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1. Financial toxicity in living donor liver transplantation: A call to action for financial neutrality

Author

Testa, G., Gupta, A., Lee, S., Fricker, Z., Hashimoto, K., Kwon, D., Emond, J., Fox, A., Samstein, B., Brown, R., Rosenblatt, R., Kubal, A., Gilroy, R., King, E., Heimbach, J., Taner, T., Watt, K., Chacko, K., von Ahrens, D., Fortune, B., Florman, S., Schiano, T., Liapakis, A., Griesemer, A., Orandi, B., Caicedo, J., Dietch, Z., Ganger, D., Duarte, A., Ravindra, K., Kappus, M., Melcher, M., Bhan, I., Tholey, D., Kaplan, A., Anderson, B., Selzner, N., Roberts, J.P., Pillai, A., DiSabato, D., Pomfret, E., Jackson, W., Maluf, D., Sonnenday, C., Bloom, P., Haakinson, D., Chinnakotla, S., Aby, E., Olthoff, K., Abu-Gazala, S., Bittermann, T., Abt, P., Humar, A., Ganesh, S., Bambha, K., Biggins, S., Hernandez-Alejandro, R., Tomiyama, K., Emamaullee, J., Kaur, N., Han, H., Klair, T., Yamaguchi, S., Cullen, J., Baker, T., Kim, R., Goldaracena, N., Sturdevant, M., Kwon, Y., Garonzik-Wang, J., Al-Adra, D., Shingina, A., Rizzari, M., Mulligan, D., Rubman, S., Batra, R., Batisti, J., Kaplan, Alyson, Aby, Elizabeth S., Scott, Sonia, Sonnenday, Christopher, Fox, Alyson, Mathur, Amit, Olthoff, Kim, Heimbach, Julie, Ladin, Keren, and Emamaullee, Juliet

Published
2024
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2. Assessment of long‐term outcomes post living liver donation highlights the importance of scientific integrity when presenting transplant registry data

Author

Emamaullee, Juliet, Heimbach, Julie K, Olthoff, Kim M, Pomfret, Elizabeth A, Roberts, John P, Selzner, Nazia, Testa, G, Gupta, A, Lee, S, Hashimoto, K, Kwon, D, Emond, J, Griesemer, A, Fox, A, Kaplan, A, Samstein, B, Halazun, K, Brown, R, Kubal, A, Gilroy, R, Davalos, M Rodriguez‐, King, E, Heimbach, J, Watt, K, Florman, S, Schiano, T, Caicedo, J, Dietch, Z, Ganger, D, Kirchner, V, Anderson, B, Shapiro, J, Roberts, J, Pillai, A, Maluf, D, Martins, PN, Sonnenday, C, Chinnakotla, S, Olthoff, K, Bittermann, T, Abt, P, Humar, A, Ganesh, S, Hernandez‐Alejandro, R, Tomiyama, K, Levstik, M, Emamaullee, J, Kaur, N, Genyk, Y, Klair, T, Yamaguchi, S, Baker, T, Kim, R, Goldaracena, N, Bambha, K, Biggins, S, Sturdevant, M, Garonzik‐Wang, J, Al‐Adra, D, Shingina, A, Alexopoulos, S, Mulligan, D, Emre, S, Liapakis, A, Rubman, S, Batra, R, Taner, T, Melcher, M, DiSabato, D, Pomfret, E, Jackson, W, Han, H, and Montenovo, M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Immunology, Organ Transplantation, Digestive Diseases, Transplantation, Clinical Research, Chronic Liver Disease and Cirrhosis, Rare Diseases, Liver Disease, Humans, Liver, Liver Transplantation, Living Donors, Registries, Transplants, living donation, living donor liver transplantation, NALLDIG Consortium*, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

Living donor liver transplantation has expanded in recent years, particularly in North America. As experience with this procedure has matured over the last 25 years, centers are increasingly faced with potential living donors who are more medically complex. As donors move through the evaluation process, completing the informed consent process continues to be challenged by a paucity of granular data demonstrating long-term outcomes and overall safety specifically in the otherwise "healthy" living liver donor population. Two recently published studies examined long-term outcomes post-living liver donation using Korean registry data and reported similar results, with excellent overall survival when compared to appropriately matched controls. However, the authors of these studies were presented differently, with one reporting an alarmist view based on one aspect of a suboptimal analysis approach using an inappropriate comparator group. Herein, the North American Living Liver Donor Innovation Group (NALLDIG) consortium discusses these two studies and their potential impact on living liver donation in North America, ultimately highlighting the importance of scientific integrity in data presentation and dissemination when using transplant registry data.

Published
2022

3. Financial toxicity in living donor liver transplantation: A call to action for financial neutrality

Author

Kaplan, Alyson, Aby, Elizabeth S., Scott, Sonia, Sonnenday, Christopher, Fox, Alyson, Mathur, Amit, Olthoff, Kim, Heimbach, Julie, Ladin, Keren, Emamaullee, Juliet, Testa, G., Gupta, A., Lee, S., Fricker, Z., Hashimoto, K., Kwon, D., Emond, J., Fox, A., Samstein, B., Brown, R., Rosenblatt, R., Kubal, A., Gilroy, R., King, E., Heimbach, J., Taner, T., Watt, K., Chacko, K., von Ahrens, D., Fortune, B., Florman, S., Schiano, T., Liapakis, A., Griesemer, A., Orandi, B., Caicedo, J., Dietch, Z., Ganger, D., Duarte, A., Ravindra, K., Kappus, M., Melcher, M., Bhan, I., Tholey, D., Kaplan, A., Anderson, B., Selzner, N., Roberts, J.P., Pillai, A., DiSabato, D., Pomfret, E., Jackson, W., Maluf, D., Sonnenday, C., Bloom, P., Haakinson, D., Chinnakotla, S., Aby, E., Olthoff, K., Abu-Gazala, S., Bittermann, T., Abt, P., Humar, A., Ganesh, S., Bambha, K., Biggins, S., Hernandez-Alejandro, R., Tomiyama, K., Emamaullee, J., Kaur, N., Han, H., Klair, T., Yamaguchi, S., Cullen, J., Baker, T., Kim, R., Goldaracena, N., Sturdevant, M., Kwon, Y., Garonzik-Wang, J., Al-Adra, D., Shingina, A., Rizzari, M., Mulligan, D., Rubman, S., Batra, R., and Batisti, J.

Abstract

After 2 decades of limited growth, living donor liver transplant (LDLT) has been increasingly accepted as a promising solution to the growing organ shortage in the US. With experience, LDLT offers superior graft and patient survival with low rates of rejection. However, not all waitlisted patients have equal access to LDLT, with financial toxicity representing a substantial barrier. Potential living liver donors face indirect, direct, and opportunity costs associated with donation as well as insurance-based discrimination and variable employer leave policies. There are multiple potential national, local, and patient-centered solutions to address some of the cost-related issues associated with living LDLT. These include standardization of employer leave policies, creation of federal and state-led tax relief programs, optimization of National Living Donor Assistance Center use, engagement of independent living donor advocates, creation of financial toolkits, and encouragement of recipient or donor-led fundraising. In this piece, members of the North American Living Liver Donation Group, a consortium of 37 LDLT programs, explore these financial challenges and discuss solutions to achieve financial neutrality, where individuals can donate free from financial constraints or gains. As a community, it is imperative that we confront factors driving financial toxicity to improve equity and access to LDLT.

Published
2024
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4. Normothermic machine perfusion of marginal grafts in high meld recipients: a NY center experience

Author

Todd, R., primary, Rosowicz, A., additional, Holzner, M., additional, Kressel, A., additional, Meyerovich, G., additional, Fagenson, A., additional, Hassan, A., additional, van Leeuwen, L., additional, Arvelakis, A., additional, DiNorcia, J., additional, Rocha, C., additional, Tabrizian, P., additional, Facciuto, M., additional, Schwartz, M., additional, Moon, J., additional, Schiano, T., additional, Kim- Schluger, L., additional, Akhtar, Z., additional, and Florman, S., additional

Published
2024
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25. Human Monoclonal Antibody MBL-HCV1 Delays HCV Viral Rebound Following Liver Transplantation: A Randomized Controlled Study

Author

Chung, R. T., Gordon, F. D., Curry, M. P., Schiano, T. D., Emre, S., Corey, K., Markmann, J. F., Hertl, M., Pomposelli, J. J., Pomfret, E. A., Florman, S., Schilsky, M., Broering, T. J., Finberg, R. W., Szabo, G., Zamore, P. D., Khettry, U., Babcock, G. J., Ambrosino, D. M., Leav, B., Leney, M., Smith, H. L., and Molrine, D. C.

Published
2013
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44. Safety of Kidney Transplantation from Donors with HIV.

Author

Durand, C. M., Massie, A., Florman, S., Liang, T., Rana, M. M., Friedman-Moraco, R., Gilbert, A., Stock, P., Mehta, S. A., Mehta, S., Stosor, V., Pereira, M. R., Morris, M. I., Hand, J., Aslam, S., Malinis, M., Haidar, G., Small, C. B., Santos, C. A. Q., and Schaenman, J.

Subjects
*KIDNEY transplantation, *HIV, *HIV infections, *BREAKTHROUGH infections, *AIDS-related opportunistic infections, *OPPORTUNISTIC infections
Abstract

BACKGROUND Kidney transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV is an emerging practice. It has been performed since 2016 under the U.S. congressional HIV Organ Policy Equity Act and is currently approved for research Only. The Department of Health and Human Services is considering expanding the procedure to clinical practice, but data are limited to small case series that did not include donors without HIV as controls. METHODS In an observational study conducted at 26 U.S. centers, we compared transplantation of kidneys from deceased donors with HIV and donors without HIV to recipients with HIV. The primary outcome was a safety event (a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection), assessed for noninferiority (margin for the upper bound of the 95 % confidence interval, 3.00). Secondary outcomes included overall survival, survival without graft loss, rejection, infection, cancer, and HIV superinfection. RESULTS We enrolled 408 transplantation candidates, of whom 198 received a kidney from deceased donor; 99 received a kidney from a donor with HIV and 99 from a donor without HIV. The adjusted hazard ratio for the composite primary outcome was 1.00 (95% confidence interval ICI], 0.73 to 1.38), which showed noninferiority. The following secondary outcomes were similar whether the donor had HIV or not: overall survival at 1 year (94% vs. 9596) and 3 years (85% vs. 87%), survival without graft loss at 1 year (93% vs. 9096) and 3 years (84% vs. 81%), and rejection at 1 year (13% vs. 21°/0) and 3 years (21% vs. 2496). The incidence of serious adverse events, infections, surgical or vascular complications, and cancer was similar in the groups. The incidence of HIV breakthrough infection was higher among recipients of kidneys from donors with HIV (incidence rate ratio, 3.14; 95°/0, CI, 1.02 to 9.63), with one potential HIV superinfection among the 58 recipients in this group with sequence data and no persistent failures of HIV treatment. CONCLUSIONS In this observational study of kidney transplantation in persons with HIV, transplantation from donors with HIV appeared to be noninferior to that from donors without HIV. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT03500315.). [ABSTRACT FROM AUTHOR]

Published
2024
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50. Trunk and branch drivers in hepatocellular carcinoma: impact of molecular heterogeneity

Author

Moeini, A., primary, Sia, D., additional, Harrington, A.N., additional, Torrecilla, S., additional, Zhang, Z., additional, Camprecios, G., additional, Toffanin, S., additional, Fiel, M.I., additional, Hao, K., additional, Higuera, M., additional, Cabellos, L., additional, Cornella, H., additional, Mahajan, M., additional, Hoshida, Y., additional, Villanueva, A., additional, Florman, S., additional, Schwartz, M.E., additional, and Llovet, J.M., additional

Published
2017
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