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11 results on '"Fady Kaldas"'

1. Clinical Impact and Safety of Non-Target Punctures (NTP) during Portal Vein Access in TIPS Procedure

Author

Sasikorn Feinggumloon, Zachary Haber, Sammy Saab, Fady Kaldas, Navid Eghbalieh, Thanh T. Luong, Justin P. McWilliams, and Edward Wolfgang Lee

Subjects
transjugular intrahepatic portosystemic shunt (TIPS), complications, non-target puncture, cirrhosis, portal vein access, angiography, Biology (General), QH301-705.5
Abstract

Background: Although non-target puncture (NPT)-related complications are well known to clinicians performing TIPS, there is no NTP-focused study to assess the true clinical sequalae of NTP-related complications. In this study, the aim was to evaluate the incidence, safety, clinical outcomes and complications related to NTPs during the portal access of TIPS procedures. Methods: A retrospective review of 369 TIPS procedures from October 2007 to September 2019 was performed. We identified inadvertent NTPs, including biliary, hepatic artery, lymphatic and capsular punctures. Next, the medical records and images were reviewed and analyzed to assess the safety and clinical outcomes of these cohorts. Results: A total of 71 NTPs were identified in 56 patients (15.18% of 369 patients). Of 369 TIPS patients, there were (1) 28 biliary punctures (7.6%), (2) 16 extracapsular punctures (4.3%), (3) 15 lymphatic punctures (4.1%) and (4) 12 hepatic artery punctures (3.3%). The overall complication rate was 2.2% (8/369). Based on the Clavien–Dindo classification, three patients (0.8%) had a minor complication. In addition, five patients (1.4%) experienced grade II–V major complications, such as symptomatic hemoperitoneum, arterio-biliary fistula or hemorrhagic shock leading to death. Mortality (0.5%) was only caused by extracapsular puncture combined with other NTP. Conclusions: NTPs during the portal access of TIPS procedures are associated with low complication risk. However, when extracapsular punctures are combined with other NTPs, a more severe complication, including mortality, can occur. Nevertheless, all patients with NTP should be closely monitored at a higher level of care after TIPS placement.

Published
2023
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2. Implications of Pleural Fluid Composition in Persistent Pleural Effusion following Orthotopic Liver Transplant

Author

Bhavesh H. Patel, Kathryn H. Melamed, Holly Wilhalme, Gwenyth L. Day, Tisha Wang, Joseph DiNorcia, Douglas Farmer, Vatche Agopian, Fady Kaldas, and Igor Barjaktarevic

Subjects
hepatic hydrothorax, orthotopic liver transplantation, exudative pleural effusion, Light’s criteria, Medicine
Abstract

Persistent pleural effusions (PPEf) represent a known complication of orthotopic liver transplant (OLT). However, their clinical relevance is not well described. We evaluated the clinical, biochemical, and cellular characteristics of post-OLT PPEf and assessed their relationship with longitudinal outcomes. We performed a retrospective cohort study of OLT recipients between 2006 and 2015. Included patients had post-OLT PPEf, defined by effusion persisting >30 days after OLT and available pleural fluid analysis. PPEf were classified as transudates or exudates (ExudLight) by Light’s criteria. Exudates were subclassified as those with elevated lactate dehydrogenase (ExudLDH) or elevated protein (ExudProt). Cellular composition was classified as neutrophil- or lymphocyte-predominant. Of 1602 OLT patients, 124 (7.7%) had PPEf, of which 90.2% were ExudLight. Compared to all OLT recipients, PPEf patients had lower two-year survival (HR 1.63; p = 0.002). Among PPEf patients, one-year mortality was associated with pleural fluid RBC count (p = 0.03). While ExudLight and ExudProt showed no association with outcomes, ExudLDH were associated with increased ventilator dependence (p = 0.03) and postoperative length of stay (p = 0.03). Neutrophil-predominant effusions were associated with increased postoperative ventilator dependence (p = 0.03), vasopressor dependence (p = 0.02), and surgical pleural intervention (p = 0.02). In summary, post-OLT PPEf were associated with increased mortality. Ninety percent of these effusions were exudates by Light’s criteria. Defining exudates using LDH only and incorporating cellular analysis, including neutrophils and RBCs, was useful in predicting morbidity.

Published
2023
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3. Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study

Author

Edward Wolfgang Lee, Puja Shahrouki, Sammy Saab, Fady Kaldas, Navid Eghbalieh, Justin McWilliams, Peng-Xu Ding, and Stephen T. Kee

Subjects
transjugular intrahepatic portosystemic shunt (TIPS), direct intrahepatic portosystemic shunt (DIPS), 3D fusion imaging, portal vein puncture, complications, Technology, Engineering (General). Civil engineering (General), TA1-2040, Biology (General), QH301-705.5, Physics, QC1-999, Chemistry, QD1-999
Abstract

Background: The use of a transjugular intrahepatic portosystemic shunt (TIPS) has been established as an effective treatment for portal hypertension. Despite the rapid development of this use, serious peri-procedural complications have been reported in over 10% of cases. This has largely been attributed to the access to the portal vein, also referred to as a “blind puncture”, which often requires multiple attempts. The aim of this study was to demonstrate the safety, reproducibility and accuracy of the use of real-time 3D fusion image-guided (3DFIG) single puncture TIPS to minimize the complications that are related to the “blind puncture” of TIPS procedures. Methods: A 3DFIG TIPS approach was utilized on 22 pigs by combining pre-procedural cross-sectional imaging (CT, MR or CBCT) with intra-procedural cone beam CT or angiogram imaging, which allowed for the improved 3D visual spatial orientation of the portal vein and real-time tracking of the needle in 3D. Results: Thirty-five portosystemic shunts were successfully deployed in all 22 subjects without any peri-procedural complications. Overall, 91% (32/35) of the procedures were carried out using a single puncture. In addition, the mean fluoroscopy time in our study was more than 12 times lower than the proposed reference level that has previously been proposed for TIPS procedures. Conclusion: Multi-modality real-time 3DFIG TIPS can be performed safely using a single puncture, without complications, and can potentially be used in both emergency and non-emergency clinical situations.

Published
2022
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4. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

Author

Joerg M Pollok, Pascale Tinguely, Marina Berenguer, Claus U Niemann, Dimitri A Raptis, Michael Spiro, Andreas Mayr, Beatriz Dominguez, Elmi Muller, Karina Rando, Mary Anne Enoch, Noam Tamir, Pamela Healy, Tanja Manser, Tim Briggs, Abhideep Chaudhary, Abhinav Humar, Ali Jafarian, Arvinder Singh Soin, Bijan Eghtesad, Charles Miller, Daniel Cherqui, Didier Samuel, Dieter Broering, Elizabeth Pomfret, Federico Villamil, Francois Durand, Gabriela Berlakovich, Geoffrey McCaughan, Georg Auzinger, Giuliano Testa, Goran Klintmalm, Jacques Belghiti, James Findlay, Jennifer Lai, John Fung, John Klinck, John Roberts, Linda Liu, Mark Cattral, Mark Ghobrial, Markus Selzner, Michael Ramsay, Mohamed Rela, Nancy Ascher, Nancy Kwan Man, Nazia Selzner, Patrizia Burra, Peter Friend, Ronald Busuttil, Shin Hwang, Stuart McCluskey, Valeria Mas, Vijay Vohra, Vivek Vij, William Merritt, Yaman Tokat, Yoogoo Kang, Albert Chan, Alessandra Mazzola, Amelia Hessheimer, Ashwin Rammohan, Brian Hogan, Carmen Vinaixa, David Nasralla, David Victor, Eleonora De Martin, Felipe Alconchel, Garrett Roll, Gokhan Kabacam, Gonzalo Sapisochin, Isabel Campos-Varela, Jiang Liu, Madhukar S. Patel, Manhal Izzy, Marit Kalisvaart, Megan Adams, Nicholas Goldaracena, Roberto Hernandez-Alejandro, Ryan Chadha, Tamer Mahmoud Shaker, Tarunjeet S. Klair, Terry Pan, Tomohiro Tanaka, Uzung Yoon, Varvara Kirchner, Vivienne Hannon, Yee Lee Cheah, Carlo Frola, Clare Morkane, Don Milliken, Georg Lurje, Jonathan Potts, Thomas Fernandez, Adam Badenoch, Ahmed Mukhtar, Alberto Zanetto, Aldo Montano-Loza, Alfred Kow Wei Chieh, Amol Shetty, Andre DeWolf, Andrea Olmos, Anna Mrzljak, Annabel Blasi, Annalisa Berzigotti, Ashish Malik, Akila Rajakumar, Brian Davidson, Bryan O'Farrell, Camille Kotton, Charles Imber, Choon Hyuck David Kwon, Christopher Wray, Chul-Soo Ahn, Claus Krenn, Cristiano Quintini, Daniel Maluf, Daniel Santa Mina, Daniel Sellers, Deniz Balci, Dhupal Patel, Dianne LaPointe Rudow, Diethard Monbaliu, Dmitri Bezinover, Dominik Krzanicki, Dong-Sik Kim, Elizabeth Brombosz, Emily Blumberg, Emmanuel Weiss, Emmanuel Wey, Fady Kaldas, Faouzi Saliba, Gabriella Pittau, Gebhard Wagener, Gi-Won Song, Gianni Biancofiore, Gonzalo Crespo, Gonzalo Rodríguez, Graciela Martinez Palli, Gregory McKenna, Henrik Petrowsky, Hiroto Egawa, Iman Montasser, Jacques Pirenne, James Eason, James Guarrera, James Pomposelli, Jan Lerut, Jean Emond, Jennifer Boehly, Jennifer Towey, Jens G Hillingsø, Jeroen de Jonge, Juan Caicedo, Julie Heimbach, Juliet Ann Emamaullee, Justyna Bartoszko, Ka Wing Ma, Kate Kronish, Katherine T. Forkin, Kenneth Siu Ho Chok, Kim Olthoff, Koen Reyntjens, Kwang-Woong Lee, Kyung-Suk Suh, Linda Denehy, Luc J.W. van der Laan, Lucas McCormack, Lucy Gorvin, Luis Ruffolo, Mamatha Bhat, María Amalia Matamoros Ramírez, Maria-Carlota Londoño, Marina Gitman, Mark Levstik, Martin de Santibañes, Martine Lindsay, Matteo Parotto, Matthew Armstrong, Mureo Kasahara, Nick Schofield, Nicole Rizkalla, Nobuhisa Akamatsu, Olivier Scatton, Onur Keskin, Oscar Imventarza, Oya Andacoglu, Paolo Muiesan, Patricia Giorgio, Patrick Northup, Paulo Matins, Peter Abt, Philip N Newsome, Philipp Dutkowski, Pooja Bhangui, Prashant Bhangui, Puneeta Tandon, Raffaele Brustia, Raymond Planinsic, Robert Brown, Robert Porte, Rolf Barth, Rubén Ciria, Sander Florman, Sebastien Dharancy, Sher-Lu Pai, Shintaro Yagi, Silvio Nadalin, Srinath Chinnakotla, Stuart J Forbes, Suehana Rahman, Suk Kyun Hong, Sun Liying, Susan Orloff, Susan Rubman, Susumu Eguchi, Toru Ikegami, Trevor Reichman, Utz Settmacher, Varuna Aluvihare, Victor Xia, Young-In Yoon, Yuji Soejima, Yuri Genyk, Arif Jalal, Aditya Borakati, Adrian Gustar, Ahmed Mohamed, Alejandro Ramirez, Alex Rothnie, Aneya Scott, Anika Sharma, Annalise Munro, Arun Mahay, Belle Liew, Camila Hidalgo, Cara Crouch, Cheung Tsz Yan, Christoph Tschuor, Conrad Shaw, Dimitrios Schizas, Dominic Fritche, Fabia Ferdousi Huda, Gemma Wells, Giselle Farrer, Hiu Tat Kwok, Ioannis Kostakis, Joao Mestre-Costa, Ka Hay Fan, Ka Siu Fan, Kyra Fraser, Lelia Jeilani, Li Pang, Lorenzo Lenti, Manikandan Kathirvel, Marinos Zachiotis, Michail Vailas, Michele Mazza Milan, Mohamed Elnagar, Mohammad Alradhawi, Nikolaos Dimitrokallis, Nikolaos Machairas, Nolitha Morare, Oscar Yeung, Pragalva Khanal, Pranav Satish, Shahi Abdul Ghani, Shahroo Makhdoom, Sithhipratha Arulrajan, Stephanie Bogan, Stephanos Pericleous, Timon Blakemore, Vanessa Otti, Walter Lam, Whitney Jackson, and Zakee Abdi

Subjects
Consensus, Hepatology, Gastroenterology, Living Donors, Humans, Liver Transplantation
Abstract

There is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices.

Published
2022

5. A VENT CALCULATOR: IDEAL TIDAL VOLUME GENERATED BASED ON DRIVING PRESSURE AND STATIC COMPLIANCE VS TIDAL VOLUME BASED ON PREDICTED BODY WEIGHT IN VOLUME-CONTROLLED VENTILATION

Author

AARON R.A DOUEN, DHWANI PA, FADY KALDAS, BHUVANESHWARI VENKATESAN, WENCHY SIU, IGOR BRODSKIY, PRAKASH RAMDASS, GEORGE U MBOLU, and GEORGE A APERGIS

Subjects
Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine
Published
2022
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11. P‐Selectin Glycoprotein Ligand‐1 (rPSGL‐Ig)‐Mediated Blockade of CD62 Selectin Molecules Protects Rat Steatotic Liver Grafts from Ischemia/Reperfusion Injury

Author

Farin Amersi, Douglas G. Farmer, Gray D. Shaw, Hirohisa Kato, Ana J. Coito, Fady Kaldas, Delai Zhao, Charles R. Lassman, Judy Melinek, Jeffrey Ma, Hans-Dieter Volk, Jerzy W. Kupiec-Weglinski, and Ronald W. Busuttil

Subjects
Male, medicine.medical_specialty, Time Factors, Ischemia, Internal medicine, medicine, Animals, Transplantation, Homologous, Immunology and Allergy, Pharmacology (medical), Peroxidase, Transplantation, Membrane Glycoproteins, business.industry, Graft Survival, Organ Preservation, medicine.disease, Liver Transplantation, Rats, Rats, Zucker, P-Selectin, medicine.anatomical_structure, Endocrinology, Liver, Reperfusion Injury, Hepatocyte, Immunology, Cytokines, Steatitis, P-selectin glycoprotein ligand-1, Liver function, business, Reperfusion injury, Ex vivo, Selectin
Abstract

We examined the effects of early blockade of CD62 selectin-mediated adhesive interactions in steatotic rat liver models of ex vivo cold ischemia followed by reperfusion or transplantation by administration of P-selectin glycoprotein ligand-1 (rPSGL-Ig). In the model of cold ischemia/reperfusion, livers pretreated ex vivo with rPSGL-Ig at harvesting from obese Zucker rats showed significantly decreased portal resistance, increased bile production, and diminished hepatic endothelial neutrophil infiltration, as compared with untreated controls. Pretreatment of fatty livers with rPSGL-Ig prior to transplantation extended the survival of lean Zucker rat recipients from 40% to 90%. This effect correlated with significantly improved liver function, depressed neutrophil activity, and decreased histologic features of hepatocyte injury. Intragraft expression of CD62 P-selectin was similar in both recipient groups. rPSGL-Ig treatment decreased intragraft infiltration by CD3/CD25 cells, diminished expression of pro-inflammatory TNFalpha, IL-6, iNOS, IL-2 and IFN-gamma, without significantly affecting mRNA levels coding for anti-inflammatory IL-4. Thus, rPSGL-Ig blockade of CD62-mediated adhesive interactions protects against severe ischemia/reperfusion injury suffered otherwise by steatotic rat livers. These findings document the potential utility of rPSGL-Ig in increasing the transplant donor pool through modulation of marginal steatotic livers.

Published
2002
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