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1. Integrative gene regulatory network analysis discloses key driver genes of fibromuscular dysplasia

Author

d’Escamard, Valentina, Kadian-Dodov, Daniella, Ma, Lijiang, Lu, Sizhao, King, Annette, Xu, Yang, Peng, Shouneng, V′Gangula, Bhargravi, Zhou, Yu, Thomas, Allison, Michelis, Katherine C., Bander, Emir, Bouchareb, Rihab, Georges, Adrien, Nomura-Kitabayashi, Aya, Wiener, Robert J., Costa, Kevin D., Chepurko, Elena, Chepurko, Vadim, Fava, Marika, Barwari, Temo, Anyanwu, Anelechi, Filsoufi, Farzan, Florman, Sander, Bouatia-Naji, Nabila, Schmidt, Lukas E., Mayr, Manuel, Katz, Michael G., Hao, Ke, Weiser-Evans, Mary C. M., Björkegren, Johan L. M., Olin, Jeffrey W., and Kovacic, Jason C.

Published
2024
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2. Wait Time Advantage for Transplant Candidates With HIV Who Accept Kidneys From Donors With HIV Under the HOPE Act.

Author

Motter, Jennifer, Hussain, Sarah, Brown, Diane, Florman, Sander, Rana, Meenakshi, Friedman-Moraco, Rachel, Gilbert, Alexander, Stock, Peter, Mehta, Shikha, Mehta, Sapna, Stosor, Valentina, Elias, Nahel, Pereira, Marcus, Haidar, Ghady, Malinis, Maricar, Morris, Michele, Hand, Jonathan, Aslam, Saima, Schaenman, Joanna, Baddley, John, Small, Catherine, Wojciechowski, David, Santos, Carlos, Blumberg, Emily, Odim, Jonah, Apewokin, Senu, Giorgakis, Emmanouil, Bowring, Mary, Werbel, William, Desai, Niraj, Tobian, Aaron, Segev, Dorry, Massie, Allan, and Durand, Christine

Subjects
Humans, Male, Waiting Lists, Kidney, Tissue Donors, Kidney Transplantation, Living Donors, Transplant Recipients, HIV Infections
Abstract

BACKGROUND: Kidney transplant (KT) candidates with HIV face higher mortality on the waitlist compared with candidates without HIV. Because the HIV Organ Policy Equity (HOPE) Act has expanded the donor pool to allow donors with HIV (D + ), it is crucial to understand whether this has impacted transplant rates for this population. METHODS: Using a linkage between the HOPE in Action trial (NCT03500315) and Scientific Registry of Transplant Recipients, we identified 324 candidates listed for D + kidneys (HOPE) compared with 46 025 candidates not listed for D + kidneys (non-HOPE) at the same centers between April 26, 2018, and May 24, 2022. We characterized KT rate, KT type (D + , false-positive [FP; donor with false-positive HIV testing], D - [donor without HIV], living donor [LD]) and quantified the association between HOPE enrollment and KT rate using multivariable Cox regression with center-level clustering; HOPE was a time-varying exposure. RESULTS: HOPE candidates were more likely male individuals (79% versus 62%), Black (73% versus 35%), and publicly insured (71% versus 52%; P

Published
2024

5. Low‐dose aspirin confers protection against acute cellular allograft rejection after primary liver transplantation

Author

Oberkofler, Christian E, Raptis, Dimitri A, Müller, Philip C, da Silva, Richard X Sousa, Lehmann, Kuno, Ito, Takahiro, Owen, Timothy, Pollok, Joerg‐Matthias, Parente, Alessandro, Schlegel, Andrea, Peralta, Peregrina, Winter, Erin, Selzner, Markus, Fodor, Margot, Maglione, Manuel, Jaklitsch, Manuel, Marques, Hugo P, Chavez‐Villa, Mariana, Contreras, Alan, Kron, Philipp, Lodge, Peter, Alford, Scott, Rana, Abbas, Magistri, Paolo, Di Benedetto, Fabrizio, Johnson, Bethany, Kirchner, Varvara, Bauldrick, Francis, Halazun, Karim J, Ghamarnedjad, Omid, Mehrabi, Arianeb, Basto, Samanta Teixeira, Fernandes, Eduardo SM, Paladini, Jose, de Santibañes, Martin, Florman, Sander, Tabrizian, Parissa, Dutkowski, Philipp, Clavien, Pierre‐Alain, Busuttil, Ronald W, Kaldas, Fady M, and Petrowsky, Henrik

Subjects
Digestive Diseases, Liver Disease, Clinical Research, Transplantation, Organ Transplantation, Prevention, Adult, Humans, Liver Transplantation, Cohort Studies, Graft Rejection, Thrombosis, Allografts, Graft Survival, Retrospective Studies, Risk Factors, Clinical Sciences, Surgery
Abstract

This study investigated the effect of low-dose aspirin in primary adult liver transplantation (LT) on acute cellular rejection (ACR) as well as arterial patency rates. The use of low-dose aspirin after LT is practiced by many transplant centers to minimize the risk of hepatic artery thrombosis (HAT), although solid recommendations do not exist. However, aspirin also possesses potent anti-inflammatory properties and might mitigate inflammatory processes after LT, such as rejection. Therefore, we hypothesized that the use of aspirin after LT has a protective effect against ACR. This is an international, multicenter cohort study of primary adult deceased donor LT. The study included 17 high-volume LT centers and covered the 3-year period from 2013 to 2015 to allow a minimum 5-year follow-up. In this cohort of 2365 patients, prophylactic antiplatelet therapy with low-dose aspirin was administered in 1436 recipients (61%). The 1-year rejection-free survival rate was 89% in the aspirin group versus 82% in the no-aspirin group (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.63-0.94; p = 0.01). The 1-year primary arterial patency rates were 99% in the aspirin group and 96% in the no-aspirin group with an HR of 0.23 (95% CI, 0.13-0.40; p

Published
2022

7. National Landscape of Human Immunodeficiency Virus-Positive Deceased Organ Donors in the United States.

Author

Werbel, William A, Brown, Diane M, Kusemiju, Oyinkansola T, Doby, Brianna L, Seaman, Shanti M, Redd, Andrew D, Eby, Yolanda, Fernandez, Reinaldo E, Desai, Niraj M, Miller, Jernelle, Bismut, Gilad A, Kirby, Charles S, Schmidt, Haley A, Clarke, William A, Seisa, Michael, Petropoulos, Christos J, Quinn, Thomas C, Florman, Sander S, Huprikar, Shirish, Rana, Meenakshi M, Friedman-Moraco, Rachel J, Mehta, Aneesh K, Stock, Peter G, Price, Jennifer C, Stosor, Valentina, Mehta, Shikha G, Gilbert, Alexander J, Elias, Nahel, Morris, Michele I, Mehta, Sapna A, Small, Catherine B, Haidar, Ghady, Malinis, Maricar, Husson, Jennifer S, Pereira, Marcus R, Gupta, Gaurav, Hand, Jonathan, Kirchner, Varvara A, Agarwal, Avinash, Aslam, Saima, Blumberg, Emily A, Wolfe, Cameron R, Myer, Kevin, Wood, R Patrick, Neidlinger, Nikole, Strell, Sara, Shuck, Marion, Wilkins, Harry, Wadsworth, Matthew, Motter, Jennifer D, Odim, Jonah, Segev, Dorry L, Durand, Christine M, Tobian, Aaron AR, Piquant, Dominque, Link, Katherine, Hemmersbach-Miller, Marion, Pearson, Thomas, Turgeon, Nicole, Lyon, G Marshall, Kitchens, William, Huckaby, Jeryl, Lasseter, A Francie, Elbein, Rivka, Roberson, April, Ferry, Elizabeth, Klock, Ethan, Cochran, Willa V, Morrison, Michelle, Rasmussen, Sarah, Bollinger, Juli, Sugarman, Jeremy, Smith, Angela R, Thomas, Margaret, Coakley, Margaret, Timpone, Joseph, Stucke, Alyssa, Haydel, Brandy, Dieter, Rebecca, Klein, Elizabeth J, Neumann, Henry, Gallon, Lorenzo, Goudy, Leah, Callegari, Michelle, Marrazzo, Ilise, Jackson, Towanda, Pruett, Timothy, Farnsworth, Mary, Locke, Jayme E, Mompoint-Williams, Darnell, Basinger, Katherine, Mekeel, Kristin, Nguyen, Phirum, Kwan, Joanne, Srisengfa, Tab, Chin-Hong, Peter, Rogers, Rodney, Simkins, Jacques, Munoz, Carlos, and Dunn, Ty

Subjects
Pediatric Research Initiative, HIV/AIDS, Infectious Diseases, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Infection, Good Health and Well Being, Anti-Retroviral Agents, HIV, HIV Infections, HIV Seropositivity, Humans, Integrases, Prospective Studies, Tissue Donors, United States, Viral Load, transplant, organ donation, drug resistance, HOPE in Action Investigators, Biological Sciences, Medical and Health Sciences, Microbiology
Abstract

BackgroundOrgan transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, immunologic, and virologic characteristics of HIV-positive donors is critical for safety.MethodsWe performed a prospective study of donors with HIV-positive and HIV false-positive (FP) test results within the HIV Organ Policy Equity (HOPE) Act in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262, NCT03500315, and NCT03734393). We compared clinical characteristics in HIV-positive versus FP donors. We measured CD4 T cells, HIV viral load (VL), drug resistance mutations (DRMs), coreceptor tropism, and serum antiretroviral therapy (ART) detection, using mass spectrometry in HIV-positive donors.ResultsBetween March 2016 and March 2020, 92 donors (58 HIV positive, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidneys and 46 livers). Each year the number of donors increased. The prevalence of hepatitis B (16% vs 0%), syphilis (16% vs 0%), and cytomegalovirus (CMV; 91% vs 58%) was higher in HIV-positive versus FP donors; the prevalences of hepatitis C viremia were similar (2% vs 6%). Most HIV-positive donors (71%) had a known HIV diagnosis, of whom 90% were prescribed ART and 68% had a VL

Published
2022

9. COVID-19 in solid organ transplant: A multi-center cohort study

Author

Kates, Olivia S, Haydel, Brandy M, Florman, Sander S, Rana, Meenakshi M, Chaudhry, Zohra S, Ramesh, Mayur S, Safa, Kassem, Kotton, Camille Nelson, Blumberg, Emily A, Besharatian, Behdad D, Tanna, Sajal D, Ison, Michael G, Malinis, Maricar, Azar, Marwan M, Rakita, Robert M, Morilla, Jose A, Majeed, Aneela, Sait, Afrah S, Spaggiari, Mario, Hemmige, Vagish, Mehta, Sapna A, Neumann, Henry, Badami, Abbasali, Goldman, Jason D, Lala, Anuradha, Hemmersbach-Miller, Marion, McCort, Margaret E, Bajrovic, Valida, Ortiz-Bautista, Carlos, Friedman-Moraco, Rachel, Sehgal, Sameep, Lease, Erika D, Fisher, Cynthia E, Limaye, Ajit P, Arya, Akanksha, Jeng, Amy, Kuo, Alexander, Luk, Alfred, Puing, Alfredo G, Rossi, Ana P, Brueckner, Andrew J, Multani, Ashrit, Keller, Brian C, Derringer, Darby, Florescu, Diana F, Dominguez, Edward A, Sandoval, Elena, Bilgili, Erin P, Hashim, Faris, Silveira, Fernanda P, Haidar, Ghady, Joharji, Hala G, Murad, Haris F, Gani, Imran Yaseen, el-amm, Jose-Marie, Kahwaji, Joseph, Popoola, Joyce, Yabu, Julie M, Hughes, Kailey, Saharia, Kapil K, Gajurel, Kiran, Bowman, Lyndsey J, Veroux, Massimiliano, Morales, Megan K, Fung, Monica, Theodoropoulos, Nicole M, de la Cruz, Oveimar, Kapoor, Rajan, La Hoz, Ricardo M, Allam, Sridhar R, Vora, Surabhi B, McCarty, Todd P, Anderson-Haag, Tracy, Malhotra, Uma, Kelly, Ursula M, Bhandaram, Vidya, Bennett, William M, and Lominadze, Zurabi

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Lung, Clinical Trials and Supportive Activities, Organ Transplantation, Transplantation, Clinical Research, Good Health and Well Being, COVID-19, Cohort Studies, Humans, Male, Middle Aged, SARS-CoV-2, Transplant Recipients, UW COVID-19 SOT Study Team, coronavirus, solid organ transplantation, transplantation, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has led to significant reductions in transplantation, motivated in part by concerns of disproportionately more severe disease among solid organ transplant (SOT) recipients. However, clinical features, outcomes, and predictors of mortality in SOT recipients are not well described.MethodsWe performed a multicenter cohort study of SOT recipients with laboratory-confirmed COVID-19. Data were collected using standardized intake and 28-day follow-up electronic case report forms. Multivariable logistic regression was used to identify risk factors for the primary endpoint, 28-day mortality, among hospitalized patients.ResultsFour hundred eighty-two SOT recipients from >50 transplant centers were included: 318 (66%) kidney or kidney/pancreas, 73 (15.1%) liver, 57 (11.8%) heart, and 30 (6.2%) lung. Median age was 58 (interquartile range [IQR] 46-57), median time post-transplant was 5 years (IQR 2-10), 61% were male, and 92% had ≥1 underlying comorbidity. Among those hospitalized (376 [78%]), 117 (31%) required mechanical ventilation, and 77 (20.5%) died by 28 days after diagnosis. Specific underlying comorbidities (age >65 [adjusted odds ratio [aOR] 3.0, 95% confidence interval [CI] 1.7-5.5, P

Published
2021

10. Downstaging Outcomes for Hepatocellular Carcinoma: Results From the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) Consortium

Author

Mehta, Neil, Frenette, Catherine, Tabrizian, Parissa, Hoteit, Maarouf, Guy, Jennifer, Parikh, Neehar, Ghaziani, T Tara, Dhanasekaran, Renu, Dodge, Jennifer L, Natarajan, Brahma, Holzner, Matthew L, Frankul, Leana, Chan, Wesley, Fobar, Austin, Florman, Sander, and Yao, Francis Y

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Liver Disease, Rare Diseases, Organ Transplantation, Transplantation, Liver Cancer, Cancer, Aged, Carcinoma, Hepatocellular, Chemoembolization, Therapeutic, Disease Progression, Feasibility Studies, Female, Humans, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Patient Dropouts, Prospective Studies, Radiopharmaceuticals, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Tumor Burden, United States, Waiting Lists, alpha-Fetoprotein, Local Regional Therapy, Tumor Recurrence, Waiting List Dropout, α-Fetoprotein, Neurosciences, Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology, Clinical sciences, Nutrition and dietetics
Abstract

Background & aimsUnited Network of Organ Sharing (UNOS) has adopted uniform criteria for downstaging (UNOS-DS) of hepatocellular carcinoma (HCC) before liver transplantation (LT), but the downstaging success rate and intention-to-treat outcomes across broad geographic regions are unknown.MethodsIn this first multiregional study (7 centers, 4 UNOS regions), 209 consecutive patients with HCC undergoing downstaging based on UNOS-DS criteria were prospectively evaluated from 2016 to 2019.ResultsProbability of successful downstaging to Milan criteria and dropout at 2 years from the initial downstaging procedure was 87.7% and 37.3%, respectively. Pretreatment with lectin-reactive α-fetoprotein ≥10% (hazard ratio, 3.7; P = .02) was associated with increased dropout risk. When chemoembolization (n = 132) and yttrium-90 radioembolization (n = 62) were compared as the initial downstaging treatment, there were no differences in Modified Response Evaluation Criteria In Solid Tumors response, probability of or time to successful downstaging, waiting list dropout, or LT. Probability of LT at 3 years was 46.6% after a median of 17.2 months. In the explant, 17.5% had vascular invasion, and 42.8% exceeded Milan criteria (understaging). The only factor associated with understaging was the sum of the number of lesions plus largest tumor diameter on the last pre-LT imaging, and the odds of understaging increased by 35% per 1-unit increase in this sum. Post-LT survival at 2 years was 95%, and HCC recurrence occurred in 7.9%.ConclusionIn this first prospective multiregional study based on UNOS-DS criteria, we observed a successful downstaging rate of >80% and similar efficacy of chemoembolization and yttrium-90 radioembolization as the initial downstaging treatment. A high rate of tumor understaging was observed despite excellent 2-year post-LT survival of 95%. Additional LRT to reduce viable tumor burden may reduce tumor understaging.

Published
2021

11. Posttransplant Outcomes in Older Patients With Hepatocellular Carcinoma Are Driven by Non–Hepatocellular Carcinoma Factors

Author

Adeniji, Nia, Arjunan, Vinodhini, Prabhakar, Vijay, Mannalithara, Ajitha, Ghaziani, Tara, Ahmed, Aijaz, Kwo, Paul, Nguyen, Mindie, Melcher, Marc L, Busuttil, Ronald W, Florman, Sander S, Haydel, Brandy, Ruiz, Richard M, Klintmalm, Goran B, Lee, David D, Taner, C Burcin, Hoteit, Maarouf A, Verna, Elizabeth C, Halazun, Karim J, Tevar, Amit D, Humar, Abhinav, Chapman, William C, Vachharajani, Neeta, Aucejo, Federico, Nydam, Trevor L, Markmann, James F, Mobley, Constance, Ghobrial, Mark, Langnas, Alan N, Carney, Carol A, Berumen, Jennifer, Schnickel, Gabriel T, Sudan, Debra L, Hong, Johnny C, Rana, Abbas, Jones, Christopher M, Fishbein, Thomas M, Agopian, Vatche, and Dhanasekaran, Renumathy

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Oncology and Carcinogenesis, Digestive Diseases, Clinical Research, Liver Disease, Organ Transplantation, Transplantation, Rare Diseases, Cancer, Liver Cancer, Aging, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Good Health and Well Being, Aged, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Liver Transplantation, Middle Aged, Retrospective Studies, Risk Assessment, Survival Rate, United States, Surgery, Clinical sciences
Abstract

The incidence of hepatocellular carcinoma (HCC) is growing in the United States, especially among the elderly. Older patients are increasingly receiving transplants as a result of HCC, but the impact of advancing age on long-term posttransplant outcomes is not clear. To study this, we used data from the US Multicenter HCC Transplant Consortium of 4980 patients. We divided the patients into 4 groups by age at transplantation: 18 to 64 years (n = 4001), 65 to 69 years (n = 683), 70 to 74 years (n = 252), and ≥75 years (n = 44). There were no differences in HCC tumor stage, type of bridging locoregional therapy, or explant residual tumor between the groups. Older age was confirmed to be an independent and significant predictor of overall survival even after adjusting for demographic, etiologic, and cancer-related factors on multivariable analysis. A dose-response effect of age on survival was observed, with every 5-year increase in age older than 50 years resulting in an absolute increase of 8.3% in the mortality rate. Competing risk analysis revealed that older patients experienced higher rates of non-HCC-related mortality (P = 0.004), and not HCC-related death (P = 0.24). To delineate the precise cause of death, we further analyzed a single-center cohort of patients who received a transplant as a result of HCC (n = 302). Patients older than 65 years had a higher incidence of de novo cancer (18.1% versus 7.6%; P = 0.006) after transplantation and higher overall cancer-related mortality (14.3% versus 6.6%; P = 0.03). Even carefully selected elderly patients with HCC have significantly worse posttransplant survival rates, which are mostly driven by non-HCC-related causes. Minimizing immunosuppression and closer surveillance for de novo cancers can potentially improve the outcomes in elderly patients who received a transplant as a result of HCC.

Published
2021

12. Multi-Center Analysis of Liver Transplantation for Combined Hepatocellular Carcinoma-Cholangiocarcinoma Liver Tumors

Author

Dageforde, Leigh Anne, Vachharajani, Neeta, Tabrizian, Parissa, Agopian, Vatche, Halazun, Karim, Maynard, Erin, Croome, Kristopher, Nagorney, David, Hong, Johnny C, Lee, David, Ferrone, Cristina, Baker, Erin, Jarnagin, William, Hemming, Alan, Schnickel, Gabriel, Kimura, Shoko, Busuttil, Ronald, Lindemann, Jessica, Florman, Sander, Holzner, Matthew L, Srouji, Rami, Najjar, Marc, Yohanathan, Lavanya, Cheng, Jane, Amin, Hiral, Rickert, Charles A, Yang, Ju Dong, Kim, Joohyun, Pasko, Jennifer, Chapman, William C, and Majella Doyle, Maria B

Subjects
Rare Diseases, Chronic Liver Disease and Cirrhosis, Cancer, Organ Transplantation, Digestive Diseases - (Gallbladder), Clinical Trials and Supportive Activities, Prevention, Digestive Diseases, Liver Cancer, Liver Disease, Transplantation, Clinical Research, Aged, Carcinoma, Hepatocellular, Cholangiocarcinoma, Disease-Free Survival, Hepatectomy, Humans, Kaplan-Meier Estimate, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasms, Complex and Mixed, Retrospective Studies, Tumor Burden, Clinical Sciences, Surgery
Abstract

BackgroundCombined hepatocellular-cholangiocarcinoma liver tumors (cHCC-CCA) with pathologic differentiation of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma within the same tumor are not traditionally considered for liver transplantation due to perceived poor outcomes. Published results are from small cohorts and single centers. Through a multicenter collaboration, we performed the largest analysis to date of the utility of liver transplantation for cHCC-CCA.Study designLiver transplant and resection outcomes for HCC (n = 2,998) and cHCC-CCA (n = 208) were compared in a 12-center retrospective review (2009 to 2017). Pathology defined tumor type. Tumor burden was based on radiologic Milan criteria at time of diagnosis and applied to cHCC-CCA for uniform analysis. Kaplan-Meier survival curves and log-rank test were used to determine overall survival and disease-free survival. Cox regression was used for multivariate survival analysis.ResultsLiver transplantation for cHCC-CCA (n = 67) and HCC (n = 1,814) within Milan had no significant difference in overall survival (5-year cHCC-CCA 70.1%, HCC 73.4%, p = 0.806), despite higher cHCC-CCA recurrence rates (23.1% vs 11.5% 5 years, p

Published
2021

13. Living Donor Liver Transplantation for Hepatocellular Carcinoma Within and Outside Traditional Selection Criteria: A Multicentric North American Experience

Author

Ivanics, Tommy, Claasen, Marco P.A.W., Samstein, Benjamin, Emond, Jean C., Fox, Alyson N., Pomfret, Elizabeth, Pomposelli, James, Tabrizian, Parissa, Florman, Sander S., Mehta, Neil, Roberts, John P., Emamaullee, Juliet A., Genyk, Yuri, Hernandez-Alejandro, Roberto, Tomiyama, Koji, Sasaki, Kazunari, Hashimoto, Koji, Nagai, Shunji, Abouljoud, Marwan, Olthoff, Kim M., Hoteit, Maarouf A., Heimbach, Julie, Taner, Timucin, Liapakis, AnnMarie H., Mulligan, David C., Sapisochin, Gonzalo, and Halazun, Karim J.

Published
2024
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15. Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium

Author

Agrawal, Neerja, Pereira, Marcus, Ranganna, Karthik, Wolfe, Cameron, Friedman-Moraco, Rachel, Kitchens, William, Adebiyi, Oluwafisayo, Kubal, Chandrashekhar, Cameron, Andrew, Desai, Niraj, Durand, Christine, Ottmann, Shane, Elias, Nahel, Gilbert, Alexander, Smith, Coleman, Castillo-Lugo, Jose A., Florman, Sander, Segev, Dorry L., Massie, Allan, Mehta, Sapna, Stosor, Valentina, Hand, Jonathan, Blumberg, Emily, Santos, Carlos A.Q., Goldberg, Ryan, Mehta, Shikha, Cannon, Robert, Giorgakis, Emmanouil, Schaenman, Joanna, Aslam, Saima, Stock, Peter, Price, Jennifer, Apewokin, Senu, Benamu, Esther, Spaggiari, Mario, Baddley, John, Morris, Michele I., Simkins, Jacques, Pruett, Timothy, Haidar, Ghady, Wojciechowski, David, Agarwal, Avinash, Balaraman, Vasanthi, Gupta, Gaurav, Chapman, Will, Muthukumar, Thangamani, Small, Catherine B., Malinis, Maricar, Durand, Christine M., Martinez, Nina, Neumann, Karl, Benedict, Reed C., Baker, Arthur W., Wolfe, Cameron R., Shetty, Aneesha, Dietch, Zachary C., Goudy, Leah, Callegari, Michelle A., Massie, Allan B., Brown, Diane, Cochran, Willa, Muzaale, Abimereki, Fine, Derek, Tobian, Aaron A.R., Winkler, Cheryl A., and Al Ammary, Fawaz

Published
2023
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16. COVID‐19 and kidney transplantation: Results from the TANGO International Transplant Consortium

Author

Cravedi, Paolo, Mothi, Suraj S, Azzi, Yorg, Haverly, Meredith, Farouk, Samira S, Pérez‐Sáez, María J, Redondo‐Pachón, Maria D, Murphy, Barbara, Florman, Sander, Cyrino, Laura G, Grafals, Monica, Venkataraman, Sandheep, Cheng, Xingxing S, Wang, Aileen X, Zaza, Gianluigi, Ranghino, Andrea, Furian, Lucrezia, Manrique, Joaquin, Maggiore, Umberto, Gandolfini, Ilaria, Agrawal, Nikhil, Patel, Het, Akalin, Enver, and Riella, Leonardo V

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Organ Transplantation, Kidney Disease, Transplantation, Renal and urogenital, Good Health and Well Being, Aged, COVID-19, Comorbidity, Europe, Female, Follow-Up Studies, Graft Rejection, Humans, Immunocompromised Host, Immunosuppression Therapy, Immunosuppressive Agents, Kidney Transplantation, Male, Middle Aged, North America, Pandemics, Retrospective Studies, SARS-CoV-2, Transplant Recipients, clinical research/practice, immunosuppressant, infection and infectious agents - viral, kidney transplantation/nephrology, Medical and Health Sciences, Surgery, Clinical sciences, Immunology
Abstract

Kidney transplant recipients may be at a high risk of developing critical coronavirus disease 2019 (COVID-19) illness due to chronic immunosuppression and comorbidities. We identified hospitalized adult kidney transplant recipients at 12 transplant centers in the United States, Italy, and Spain who tested positive for COVID-19. Clinical presentation, laboratory values, immunosuppression, and treatment strategies were reviewed, and predictors of poor clinical outcomes were determined through multivariable analyses. Among 9845 kidney transplant recipients across centers, 144 were hospitalized due to COVID-19 during the 9-week study period. Of the 144 patients, 66% were male with a mean age of 60 (±12) years, and 40% were Hispanic and 25% were African American. Prevalent comorbidities included hypertension (95%), diabetes (52%), obesity (49%), and heart (28%) and lung (19%) disease. Therapeutic management included antimetabolite withdrawal (68%), calcineurin inhibitor withdrawal (23%), hydroxychloroquine (71%), antibiotics (74%), tocilizumab (13%), and antivirals (14%). During a median follow-up period of 52 days (IQR: 16-66 days), acute kidney injury occurred in 52% cases, with respiratory failure requiring intubation in 29%, and the mortality rate was 32%. The 46 patients who died were older, had lower lymphocyte counts and estimated glomerular filtration rate levels, and had higher serum lactate dehydrogenase, procalcitonin, and interleukin-6 levels. In sum, hospitalized kidney transplant recipients with COVID-19 have higher rates of acute kidney injury and mortality.

Published
2020

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

Author

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

Published
2023
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18. Incidence, management and outcomes in hepatic artery complications after paediatric liver transplantation: protocol of the retrospective, international, multicentre HEPATIC Registry

Author

Li, Weihao, primary, van der Doef, Hubert P J, additional, Wildhaber, Barbara E, additional, Marra, Paolo, additional, Bravi, Michela, additional, Pinelli, Domenico, additional, Minetto, Julia, additional, Dip, Marcelo, additional, Sierre, Sergio, additional, de Santibañes, Martin, additional, Ardiles, Victoria, additional, Uno, Jimmy Walker, additional, Hardikar, Winita, additional, Bates, Sue, additional, Goh, Lynette, additional, Aldrian, Denise, additional, Seisenbacher, Jonathan, additional, Vogel, Georg F, additional, Neto, Joao Seda, additional, Antunes da Fonseca, Eduardo, additional, Magalhães Costa, Carolina, additional, Ferreira, Cristina T, additional, Nader, Luiza S, additional, Farina, Marco A, additional, Dajani, Khaled Z, additional, Parente, Alessandro, additional, Bigam, David L, additional, Liang, Ting-Bo, additional, Bai, Xueli, additional, Zhang, Wei, additional, Gonsorčíková, Lucie, additional, Froněk, Jiří, additional, Bohuš, Šimon, additional, Franchi-Abella, Stéphanie, additional, Gonzales, Emmanuel, additional, Guérin, Florent, additional, Junge, Norman, additional, Baumann, Ulrich, additional, Richter, Nicolas, additional, Hartleif, Steffen, additional, Sturm, Ekkehard, additional, Rajakannu, Muthukumarassamy, additional, Palaniappan, Kumar, additional, Rela, Mohamed, additional, Pawaria, Arti, additional, Rajakrishnan, Haritha, additional, Surendran, Sudhindran, additional, Kumar, Mukesh, additional, Agarwal, Shaleen, additional, Gupta, Subhash, additional, Asthana, Sonal, additional, Bandewar, Vaishnavi, additional, Raichurkar, Karthik, additional, Spada, Marco, additional, Monti, Lidia, additional, Alterio, Tommaso, additional, Yanagi, Yusuke, additional, Uchida, Hajime, additional, Komine, Ryuji, additional, Evans, Helen, additional, Carr-Boyd, Peter, additional, Duncan, David, additional, Stefanowicz, Marek, additional, Latka-Grot, Julita, additional, Kolesnik, Adam, additional, Broering, Dieter C, additional, Raptis, Dimitri A, additional, Ann H Marquez, Kris, additional, Mali, Vidyadhar, additional, Aw, Marion, additional, Beretta, Marisa, additional, Van der Schyff, Francisca, additional, Quintero-Bernabeu, Jesús, additional, Mercadal-Hally, Maria, additional, Larrarte K, Mauricio, additional, Andres, Ane M, additional, Hernandez-Oliveros, Francisco, additional, Frauca, Esteban, additional, Casswall, Thomas, additional, Jorns, Carl, additional, Delle, Martin, additional, Gupte, Girish, additional, Sharif, Khalid, additional, McGuirk, Simon, additional, Superina, Riccardo, additional, Caicedo, Juan Carlos, additional, Jaramillo, Catalina, additional, Bitterfeld, Leandra, additional, Kastenberg, Zachary, additional, Shah, Amit A, additional, Domenick, Bryanna, additional, Acord, Michael R, additional, Mazariegos, George V, additional, Soltys, Kyle, additional, DiNorcia, Joseph, additional, Antala, Swanti, additional, Florman, Sander S, additional, Buchholz, Bettina M, additional, Herden, Uta, additional, Fischer, Lutz, additional, Dierckx, Rudi A J O, additional, Hartog, Hermien, additional, and Bokkers, Reinoud P H, additional

Published
2024
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25. HOPE in action: A prospective multicenter pilot study of liver transplantation from donors with HIV to recipients with HIV

Author

Durand, Christine M., Florman, Sander, Motter, Jennifer D., Brown, Diane, Ostrander, Darin, Yu, Sile, Liang, Tao, Werbel, William A., Cameron, Andrew, Ottmann, Shane, Hamilton, James P., Redd, Andrew D., Bowring, Mary G., Eby, Yolanda, Fernandez, Reinaldo E., Doby, Brianna, Labo, Nazzarena, Whitby, Denise, Miley, Wendell, Friedman-Moraco, Rachel, Turgeon, Nicole, Price, Jennifer C., Chin-Hong, Peter, Stock, Peter, Stosor, Valentina, Kirchner, Varvara A., Pruett, Timothy, Wojciechowski, David, Elias, Nahel, Wolfe, Cameron, Quinn, Thomas C., Odim, Jonah, Morsheimer, Megan, Mehta, Sapna A., Rana, Meenakshi M., Huprikar, Shirish, Massie, Allan, Tobian, Aaron A.R., and Segev, Dorry L.

Published
2022
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30. A prospective multicenter pilot study of HIV-positive deceased donor to HIV-positive recipient kidney transplantation: HOPE in action

Author

Durand, Christine M., Zhang, Wanying, Brown, Diane M., Yu, Sile, Desai, Niraj, Redd, Andrew D., Bagnasco, Serena M., Naqvi, Fizza F., Seaman, Shanti, Doby, Brianna L., Ostrander, Darin, Bowring, Mary Grace, Eby, Yolanda, Fernandez, Reinaldo E., Friedman-Moraco, Rachel, Turgeon, Nicole, Stock, Peter, Chin-Hong, Peter, Mehta, Shikha, Stosor, Valentina, Small, Catherine B., Gupta, Gaurav, Mehta, Sapna A., Wolfe, Cameron R., Husson, Jennifer, Gilbert, Alexander, Cooper, Matthew, Adebiyi, Oluwafisayo, Agarwal, Avinash, Muller, Elmi, Quinn, Thomas C., Odim, Jonah, Huprikar, Shirish, Florman, Sander, Massie, Allan B., Tobian, Aaron A.R., and Segev, Dorry L.

Published
2021
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31. Retrospective-prospective study of safety and efficacy of sofosbuvir-based direct-acting antivirals in HIV/HCV-coinfected participants with decompensated liver disease pre– or post–liver transplant

Author

Peters, Marion G., Kottilil, Shyam, Terrault, Norah, Amara, Dominic, Husson, Jennifer, Huprikar, Shirish, Florman, Sander, Sulkowski, Mark S., Durand, Christine M., Luetkemeyer, Anne F., Rogers, Rodney, Grab, Joshua, Haydel, Brandy, Blumberg, Emily, Dove, Lorna, Emond, Jean, Olthoff, Kim, Smith, Coleman, Fishbein, Thomas, Masur, Henry, and Stock, Peter G.

Published
2021
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32. Living Donor Liver Transplantation for Hepatocellular Carcinoma Within and Outside Traditional Selection Criteria

Author

Ivanics, Tommy, Claasen, Marco P. A. W., Samstein, Benjamin, Emond, Jean C., Fox, Alyson N., Pomfret, Elizabeth, Pomposelli, James, Tabrizian, Parissa, Florman, Sander S., Mehta, Neil, Roberts, John P., Emamaullee, Juliet A., Genyk, Yuri, Hernandez-Alejandro, Roberto, Tomiyama, Koji, Sasaki, Kazunari, Hashimoto, Koji, Nagai, Shunji, Abouljoud, Marwan, Olthoff, Kim M., Hoteit, Maarouf A., Heimbach, Julie, Taner, Timucin, Liapakis, AnnMarie H., Mulligan, David C., Sapisochin, Gonzalo, Halazun, Karim J., Ivanics, Tommy, Claasen, Marco P. A. W., Samstein, Benjamin, Emond, Jean C., Fox, Alyson N., Pomfret, Elizabeth, Pomposelli, James, Tabrizian, Parissa, Florman, Sander S., Mehta, Neil, Roberts, John P., Emamaullee, Juliet A., Genyk, Yuri, Hernandez-Alejandro, Roberto, Tomiyama, Koji, Sasaki, Kazunari, Hashimoto, Koji, Nagai, Shunji, Abouljoud, Marwan, Olthoff, Kim M., Hoteit, Maarouf A., Heimbach, Julie, Taner, Timucin, Liapakis, AnnMarie H., Mulligan, David C., Sapisochin, Gonzalo, and Halazun, Karim J.

Abstract

Objective:To evaluate long-term oncologic outcomes of patients post-living donor liver transplantation (LDLT) within and outside standard transplantation selection criteria and the added value of the incorporation of the New York-California (NYCA) score.Background:LDLT offers an opportunity to decrease the liver transplantation waitlist, reduce waitlist mortality, and expand selection criteria for patients with hepatocellular carcinoma (HCC).Methods:Primary adult LDLT recipients between October 1999 and August 2019 were identified from a multicenter cohort of 12 North American centers. Posttransplantation and recurrence-free survival were evaluated using the Kaplan-Meier method.Results:Three hundred sixty LDLTs were identified. Patients within Milan criteria (MC) at transplantation had a 1, 5, and 10-year posttransplantation survival of 90.9%, 78.5%, and 64.1% versus outside MC 90.4%, 68.6%, and 57.7% (P = 0.20), respectively. For patients within the University of California San Francisco (UCSF) criteria, respective posttransplantation survival was 90.6%, 77.8%, and 65.0%, versus outside UCSF 92.1%, 63.8%, and 45.8% (P = 0.08). Fifty-three (83%) patients classified as outside MC at transplantation would have been classified as either low or acceptable risk with the NYCA score. These patients had a 5-year overall survival of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplantation would have been classified as a low or acceptable risk with a 5-year overall survival of 65.3%.Conclusions:Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-year rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.

Published
2024
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37. Comparison of Single-Port Robotic Donor Nephrectomy and Laparoscopic Donor Nephrectomy

Author

Palese, Michael A., primary, Chin, Chih Peng, additional, Garden, Evan B., additional, Eilender, Benjamin, additional, Levy, Micah, additional, Ravivarapu, Krishna T., additional, Wang, Daniel, additional, Freid, Hannah, additional, Al-Alao, Osama, additional, Araya, Joseph Sewell, additional, LaPointe-Rudow, Dianne, additional, Herron, Daniel, additional, Chin, Edward, additional, Arvelakis, Antonios, additional, Shapiro, Ron, additional, Larenas, Francisca, additional, and Florman, Sander S., additional

Published
2024
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42. Asystolic donor warm ischemia time is associated with development of postreperfusion syndrome in donation after circulatory death liver transplant.

Author

Bekki, Yuki, Rocha, Chiara, Myers, Bryan, Wang, Ryan, Smith, Natalie, Tabrizian, Parissa, DiNorcia, Joseph, Moon, Jang, Arvelakis, Antonios, Facciuto, Marcelo E., DeMaria, Samuel, and Florman, Sander

Subjects
LIVER transplantation, SYSTOLIC blood pressure, ISCHEMIA, OXYGEN saturation, RENAL replacement therapy
Abstract

Background: Individual events during donation after circulatory death (DCD) procurement, such as hypotensive or hypoxic warm ischemia, or circulatory arrest are all a part of donor warm ischemia time (dWIT), and may have differing effects on the outcome of the liver graft. This study aimed to identify risk factors for postreperfusion syndrome (PRS), a state of severe hemodynamic derangement following graft reperfusion, and its impact on DCD liver transplantation (LT) outcomes. Methods: This was a retrospective analysis using 106 DCD LT. Detailed information for events during procurement (withdrawal of life support; systolic blood pressure < 80 mmHg; oxygen saturation < 80%; circulatory arrest; aortic cold perfusion) and their association with the development of PRS were examined using logistic regression. Results: The overall incidence of PRS was 26.4%, occurring in 28 patients. Independent risk factors for PRS were asystolic dWIT (odds ratio (OR) 3.65, 95% confidence interval (CI) 1.38–9.66) and MELD score (OR 1.06, 95% CI 1.01–1.10). Total bilirubin was significantly higher in the PRS group at postoperative day (POD) 1 (p =.02; 5.2 mg/dL vs. 3.4 mg/dL), POD 3 (p =.049; 4.5 mg/dL vs. 2.8 mg/dL), and POD 7 (p =.04; 3.1 mg/dL vs. 1.9 mg/dL). Renal replacement therapy after LT was more likely to be required in the PRS group (p =.01; 48.2% vs. 23.1%). Conclusion: Asystolic dWIT is a risk factor for the development of PRS in DCD LT. Our results suggest that asystolic dWIT should be considered when selecting DCD liver donors. [ABSTRACT FROM AUTHOR]

Published
2024
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46. Incidence and Outcomes of COVID-19 in Kidney and Liver Transplant Recipients With HIV: Report From the National HOPE in Action Consortium

Author

Mehta, Sapna A., Rana, Meenakshi M., Motter, Jennifer D., Small, Catherine B., Pereira, Marcus R., Stosor, Valentina, Elias, Nahel, Haydel, Brandy, Florman, Sander, Odim, Jonah, Morsheimer, Megan, Robien, Mark, Massie, Allan B., Brown, Diane, Boyarsky, Brian, Garonzik Wang, Jacqueline, Tobian, Aaron A.R., Werbel, William A., Segev, Dorry L., and Durand, Christine M.

Published
2020
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47. Surgical complications in 275 HIV-infected liver and/or kidney transplantation recipients

Author

Harbell, Jack, Fung, John, Nissen, Nicholas, Olthoff, Kim, Florman, Sander S, Hanto, Douglas W, Light, Jimmy, Bartlett, Steve T, Tzakis, Andreas G, Pearson, Thomas C, Barin, Burc, Roland, Michelle E, Stock, Peter G, and Investigators, HIV-TR

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Organ Transplantation, Transplantation, Kidney Disease, Digestive Diseases, Genetics, HIV/AIDS, Clinical Research, Liver Disease, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Infection, Anastomotic Leak, Graft Survival, HIV Infections, Humans, Intraoperative Complications, Kidney Transplantation, Liver Transplantation, Postoperative Complications, Proportional Hazards Models, Prospective Studies, Reoperation, Surgical Wound Dehiscence, Surgical Wound Infection, Survival Rate, Viral Load, HIV-TR Investigators, Surgery, Clinical sciences
Abstract

BackgroundIn this report, we examine the surgical safety and complications (SC) among 125 liver (L) and 150 kidney (K) HIV+ transplantation (TX) recipients in a prospective nonrandomized U.S. multicenter trial.MethodsSubjects were required to have CD4+ T-cell counts >200/100 cells/mm3 (K/L) and undetectable plasma HIV-1 RNA (Viral Load [VL]) (K) or expected posttransplantation suppression (L). Impact of SCs (N ≥ 7) was evaluated by use of the proportional hazards models. Baseline morbidity predictors for SCs (N ≥ 7) were assessed in univariate proportional hazards models.ResultsAt median 2.7 (interquartile range 1.9-4.1) and 2.3 (1.0-3.7) years after TX, 3-month and 1-year graft survival were [K] 96% (95% CI 91%-98%) and 91% (95% CI 85%-94%) and [L] 91% (95% CI 85%-95%) and 77% (95% CI 69%-84%), respectively. A total of 14 K and 28 L graft losses occurred in the first year; 6 K and 11 L were in the first 3 months. A total of 26 (17%) K and 43 (34%) L experienced 29 and 62 SCs, respectively. In the liver multivariate model, re-exploration was marginally associated (hazard ratio [HR] 2.8; 95% CI 1.0-8.4; P = .06) with increased risk of graft loss, whereas a greater MELD score before transplantation (HR 1.07 per point increase; 95% CI: 1.01-1.14; P = .02), and detectable viral load before TX (HR 3.6; 95% CI 0.9-14.6; P = .07) was associated with an increased risk of wound infections/dehiscence.ConclusionThe rates and outcomes of surgical complications are similar to what has been observed in the non-HIV setting in carefully selected HIV-infected liver and kidney TX recipients.

Published
2012

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