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6. 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

10. Liver Transplantation

Author

Hanto, Douglas W., Johnson, Scott R., Karp, Seth J., Khwaja, Khalid, Norton, Jeffrey A., editor, Barie, Philip S., editor, Bollinger, R. Randal, editor, Chang, Alfred E., editor, Lowry, Stephen F., editor, Mulvihill, Sean J., editor, Pass, Harvey I., editor, and Thompson, Robert W., editor

Published
2008
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14. Transplantation of the Liver and Intestine

Author

Hanto, Douglas W., Whiting, James F., Valente, John F., Li, Michelle, Norton, Jeffrey A., Bollinger, R. Randal, Chang, Alfred E., Lowry, Stephen F., Mulvihill, Sean J., Pass, Harvey I., and Thompson, Robert W.

Published
2003
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15. Transplantation of the Liver and Intestine

Author

Hanto, Douglas W., Whiting, James F., Valente, John F., Norton, Jeffrey A., editor, Bollinger, R. Randal, editor, Chang, Alfred E., editor, Lowry, Stephen F., editor, Mulvihill, Sean J., editor, Pass, Harvey I., editor, and Thompson, Robert W., editor

Published
2001
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22. Ethical challenges posed by the solicitation of deceased and living organ donors

Author

Hanto, Douglas W.

Subjects
Organ donors -- Ethical aspects, Organ donors -- Social aspects, Organ donors -- Health aspects, Dead -- Social aspects
Abstract

The medical, ethical and public policy issues that are involved in solicitation of deceased and living organ donors are discussed. A clear policy should be developed for defining the preexisting emotional relationships that are acceptable and the final rule, which technically permits any directed donation of deceased-donor organs to a named person, should be amended to be consistent with this new policy.

Published
2007

29. A 50-year-old man with hepatitis C and cirrhosis needing liver transplantation

Author

Hanto, Douglas W.

Subjects
Hepatitis C -- Care and treatment, Liver -- Transplantation
Abstract

The use of liver transplantation for people with advanced hepatitis C disease is reviewed. Topics include epidemiology, indications and contraindications, pretransplant evaluation and listing, immunosuppression, infections, and complications after transplantation, and prognosis. Hepatitis C is a liver disease caused by a virus.

Published
2003

48. 7_19-0054_Supplementary_Table_1_final_rpw - A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States

Author

Ladin, Keren, Satia A. Marotta, Butt, Zeeshan, Gordon, Elisa J., Daniels, Norman, Lavelle, Tara A., and Hanto, Douglas W.

Subjects
111099 Nursing not elsewhere classified, FOS: Clinical medicine, 110323 Surgery, FOS: Health sciences, 110305 Emergency Medicine
Abstract

7_19-0054_Supplementary_Table_1_final_rpw for A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States by Keren Ladin, Satia A. Marotta, Zeeshan Butt, Elisa J. Gordon, Norman Daniels, Tara A. Lavelle and Douglas W. Hanto in Progress in Transplantation

Published
2019
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49. 8_19-0054_Supplementary_table_2_final_rpw - A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States

Author

Ladin, Keren, Satia A. Marotta, Butt, Zeeshan, Gordon, Elisa J., Daniels, Norman, Lavelle, Tara A., and Hanto, Douglas W.

Subjects
111099 Nursing not elsewhere classified, FOS: Clinical medicine, 110323 Surgery, FOS: Health sciences, 110305 Emergency Medicine
Abstract

8_19-0054_Supplementary_table_2_final_rpw for A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States by Keren Ladin, Satia A. Marotta, Zeeshan Butt, Elisa J. Gordon, Norman Daniels, Tara A. Lavelle and Douglas W. Hanto in Progress in Transplantation

Published
2019
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