14 results on '"Leise MD"'
Search Results
2. Liver transplantation for acute liver failure in a SARS-CoV-2 PCR-positive patient.
- Author
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Yohanathan L, Campioli CC, Mousa OY, Watt K, Friedman DZP, Shah V, Ramkissoon R, Hines AS, Kamath PS, Razonable RR, Badley AD, DeMartino ES, Joyner MJ, Graham R, Vergidis P, Simonetto DA, Sanchez W, Taner T, Heimbach JK, Beam E, and Leise MD
- Subjects
- Adolescent, Female, Humans, Pandemics, Polymerase Chain Reaction, SARS-CoV-2, COVID-19, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Liver Transplantation adverse effects
- Abstract
Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.2, elevated serum copper, and low uric acid, although an unusual presentation of COVID-19 causing ALF could not be excluded. After meeting criteria for status 1a listing, the patient underwent successful LT, despite ongoing SARS-CoV-2 PCR positivity. Remdesivir was given immediately posttransplant, and mycophenolate mofetil was withheld initially and the SARS-CoV-2 PCR test eventually became negative. Three months following transplantation, the patient has made a near-complete recovery. This case highlights that COVID-19 with SARS-CoV-2 PCR positivity may not be an absolute contraindication for transplantation in ALF. Criteria for patient selection and timing of LT amid the COVID-19 pandemic need to be validated in future studies., (© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2021
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3. MELD-GRAIL-Na: Glomerular Filtration Rate and Mortality on Liver-Transplant Waiting List.
- Author
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Asrani SK, Jennings LW, Kim WR, Kamath PS, Levitsky J, Nadim MK, Testa G, Leise MD, Trotter JF, and Klintmalm G
- Subjects
- Adult, Aged, Creatinine blood, Female, Humans, Male, Middle Aged, Models, Theoretical, Sodium blood, Glomerular Filtration Rate, Liver Cirrhosis mortality, Liver Transplantation, Waiting Lists mortality
- Abstract
Background and Aims: Among patients with cirrhosis awaiting liver transplantation, prediction of wait-list (WL) mortality is adjudicated by the Model for End Stage Liver Disease-Sodium (MELD-Na) score. Replacing serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) in the MELD-Na score may improve prediction of WL mortality, especially for women and highest disease severity., Approach and Results: We developed (2014) and validated (2015) a model incorporating eGFR using national data (n = 17,095) to predict WL mortality. Glomerular filtration rate (GFR) was estimated using the GFR assessment in liver disease (GRAIL) developed among patients with cirrhosis. Multivariate Cox proportional hazard analysis models were used to compare the predicted 90-day WL mortality between MELD-GRAIL-Na (re-estimated bilirubin, international normalized ratio [INR], sodium, and GRAIL) versus MELD-Na. Within 3 months, 27.8% were transplanted, 4.3% died on the WL, and 4.7% were delisted for other reasons. GFR as estimated by GRAIL (hazard ratio [HR] 0.382, 95% confidence interval [CI] 0.344-0.424) and the re-estimated model MELD-GRAIL-Na (HR 1.212, 95% CI 1.199-1.224) were significant predictors of mortality or being delisted on the WL within 3 months. MELD-GRAIL-Na was a better predictor of observed mortality at highest deciles of disease severity (≥ 27-40). For a score of 32 or higher (observed mortality 0.68), predicted mortality was 0.67 (MELD-GRAIL-Na) and 0.51 (MELD-Na). For women, a score of 32 or higher (observed mortality 0.67), the predicted mortality was 0.69 (MELD-GRAIL-Na) and 0.55 (MELD-Na). In 2015, use of MELD-GRAIL-Na as compared with MELD-Na resulted in reclassification of 16.7% (n = 672) of patients on the WL., Conclusion: Incorporation of eGFR likely captures true GFR better than SCr, especially among women. Incorporation of MELD-GRAIL-Na instead of MELD-Na may affect outcomes for 12%-17% awaiting transplant and affect organ allocation., (© 2019 by the American Association for the Study of Liver Diseases.)
- Published
- 2020
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4. Liver Transplantation Trends and Outcomes for Hereditary Hemorrhagic Telangiectasia in the United States.
- Author
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Iyer VN, Saberi B, Heimbach JK, Larson JJ, Raghavaiah S, Ditah I, Swanson K, Kamath PS, Watt KD, Taner T, Krowka MJ, and Leise MD
- Subjects
- Adult, Aged, Cardiac Output, High epidemiology, Cardiac Output, High physiopathology, Databases, Factual, Female, Graft Survival, Heart Failure epidemiology, Heart Failure physiopathology, Humans, Liver Failure diagnosis, Liver Failure mortality, Liver Failure physiopathology, Liver Transplantation adverse effects, Liver Transplantation mortality, Male, Middle Aged, Recovery of Function, Registries, Retrospective Studies, Telangiectasia, Hereditary Hemorrhagic diagnosis, Telangiectasia, Hereditary Hemorrhagic mortality, Telangiectasia, Hereditary Hemorrhagic physiopathology, Time Factors, Treatment Outcome, United States epidemiology, Ventricular Function, Left, Liver Failure surgery, Liver Transplantation trends, Outcome and Process Assessment, Health Care trends, Telangiectasia, Hereditary Hemorrhagic surgery
- Abstract
Background: Liver arteriovenous malformations (AVM) in hereditary hemorrhagic telangiectasia (HHT) can necessitate liver transplantation. There is limited data on HHT patients undergoing liver transplantation (LT) in the United States., Methods: Two sources of data were used: (1) Scientific Registry of Transplant Recipients (SRTR) database (1998-2016) (2) Single center liver transplant database (Mayo Clinic Rochester, MN). The aims of this study were (1) to determine trends in LT for HHT-related liver involvement in the United States using the SRTR database; (2) to identify clinical characteristics, indications, and outcomes for LT in HHT., Results: Thirty-nine HHT patients were listed for LT in the SRTR database from 1998-2016 to 1998-2001 (n = 1); 2002-2005 (n = 4); 2006-2010 (n = 10), and 2011-2016 (n = 24). Twenty-four underwent LT at a median age of 47.5 years (interquartile range, 37.0-58.5 years). Median calculated MELD score at time of LT was 8.0 (interquartile range, 7.0-9.5), and 75% received an exception MELD score. Two status-1 patients died during transplant surgery. Nineteen (86%) patients were alive after a median post-LT follow-up of 48 months, whereas 2 patients were lost to follow-up. Five of the aforementioned HHT patients underwent LT at Mayo Clinic, 4 with high output cardiac failure, and 1 with biliary ischemia. All 5 were alive at the time of last follow-up with good graft function and resolution of heart failure., Conclusions: Outcomes after LT for HHT patients are excellent with 86% survival after a median follow-up of 48 months and resolution of heart failure. LT listing for HHT has increased in substantially in more recent eras.
- Published
- 2019
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5. Risk of Post-transplant Hepatocellular Carcinoma Recurrence Is Higher in Recipients of Livers From Male Than Female Living Donors.
- Author
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Han S, Yang JD, Sinn DH, Kim JM, Choi GS, Jung G, Ahn JH, Kim S, Ko JS, Gwak MS, Kwon CHD, Leise MD, Gwak GY, Heimbach JK, and Kim GS
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Propensity Score, Risk, Risk Factors, Sex Factors, Survival Analysis, Treatment Outcome, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Liver Neoplasms pathology, Liver Neoplasms surgery, Liver Transplantation, Living Donors, Neoplasm Recurrence, Local pathology
- Abstract
Objective: To evaluate the relationship between donor sex and hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation., Background: HCC shows a male predominance in incidence and recurrence after tumor resection due to sex differences in hepatic sex hormone receptors. There have been no studies evaluating the importance of donor sex on post-transplant HCC recurrence., Methods: Of 384 recipients of livers, from living donors, for HCC: 104/120 who received grafts from female donors were matched with 246/264 who received grafts from male donors using propensity score matching, with an unfixed matching ratio based on factors like tumor biology. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence., Results: The median follow-up time was 39 months. Before matching, recurrence probability at 1/2/5 years after transplantation was 6.1/9.7/12.7% in recipients with female donors and 11.7/19.2/25.3% in recipients with male donors. Recurrence risk was significantly higher with male donors in univariable analysis (hazard ratio [HR] = 2.04 [1.15-3.60], P = 0.014) and multivariable analysis (HR=2.10 [1.20-3.67], P = 0.018). In the matched analysis, recurrence risk was also higher with male donors (HR=1.92 [1.05-3.52], P = 0.034): both in intrahepatic recurrence (HR=1.92 [1.05-3.51], P = 0.034) and extrahepatic recurrence (HR=1.93 [1.05-3.52], P = 0.033). Multivariable analysis confirmed the significance of donor sex (HR=2.08 [1.11-3.91], P = 0.023). Interestingly, the significance was lost when donor age was >40 years. Two external cohorts validated the significance of donor sex., Conclusions: Donor sex appears to be an important graft factor modulating HCC recurrence after living donor liver transplantation.
- Published
- 2018
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6. Risk of posttransplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation.
- Author
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Han S, Lee S, Yang JD, Leise MD, Ahn JH, Kim S, Jung K, Gwak MS, Kim GS, and Ko JS
- Subjects
- Adult, Carcinoma, Hepatocellular blood, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular pathology, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Liver Neoplasms blood, Liver Neoplasms epidemiology, Liver Neoplasms pathology, Liver Transplantation methods, Living Donors, Male, Middle Aged, Neoplasm Recurrence, Local blood, Neoplasm Recurrence, Local pathology, Preoperative Period, Propensity Score, Risk Factors, Treatment Outcome, Young Adult, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation adverse effects, Neoplasm Recurrence, Local epidemiology, Platelet Count
- Abstract
Platelets interact with tumor cells and promote metastasis. The importance of platelets in posttransplant hepatocellular carcinoma (HCC) recurrence is unclear. Thus, we aimed to evaluate the association between preoperative platelet count (PLT) and HCC recurrence after living donor liver transplantation. Of 359 recipients of livers from living donors for HCC, 209 of 240 patients who had preoperative PLT ≤75 × 10
9 /L were matched with 97 of 119 patients who had preoperative PLT >75 × 109 /L using propensity score matching, with an unfixed matching ratio based on factors such as tumor biology. The cutoff value of 75 × 109 /L was set based on optimum stratification analysis. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence. The median follow-up time was 59 months. Before matching, recurrence probability at 1, 2, and 5 years after transplantation was 4.7%, 9.2%, and 11.3% for the low platelet group and 14.5%, 23.0%, and 30.5% for the high platelet group. Recurrence risk was significantly greater in the high platelet group in both univariate (hazard ratio [HR] = 3.09; 95% confidence interval [CI], 1.86-5.14; P < 0.001) and multivariate analyses (HR = 2.10; 95% CI, 1.23-3.60; P = 0.007). In the matched analysis, recurrence risk was also greater in the high platelet group in both univariate (HR = 2.33; 95% CI, 1.36-4.01; P = 0.002) and multivariate analyses (HR = 1.90; 95% CI, 1.02-3.54; P = 0.04). Preoperative PLT had no interaction with the Milan criteria, alpha-fetoprotein level, Edmonson grade, microvascular invasion, or intrahepatic metastasis. Incorporation of preoperative PLT into the Milan criteria significantly improved predictive power. Inflammation-based scores including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the inflammation-based index did not show superiority to preoperative PLT in predicting HCC recurrence. In conclusion, preoperative PLT appears to be an important host factor affecting HCC recurrence after living donor liver transplantation. Liver Transplantation 24 44-55 2018 AASLD., (© 2017 by the American Association for the Study of Liver Diseases.)- Published
- 2018
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7. Interpreting Outcomes in DCDD Liver Transplantation: First Report of the Multicenter IDOL Consortium.
- Author
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Goldberg DS, Karp SJ, McCauley ME, Markmann JF, Croome KP, Taner CB, Heimbach JK, Leise MD, Fryer JP, Bohorquez HE, Cohen AJ, Gilroy RK, Kumer SC, Foley DP, Karim AS, Hernandez-Alejandro R, Levstik MA, and Abt PL
- Subjects
- Adult, Aged, Cause of Death, Databases, Factual, Female, Humans, Male, Middle Aged, Multivariate Analysis, Outcome Assessment, Health Care, Retrospective Studies, Risk Factors, United States, Bile Duct Diseases etiology, Bile Ducts, Intrahepatic blood supply, Donor Selection methods, Ischemia etiology, Liver Transplantation methods, Postoperative Complications etiology, Tissue Donors
- Abstract
Background: In the United States, 5% of adult liver transplant recipients receive a graft donation after circulatory determination of death (DCDD). Concerns for ischemic cholangiopathy (IC), a disease of diffuse intrahepatic stricturing limits broader DCDD use. Single-center reports demonstrate large variation in outcomes., Methods: Retrospective deidentified data collected between 2005 and 2013 were entered electronically by 10 centers via a Research Electronic Data Capture database. Our primary outcome was development of intrahepatic biliary strictures consistent with IC., Results: Within 6 months post-DCDD transplant, 162 (21.8%) patients developed a biliary stricture, of which 88 (11.8%) exhibited intrahepatic structuring consistent with IC. Unadjusted 6-month IC rate among the 10 centers varied significantly (P = 0.006) from 6.3% to 25.9%. The only factor associated with increased risk of IC within 6 months was Roux-en-Y hepaticojejunostomy (vs duct-to-duct) (odds ratio, 3.06; 95% confidence interval, 1.52-6.16; P = 0.002). Graft failure by 6 months was more than 3 times higher for DCDD recipients with IC (odds ratio for IC, 3.36; 95% confidence interval, 1.95-5.79)., Conclusions: This first report of the large combined experience with DCDD from the Improving DCDD Outcomes in Liver Transplant consortium demonstrates significant differences in IC among centers, the importance of biliary strictures as a risk factor for graft failure, and does not validate other risk factors for IC found in smaller studies.
- Published
- 2017
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8. Hepatocellular Carcinoma Is the Most Common Indication for Liver Transplantation and Placement on the Waitlist in the United States.
- Author
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Yang JD, Larson JJ, Watt KD, Allen AM, Wiesner RH, Gores GJ, Roberts LR, Heimbach JA, and Leise MD
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- Adolescent, Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Retrospective Studies, United States epidemiology, Waiting Lists, Young Adult, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular surgery, Liver Failure etiology, Liver Failure surgery, Liver Transplantation
- Abstract
Background & Aims: Management strategies for patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) have changed, along with liver allocation policies based on model for end-stage liver disease score. We investigated etiologic-specific trends in liver transplantation in the United States during different time periods., Methods: We performed a retrospective study, using the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry data, to identify all adult patients registered for liver transplantation in the United States from January 1, 2004, through December 31, 2015. For subjects listed with multiple diagnoses, HCC was considered the primary listing diagnosis. To determine whether availability of direct-acting antiviral agents, which began in 2011, affected pretransplant (death or drop-out) and post-transplant outcomes for patients with HCV infection, we compared data from the time periods of 2004 to 2010 and 2011 to 2014. We used competing-risk analysis to compare differences in end points between these periods. Differences between periods in pretransplantation and post-transplantation outcomes were estimated using Kaplan-Maier analysis and compared using the log-rank test. Associations between year of listing and pre-liver transplant outcome, and year of liver transplant and survival after transplant, were examined using the log-rank test. Proportional hazard regression was used to evaluate the reliability of the time period effect with potential confounders., Results: Among 109,018 registrants, 18.5% were registered for liver transplantation because of HCC. In 2015, HCC was the leading diagnosis among registrants (23.9% of registrations) and recipients (27.2% of recipients). Between 2004 and 2015, the ratio of registrants with vs without HCC increased 5.6-fold for patients with HCV infection, 1.9-fold for patients with hepatitis B virus (HBV) infection, 2.7-fold for patients with alcohol abuse, and 10.2-fold for patients with nonalcoholic steatohepatitis. After adjusting for covariates, we associated the period of 2011 to 2014 with a decreased probability that HCC registrants would undergo liver transplantation (hazard ratio [HR], 0.62; P < .0001). The period of 2011 to 2014 also was associated with a decreased probability of drop-out owing to deterioration or death from HCV-induced (HR, 0.90; P = .0003), HBV-induced (HR, 0.71; P = .002), or alcohol-induced (HR, 0.90; P = .01) liver disease, and an increased probability of delisting as a result of clinical improvement in patients with HCV infection (HR, 3.4; P < .0001), HBV infection (HR, 2.3; P = .004), or alcohol abuse (HR, 2.2; P < .0001). The period of 2011 to 2014 was associated with a decreased risk of graft loss or death, with the largest effect seen in HCV-infected recipients (HR, 0.76; P < .0001)., Conclusions: HCC was the leading indication for liver transplantation in the United States in 2015. Despite this, the probability of liver transplantation decreased the most in registrants with HCC. Pretransplantation and post-transplantation outcomes have improved, particularly in patients with HCV infection., (Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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9. Direct acting antiviral therapy and tumor recurrence after liver transplantation for hepatitis C-associated hepatocellular carcinoma.
- Author
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Yang JD, Aqel BA, Pungpapong S, Gores GJ, Roberts LR, and Leise MD
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- Antiviral Agents, Hepatitis C, Hepatitis C, Chronic, Humans, Liver Neoplasms, Neoplasm Recurrence, Local, Recurrence, Carcinoma, Hepatocellular, Liver Transplantation
- Published
- 2016
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10. The Intestinal Microbiome and the Liver Transplant Recipient: What We Know and What We Need to Know.
- Author
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Doycheva I, Leise MD, and Watt KD
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- Animals, Bacteria classification, Bacteria immunology, Bacterial Translocation, Dysbiosis, Graft Rejection immunology, Graft Rejection microbiology, Host-Pathogen Interactions, Humans, Immunocompromised Host, Immunosuppressive Agents adverse effects, Intestines immunology, Liver Cirrhosis immunology, Liver Cirrhosis microbiology, Risk Factors, Treatment Outcome, Bacteria pathogenicity, Gastrointestinal Microbiome, Intestines microbiology, Liver Cirrhosis surgery, Liver Transplantation adverse effects
- Abstract
The intestinal microbiome and immune system are in close symbiotic relationship in health. Gut microbiota plays a role in many chronic liver diseases and cirrhosis. However, alterations in the gut microbiome after liver transplantation and the implications for liver transplant recipients are not well understood and rely mainly on experimental animal studies. Recent advances in molecular techniques have identified that increased intestinal permeability, decreased beneficial bacteria, and increased pathogenic species may play important roles in the early posttransplant period. The associations between microbiota perturbation and postliver transplant infections and acute rejection are evolving. The link with metabolic syndrome, obesity, and cardiac disease in the general population require translation into the transplant recipient. This review focuses on our current knowledge of the known and potential interaction of the microbiome in the liver transplant recipient. Future human studies focused on microbiota changes in liver transplant patients are warranted and expected.
- Published
- 2016
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11. Cardiovascular disease after liver transplantation: When, What, and Who Is at Risk.
- Author
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Fussner LA, Heimbach JK, Fan C, Dierkhising R, Coss E, Leise MD, and Watt KD
- Subjects
- Adult, Biomarkers, Body Mass Index, Comorbidity, Cyclosporine therapeutic use, Diabetes Complications, End Stage Liver Disease complications, Female, Glomerular Filtration Rate, Humans, Hypertension complications, Immunosuppression Therapy, Incidence, Male, Metabolic Syndrome complications, Middle Aged, Obesity complications, Odds Ratio, Prevalence, Proportional Hazards Models, Retrospective Studies, Risk Factors, Tacrolimus therapeutic use, Cardiovascular Diseases complications, End Stage Liver Disease surgery, Liver Transplantation adverse effects
- Abstract
The evolution of metabolic and cardiovascular disease (CVD) complications after liver transplantation (LT) is poorly characterized. We aim to illustrate the prevalence of obesity and metabolic syndrome (MS), define the cumulative incidence of CVD, and characterize risk factors associated with these comorbidities after LT. A retrospective review of 455 consecutive LT recipients from 1999 to 2004 with an 8- to 12-year follow-up was performed. Obesity increased from 23.8% (4 months) to 40.8% (3 years) after LT. Increase in body mass index predicted MS at 1 year after LT (odds ratio, 1.1; P < 0.001, per point). CVD developed in 10.6%, 20.7%, and 30.3% of recipients within 1, 5, and 8 years, respectively. Age, diabetes, hypertension, glomerular filtration rate < 60 mL/minute, prior CVD, ejection fraction < 60%, left ventricular hypertrophy, and serum troponin (TN) > 0.07 ng/mL were associated with CVD on univariate analysis. Age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01-1.06; P = 0.019), diabetes (HR, 1.78; 95% CI, 1.09-2.92; P = 0.022), prior history of CVD (HR, 2.46; 95% CI, 1.45-4.16; P < 0.001), and serum TN > 0.07 ng/mL (HR, 1.98; 95% CI, 1.23-3.18; P = 0.005) were independently associated with CVD in the long term. Smoking history (ever), sex, hyperlipidemia, and serum ferritin levels were not predictive of CVD. Tacrolimus use versus noncalcineurin-based immunosuppression (HR, 0.26; 95% CI, 0.14-0.49; P < 0.001) was associated with reduced risk of CVD but not versus cyclosporine (HR, 0.67; 95% CI, 0.30-1.49; P = 0.322). CVD is common after LT. Independent of MS, more data are needed to identify nonconventional risk factors and biomarkers like serum TN. Curbing weight gain in the early months after transplant may impact MS and subsequent CVD in the long term., (© 2015 American Association for the Study of Liver Diseases.)
- Published
- 2015
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12. Living donor liver transplantation: Alive and well.
- Author
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Leise MD
- Subjects
- Female, Humans, Male, Liver Transplantation mortality, Living Donors
- Published
- 2014
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13. Role of immunosuppression in post-endoscopic retrograde cholangiopancreatography pancreatitis after liver transplantation: a retrospective analysis.
- Author
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Law R, Leal C, Dayyeh BA, Leise MD, Balderramo D, Baron TH, and Cardenas A
- Subjects
- Acute Disease, Adult, Aged, Chi-Square Distribution, Female, Hospitals, High-Volume, Humans, Logistic Models, Male, Middle Aged, Minnesota, Multivariate Analysis, Odds Ratio, Pancreatitis diagnosis, Pancreatitis etiology, Retrospective Studies, Risk Factors, Spain, Time Factors, Adrenal Cortex Hormones therapeutic use, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Immunosuppressive Agents therapeutic use, Liver Transplantation adverse effects, Pancreatitis prevention & control, Prednisone therapeutic use
- Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used for diagnosis and therapeutic interventions in recipients of liver transplantation (LT) who develop biliary complications. Post-endoscopic retrograde cholangiopancreatography acute pancreatitis (PEP) is the most common major adverse event after ERCP; however, the frequency of PEP in LT recipients is not well established. We aimed to determine the rate of PEP in this population and to identify its predictors, especially among immunosuppressive agents. We reviewed all ERCP procedures performed in LT recipients after duct-to-duct biliary anastomoses at 2 high-volume transplant centers. Patients who had undergone sphincterotomy or had a surgically altered pancreaticobiliary anatomy before LT were excluded. Electronic medical records and endoscopy databases were used to obtain clinical, endoscopic, and medication data. A multivariate logistic regression analysis was used to determine predictors of PEP in this cohort. In all, 730 ERCP procedures were performed in 301 patients during the study period with an observed PEP rate of 3% (22/730). A univariate analysis revealed an increased risk of PEP with index ERCP after LT [odds ratio (OR) = 4.04, 95% confidence interval (CI) = 1.40-11.65] and in cases with difficult biliary cannulation (OR = 2.89, 95% CI = 1.10-7.65), whereas prednisone use was found to have a protective effect in both univariate (OR = 0.34, 95% CI = 0.14-0.84) and multivariate analyses (OR = 0.22, 95% CI = 0.09-0.57) after adjustments for difficult biliary cannulation and post-LT index ERCP. This retrospective analysis demonstrates that corticosteroid therapy has a protective role in the development of PEP in LT recipients. Further studies are warranted to confirm our findings., (© 2013 American Association for the Study of Liver Diseases.)
- Published
- 2013
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14. Use of sirolimus in liver transplant recipients with renal insufficiency: a systematic review and meta-analysis.
- Author
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Asrani SK, Leise MD, West CP, Murad MH, Pedersen RA, Erwin PJ, Tian J, Wiesner RH, and Kim WR
- Subjects
- Adult, Calcineurin Inhibitors, Creatinine metabolism, Glomerular Filtration Rate drug effects, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Immunosuppressive Agents adverse effects, Liver Transplantation adverse effects, Renal Insufficiency chemically induced, Sirolimus adverse effects
- Abstract
Unlabelled: Sirolimus is used in patients with renal insufficiency after liver transplantation (LT) and especially in those with calcineurin inhibitor (CNI)-associated nephrotoxicity. We conducted a systematic review of all randomized controlled trials and observational studies to test the hypothesis that the use of sirolimus is associated with an improvement in renal function at 1 year in LT recipients with renal insufficiency [glomerular filtration rate (GFR) < 60 mL/minute or creatinine level ≥ 1.5 mg/dL]. We performed a search of all major databases, conference proceedings, and relevant journals through December 2009 and contacted content experts, corresponding authors, and the pharmaceutical manufacturer. A random effects model was used to determine the pooled estimate of the change in renal function and pooled risk estimates of adverse events that may be associated with sirolimus-based therapy at 1 year. Eleven studies (three randomized controlled trials and eight observational studies) met the final inclusion criteria. A nonsignificant improvement of 3.38 mL/minute [95% confidence interval (CI) = -2.93 to 9.69] was observed in methodologically sound observational studies and controlled trials reporting the primary outcome. In controlled trials, baseline GFR >50 mL/min sirolimus use was associated with an improvement of 10.35 mL/minute (95% CI = 3.98-16.77) in GFR or creatinine clearance. Sirolimus was not significantly associated with death [relative risk (RR) = 1.12, 95% CI = 0.66-1.88] or graft failure (RR = 0.80, 95% CI = 0.45-1.41), although reporting was incomplete. It was associated with a statistically significant risk of infection (RR = 2.47, 95% CI = 1.14-5.36), rash (RR = 7.57, 95% CI = 1.75-32.70), ulcers (RR = 7.44, 95% CI = 2.03-27.28), and discontinuation of therapy (RR = 3.61, 95% CI = 1.32-9.89)., Conclusion: Conversion to sirolimus from CNIs is associated with a nonsignificant improvement in renal function in LT recipients with renal insufficiency, although the results are limited by heterogeneity, a risk of bias, and a lack of standardized reporting.
- Published
- 2010
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