attanyake, A. U. L., Auchabie, J., Aumaitre, H., Auvet, A., Azemar, L., Azoulay, C., Bach, B., Bachelet, D., Badr, C., Baig, N., Baillie, J. K., Baird, J. K., Bak, E., Bakakos, A., Bakar, N. A., Bal, A., Balakrishnan, M., Balan, V., Bani-Sadr, F., Barbalho, R., Barbosa, N. Y., Barclay, W. S., Barnett, S. U., Barnikel, M., Barrasa, H., Barrelet, A., Barrigoto, C., Bartoli, M., Bartone, C., Baruch, J., Bashir, M., Basmaci, R., Basri, M. F. H., Bastos, D., Battaglini, D., Bauer, J., Bautista Rincon, D. F., Bazan Dow, D., Bedossa, A., Bee, K. H., Behilill, S., Beishuizen, A., Beljantsev, A., Bellemare, D., Beltrame, A., Beltrao, B. A., Beluze, M., Benech, N., Benjiman, L. E., Benkerrou, D., Bennett, S., Bento, L., Berdal, J. -E., Bergeaud, D., Bergin, H., Bernal Sobrino, J. L., Bertoli, G., Bertolino, L., Bessis, S., Betz, A., Bevilcaqua, S., Bezulier, K., Bhatt, A., Bhavsar, K., Bianchi, I., Bianco, C., Bidin, F. N., Bikram Singh, M., Bin Humaid, F., Bin Kamarudin, M. N., Bissuel, F., Biston, P., Bitker, L., Blanco-Schweizer, P., Blier, C., Bloos, F., Blot, M., Blumberg, L., Boccia, F., Bodenes, L., Bogaarts, A., Bogaert, D., Boivin, A. -H., Bolze, P. -A., Bompart, F., Bonfasius, A., Borges, D., Borie, R., Bosse, H. M., Botelho-Nevers, E., Bouadma, L., Bouchaud, O., Bouchez, S., Bouhmani, D., Bouhour, D., Bouiller, K., Bouillet, L., Bouisse, C., Boureau, A. -S., Bourke, J., Bouscambert, M., Bousquet, A., Bouziotis, J., Boxma, B., Boyer-Besseyre, M., Boylan, M., Bozza, F. A., Brack, M., Braconnier, A., Braga, C., Brandenburger, T., Bras Monteiro, F., Brazzi, L., Breen, D., Breen, P., Brett, S., Brickell, K., Broadley, T., Browne, A., Browne, S., Brozzi, N., Brusse-Keizer, M., Buchtele, N., Buesaquillo, C., Bugaeva, P., Buisson, M., Burhan, E., Burrell, A., Bustos, I. G., Butnaru, D., Cabie, A., Cabral, S., Caceres, E., Cadoz, C., Callahan, M., Calligy, K., Calvache, J. 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A., Dantas, J., D'Aragon, F., de Boer, M., de Loughry, G., de Mendoza, D., De Montmollin, E., de Oliveira Franca, R. F., de Pinho Oliveira, A. I., De Rosa, R., de Silva, T., de Vries, P., Deacon, J., Dean, D., Debard, A., Debenedictis, B., Debray, M. -P., Decastro, N., Dechert, W., Deconninck, L., Decours, R., Defous, E., Delacroix, I., Delaveuve, E., Delavigne, K., Delfos, N. M., Deligiannis, I., Dell'Amore, A., Delmas, C., Delobel, P., Delsing, C., Demonchy, E., Denis, E., Deplanque, D., Depuydt, P., Desai, M., Descamps, D., Desvallee, M., Dewayanti, S., Diallo, A., Diamantis, S., Dias, A., Diaz, P., Diaz, R., Diaz Diaz, J. J., Didier, K., Diehl, J. -L., Dieperink, W., Dimet, J., Dinot, V., Diop, F., Diouf, A., Dishon, Y., Dixit, D., Djossou, F., Docherty, A. B., Doherty, H., Dondorp, A. M., Dong, A., Donnelly, C. A., Donnelly, M., Donohue, C., Donohue, S., Donohue, Y., Doran, C., Doran, P., Dorival, C., D'Ortenzio, E., Douglas, J. 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Subjects: Biomedical Research, [SDV]Life Sciences [q-bio], Clinical science, Global Health, Corrections, Microbiology, 1117 Public Health and Health Services, 1108 Medical Microbiology, Pandemic, Economics, Humans, ISARIC Clinical Characterisation Group, Pandemics, COVID-19/epidemiology, Actuarial science, Information Dissemination, SARS-CoV-2, Comment, ISARIC, COVID-19, 1103 Clinical Sciences, Communicable Disease Control/methods, Infectious Diseases, Open source, Communicable Disease Control, Value (mathematics), Human
Abstract: International audience
Published: 2021
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19. Role of Biomarkers and Biopsy in Hepatocellular Carcinoma

Author: Pratima Sharma and Vincent L. Chen
Subjects: Oncology, medicine.medical_specialty, Carcinoma, Hepatocellular, Biopsy, Cancer therapy, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Biomarkers, Tumor, Humans, AFP-L3, Liquid biopsy, Precision Medicine, Protein Precursors, neoplasms, Hepatology, medicine.diagnostic_test, Tumor biology, business.industry, Liver Neoplasms, Liquid Biopsy, medicine.disease, Prognosis, digestive system diseases, Molecular Diagnostic Techniques, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Cancer genetics, Tissue diagnosis, 030211 gastroenterology & hepatology, Prothrombin, alpha-Fetoproteins, Plant Lectins, business, Biomarkers
Abstract: Hepatocellular carcinoma (HCC) is increasing in prevalence and is the third leading cause of cancer-related death worldwide. Unlike other malignancies, HCC can be diagnosed with dynamic imaging with very high accuracy, and tissue diagnosis is not needed for cancer therapy. There is a unique role of established as well as developing biomarkers in diagnosis, prognosis, and management of HCC. Sequencing HCC tumors has yielded substantial insights into HCC tumor biology and has raised the possibility of precision oncology in which therapy decisions are guided by cancer genetics. However, it is not ready for prime time yet.
Published: 2020

20. COVID-19 Outcomes Among Solid Organ Transplant Recipients: A Case-control Study

Author: Christopher J. Sonnenday, Vaiibhav N. Patel, Jonathan P. Troost, Michael P. Combs, Christopher Fung, Vincent L. Chen, Jonathan L. Golob, Emily C. Somers, Mona M. Doshi, Pratima Sharma, Monica Colvin, Keith D. Aaronson, Silas P. Norman, and Puneet Garg
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, 030230 surgery, Organ transplantation, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, Renal replacement therapy, Aged, Retrospective Studies, Transplantation, business.industry, SARS-CoV-2, Hazard ratio, Case-control study, COVID-19, Retrospective cohort study, Hydroxychloroquine, Immunosuppression, Odds ratio, Organ Transplantation, Middle Aged, Transplant Recipients, COVID-19 Drug Treatment, Renal Replacement Therapy, 030211 gastroenterology & hepatology, Female, business, medicine.drug
Abstract: Background Solid organ transplant (SOT) recipients are considered to be "vulnerable" to COVID-19 infection due to immunosuppression. To date, there are no studies that compared the disease severity of COVID-19 in SOT recipients with nontransplant patients. Methods In this case-control study, we compared the outcomes of COVID-19 between SOT recipients and their matched nontransplant controls. The cases were all adult SOT recipients (N = 41) from our academic health center who were diagnosed with COVID-19 between March 10, 2020 and May 15, 2020 using positive reverse transcriptase polymerase chain reaction for SARS-CoV2. The controls (N = 121) were matched on age (±5 y), race, and admission status (hospital or outpatient). The primary outcome was death and secondary outcomes were severe disease, intubation and renal replacement therapy (RRT). Results Median age of SOT recipients (9 heart, 3 lung, 16 kidney, 8 liver, and 5 dual organ) was 60 y, 80% were male and 67% were Black. Severe disease adjusted risk of death was similar in both the groups (hazard ratio = 0.84 [0.32-2.20]). Severity of COVID-19 and intubation were similar, but the RRT use was higher in SOT (odds ratio = 5.32 [1.26, 22.42]) compared to non-SOT COVID-19 patients. Among SOT recipients, COVID-19-related treatment with hydroxychloroquine (HCQ) was associated with 10-fold higher hazard of death compared to without HCQ (hazard ratio = 10.62 [1.24-91.09]). Conclusions Although African Americans constituted one-tenth of all SOT in our center, they represented two-thirds of COVID-19 cases. Despite high RRT use in SOT recipients, the severe disease and short-term death were similar in both groups. HCQ for the treatment of COVID-19 among SOT recipients was associated with high mortality and therefore, its role as a treatment modality requires further scrutiny.
Published: 2020
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21. Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19

Author: Ihab Kassab, Naresh T Gunaratnam, Jeffrey A. Berinstein, Vincent L. Chen, Jeremy Louissaint, Calen A. Steiner, Pratima Sharma, Kevin D. Platt, Fadi Hawa, Chia-Yang Hsu, and Chanakyaram A. Reddy
Subjects: medicine.medical_specialty, Physiology, medicine.medical_treatment, Disease, Outcomes, Gastroenterology, Severity of Illness Index, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, NAFLD, Prevalence, Acute liver injury, Medicine, Humans, Dialysis, Cardiopulmonary disease, business.industry, SARS-CoV-2, COVID-19, Hepatology, Jaundice, medicine.disease, Fatty Liver, Liver, 030220 oncology & carcinogenesis, Transaminitis, 030211 gastroenterology & hepatology, Original Article, Steatosis, medicine.symptom, business, Cohort study
Abstract: Background Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. Aims To characterize the impact of HS on disease severity and liver injury in COVID-19. Methods We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. Results In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. Conclusions HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.
Published: 2020

22. Tocilizumab for treatment of mechanically ventilated patients with COVID-19

Author: Nina Zhou, Dan R Kaul, Shiwei Zhou, Twisha S Patel, Emily T. Martin, Adam S. Lauring, David Frame, Ji Hoon Baang, Tejal N Gandhi, Gregory A. Eschenauer, Jason M. Pogue, Jerod Nagel, Jonathan P. Troost, Nicholas O Dillman, Jonathan L. Golob, Pratima Sharma, Lu Wang, Lindsay A Petty, David A. Hanauer, Kevin S. Gregg, Christopher Fung, and Emily C. Somers
Subjects: 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, medicine.medical_treatment, medicine.disease_cause, Antibodies, Monoclonal, Humanized, Gastroenterology, Article, law.invention, 03 medical and health sciences, chemistry.chemical_compound, tocilizumab, 0302 clinical medicine, Tocilizumab, Randomized controlled trial, law, Internal medicine, Clinical endpoint, medicine, Major Article, Humans, Decompensation, 030212 general & internal medicine, Interleukin 6, Mechanical ventilation, biology, Proportional hazards model, business.industry, SARS-CoV-2, interleukin-6, Hazard ratio, COVID-19, Odds ratio, medicine.disease, Blockade, Cytokine release syndrome, 030104 developmental biology, Infectious Diseases, AcademicSubjects/MED00290, Respiratory failure, chemistry, Superinfection, biology.protein, business
Abstract: BackgroundSevere COVID-19 can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers. This presentation is consistent with cytokine release syndrome in chimeric antigen receptor T cell therapy, for which IL-6 blockade is approved treatment.MethodsWe assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability post-intubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared to tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability weighting (IPTW).Findings154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean 55 vs. 60 years), less likely to have chronic pulmonary disease (10% vs. 28%), and had lower D-dimer values at time of intubation (median 2.4 vs. 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death [hazard ratio 0.55 (95% CI 0.33, 0.90)] and improved status on the ordinal outcome scale [odds ratio per 1-level increase: 0.59 (0.36, 0.95)]. Though tocilizumab was associated with an increased proportion of patients with superinfections (54% vs. 26%; pInterpretationIn this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with a decreased likelihood of death despite higher superinfection occurrence. Randomized controlled trials are urgently needed to confirm these findings.KEY POINTSQuestionCan therapy with the IL-6 receptor antagonist tocilizumab improve outcomes in patients with severe COVID-19 illness requiring mechanical ventilation?FindingsIn this observational, controlled study of 154 patients, receipt of tocilizumab was associated with a 45% reduction in the hazard of death, despite twice the frequency of superinfection (54% vs 26%), both of which were statistically significant findings.MeaningTocilizumab therapy may improve survival in patients with COVID-19 illness requiring mechanical ventilation. These results can inform clinical practice pending the results of randomized clinical trials.
Published: 2020

23. Knowledge of Chronic Kidney Disease Among Liver Transplant Recipients

Author: Jennifer Mawby, Julie A. Wright Nunes, Pratima Sharma, Claire Koerschner, Christopher J. Sonnenday, Sara Selman, Jeong M. Park, and Hellan K. Kwon
Subjects: Male, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Cross-sectional study, medicine.medical_treatment, Treatment outcome, 030232 urology & nephrology, MEDLINE, Health knowledge, 030230 surgery, Liver transplantation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Internal medicine, Humans, Medicine, Renal Insufficiency, Chronic, Transplantation, Hepatology, business.industry, Middle Aged, medicine.disease, Transplant Recipients, Liver Transplantation, Cross-Sectional Studies, Treatment Outcome, Female, Surgery, business, Kidney disease
Published: 2018
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24. The adoption of generic immunosuppressant medications in kidney, liver, and heart transplantation among recipients in Colorado or nationally with Medicare part D

Author: Adam Saulles, Sarah K. Dutcher, Ghalib Bello, Alan B. Leichtman, Sangeeta Goel, Murewa Oguntimein, Marc N. Turenne, Jeong M. Park, Jarcy Zee, Melissa Fava, Rajesh Balkrishnan, Abigail R. Smith, Margaret E. Helmuth, Charlotte A. Beil, Pratima Sharma, and Qian Liu
Subjects: Male, Drug, medicine.medical_specialty, Prescription drug, medicine.medical_treatment, media_common.quotation_subject, Medicare Part D, Pharmacy, 030230 surgery, Article, Organ transplantation, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Drugs, Generic, Humans, Immunology and Allergy, Pharmacology (medical), 030212 general & internal medicine, Kidney transplantation, media_common, Heart transplantation, Transplantation, business.industry, Middle Aged, Prognosis, medicine.disease, Kidney Transplantation, Transplant Recipients, United States, Tacrolimus, Liver Transplantation, Heart Transplantation, Female, business, Immunosuppressive Agents, Follow-Up Studies
Abstract: The transplant community is divided regarding whether substitution with generic immunosuppressants is appropriate for organ transplant recipients. We estimated the rate of uptake over time of generic immunosuppressants using US Medicare Part D Prescription Drug Event (PDE) and Colorado pharmacy claims (including both Part D and non-Part D) data from 2008 to 2013. Data from 26 070 kidney, 15 548 liver, and 6685 heart recipients from Part D, and 1138 kidney and 389 liver recipients from Colorado were analyzed. The proportions of patients with PDEs or claims for generic and brand-name tacrolimus or mycophenolate mofetil were calculated over time by transplanted organ and drug. Among Part D kidney, liver, and heart beneficiaries, the proportion dispensed generic tacrolimus reached 50%−56% at 1 year after first generic approval and 78%−81% by December 2013. The proportion dispensed generic mycophenolate mofetil reached 70%−73% at 1 year after generic market entry and 88%−90% by December 2013. There was wide interstate variability in generic uptake, with faster uptake in Colorado compared with most other states. Overall, generic substitution for tacrolimus and mycophenolate mofetil for organ transplant recipients increased rapidly following first availability, and utilization of generic immunosuppressants exceeded that of brand-name products within a year of market entry.
Published: 2018
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25. Assessing the impact of a program for late surgical intervention in early-blind children

Author: S.D. Gupta, S. Bi, Piyush Swami, Pawan Sinha, H. Dhillon, Tapan K. Gandhi, S. Sood, Umang Mathur, Naresh Chauhan, Amy Kalia, Suma Ganesh, Garga Chatterjee, and Pratima Sharma
Subjects: Male, Rural Population, Gerontology, Pediatrics, medicine.medical_specialty, Time Factors, Adolescent, medicine.medical_treatment, Visual impairment, India, Developing country, Blindness, Article, Cataract, Young Adult, 03 medical and health sciences, Corneal Opacity, 0302 clinical medicine, Social integration, Quality of life, Surveys and Questionnaires, Intervention (counseling), medicine, Humans, Age of Onset, Child, Rehabilitation, business.industry, Public health, Public Health, Environmental and Occupational Health, General Medicine, Child, Preschool, Vocational education, Quality of Life, 030221 ophthalmology & optometry, Female, medicine.symptom, business, 030217 neurology & neurosurgery, Program Evaluation
Abstract: © 2017 The Royal Society for Public Health Objective Many blind children in the developing world are unable to obtain timely treatment due to lack of financial and medical resources. Can public health programs that identify and treat such children several years after the onset of blindness enhance their quality of life? The notion that visual development is subject to an early ‘critical period’ argues against this possibility. However, there are inadequate empirical data from humans on this issue. To address this need, we examined the quality of life of children living in India and who were treated for early-onset blindness (before one year of age), due to cataracts or corneal opacities. Study design Survey study. Methods As part of an ongoing scientific effort named Project Prakash, we screened over 40,000 children in rural northern India to identify those suffering from early-onset blindness. They were provided eye surgeries in a tertiary care ophthalmic center in New Delhi. We subsequently surveyed 64 Prakash children, ranging in age from 5 to 22 years and obtained their responses on a multi-dimensional quality of life questionnaire. Results Nearly all of the subjects indicated that their quality of life had improved after treatment. Children reported marked enhancement in their mobility, independence, and safety, and also in social integration. Surprisingly, we found no significant correlations between quality of life metrics and factors such as age at treatment, gender, time since treatment, and pre-surgery and post-surgery acuity. Conclusions A key question for public health policy makers is whether a program of surgical intervention for older blind children is likely to be beneficial, or if the resources are better spent on rehabilitation via vocational training and assistive devices. The marked improvements in quality of life we find in our data strongly argue for the provision of surgical care regardless of a child's age.
Published: 2017
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26. Incidence and Risks for Nonalcoholic Fatty Liver Disease and Steatohepatitis Post-liver Transplant: Systematic Review and Meta-analysis

Author: Christopher J. Sonnenday, Carol Shannon, Naba Saeed, Monica A. Tincopa, Pratima Sharma, and Lisa M. Glass
Subjects: medicine.medical_specialty, Multivariate analysis, Biopsy, digestive system, Gastroenterology, End Stage Liver Disease, Non-alcoholic Fatty Liver Disease, Recurrence, Risk Factors, Internal medicine, Nonalcoholic fatty liver disease, medicine, Humans, Postoperative Period, Retrospective Studies, Transplantation, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Incidence, Fatty liver, nutritional and metabolic diseases, Retrospective cohort study, medicine.disease, digestive system diseases, Liver Transplantation, Fatty Liver, Treatment Outcome, Meta-analysis, Multivariate Analysis, Steatohepatitis, business
Abstract: The true incidence and unique risk factors for recurrent and de novo nonalcoholic fatty liver (NAFLD) and nonalcoholic steatohepatitis (NASH) post-liver transplant (LT) remain poorly characterized. We aimed to identify the incidence and risk factors for recurrent and de novo NAFLD/NASH post-LT.MEDLINE via PubMed, Embase, Scopus, and CINAHL were searched for studies from 2000 to 2018. Risk of bias was adjudicated using the Newcastle-Ottawa Scale.Seventeen studies representing 2378 patients were included. All were retrospective analyses of patients with post-LT liver biopsies, with the exception of 2 studies that used imaging for outcome assessment. Seven studies evaluated occurrence of recurrent NAFLD/NASH, 3 evaluated de novo occurrence, and 7 evaluated both recurrent and de novo. In studies at generally high or moderate risk of bias, mean 1-, 3-, and ≥5-year incidence rates may be 59%, 57%, and 82% for recurrent NAFLD; 67%, 40%, and 78% for de novo NAFLD; 53%, 57.4%, and 38% for recurrent NASH; and 13%, 16%, and 17% for de novo NASH. Multivariate analysis demonstrated that post-LT body mass index (summarized odds ratio = 1.27) and hyperlipidemia were the most consistent predictors of outcomes.There is low confidence in the incidence of recurrent and de novo NAFLD and NASH after LT due to study heterogeneity. Recurrent and de novo NAFLD may occur in over half of recipients as soon as 1 year after LT. NASH recurs in most patients after LT, whereas de novo NASH occurs rarely. NAFLD/NASH after LT is associated with metabolic risk factors.
Published: 2019

27. Liver transplantation for hepatocellular carcinoma: Management after the transplant

Author: Francis Y. Yao, Archita P. Desai, Anil B. Seetharam, Yuval A. Patel, Anjana Pillai, Courtney B. Sherman, Elizabeth C. Verna, Avin Aggarwal, Reena Salgia, Catherine Frenette, Georgios Tsoulfas, and Pratima Sharma
Subjects: medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Population, Disease, 030230 surgery, Liver transplantation, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Immunology and Allergy, Humans, Pharmacology (medical), Intensive care medicine, education, Postoperative Care, Transplantation, education.field_of_study, business.industry, Liver Neoplasms, Immunosuppression, Hepatology, medicine.disease, Liver Transplantation, Regimen, Hepatocellular carcinoma, Biomarker (medicine), Neoplasm Recurrence, Local, business
Abstract: Hepatocellular carcinoma (HCC) is an increasingly common indication for liver transplantation (LT) in the United States and in many parts of the world. In the last decade, significant work has been done to better understand how to risk stratify LT candidates for recurrence of HCC following transplant using a combination of biomarker and imaging findings. However, despite the high frequency of HCC in the LT population, guidance regarding posttransplant management is lacking. In particular, there is no current evidence to support specific post-LT surveillance strategies, leading to significant heterogeneity in practices. In addition, there are no current recommendations regarding recurrence prevention, including immunosuppression regimen or secondary prevention with adjuvant chemotherapy. Finally, guidance on treatment of disease recurrence is also lacking and there is significant controversy about the use of immunotherapy in transplant recipients due to the risk of rejection. Thus, outcomes for patients with recurrence are poor. This paper therefore provides a comprehensive review of the current literature on post-LT management of patients with HCC and identifies gaps in our current knowledge that are in urgent need of further investigation.
Published: 2019

28. Impact of a Prohibitive Versus Restrictive Tobacco Policy on Liver Transplant Candidate Outcomes

Author: Gerald Scott Winder, Frederick K. Askari, Pratima Sharma, Robert J. Fontana, Naba Saeed, Jessica L. Mellinger, Ammar Hassan, Christopher J. Sonnenday, and Alisa Likhitsup
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Waiting Lists, medicine.medical_treatment, 030230 surgery, Liver transplantation, Severity of Illness Index, End Stage Liver Disease, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Risk Factors, Internal medicine, Severity of illness, medicine, Tobacco Smoking, Humans, Aged, Retrospective Studies, Transplantation, Smokers, Hepatology, business.industry, Medical record, Incidence (epidemiology), Patient Selection, Retrospective cohort study, Middle Aged, medicine.disease, Smoking Reduction, Comorbidity, Liver Transplantation, Policy, Smoking cessation, 030211 gastroenterology & hepatology, Surgery, Female, Smoking Cessation, business
Abstract: Tobacco use has been associated with poorer outcomes after liver transplantation (LT). Our study examined the effect on LT listing outcomes of a newly implemented policy prohibiting the use of all tobacco products compared with a prior restrictive policy. Medical records of consecutive adult patients evaluated for LT from January 2010 to July 2013 (era 1, n = 1344) and August 2013 to March 2017 (era 2, n = 1350) were reviewed. The proportion of LT candidates listed was the primary outcome. The mean age of the 2694 LT candidates was 54 ± 11 years, 60% were male, and the mean Model for End-Stage Liver Disease (MELD) score was 15 ± 7. Although the proportion of LT candidates who were smokers was significantly higher in era 2 (33% versus 23%; P < 0.005), the proportion of smokers listed for LT remained stable (13% versus 17%; P = 0.25). However, there were more smokers excluded for ongoing tobacco use in era 2 compared with era 1 (9.6% versus 4.4%; P = 0.001). Factors independently associated with LT listing included a diagnosis of hepatocellular carcinoma, being married, private insurance, absence of psychiatry comorbidity, and absence of tobacco, marijuana, or opiate use but evaluation during era 2 was not associated with LT listing. However, the median time to listing significantly increased over time, especially in smokers (from 65 to 122 days; P = 0.001), and this trend was independently associated with evaluation during era 2, a lower MELD score, not having children, and a lower level of education (P < 0.05). In conclusion, despite an increasing incidence of active smokers being referred for LT evaluation, the proportion of smoker candidates listed for LT was unchanged after instituting our prohibitive tobacco use policy. However, the time to get on the waiting list for smokers who were eventually listed was significantly longer due to the need to achieve complete tobacco cessation.
Published: 2019

29. National Assessment of Hospitalization Rates for Incident End-Stage Renal Disease After Liver Transplantation

Author: Nathan P. Goodrich, Robert M. Merion, Douglas E. Schaubel, Abigail R. Smith, and Pratima Sharma
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Disease, 030230 surgery, Liver transplantation, urologic and male genital diseases, 01 natural sciences, Article, End stage renal disease, End Stage Liver Disease, 010104 statistics & probability, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Claims data, medicine, Humans, 0101 mathematics, Intensive care medicine, Data Linkage, health care economics and organizations, Aged, Transplantation, business.industry, Incidence, Incidence (epidemiology), Length of Stay, Middle Aged, female genital diseases and pregnancy complications, Liver Transplantation, Hospitalization, Emergency medicine, Female, business, Medicaid, Resource utilization
Abstract: We examined the association of incident end stage renal disease (ESRD) after liver transplantation (LT) and resource utilization using a data linkage between the Scientific Registry of Transplant Recipients (SRTR) and claims data from the Centers for Medicare and Medicaid Services (CMS). Methods: The study cohort consisted of patients aged ≥18years who underwent deceased donor LT between 1/1/2003 and 12/31/2010 with Medicare as primary or secondary insurance and were discharged alive from the index LT hospitalization (n=7019). The association of ESRD and post-LT hospitalization was assessed by sequential stratification, which entailed prognostic score matching of ESRD-free patients to each LT recipient at ESRD onset. The prognostic score was developed from a model of time to hospitalization and included baseline factors and hospitalization history as predictors. Results: The overall hospitalization rates for LT recipients with and without ESRD were 2.7 and 1.1 per patient-year at risk, respectively. The total number of days hospitalized patient per year was 23 in ESRD and 7 in non-ESRD LT recipients. The adjusted post-LT hospitalization rate was 97% higher after reaching ESRD compared to non-ESRD (HR=1.97; p
Published: 2016
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30. National Assessment of Early Hospitalization after Liver Transplantation: Risk Factors and Association with Patient Survival

Author: Nathan P. Goodrich, Robert M. Merion, Douglas E. Schaubel, Pratima Sharma, and Abigail R. Smith
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Hepacivirus, 030230 surgery, Liver transplantation, Medicare, Article, Body Mass Index, End Stage Liver Disease, 03 medical and health sciences, 0302 clinical medicine, Model for End-Stage Liver Disease, Internal medicine, Diabetes Mellitus, Medicine, Humans, Longitudinal Studies, Registries, Dialysis, Aged, Proportional Hazards Models, Retrospective Studies, Transplantation, Hepatology, business.industry, Mortality rate, Hazard ratio, Hepatitis C, Middle Aged, medicine.disease, Transplant Recipients, United States, Surgery, Liver Transplantation, Hospitalization, 030211 gastroenterology & hepatology, Female, business, Body mass index, Transjugular intrahepatic portosystemic shunt, Follow-Up Studies
Abstract: Hospitalization is known to occur frequently in the first 6 months following liver transplantation (LT). Using a novel data linkage between the Scientific Registry of Transplant Recipients and Centers for Medicare and Medicaid Services, our study has 2 objectives: (1) to determine risk factors for "early" hospitalization (ie, within 6 months of LT); and (2) to quantify the importance of hospitalization history in the first 6 months with respect to subsequent patient survival (ie, survival, conditional on surviving 6 months post-LT). The study population consisted of patients aged ≥18 years who underwent deceased donor LT between January 1, 2003 and December 31, 2010, with Medicare as primary or secondary insurance and were discharged alive from the index LT hospitalization (n = 7220). The early hospitalization rate was 2.76 per patient-year and was significantly associated with many recipient factors (eg, recipient age, hepatitis C, diabetes, poor renal function including dialysis, and recipient of transjugular intrahepatic portosystemic shunt procedure before LT), as well as donor race and donation after cardiac death. Conditional on surviving 6 months after LT, the covariate-adjusted death rate increased by 22% for each additional hospitalization occurring in the first 6 months (hazard ratio, 1.22; P
Published: 2017

31. Incidence of and Risk Assessment for Adverse Cardiovascular Outcomes After Liver Transplantation: A Systematic Review

Author: Richard L. Weinberg, Christopher J. Sonnenday, Pratima Sharma, Danielle Fritze, and Monica A. Konerman
Subjects: Adult, Male, medicine.medical_specialty, Multivariate analysis, Time Factors, medicine.medical_treatment, Disease, 030230 surgery, Liver transplantation, Risk Assessment, Article, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Risk Factors, Nonalcoholic fatty liver disease, medicine, Humans, Intensive care medicine, Transplantation, business.industry, Incidence (epidemiology), Incidence, Age Factors, Middle Aged, medicine.disease, Surgery, Liver Transplantation, Treatment Outcome, Cardiovascular Diseases, Multivariate Analysis, 030211 gastroenterology & hepatology, Female, Risk assessment, business
Abstract: BACKGROUND Cardiovascular events represent a major source of morbidity and mortality after liver transplantation and will likely increase given the aging population and nonalcoholic fatty liver disease as a leading indication for transplant. The optimal cardiovascular risk stratification approach in this evolving patient population remains unclear. The aims of this systematic review are to: (1) refine the definition, (2) characterize the incidence, and (3) identify risk factors for cardiovascular events post-liver transplantation. Additionally, we evaluated performance characteristics of different cardiac testing modalities. METHODS MEDLINE via PubMed, EMBASE, Web of Science, and Scopus were searched for studies published between 2002 and 2016 (model of end-stage liver disease era). Two authors independently reviewed articles to select eligible studies and performed data abstraction. RESULTS Twenty-nine studies representing 57 493 patients from 26 unique cohorts were included. Definitions of cardiovascular outcomes were highly inconsistent. Incidence rates were widely variable: 1% to 41% for outcomes of 6 months or shorter and 0% to 31% for outcomes longer than 6 months. Multivariate analyses demonstrated that older age and history of cardiac disease were the most consistent predictors of cardiovascular events posttransplant (significant in 8/23 and 7/22, studies, respectively). Predictive capacity of various cardiac imaging modalities was also discrepant. CONCLUSIONS The true incidence of cardiovascular outcomes post-liver transplant remains unknown in large part due to lack of consensus regarding outcome definition. Overall, poor data quality and gaps in knowledge limit the ability to clearly identify predictors of outcomes, but existing data support a more aggressive risk stratification protocol for patients of advanced age and/or with preexisting cardiac disease.
Published: 2017

32. Outcomes of Liver Transplantation for Porto-Pulmonary Hypertension in Model for End-Stage Liver Disease Era

Author: Heather Simpson, Pratima Sharma, Reena Salgia, Robert M. Merion, and Nathan P. Goodrich
Subjects: Male, medicine.medical_specialty, Physiology, Hypertension, Pulmonary, medicine.medical_treatment, Liver transplantation, Severity of Illness Index, Article, End Stage Liver Disease, Model for End-Stage Liver Disease, Internal medicine, Hypertension, Portal, medicine, Humans, Contraindication, Retrospective Studies, Proportional hazards model, business.industry, Graft Survival, Hazard ratio, Gastroenterology, Retrospective cohort study, Middle Aged, Hepatology, medicine.disease, Pulmonary hypertension, United States, Liver Transplantation, Surgery, Treatment Outcome, Female, business
Abstract: Porto-pulmonary hypertension (POPH), once considered an absolute contraindication for liver transplantation (LT), has become a more accepted indication because of the evolution of treatment with prostacyclin analogues, phosphodiesterase inhibitors and endothelin receptor antagonists. An exception model for end stage liver disease (MELD) score of 22 is assigned to candidates with documentation of effective treatment. We examined the post-transplant outcomes of patients who received LT for POPH with exception. Scientific Registry of Transplant Recipients data on 34,318 adult (≥18 years) deceased donor LT recipients transplanted between March 1, 2002 and August 31, 2010 were reviewed. The diagnosis of POPH was ascertained from MELD exception forms. Patients were followed from the time of transplant until the earlier occurrence of death or end of the follow-up period. Cox regression was used to evaluate the predictors of post-LT mortality and graft failure. During the study period, 34,318 patients received deceased donor LT. Seventy eight out of 34,318 patients were transplanted for POPH with MELD exception. The 1-year adjusted risks of patient death and graft failure for patients transplanted under exception rules for POPH were significantly higher than with POPH adult recipients who did not receive exception points (death:hazard ratio [HR] = 2.25, p = 0.005 and graft failure HR = 1.96, p = 0.012). This study of national data suggests that treated POPH continues to be associated with inferior early post-transplant outcomes.
Published: 2014
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33. Novel educational and goal-setting tool to improve knowledge of chronic kidney disease among liver transplant recipients: A pilot study

Author: Julie A. Wright Nunes, Jennifer Mawby, Rachael B Leek, Jeong M. Park, Pratima Sharma, Christopher J. Sonnenday, and Claire Koerschner
Subjects: Male, Health Knowledge, Attitudes, Practice, Epidemiology, medicine.medical_treatment, 030232 urology & nephrology, Pilot Projects, 030230 surgery, Biochemistry, Endocrinology, 0302 clinical medicine, Chronic Kidney Disease, Medicine and Health Sciences, Renal Transplantation, Diabetes diagnosis and management, Prospective Studies, Prospective cohort study, Kidney transplantation, Multidisciplinary, Middle Aged, Tailored Intervention, Nephrology, Medicine, Female, Hemodialysis, Anatomy, Goals, Glomerular Filtration Rate, Research Article, Adult, medicine.medical_specialty, HbA1c, Patients, Endocrine Disorders, Science, MEDLINE, Renal function, Surgical and Invasive Medical Procedures, Urinary System Procedures, Digestive System Procedures, 03 medical and health sciences, Patient Education as Topic, Internal medicine, Diabetes Mellitus, medicine, Humans, Hemoglobin, Renal Insufficiency, Chronic, Aged, Transplantation, business.industry, Biology and Life Sciences, Proteins, Kidneys, Organ Transplantation, Renal System, medicine.disease, Diagnostic medicine, Liver Transplantation, Health Care, Metabolic Disorders, Medical Risk Factors, Linear Models, Feasibility Studies, business, Kidney disease
Abstract: IntroductionLiver transplant (LT) recipients have limited understanding of post-transplant chronic kidney disease (CKD) despite an excellent pre-existing framework of transplant care. This pilot study examined the efficacy and feasibility of a tailored educational and goal-setting tool in improving CKD knowledge among LT recipients with early-stage CKD.MethodsIn this prospective cohort study, we administered the CKD educational and goal-setting tool to 81 LT recipients between 7/1/2016 and 12/31/2017. We excluded patients with simultaneous liver-kidney transplantation, eGFRResultsMean age was 56.3 years, 69.1% were males, 85.2% were Caucasians and mean eGFR was 61.2 ± 20.0 ml/min. The CKD educational and goal-setting tool improved the CKD knowledge scores among LT recipients (pre: 71.8 ± 16.6%, post: 83.3 ± 10.4%; pConclusionsA simple LT-specific patient educational and goal-setting tool effectively improved CKD knowledge. Implementation of this tailored intervention will improve CKD awareness and may promote goal-setting in the target population.
Published: 2019
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34. Impact of direct‐acting antivirals for hepatitis C virus therapy on tacrolimus dosing in liver transplant recipients

Author: Rachael Leek, Linda J Fitzgerald, Sarah Tischer, Alexandra L. Bixby, Pratima Sharma, and Jessica L. Mellinger
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Hepatitis C virus, 030230 surgery, Liver transplantation, medicine.disease_cause, DIRECT ACTING ANTIVIRALS, Antiviral Agents, Gastroenterology, Article, Tacrolimus, 03 medical and health sciences, 0302 clinical medicine, Dose adjustment, Internal medicine, medicine, Humans, Drug Interactions, Dosing, Aged, Retrospective Studies, Immunosuppression Therapy, Transplantation, business.industry, Disease Management, Immunosuppression, Middle Aged, Hepatitis C, Liver Transplantation, surgical procedures, operative, Infectious Diseases, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Sofosbuvir, business, Immunosuppressive Agents, Drug metabolism
Abstract: INTRODUCTION: Direct-acting antivirals (DAAs) have transformed hepatitis C virus (HCV) management post-liver transplant. As HCV clears during DAA treatment, hepatic metabolism improves, resulting in decreased tacrolimus concentrations that may require dose adjustment. The purpose of this study was to determine appropriate management of immunosuppression in liver transplant recipients during and following treatment of HCV. METHODS: This study was a single-center retrospective analysis of 71 liver transplant recipients who were treated for HCV with DAAs. The primary outcome was change in dose-normalized tacrolimus concentrations from the start of DAA treatment to 12 weeks following therapy. RESULTS: The mean change in log-transformed dose-normalized tacrolimus concentrations was a reduction of 0.43 ng/mL/mg (95% CI; 0.26-0.60, P < 0.0001). The greatest decrease occurred in the first 4 weeks of treatment, after which levels stabilized. The overall mean tacrolimus concentration was 4.8 ng/mL (±2.5). Two patients (3%) developed acute cellular rejection and two patients (3%) had graft loss and died. CONCLUSION: From the start of treatment to 12 weeks post-DAA therapy, liver transplant recipients experienced a significant decrease in dose-normalized tacrolimus concentrations. In conclusion, close monitoring of tacrolimus concentrations is warranted during and following treatment with DAAs, as dose increases may be indicated in order to maintain therapeutic concentrations to prevent graft rejection.
Published: 2019
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35. Short-Term Pretransplant Renal Replacement Therapy and Renal Nonrecovery after Liver Transplantation Alone

Author: Robert M. Merion, Nathan P. Goodrich, Mary K. Guidinger, Douglas E. Schaubel, Pratima Sharma, and Min Zhang
Subjects: Male, medicine.medical_specialty, Hepatorenal Syndrome, Time Factors, Tissue and Organ Procurement, Waiting Lists, Epidemiology, medicine.medical_treatment, Renal function, Liver transplantation, Kidney, urologic and male genital diseases, Critical Care and Intensive Care Medicine, Centers for Medicare and Medicaid Services, U.S, Hepatorenal syndrome, Risk Factors, Internal medicine, Preoperative Care, medicine, Humans, Cumulative incidence, Registries, Renal replacement therapy, Kidney transplantation, Proportional Hazards Models, Retrospective Studies, Transplantation, business.industry, Acute kidney injury, Recovery of Function, Original Articles, Acute Kidney Injury, Middle Aged, medicine.disease, Kidney Transplantation, United States, Liver Transplantation, Surgery, Renal Replacement Therapy, Treatment Outcome, medicine.anatomical_structure, Nephrology, Disease Progression, Kidney Failure, Chronic, Female, business
Abstract: Candidates with AKI including hepatorenal syndrome often recover renal function after successful liver transplantation (LT). This study examined the incidence and risk factors associated with renal nonrecovery within 6 months of LT alone among those receiving acute renal replacement therapy (RRT) before LT.Scientific Registry of Transplant Recipients data were linked with Centers for Medicare and Medicaid Services ESRD data for 2112 adult deceased-donor LT-alone recipients who received acute RRT for ≤90 days before LT (February 28, 2002 to August 31, 2010). Primary outcome was renal nonrecovery (post-LT ESRD), defined as transition to chronic dialysis or waitlisting or receipt of kidney transplant within 6 months of LT. Cumulative incidence of renal nonrecovery was calculated using competing risk analysis. Cox regression identified recipient and donor predictors of renal nonrecovery.The cumulative incidence of renal nonrecovery after LT alone among those receiving the pre-LT acute RRT was 8.9%. Adjusted renal nonrecovery risk increased by 3.6% per day of pre-LT RRT (P0.001). Age at LT per 5 years (P=0.02), previous-LT (P=0.01), and pre-LT diabetes (P0.001) were significant risk factors of renal nonrecovery. Twenty-one percent of recipients died within 6 months of LT. Duration of pretransplant RRT did not predict 6-month post-transplant mortality.Among recipients on acute RRT before LT who survived after LT alone, the majority recovered their renal function within 6 months of LT. Longer pre-LT RRT duration, advanced age, diabetes, and re-LT were significantly associated with increased risk of renal nonrecovery.
Published: 2013
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36. Family history in colonoscopy patients: feasibility and performance of electronic and paper-based surveys for colorectal cancer risk assessment in the outpatient setting

Author: Joseph C. Kolars, Andrea Todisco, Pratima Sharma, Joel H. Rubenstein, Stacy B. Menees, Tannaz Guivatchian, Elena M. Stoffel, Erika Koeppe, Michael D. Rice, Caitlin Foor-Pessin, Matthew Demerath, Michael Rajala, Rafat S. Rizk, Cristina Moisa, Shanti Eswaran, William D. Chey, and Jason Baker
Subjects: Male, medicine.medical_specialty, Colorectal cancer, Colonoscopy, Risk management tools, Gene mutation, Risk Assessment, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, medicine, Ambulatory Care, Humans, Radiology, Nuclear Medicine and imaging, Diagnosis, Computer-Assisted, Genetic Testing, Family history, Medical History Taking, Germ-Line Mutation, medicine.diagnostic_test, business.industry, Gastroenterology, Middle Aged, medicine.disease, Colorectal Neoplasms, Hereditary Nonpolyposis, Surgery, Test (assessment), Pedigree, 030220 oncology & carcinogenesis, Family medicine, Cohort, Feasibility Studies, 030211 gastroenterology & hepatology, Female, Risk assessment, business, Colorectal Neoplasms
Abstract: Background and Aims Family history is crucial in stratifying patients' risk for colorectal cancer (CRC). Previous risk assessment tools developed for use in clinic or endoscopy settings have demonstrated suboptimal specificity for identifying patients with hereditary cancer syndromes. Our aim was to test the feasibility and performance of 2 family history surveys (paper and electronic) in individuals presenting for outpatient colonoscopy. Methods Patients presenting for outpatient colonoscopy at a tertiary care center were asked to complete a 5-question paper risk assessment survey (short paper survey) either alone or in conjunction with a second, comprehensive electronic family risk assessment survey (comprehensive tablet survey). Each subject's survey results, along with the electronic medical record, were reviewed, and 10 high-risk criteria and PREMM1,2,6 model scores (a predictive model for carrying a Lynch syndrome-associated gene mutation) were used to identify patients warranting genetic evaluation for suspected hereditary cancer syndromes. Results Six hundred patients completed the short paper survey (cohort 1), with an additional 100 patients completing both the short paper and comprehensive tablet survey (cohort 2). Using 10 high-risk criteria and/or a PREMM1,2,6 score ≥5%, we identified 10% and 9% of patients as high risk for CRC in cohorts 1 and 2, respectively. Of the 69 high-risk subjects, 23 (33%) underwent genetic evaluations and 7 (10%) carried germline mutations associated with cancer predisposition. Both patients and endoscopists reported the tools were user-friendly and helpful for CRC risk stratification. Conclusions Systematic assessment of family history in colonoscopy patients is feasible and can help endoscopists identify high-risk patients who would benefit from genetic evaluation.
Published: 2016

37. Evidence-Based Therapeutic Options for Hepatorenal Syndrome

Author: Pratima Sharma and Lisa M. Glass
Subjects: Male, medicine.medical_specialty, Evidence-based practice, Hepatorenal Syndrome, Hepatology, business.industry, Midodrine, Gastroenterology, MEDLINE, Octreotide, Lypressin, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Hepatorenal syndrome, Albumins, medicine, Humans, 030211 gastroenterology & hepatology, Female, Intensive care medicine, business, medicine.drug
Published: 2016

38. Impact of MELD-Based Allocation on End-Stage Renal Disease After Liver Transplantation

Author: Pratima Sharma, Robert M. Merion, Nathan P. Goodrich, Akinlolu Ojo, Douglas E. Schaubel, and Mary K. Guidinger
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Liver transplantation, urologic and male genital diseases, Article, End stage renal disease, End Stage Liver Disease, Liver disease, chemistry.chemical_compound, Risk Factors, Internal medicine, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Aged, Proportional Hazards Models, Transplantation, Creatinine, Health Care Rationing, Proportional hazards model, business.industry, Patient Selection, Incidence (epidemiology), Hazard ratio, Hepatitis C, Middle Aged, medicine.disease, United States, female genital diseases and pregnancy complications, Liver Transplantation, Surgery, chemistry, Kidney Failure, Chronic, Female, business
Abstract: The proportion of patients undergoing liver transplantation (LT), with concomitant renal dysfunction, markedly increased after allocation by the model for end-stage liver disease (MELD) score was introduced. We examined the incidence of subsequent post-LT end-stage renal disease (ESRD) before and after the policy was implemented. Data on all adult deceased donor LT recipients between April 27, 1995 and December 31, 2008 (n = 59 242), from the Scientific Registry of Transplant Recipients, were linked with Centers for Medicare & Medicaid Services' ESRD data. Cox regression was used to (i) compare pre-MELD and MELD eras with respect to post-LT ESRD incidence, (ii) determine the risk factors for post-LT ESRD and (iii) quantify the association between ESRD incidence and mortality. Crude rates of post-LT ESRD were 12.8 and 14.5 per 1000 patient-years in the pre-MELD and MELD eras, respectively. Covariate-adjusted post-LT ESRD risk was higher in the MELD era (hazard ratio [HR]= 1.15; p = 0.0049). African American race, hepatitis C, pre-LT diabetes, higher creatinine, lower albumin, lower bilirubin and sodium >141 mmol/L at LT were also significant predictors of post-LT ESRD. Post-LT ESRD was associated with higher post-LT mortality (HR = 3.32; p < 0.0001). The risk of post-LT ESRD, a strong predictor of post-LT mortality, is 15% higher in the MELD era. This study identified potentially modifiable risk factors of post-LT ESRD. Early intervention and modification of these risk factors may reduce the burden of post-LT ESRD.
Published: 2011
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39. Incidence and Risk Factors of Hepatocellular Carcinoma Recurrence After Liver Transplantation in the MELD Era

Author: Shawn J. Pelletier, Kathy Welch, Jorge A. Marrero, Robert M. Merion, Pratima Sharma, Robert J. Fontana, and Hero K. Hussain
Subjects: Graft Rejection, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Physiology, medicine.medical_treatment, Kaplan-Meier Estimate, Liver transplantation, Gastroenterology, Article, Young Adult, Model for End-Stage Liver Disease, Predictive Value of Tests, Risk Factors, Internal medicine, Cadaver, Carcinoma, medicine, Humans, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, Incidence, Incidence (epidemiology), Liver Neoplasms, Middle Aged, Hepatology, medicine.disease, Tissue Donors, digestive system diseases, Liver Transplantation, body regions, Predictive value of tests, Hepatocellular carcinoma, Female, Neoplasm Recurrence, Local, business, Immunosuppressive Agents
Abstract: Deceased donor liver transplantation (DDLT) rates for candidates with hepatocellular carcinoma (HCC) have significantly increased in the MELD era because of the extra priority given to these candidates. We examined the incidence and pre-DDLT radiological and donor factors associated with post-DDLT HCC recurrence in the MELD era.Outcomes of HCC candidates aged ≥18 years that underwent DDLT between 2/28/02 and 6/30/08 (n = 94) were reviewed. The primary outcome was biopsy-proven post-LT HCC recurrence at any site. Kaplan-Meier analysis was used to calculate the cumulative incidence and Cox regression was used to identify the predictors of post-LT HCC recurrence.The median age of the 94 candidates who met the study criteria was 54 years, 64% had hepatitis C, median lab MELD was 13, and median pre-LT AFP was 47 ng/dl. Based upon pre-DDLT imaging, 94% candidates met the Milan criteria. The median waiting time to transplant was 47 days and 27% received pre-DDLT loco-regional therapy. Seventeen (18%) developed HCC recurrence after 2.1 median years with a cumulative incidence of 6.8, 12, and 19% at 1, 2, and 3 years post-DDLT. The pre-DDLT number of lesions (p = 0.015), largest lesion diameter (p = 0.008), and higher donor age (p = 0.002) were the significant predictors of HCC recurrence after adjusting for pre-LT loco-regional therapy and waiting time. Post-LT HCC recurrence (p0.0001) and higher donor age (p = 0.029) were associated with lower post-LT survival.Post-LT HCC recurrence is higher in our MELD era cohort than the reported rate of 8% at 4 years in Mazzaferro et al.'s study. The risk of HCC recurrence was significantly associated with the number of lesions and size of the largest lesion at the time of DDLT as well as with older donor age. Risk stratification using a predictive model for post-LT HCC recurrence based on pre-LT imaging and donor factors may help guide candidate selection and tailoring of HCC surveillance strategies after LT.
Published: 2011
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40. Knowledge of Hepatocellular Carcinoma Screening Guidelines and Clinical Practices Among Gastroenterologists

Author: Joel H. Rubenstein, Pratima Sharma, Philip Schoenfeld, Jorge A. Marrero, Sameer D. Saini, Darrell S. Pardi, and Latoya B. Kuhn
Subjects: Diagnostic Imaging, Male, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Carcinoma, Hepatocellular, Physiology, Gastroenterology, Article, Diagnosis, Differential, Transplant surgery, Risk Factors, Surveys and Questionnaires, Internal medicine, Humans, Mass Screening, Medicine, Intensive care medicine, Mass screening, business.industry, Guideline adherence, Data Collection, Liver Neoplasms, Hepatology, medicine.disease, digestive system diseases, Clinical Practice, Population Surveillance, Hepatocellular carcinoma, Practice Guidelines as Topic, Guideline Adherence, Differential diagnosis, business
Abstract: Screening of high-risk patients for hepatocellular carcinoma (HCC) may result in early diagnosis and improved outcomes. Our aim was to assess gastroenterologists' knowledge of HCC management guidelines established by the American Association for the Study of Liver Diseases (AASLD) and usual clinical practice.We surveyed gastroenterologists attending two gastroenterology board review courses regarding their knowledge of HCC screening guidelines and usual practice of screening for HCC. Practices were compared and adherence to the 2005 published HCC guidelines was assessed.The median age of gastroenterology attending physicians (n = 160) was 41 years, and 75% were men with a median of 11.5 years of practice. A total of 79% of respondents correctly identified the high-risk patients who qualify for HCC screening. Most gastroenterologists correctly identified the screening methods (88.5%) and screening interval (98%). Among those who knew guideline recommendations (i.e., correct identification and certainty of guideline recommendations), 100% reported that they followed the guideline recommendation in their own practices. Regarding the management of abnormal test, 31% of gastroenterologists did not identify that referral for liver transplantation is the recommended management strategy for small HCC in a Child B patient with cirrhosis. The number of years in clinical practice (p = 0.30) and involvement in a malpractice suit (p = 0.34) did not affect the practice patterns.Most gastroenterologists correctly identified the common high-risk scenarios, methods, and interval of HCC screening as recommended by AASLD. Gastroenterologists who knew the HCC guidelines applied them in their own practice. However, approximately one-quarter do not know the appropriate management of a positive result, thereby likely hampering the overall effectiveness of screening.
Published: 2010
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41. Renal outcomes after liver transplantation in the model for end-stage liver disease era

Author: Richard Eikstadt, Anna S. Lok, Pratima Sharma, Robert J. Fontana, Jorge A. Marrero, and Kathy Welch
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, medicine.medical_treatment, Renal function, Kaplan-Meier Estimate, Liver transplantation, Models, Biological, Risk Assessment, Severity of Illness Index, Gastroenterology, Young Adult, Liver disease, Model for End-Stage Liver Disease, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, Humans, Cumulative incidence, Renal Insufficiency, Renal replacement therapy, Aged, Proportional Hazards Models, Transplantation, Hepatology, business.industry, Incidence, Liver Diseases, Incidence (epidemiology), Perioperative, Middle Aged, medicine.disease, Liver Transplantation, Surgery, Renal Replacement Therapy, body regions, Treatment Outcome, Disease Progression, Kidney Failure, Chronic, Female, business, Immunosuppressive Agents, Glomerular Filtration Rate
Abstract: The proportion of patients undergoing liver transplantation (LT) with renal insufficiency has significantly increased in the Model for End-Stage Liver Disease (MELD) era. This study was designed to determine the incidence and predictors of post-LT chronic renal failure (CRF) and its effect on patient survival in the MELD era. Outcomes of 221 adult LT recipients who had LT between February 2002 and February 2007 were reviewed retrospectively. Patients who were listed as status 1, were granted a MELD exception, or had living-donor, multiorgan LT were excluded. Renal insufficiency at LT was defined as none to mild [estimated glomerular filtration rate (GFR)or= 60 mL/minute], moderate (30-59 mL/minute), or severe (30 mL/minute). Post-LT CRF was defined as an estimated GFR30 mL/minute persisting for 3 months, initiation of renal replacement therapy, or listing for renal transplantation. The median age was 54 years, 66% were male, 89% were Caucasian, and 43% had hepatitis C. At LT, the median MELD score was 20, and 6.3% were on renal replacement therapy. After a median follow-up of 2.6 years (range, 0.01-5.99), 31 patients developed CRF with a 5-year cumulative incidence of 22%. GFR at LT was the only independent predictor of post-LT CRF (hazard ratio = 1.33, P0.001). The overall post-LT patient survival was 74% at 5 years. Patients with MELDor= 20 at LT had a higher cumulative incidence of post-LT CRF in comparison with patients with MELD20 (P = 0.03). A decrease in post-LT GFR over time was the only independent predictor of survival. In conclusion, post-LT CRF is common in the MELD era with a 5-year cumulative incidence of 22%. Low GFR at LT was predictive of post-LT CRF, and a decrease in post-LT GFR over time was associated with decreased post-LT survival. Further studies of modifiable preoperative, perioperative, and postoperative factors influencing renal function are needed to improve outcomes following LT.
Published: 2009
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42. Survival Benefit-Based Deceased-Donor Liver Allocation

Author: Robert M. Merion, John D. Kalbfleisch, Douglas E. Schaubel, Scott W. Biggins, Elizabeth A. Pomfret, Mary K. Guidinger, and Pratima Sharma
Subjects: Reoperation, medicine.medical_specialty, Waiting Lists, medicine.medical_treatment, Liver transplantation, Article, Resource Allocation, Liver disease, Life Expectancy, Internal medicine, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Survivors, Organ donation, Intensive care medicine, Survival rate, Transplantation, Deceased donor, business.industry, Liver Diseases, medicine.disease, Tissue Donors, Liver Transplantation, Survival Rate, Survival benefit, Waiting list, Life expectancy, business, Follow-Up Studies
Abstract: Currently, patients awaiting deceased-donor liver transplantation are prioritized by medical urgency. Specifically, wait-listed chronic liver failure patients are sequenced in decreasing order of Model for End-stage Liver Disease (MELD) score. To maximize lifetime gained through liver transplantation, posttransplant survival should be considered in prioritizing liver waiting list candidates. We evaluate a survival benefit based system for allocating deceased-donor livers to chronic liver failure patients. Under the proposed system, at the time of offer, the transplant survival benefit score would be computed for each patient active on the waiting list. The proposed score is based on the difference in 5-year mean lifetime (with vs. without a liver transplant) and accounts for patient and donor characteristics. The rank correlation between benefit score and MELD score is 0.67. There is great overlap in the distribution of benefit scores across MELD categories, since waiting list mortality is significantly affected by several factors. Simulation results indicate that over 2000 life-years would be saved per year if benefit-based allocation was implemented. The shortage of donor livers increases the need to maximize the life-saving capacity of procured livers. Allocation of deceased-donor livers to chronic liver failure patients would be improved by prioritizing patients by transplant survival benefit.
Published: 2009
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43. Sustained virologic response to therapy of recurrent hepatitis C after liver transplantation is related to early virologic response and dose adherence

Author: Patricia Sullivan, Joel K. Greenson, Grace L. Su, Anna S.F. Lok, Frederick K. Askari, Pratima Sharma, Robert J. Fontana, Jorge A. Marrero, and Hari S. Conjeevaram
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Hepacivirus, Liver transplantation, Antiviral Agents, Gastroenterology, Virus, Autoimmune Diseases, Polyethylene Glycols, chemistry.chemical_compound, Pegylated interferon, Internal medicine, Ribavirin, medicine, Humans, Recurrent hepatitis, Adverse effect, Transplantation, Hepatology, business.industry, virus diseases, Middle Aged, Hepatitis C, digestive system diseases, Liver Transplantation, chemistry, Virologic response, Immunology, RNA, Viral, Female, Surgery, Interferons, business, Immunosuppressive Agents, medicine.drug, Biomedical sciences
Abstract: Sustained virologic response (SVR) after antiviral therapy for recurrent hepatitis C virus (HCV) infection in liver transplant (LT) recipients is consistently lower than that achieved in non-LT patients. We evaluated efficacy and safety of pegylated interferon (IFN) and ribavirin (RBV) therapy in LT recipients with recurrent HCV and factors associated with SVR. All subjects with histologic evidence of recurrent HCV were intended to be treated for 48 weeks with full-dose pegylated IFN; target dose of RBV was 800 mg/day. Thirty-five LT recipients with recurrent HCV, median age 48.5 years, 77% genotype 1, and median pretreatment HCV RNA 6.4 log10 IU/mL were treated between January 2000 and February 2006. Antiviral therapy was discontinued prematurely in 15 subjects as a result of adverse events. Median overall treatment duration was 46 weeks. Early virologic response at week 12 was seen in 17 (49%) and an end-of-treatment virological response in 19 (54%) patients. SVR was achieved in 13 patients (37%), and all 9 patients followed for >1 year after treatment had durable response. Patients with SVR had significantly lower pretreatment HCV RNA (5.7 vs. 6.5 log10 IU/mL, P=0.003), more likely to have a week 12 virological response (85% vs. 27%, P=0.0009) and received higher cumulative doses of pegylated IFN (75% vs. 33%, P=0.029) and RBV (90% vs. 26%, P=0.016) compared with patients whose disease did not respond to therapy. In conclusion, SVR was achieved in 37% of patients with recurrent hepatitis C after LT. Similar to non-LT patients, those with lower pretreatment HCV RNA, a week 12 virological response, and pegylated IFN and RBV dose adherence were more likely to achieve SVR.
Published: 2007
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44. Chronic Kidney Disease and Related Long-term Complications Following Liver Transplantation

Author: Khurram Bari and Pratima Sharma
Subjects: Graft Rejection, Male, medicine.medical_specialty, medicine.medical_treatment, Liver transplantation, Risk Assessment, Article, End stage renal disease, End Stage Liver Disease, Liver disease, Internal medicine, Medicine, Humans, Risk factor, Intensive care medicine, Survival analysis, business.industry, Graft Survival, medicine.disease, Prognosis, Survival Analysis, Liver Transplantation, surgical procedures, operative, Treatment Outcome, Nephrology, Disease Progression, Kidney Failure, Chronic, Female, business, Risk assessment, Stage 4 chronic kidney disease, Kidney disease
Abstract: Liver transplantation is the standard of care for patients with decompensated cirrhosis. Liver transplantation recipients have excellent short-term and long-term outcomes including patient and graft survival. Since the adoption of model for end-stage liver disease (MELD)-based allocation policy, the incidence of post-transplant end stage renal disease has risen significantly. Occurrence of Stage 4 chronic kidney disease and end stage renal disease substantially increases the risk of post-transplant deaths. Because majority of late post-transplant mortality is due to nonhepatic post-transplant comorbidities, personalized care directed toward risk factor modification may further improve post-transplant survival.
Published: 2015

45. Predictors of Early Hospitalization After Deceased Donor Liver Transplantation

Author: Christopher J. Sonnenday, Jessica Yu, Amy Hosmer, Tamara Parks, and Pratima Sharma
Subjects: Male, medicine.medical_specialty, Time Factors, Physiology, medicine.medical_treatment, Kaplan-Meier Estimate, Liver transplantation, Logistic regression, Patient Readmission, Article, chemistry.chemical_compound, Risk Factors, Internal medicine, medicine, Odds Ratio, Humans, Transitional care, Proportional Hazards Models, Retrospective Studies, Deceased donor, Creatinine, Framingham Risk Score, business.industry, Gastroenterology, Hepatology, Middle Aged, Transplant Recipients, Surgery, Liver Transplantation, surgical procedures, operative, Logistic Models, Treatment Outcome, chemistry, Ambulatory, Multivariate Analysis, Linear Models, Female, business
Abstract: Hospitalizations after solid organ transplantation may affect patient outcomes. Identification of the factors attributed to them may decrease hospitalization rates, reduce overall cost, and improve post-transplant outcomes. We examined the risk factors for early hospitalization within 30 and 90 days after liver transplantation (LT). Data on all deceased donor LT recipients (age ≥18 years) transplanted between 2/28/2002–2/27/2007 and discharged alive from the index hospitalization within 30 days of LT were collected (N = 267). Patients were followed up until December 31, 2013. Logistic regression was used to identify the predictors of 30-day hospitalization, and linear regression was used to identify the factors associated with number of days hospitalized during 30- and 90-day hospitalization after LT. Renal risk index (RRI), a recently developed and validated risk score that accurately predicts the post-LT ESRD based upon recipient factors at LT, was computed using RRI calculator ( http://rri.med.umich.edu ). One-third and more than half of the patients had at least one 30- and 90-day hospitalization, respectively. RRI decile (OR 1.12, P = 0.02) and serum sodium at LT (OR 0.90, P
Published: 2015

46. Viral Hepatitis and Liver Transplantation

Author: Anna Lok and Pratima Sharma
Subjects: Reoperation, medicine.medical_treatment, Hepatitis C virus, Immunoglobulins, Liver transplantation, medicine.disease_cause, Antiviral Agents, chemistry.chemical_compound, Pegylated interferon, Preoperative Care, Living Donors, Secondary Prevention, medicine, Humans, Hepatitis B Vaccines, Immunosuppression Therapy, Postoperative Care, Hepatology, business.industry, Ribavirin, Graft Survival, Hepatitis C, Hepatitis B, medicine.disease, Liver Transplantation, Transplantation, surgical procedures, operative, chemistry, Immunology, Viral hepatitis, business, medicine.drug
Abstract: Hepatitis C is the one of the most common indications for liver transplantation. Infection of the allograft after transplantation is universal, and recurrent hepatitis C progresses at an accelerated rate. Antiviral therapy in selected patients on the transplant waiting list may reduce the rate of hepatitis C virus reinfection. Preemptive antiviral therapy after transplantation has been disappointing. However, treatment of established histological disease with a combination of pegylated interferon and ribavirin is associated with sustained virologic response rates of 25 to 40%. Significant advances have been made in the prevention of hepatitis B reinfection after transplantation. Results are now excellent, with graft infection rates less than 10%. The challenges for the future include designing strategies to optimize the use of antiviral agents to prevent the need for transplantation and to avoid antiviral resistance and to determine the dose and duration of hepatitis B immunoglobulin needed in the era of multiple nucleoside analogs.
Published: 2006
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47. Reduced Priority MELD Score for Hepatocellular Carcinoma Does Not Adversely Impact Candidate Survival Awaiting Liver Transplantation

Author: Russell H. Wiesner, Pratima Sharma, Jose L. Hernandez, Vijayan Balan, David C. Mulligan, T. Heffron, and Ann M. Harper
Subjects: Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Time Factors, Waiting Lists, medicine.medical_treatment, Liver transplantation, Liver disease, Model for End-Stage Liver Disease, Internal medicine, Cadaver, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Stage (cooking), Neoplasm Staging, Transplantation, business.industry, Middle Aged, medicine.disease, Stage t1, Survival Analysis, Tissue Donors, United States, digestive system diseases, Liver Transplantation, Surgery, Waiting list, Hepatocellular carcinoma, Female, business
Abstract: The liver organ allocation policy of the United Network for Organ Sharing (UNOS) is based on the model for end-stage liver disease (MELD). The policy provides additional priority for candidates with hepatocellular carcinoma (HCC) who are awaiting deceased donor liver transplantation (DDLT). However, this priority was reduced on February 27, 2003 to a MELD of 20 for stage T1 and of 24 for stage T2 HCC. The aim of this study was to determine the impact of reduced priority on HCC candidate survival while on the waiting list. The UNOS database was reviewed for all HCC candidates listed after February 27, 2002, The HCC candidates were grouped into two time periods: MELD 1 (listed between February 27, 2002, and February 26, 2003) and MELD 2 (listed between February 27, 2003 and February 26, 2004). For the two time periods, the national DDLT incidence rates for HCC patients were 1.44 versus 1.53 DDLT per person-year (p = NS) and the waiting times were similar for the two periods (138.0 +/- 196.8 vs. 129.0 +/- 133.8 days; p = NS). Furthermore, the 3-, 6- and 12-month candidate, patient survival and dropout rates were also similar nationally. Regional differences in rates of DDLT for HCC were observed during both MELD periods. Consequently, the reduced MELD score for stage T1 and T2 HCC candidates awaiting DDLT has not had an impact nationally either on their survival on the waiting list or on their ability to obtain a liver transplant within a reasonable time frame. However, regional variations point to the need for reform in how organs are allocated for HCC at the regional level.
Published: 2006
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48. Liver Transplantation in the MELD Era: A Single-Center Experience

Author: Jorge Rakela, M. Edwyn Harrison, Pratima Sharma, Adyr A. Moss, Hugo E. Vargas, Jose L. Hernandez, Mankanwal Sachdev, David C. Mulligan, Vijayan Balan, David D. Douglas, Thomas J. Byrne, and Kunam S. Reddy
Subjects: Male, medicine.medical_specialty, Pediatrics, Carcinoma, Hepatocellular, Tissue and Organ Procurement, Waiting Lists, Physiology, Hepatitis C virus, medicine.medical_treatment, Liver transplantation, medicine.disease_cause, Single Center, Risk Assessment, Severity of Illness Index, Medical Records, Resource Allocation, Liver disease, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, Retrospective Studies, business.industry, Liver Diseases, Incidence (epidemiology), Liver Neoplasms, Arizona, Gastroenterology, Middle Aged, Hepatology, medicine.disease, Hepatitis C, Survival Analysis, Liver Transplantation, Surgery, body regions, Transplantation, Hepatocellular carcinoma, Female, business
Abstract: Model for Endstage Liver Disease (MELD) score has been used to allocate organs since February 2002. This policy allocates organs to candidates with regard to severity of their underlying liver disease except in the case of hepatocellular carcinoma (HCC) patients. The purpose of this study was to determine the impact of MELD on waiting times, dropout rates, and transplantation rates in all patients awaiting liver transplantation at our center. The records of all patients listed for liver transplantation between May 28, 1999, and February 27, 2004, at the Mayo Clinic, Scottsdale, Arizona, were reviewed. Candidates were grouped by two time periods as pre-MELD or post-MELD based on date of MELD implementation (February 27, 2002). The incidence of deceased donor liver transplantation (DDLT), waiting time to DDLT, dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting for or after DDLT were determined for each group. Three hundred fifty-one patients were listed for liver transplantation (195 pre-MELD, 156 post-MELD) during the study period. HCC patients had an improved rate of transplantation after MELD (pre-MELD, 1.39 persons per year; post-MELD, 3.48 persons per year). In all groups, with the exception of hepatitis C virus, the transplantation rates were the same for both categories. The hepatitis C virus group also had improved transplantation rates in the post-MELD period. HCC candidates under the new allocation policy have an increased incidence of DDLT in our institution. However, this has not disadvantaged patients with non-HCC diagnoses. Thus, the new MELD-based allocation policy has benefited all candidates by allowing more timely transplants.
Published: 2006
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49. Management of pre-liver transplantation patient?Part 2

Author: Pratima Sharma and Jorge Rakela
Subjects: medicine.medical_specialty, Hypertension, Pulmonary, medicine.medical_treatment, Hydrothorax, Peritonitis, Liver transplantation, Esophageal and Gastric Varices, Preoperative care, Liver disease, Postoperative Complications, Preoperative Care, Ascites, Humans, Medicine, Renal Insufficiency, Intensive care medicine, Hepatic encephalopathy, Transplantation, Hepatology, business.industry, Bacterial Infections, medicine.disease, Liver Transplantation, Hepatic Encephalopathy, Etiology, Surgery, medicine.symptom, business
Abstract: Liver transplantation (LT) has grown dramatically over last 2 decades and the hepatologist has had to assume a larger role inmanaging the potential candidate awaiting surgery. In part 1 of this review, we described the pre-LT evaluation process, contraindications of LT, general care, and treatment of various etiologies of liver disease prior to LT. In this part, we review the management of liver-specific complications that are responsible for significant morbidity and waitlist mortality of LT candidates.
Published: 2005
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50. Hepatitis C Virus Recurrence in Living Donor Liver Transplant Recipients

Author: Vijayan Balan, Pratima Sharma, Hugo E. Vargas, Adyr A. Moss, Jorge Rakela, Hector Rodriguez-Luna, Jose A. Ortiz, Thomas J. Byrne, David D. Douglas, Giovanni De Petris, and David C. Mulligan
Subjects: Adult, Graft Rejection, Male, medicine.medical_specialty, Genotype, Physiology, medicine.medical_treatment, Hepatitis C virus, Population, Hepacivirus, Liver transplantation, medicine.disease_cause, Polymerase Chain Reaction, Gastroenterology, Medical Records, Liver disease, Recurrence, Internal medicine, medicine, Humans, education, Aged, Retrospective Studies, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), Arizona, Middle Aged, Hepatology, medicine.disease, Hepatitis C, Ishak Score, Liver Transplantation, Surgery, Transplantation, DNA, Viral, Female, business
Abstract: Recurrence of hepatitis C virus (HCV) after liver transplantation (LT) is a universal phenomenon. Recent reports have suggested an earlier and more aggressive recurrence in the living donor liver transplant (LDLT) population. The aim of this study was to compare the histological recurrence of HCV after LDLT versus deceased donor transplantation (DDT). Twenty-nine patients underwent LT for HCV-related end-stage liver disease at our institution between April 2001 and March 2003 (42 months). Twenty patients underwent DDT, and nine patients LDLT. Laboratory data were collected on a weekly to biweekly basis and HCV PCR was performed before LT and 3-4 months and yearly post-LT. Liver biopsies were performed as needed and per institutional protocol at 7 days, at 4 months, and yearly thereafter. All biopsies were evaluated by a single pathologist and scored for rejection (Banff score) and chronic hepatitis (Ishak score system). The predominant genotype in the DDT and LDLT groups was genotype 1 (DDT = 70%, LDLT = 79%). HCV RNA titers pre-LT and 3-4 months after LT did not differ. The incidence of rejection was higher in the DDT group (P0.05). There was a trend toward improved Ishak stage and grade in the LDLT group at 4 and 12 months post-LT, however, this trend did not reach statistical significance. No histological difference in the recurrence or severity rate was observed at 4 or 12 months post-LT in the DDT group vs. the LDLT group.
Published: 2004
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