504 results on '"John A. Goss"'
Search Results
2. Radiological‐histopathological discordance in patients transplanted for HCC and its impact on post‐transplant outcomes
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Islam B. Mohamed, Mohamed Saleh Ismail, Ahmed El Sabagh, Ahmed M. Afifi Abdelwahab, Efstathia Polychronopoulou, Yong‐Fang Kuo, Manal Hassan, John A. Goss, Fasiha Kanwal, and Prasun K. Jalal
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explant pathology ,HCC recurrence ,hepatocellular carcinoma ,liver transplantation ,OPTN/UNOS ,survival after LT ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background and Aims Contrast‐enhanced cross‐sectional imaging is the cornerstone in the diagnosis, staging, and management of HCC, including eligibility for liver transplantation (LT). Radiological‐histopathological discordance may lead to improper staging and may impact patient outcomes. We aimed to assess the radiological‐histopathological discordance at the time of LT in HCC patients and its impact on the post‐LT outcomes. Methods We analyzed further the effect of 6‐month waiting policy on the discordance. Using United Network for Organ Sharing—Organ Procurement and Transplantation Network (UNOS‐OPTN) database, we examined the discordance between pre‐LT imaging and explant histopathology for all adult HCC patients who received liver transplants from deceased donors between April 2012 and December 2017. Kaplan–Meier methods and Cox regression analyses were used to evaluate the impact of discordance on 3‐year HCC recurrence and mortality. Results Of 6842 patients included in the study, 66.7% were within Milan criteria on both imaging and explant histopathology, and 33.3% were within the Milan based on imaging but extended beyond Milan on explant histopathology. Male gender, increasing numbers of tumors, bilobar distribution, larger tumor size, and increasing AFP are associated with increased discordance. Post‐LT HCC recurrence and death were significantly higher in patients who were discordant, with histopathology beyond Milan (adj HR 1.86, 95% CI 1.32–2.63 for mortality and 1.32, 95% CI 1.03–1.70 for recurrence). Graft allocation policy with 6‐month waiting time led to increased discordance (OR 1.19, CI 1.01–1.41), although it did not impact post‐LT outcome. Conclusion Current practice for staging of HCC based on radiological imaging features alone results in underestimation of HCC burden in one out of three patients with HCC. This discordance is associated with a higher risk of post‐LT HCC recurrence and mortality. These patients will need enhanced surveillance to optimize patient selection and aggressive LRT to reduce post‐LT recurrence and increase survival.
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- 2023
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3. Selecting DCD Recipients Using Predictive Indices
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Saif Ganni, Greta Handing, BS, Adrish Anand, BS, Spencer Barrett, BS, Nhu Thao Nguyen Galvan, MD, MPH, Christine O’Mahony, MD, John A. Goss, MD, Ronald T. Cotton, MD, FACS, and Abbas Rana, MD, FACS
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Surgery ,RD1-811 - Abstract
Background. Donation after circulatory death (DCD) allografts might represent one of the largest untapped sources of liver allografts. Our aim was to identify independent recipient risk factors that predict mortality in DCD allograft recipients to preselect optimal candidates for successful transplantation. Furthermore, we compared the application of our newly constructed DCD Recipient Selector Index (RSI) score to previously developed models to determine superiority in predicting recipient survival. Methods. Using the Organ Procurement and Transplantation Network database, we performed univariate and multivariate retrospective analyses on 4228 DCD liver allograft recipients. Results. We identified 8 significant factors and incorporated them into the weighted RSI to predict 3-mo survival following DCD liver transplantation with a C-statistic of 0.6971. The most significant recipient risk factors were recipient serum sodium levels >150 mEq/L at transplant, recipient albumin
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- 2023
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4. Early Impact of MMaT-3 Policy on Liver Transplant Waitlist Outcomes for Hepatocellular Carcinoma
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Anjiya Shaikh, MBBS, Karthik Goli, BS, Nicole E. Rich, MD, Jihane N. Benhammou, MD, PhD, Saira Khaderi, MD, PhD, Ruben Hernaez, MD, PhD, Vatche G. Agopian, MD, John M. Vierling, MD, Donghee Kim, MD, PhD, Aijaz Ahmed, MD, John A. Goss, MD, Abbas Rana, MD, Fasiha Kanwal, MD, MSHS, and George Cholankeril, MD, MSECR,
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Surgery ,RD1-811 - Abstract
Background. To reduce the disparity in access to liver transplant (LT), United Network for Organ Sharing implemented an exception policy in May 2019, which capped hepatocellular carcinoma (HCC) exception score to the median Model for End-Stage Liver Disease (MELD) at transplant within the donor service area minus 3 points (MMaT-3) after the 6-mo wait period. We aimed to evaluate how this policy affected HCC waitlist outcomes. Methods. Using United Network for Organ Sharing data, we analyzed waitlist outcomes in HCC patients at the time they received exception points from in the pre-MMaT era (August 15, 2017, to November 15, 2018) and MMaT era (June 1, 2019, to August 30, 2020). Comparisons were made within the HCC group and HCC versus non-HCC (at time of listing) groups in the pre-MMaT and MMaT eras and regions were grouped as low, medium, and high MELD based on MMaT. Results. HCC group: LT probability within HCC patients decreased by 20% (subhazard ratio [sHR], 0.78; 95% confidence interval [CI], 0.74-0.85) between the eras and decreased by 41% in low MELD regions (sHR, 0.59; 95% CI, 0.52-0.66). Waitlist dropout was unchanged. Matched HCC versus non-HCC groups: HCC patients had 80% higher LT probability (sHR, 1.84; 95% CI, 1.71-1.99) than non-HCC patients in the pre-MMaT era; which decreased to a 14% higher LT probability in MMaT era. In low and medium regions, HCC patients had over twofold higher LT probability in the pre-MMaT era, which decreased to a ~20% higher probability (sHR, 1.14; 95% CI, 1.06-1.23) in the MMaT era. After implementation of the acuity circle policy, HCC patients had lower LT probability (sHR, 0.84; 95% CI, 0.74-0.94) than non-HCC patients. Conclusions. The geographic disparity between HCC and non-HCC patients has improved with the MMaT-3 policy. Despite lower LT probability for HCC patients, waitlist dropout was not adversely impacted.
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- 2022
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5. Do Patients with Autoimmune Conditions Have Less Access to Liver Transplantation despite Superior Outcomes?
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Stephanie S. Keeling, Malcolm F. McDonald, Adrish Anand, Cameron R. Goff, Caroline R. Christmann, Spencer C. Barrett, Michael Kueht, John A. Goss, George Cholankeril, and Abbas Rana
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autoimmune liver disease ,organ allocation ,liver transplantation ,survival ,Medicine - Abstract
Orthotopic liver transplantation (OLT) is a lifesaving therapy for patients with irreversible liver damage caused by autoimmune liver diseases (AutoD) including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). Currently, it is unclear how access to transplantation differs among patients with various etiologies of liver disease. Our aim is to evaluate the likelihood of transplant and the long-term patient and graft survival after OLT for each etiology for transplantation from 2000 to 2021. We conducted a large retrospective study of United Network for Organ Sharing (UNOS) liver transplant patients in five 4-year eras with five cohorts: AutoD (PBC, PSC, AIH cirrhosis), alcohol-related liver disease (ALD), hepatocellular carcinoma (HCC), viral hepatitis, and nonalcoholic steatohepatitis (NASH). We conducted a multivariate analysis for probability of transplant. Intent-to-treat (ITT) analysis was performed to assess the 10-year survival differences for each listing diagnosis while accounting for both waitlist and post-transplant survival. Across all eras, autoimmune conditions had a lower adjusted probability of transplant of 0.92 (0.92, 0.93) compared to ALD 0.97 (0.97, 0.97), HCC 1.08 (1.07, 1.08), viral hepatitis 0.99 (0.99, 0.99), and NASH 0.99 (0.99, 1.00). Patients with AutoD had significantly better post-transplant patient and graft survival than ALD, HCC, viral hepatitis, and NASH in each and across all eras (p-values all < 0.001). Patients with AutoD had superior ITT survival (p-value < 0.001, log rank test). In addition, the waitlist survival for patients with AutoD compared to other listing diagnoses was improved with the exception of ALD, which showed no significant difference (p-value = 0.1056, log rank test). Despite a superior 10-year graft and patient survival in patients transplanted for AutoD, patients with AutoD have a significantly lower probability of receiving a liver transplant compared to those transplanted for HCC, ALD, viral hepatitis, and NASH. Patients with AutoD may benefit from improved liver allocation while maintaining superior waitlist and post-transplant survival. Decreased access in spite of appropriate outcomes for patients poses a significant risk for increased morbidity for patients with AutoD.
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- 2022
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6. Splenic Artery Transposition for Liver Transplantation: An Underutilized Technique?
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Matthew B. Goss, MS, N. Thao N. Galván, MD, MPH, Joseph D. Geha, DDS, Nicolas F. Moreno, BS, Ronald T. Cotton, MD, Abbas Rana, MD, Christine A. O’Mahony, MD, and John A. Goss, MD
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Surgery ,RD1-811 - Abstract
Background. Successful liver transplantation is dependent on restoration of hepatic arterial (HA) flow. Although uncommon, some native recipient HAs are not suitable or inadequate for anastomosis, thereby necessitating extra-anatomic HA reconstruction. Splenic artery transposition (SAT) is 1 method of HA reconstruction, in which the recipient splenic artery is transposed to reestablish perfusion of the donor liver. Due to the rarity of the technique, literature describing outcomes is limited. In the current report, we describe 3 patients (2 adults, 1 pediatric) who underwent complex upper abdominal surgery before whole-organ deceased donor liver transplantation with SAT. Methods. The demographic and patient care information was collected prospectively and subsequently reviewed retrospectively. Given the de-identified nature of the data included, this study was exempt from approval from an ethics board. Results. Recipient splenic arteries were dissected from their origin at the celiac trunk, for approximately 3–5 cm to ensure a gentle anterior-cranial curve toward the right upper quadrant, allowing anastomosis to the donor celiac trunk in an end-to-end fashion. Postoperatively, all 3 patients had rapid normalization of liver function tests and brisk HA flow demonstrated by Doppler ultrasound. Longer-term follow-up, ranging from 1 to 3 years, reveals continued patency of the reconstructed HAs and liver function tests within normal limits. Conclusions. Our experience points to SAT as a safe and effective technique for extra-anatomic HA reconstruction.
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- 2021
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7. Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation
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N. Thao Galván, Kayla Kumm, Michael Kueht, Cindy P. Ha, Dor Yoeli, Ronald T. Cotton, Abbas Rana, Christine A. O’Mahony, Glenn Halff, and John A. Goss
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Surgery ,RD1-811 - Abstract
Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo’s Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure.
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- 2018
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8. Biliary Adenofibroma with Carcinoma In Situ: A Rare Case Report
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N. Thao T. Nguyen, Theresa R. Harring, Laurie Holley, John A. Goss, and Christine A. O’Mahony
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
This case report exhibits a rare biliary tumor within the liver of a 53-year-old Caucasian woman. This exophytic, multicystic, 6.5 × 5.0 cm mass was composed of complex tubulocystic structures lined by nonmucin-secreting, biliary epithelium embedded in fibrous stroma, consistent with biliary adenofibroma. This is the seventh case described in the literature. Multiple foci of high-grade dysplasia/carcinoma in situ were found with a microscopic focus of invasive carcinoma in review of the pathology, making this only the second case reporting malignant transformation. It is presented to illustrate the premalignant potential in a biliary epithelial tumor currently categorized as benign.
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- 2012
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9. Treatment of Liver Metastases in Patients with Neuroendocrine Tumors: A Comprehensive Review
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Theresa R. Harring, N. Thao N. Nguyen, John A. Goss, and Christine A. O'Mahony
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Patients diagnosed with Neuroendocrine Tumors (NET) often are also diagnosed with Neuroendocrine Liver Metastases (NLM) during the course of their disease. NLM can cause significant morbidity and mortality, oftentimes much more than compared to patients with NET. Treatment options have been limited in the past, focusing on surgical resections, for which only a minority of patients are candidates. However, developments of new treatment modalities have progressed rapidly and patients with NLM now have significantly more options, including surgical-directed therapies; liver-directed therapies; and nonsurgical, non-liver-directed therapies. This review provides information about the roles of hepatic resection, orthotopic liver resection, radiofrequency ablation, hepatic artery embolization and hepatic artery chemoembolization, hepatic artery radioembolization and selective internal radiation therapy, peptide receptor radionuclide therapy, systemic chemotherapy, biotherapies including somatostatin analogs and interferon-α, vascular endothelial growth factor and mTOR targets, and microRNA-regulated pathways. Given these new options, the clinician can tailor therapy specific to the patient diagnosed with NLM, thereby giving the patient the best possible chance of prolonged survival.
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- 2011
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10. Homozygous Familial Hypercholesterolemia: Case Series and Review of the Literature
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Carlos H. Palacio, Theresa R. Harring, N. Thao T. Nguyen, John A. Goss, and Christine A. O'Mahony
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Surgery ,RD1-811 - Abstract
Introduction. Familial hypercholesterolemia (FH) is caused by nonfunctioning low-density lipoprotein (LDL) receptors, resulting in high serum cholesterol. Two types of FH are described: the heterozygous form is diagnosed in adults and responds well to medical therapy; the homozygous form is rare, diagnosed in children, and often requires multiple treatments to prevent complications. Cholesterol accumulation in tissues produces common clinical manifestations including cutaneous xanthomas, coronary artery disease, and aortic stenosis. Treatment options consist of lifestyle modifications, lipid-lowering medications, LDL aphaeresis, and orthotopic liver transplantation (OLT). Case Presentation. Two patients with FH presented at young ages due to characteristic cutaneous xanthomas. The patients underwent cardiac testing that revealed atherosclerotic changes. The patients received maximal medical therapy, but only experienced a small decrease in serum cholesterol and LDL levels. After several years of medical treatment without improvement of symptoms, the patients were listed for OLT. The transplantations were successful, and only one patient had a postoperative complication of acute rejection, treated successfully. Currently, both patients are doing well with regression of the cutaneous xanthomas and atherosclerotic changes. Conclusion. OLT is a safe and effective option for patients with homozygous FH refractory to maximal medical therapy and may represent the optimal treatment for these patients.
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- 2011
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11. Neuroendocrine Liver Metastases and Orthotopic Liver Transplantation: The US Experience
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N. Thao T. Nguyen, Theresa R. Harring, John A. Goss, and Christine A. O'Mahony
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Liver transplantation remains a controversial therapy for Neuroendocrine liver metastases (NLM), with coflicting suvival data reported. The aim was to assess the evolution of outcomes for patients transplanted for NLM in the US, both before and after the introduction of the MELD scoring system in 2002. The UNOS/OPTN database was reviewed to identify patients diagnosed with NLM who subsequently underwent a liver transplantation from 1988 to March 2011 (𝑛=184); Patient survival was determined using Kaplan-Meier methods and log-rank tests, and cox regression analysis was performed, using SPSS 15.0 (SPSS, Inc, Chicago, IL). The overall NLM patient survivals in the pre-MELD era were 79.5%, 61.4%, and 49.2% at 1, 3, and 5 years, respectively. After the introduction of the MELD score, NET/NLM patients had improved overall patient survivals at 1, 3, and 5 years of 84.7%, 65%, and 57.8%. Patients transplanted after 2002 had an improved survival outcome. Notably, the overall patient survival for NET is not significantly different when compared to the outcomes of patients transplanted for HCC, in the current era. This progress acknowleges the significant improvement in outcomes for NLM patients after liver transplantation and the potential for further gain in the survival of otherwise nonsurgical, terminal patients.
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- 2011
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12. Toward Maximizing the Success Rates of Human Islet Isolation: Influence of Donor and Isolation Factors
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Gaston M. Ponte, Antonello Pileggi, Shari Messinger, Angel Alejandro, Hirohito Ichii, David A. Baidal, Aisha Khan, Camillo Ricordi, John A. Goss, and Rodolfo Alejandro
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Medicine - Abstract
In order to make islet transplantation a therapeutic option for patients with diabetes there is an urgent need for more efficient islet cell processing to maximize islet recovery. Improved donor management, organ recovery techniques, implementation of more stringent donor criteria, and improved islet cell processing techniques may contribute to enhance organ utilization for transplantation. We have analyzed the effects of donor and islet processing factors on the success rate of human islet cell processing for transplantation performed at a single islet cell processing center. Islet isolation outcomes improved when vasopressors, and in particular pitressin, and steroids were used for the management of multiorgan donors. Higher islet yields were obtained from adult male donors, BMI >25 kg/m2, adequate glycemic control during hospital stay, and when the pancreas was retrieved by a local surgical team. Successful isolations were obtained in 58% of the cases when ≥ 4 donor criteria were met, and even higher success rates (69%) were observed when considering ≥ 5 criteria. Our data suggest that a sequential, integrated approach is highly desirable to improve the success rate of islet cell processing.
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- 2007
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13. Lack of Cytomegalovirus Transmission after Pancreatic Islet Transplantation
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Neal R. Barshes, Timothy C. Lee, F. Charles Brunicardi, Amy Mote, A. Paige Schock, Rodolfo Alejandro, Camillo Ricordi, and John A. Goss M.D.
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Medicine - Abstract
In spite of antiviral prophylaxis, the transmission rate of cytomegalovirus (CMV) after solid organ transplantation remains high. In contrast, CMV transmission has never been reported following pancreatic islet transplantation (PIT). Eleven (seven CMV seronegative, four CMV seropositive) recipients underwent a total of 26 PITs. Following PIT recipients were monitored clinically and tested monthly for CMV antigenemia. Valganciclovir was given to all patients for 100 days after each PIT. Follow-up ranged from 6 to 24 months (median 14.5 months). Pancreatic islet grafts were procured from 18 CMV seropositive and 8 seronegative donors (69% and 31% of donors, respectively). In total there were 6 R+D+, 3 R+D-, 12 R-D+, and 5 R-D-PITs. No patient developed CMV antigenemia or symptoms consistent with CMV infection at any time following PIT. Routine posttransplant testing of PIT recipients demonstrated that neither CMV transmission nor CMV infection occurred after PIT.
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- 2004
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14. Acute liver failure and unique challenges of pediatric liver transplantation amidst a worldwide cluster of adenovirus-associated hepatitis
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Anna M. Banc-Husu, Elizabeth A. Moulton, Henry Shiau, Luz Helena Gutierrez Sanchez, Moreshwar S. Desai, Dana Cerminara, Flor M. Munoz, Leanne M. Buffaloe, Kristen G. Valencia-Deray, N. Thao N. Galvan, Julu Bhatnagar, Lindsey Estetter, Negar Rassaei, Sarah Reagan-Steiner, Jason Wicker, James J. Dunn, Carl E. Allen, Kalyani R. Patel, Sanjiv Harpavat, John A. Goss, and Daniel H. Leung
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Transplantation ,Immunology and Allergy ,Pharmacology (medical) - Published
- 2023
15. Innate immune cell dysfunction and systemic inflammation in children with chronic liver diseases undergoing transplantation
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Krupa R. Mysore, Sunil Kannanganat, Jeremy M. Schraw, Philip J. Lupo, John A. Goss, Kenneth D.R. Setchell, Farrah Kheradmand, Xian C. Li, and Benjamin L. Shneider
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Transplantation ,Immunology and Allergy ,Pharmacology (medical) - Published
- 2023
16. Recipient Age Predicts 20-Year Survival in Pediatric Liver Transplant
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Stephanie Keeling, Malcolm F. McDonald, Adrish Anand, Jordan Dunson, Elizabeth Williams, Theodore Zhang, Brian Hickner, Nhu Thao Nguyen Galván, Christine O’ Mahony, John A Goss, and Abbas Rana
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Survival Rate ,Article Subject ,Hepatology ,Child, Preschool ,Graft Survival ,Living Donors ,Gastroenterology ,Humans ,General Medicine ,Child ,Liver Transplantation ,Retrospective Studies - Abstract
Introduction. Pediatric liver transplant recipients have demonstrated excellent long-term survival. The purpose of this analysis is to investigate factors associated with 20-year survival to identify areas for improvement in patient care. Methods. Kaplan–Meier with log-rank test as well as univariate and multivariate logistic regression methods were used to retrospectively analyze 4,312 liver transplant recipients under the age of 18 between September 30, 1987 and March 9, 1998. Our primary endpoint was 20-year survival among one-year survival. Results. Logistic regression analysis identified recipient age as a significant risk factor, with recipients below 5 years old having a higher 20-year survival rate ( p < 0.001 ). A preoperative primary diagnosis of a metabolic dysfunction was found to be protective compared to other diagnoses (OR 1.64, CI 1.20–2.25). African-American ethnicity (OR 0.71, CI 0.58–0.87) was also found to be a risk factor for mortality. Technical variant allografts (neither living donor nor cadaveric) were not associated with increased or decreased rates of 20-year survival. Conclusions. Our analysis suggests that long-term survival is inversely correlated with recipient age following pediatric liver transplant. If validated with further studies, this conclusion may have profound implications on the timing of pediatric liver transplantation.
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- 2022
17. Integration of a dedicated management protocol in the care of pediatric liver cancer: From specialized providers to complication reduction
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John A. Goss, Prakash Masand, Dolores Lopez Terrada, Jorge I. Portuondo, Sarah Jane Commander, Andras Heczey, HaiThuy N Nguyen, Richard S. Whitlock, Huirong Zhu, Sanjeev A. Vasudevan, Tu-Anh Ha, Daniel H. Leung, Jed G. Nuchtern, Kamlesh Kukreja, and David E. Wesson
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Hepatoblastoma ,Protocol (science) ,medicine.medical_specialty ,Multivariate analysis ,Liver tumor ,business.industry ,Proportional hazards model ,Liver Neoplasms ,General Medicine ,Perioperative ,medicine.disease ,Logistic regression ,Postoperative Complications ,Treatment Outcome ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Hepatectomy ,Humans ,Surgery ,Child ,business ,Complication ,Retrospective Studies - Abstract
Up to a third of children undergoing partial hepatectomy for primary hepatic malignancies experience at least one perioperative complication, with a presumed deleterious effect on both short- and long-term outcomes. We implemented a multidisciplinary treatment protocol in the management of these patients in order to improve complication rates following partial hepatectomy.A retrospective chart review was completed for all patients 18 years of age who underwent liver resection at our institution between 2002 and 2019 for primary hepatic cancer. Demographic, intraoperative, postoperative, pathologic, and outcome data were analyzed for perioperative complications using the CLASSIC and Clavien-Dindo (CD) scales, event-free survival (EFS) and overall survival (OS).A total of 73 patients were included in the analysis with 33 prior-to and 40 after dedicated provider protocol implementation. Perioperative complication rates decreased from 52% to 20% (p = 0.005) with major complications going from 18% to 10% (p = 0.31). On multivariable logistic regression, protocol implementation was associated with a reduction in any (OR 0.29 [95% CI 0.09 - 0.89]) but not major complications. On multivariate cox models, post protocol implementation was associated with improved event free survival (EFS) (HR 0.19 (0.036 - 0.195). Among patients with a diagnosis of hepatoblastoma (n = 62), the occurrence of a major perioperative complication was associated with a worse EFS (HR=5.45, p = 0.03) on multivariate analysis, however this did not translate into an impact on overall survival.Our results demonstrate that, for children with primary liver malignancies, a dedication of patients to high-volume surgeons can improve rates of complications of liver resections and may improve the oncological outcome of hepatoblastoma.
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- 2022
18. Surgical Management and Outcomes of Patients with Multifocal Hepatoblastoma
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Richard S. Whitlock, Jorge I. Portuondo, Andres F. Espinoza, Rachel Ortega, N. Thao N. Galván, Daniel H. Leung, Dolores Lopez-Terrada, Prakash Masand, HaiThuy N. Nguyen, Kalyani A. Patel, John A. Goss, Andras M. Heczey, and Sanjeev A. Vasudevan
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Pediatrics, Perinatology and Child Health ,Surgery ,General Medicine - Published
- 2023
19. Post-transplant outcomes for alcohol-associated liver disease during the COVID-19 pandemic
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Karthik Goli, Peter Lymberopoulos, Ronald Samuel, Anjiya Shaikh, Nisha Parakadavil, Donghee Kim, Aijaz Ahmed, John A. Goss, Abbas Rana, Tzu-Hao Lee, Fasiha Kanwal, and George Cholankeril
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Transplantation ,Hepatology ,Surgery - Published
- 2023
20. COVID-19 Vaccine Efficacy and Immunogenicity in End-Stage Renal Disease Patients and Kidney Transplant Recipients
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Nicolas F. Moreno, Robert McAdams, John A. Goss, and N. Thao. N. Galvan
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Transplantation ,Hepatology ,Nephrology ,Immunology ,Surgery - Abstract
To summarize the current literature with respect to COVID-19 vaccine efficacy patients with end-stage renal disease on dialysis and kidney transplant recipients.Immunosuppressed patients are at greater risk of morbidity and mortality from COVID-19 infection. Patients with ESRD and KTR are immunosuppressed and mount a weaker antibody response to COVID-19 mRNA vaccination, and factors including immunosuppressant medications have been implicated for this weakened response. Third and fourth doses of vaccine doses have been shown to increase seropositivity and antibody production in kidney transplant recipients and patients on dialysis. Retrospective studies have demonstrated decreased mortality in vaccinated, immunosuppressed patients.ESRD and KTR patients have decreased antibody response to COVID-19 vaccines, but third and fourth doses have been shown to increase antibody production. Though a correlate of protection between antibody production and efficacy has yet to be fully established in this subset of the population, all US professional bodies who treat ESRD and KTR patients advocate for full vaccination against SARS-CoV-2 based on the data available. Studies demonstrating decreased mortality in vaccinated patients are promising on efficacy. Importantly, because KTR patients mount a weaker antibody response than ESRD patients, vaccination prior to kidney transplantation is critical.
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- 2022
21. Management of Acute Portal Vein Thrombosis With Serial Mechanical Thrombectomy and tPA in a Pediatric Liver Transplant Recipient: A Case Report
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Matthew B. Goss, Nicolas F. Moreno, Ashley Upton, N. Thao N. Galvan, John A. Goss, Sarah Koohmaraie, J. Alberto Hernandez, and Moreshwar S. Desai
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Male ,medicine.medical_specialty ,Adolescent ,Fulminant ,medicine.medical_treatment ,Liver transplantation ,medicine ,Humans ,Thrombus ,Child ,Hepatic encephalopathy ,Thrombectomy ,Transplantation ,Portal Vein ,business.industry ,Acute kidney injury ,Thrombosis ,medicine.disease ,Liver Transplantation ,Portal vein thrombosis ,Surgery ,Respiratory failure ,Tissue Plasminogen Activator ,business - Abstract
Background Acute portal vein thrombosis is a major cause of fulminant allograft failure in pediatric liver transplantation. Timely intervention is critical to save the graft and patient. Serial interventional radiologic management of this condition is scarcely reported in the literature. Case Summary A recently transplanted 17-year-old male presented to the emergency department with abdominal pain. Rising liver enzymes prompted discovery of a diffuse portal thrombus, which precipitated fulminant liver failure. The adolescent developed respiratory failure, vasodilatory shock, acute kidney injury, and hepatic encephalopathy, complicating treatment. Multiple interventions attempted to clear the thrombus, including interventional radiologic and medical therapies. Uniquely, a continuous infusion catheter was placed at the thrombosis, delivering local tissue plasminogen activator during a 5-day period. Upon thrombus clearance, the patient made a full recovery with no complications during 12 months of follow-up. Conclusions When used as a component of multidisciplinary management, continuous locally directed tissue plasminogen activator may be a useful tool for clearance of persistent portal vein thrombosis.
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- 2021
22. The Surge in Deceased Liver Donors Due to the Opioid Epidemic: Is It Time to Split the Difference?
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Megan A. Adams, Michael Wachs, Elizabeth A. Pomfret, John A. Goss, James J. Pomposelli, Rashikh A. Choudhury, Trevor L. Nydam, and Dor Yoeli
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Transplantation ,education.field_of_study ,Opioid epidemic ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Population ,Liver transplantation ,Drug overdose ,medicine.disease ,Normal limit ,Surgery ,Liver donors ,Split liver transplantation ,Medicine ,Adult liver ,business ,education - Abstract
BACKGROUND This study aimed to compare trends in use of drug overdose (DO) donors in adult versus pediatric liver transplants and the utilization of split liver transplantation in this donor population. METHODS The United Network for Organ Sharing database was reviewed for deceased donor liver transplants from March 2002 to December 2017. Recipients were categorized by donor mechanism of death. Donor splitting criteria was defined as age 3 times the normal limit, and body mass index ≤ 28 kg/m2. RESULTS Adult liver transplants from DO donors increased from 2% in 2002 to 15% in 2017, while pediatric liver transplants from DO donors only increased from
- Published
- 2021
23. Elevated serum sodium in recipients of liver transplantation has a substantial impact on outcomes
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Cameron R. Goff, John A. Goss, Spencer C. Barrett, Caroline R. Christmann, Fasiha Kanwal, Malcolm F McDonald, Adrish Anand, Abbas Rana, Thao Galvan, George Cholankeril, Tahir H Malik, and Stephanie S. Keeling
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medicine.medical_specialty ,Sodium ,medicine.medical_treatment ,chemistry.chemical_element ,Liver transplantation ,Gastroenterology ,Elevated serum ,chemistry.chemical_compound ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Retrospective Studies ,Transplantation ,Creatinine ,Hypernatremia ,business.industry ,Proportional hazards model ,medicine.disease ,Liver Transplantation ,surgical procedures, operative ,chemistry ,Graft survival ,business ,Hyponatremia - Abstract
Dysnatremias are a rare but significant event in liver transplantation. While recipient pre-transplant hypernatremia has been demonstrated to increase post-transplant mortality, the degree of hypernatremia and the impact of its resolution have been less well characterized. Here, we used multivariate Cox regression with a comprehensive list of donor and recipient factors in order to conduct a robust multivariate retrospective database study of 54,311 United Network for Organ Sharing (UNOS) liver transplant patients to analyze the effect of pre-transplant serum sodium on post-transplant mortality, post-transplant length of hospitalization, and post-transplant graft survival. Mortality and graft failure increased in a stepwise fashion with increasing pre-transplant hypernatremia: 145 -150 mEq/L (HR = 1.118 and HR = 1.113), 150-155 mEq/L (HR = 1.324 and HR = 1.306), and > 155 mEq/L (HR = 1.623 and HR = 1.661). Pre-transplant hypo- and hypernatremia also increased length of post-transplant hospitalization: < 125 mEq/L (HR = 1.098), 125-130 mEq/L (HR = 1.060), 145 -150 mEq/L (HR = 1.140), and 150-155 mEq/L (HR = 1.358). Resolution of hypernatremia showed no significant difference in mortality compared with normonatremia, while unresolved hypernatremia significantly increased mortality (HR = 1.254), including a durable long-term increased mortality risk for patients with creatinine < 2 mg/dL and MELD < 25. Pre-transplant hypernatremia serves as a morbid prognostic indicator for post-transplant morbidity and mortality.
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- 2021
24. A fully integrated undergraduate introductory biology and chemistry course with a community‐based focus I: Vision, design, implementation, and development
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Donald E. Elmore, Mala L. Radhakrishnan, Mona L. Hall, Adam G. W. Matthews, Melissa A. Beers, John W. Goss, and Elizabeth S. C. Oakes
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Community based ,Structure (mathematical logic) ,Focus (computing) ,Universities ,Guiding Principles ,Community building ,Learning community ,Faculty ,Biochemistry ,Course (navigation) ,ComputingMilieux_COMPUTERSANDEDUCATION ,Humans ,Learning ,Engineering ethics ,Curriculum ,Chemistry (relationship) ,Students ,Biology ,Molecular Biology - Abstract
We describe a first-semester, integrated, introductory biology and chemistry course for undergraduates at Wellesley College in Wellesley, MA, USA. Our vision was to create a supportive learning community in which students could comfortably make connections between scientific disciplines as they learned necessary content for subsequent courses, further developed problem solving, communication, and laboratory skills, and meaningfully connected with other students and with faculty during their first semester in college. Through highlighting five guiding principles that are central to the course, we describe the integrated course structure and content as well as our efforts to build community, provide support, and engage students in building skills crucial to scientists. We also highlight features of this course and institutional policies that facilitated its logistical and collaborative implementation that can be adapted to fit the needs, goals, and constraints of a diverse range of institutions. A companion article describes an assessment of our course in achieving academic and community building goals.
- Published
- 2021
25. A new chapter in an evolving pandemic: Successful pediatric liver transplantation with SARS-CoV-2+ donors
- Author
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Matthew Benjamin Goss, Daniel Hao Bin Leung, Stephanie Marie Pouch, Flor M. Munoz, Elizabeth Andrea Moulton, Tyler Malcolm Mccann Lambing, Sarah Koohmaraie, Nicolas Fernando Moreno, Christine A. O'Mahony, John A. Goss, and Nhu Thao Nguyen Galván
- Subjects
Adult ,Male ,Transplantation ,SARS-CoV-2 ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Humans ,Infant ,COVID-19 ,Child ,Pandemics ,Tissue Donors ,Liver Transplantation - Abstract
Amid a viral pandemic with poorly understood transmissibility and pathogenicity in the pediatric patient, we report the first pediatric liver transplants utilizing allografts from SARS-CoV-2+ donors.We describe the outcomes of two pediatric liver transplant recipients who received organs from SARS-CoV-2 nucleic acid test-positive (NAT+) donors. Data were obtained through the respective electronic medical record system and UNet DonorNet platform.The first donor was a 3-year-old boy succumbing to head trauma. One of four nasopharyngeal (NP) swabs and 1 of 3 bronchoalveolar lavage (BAL) NAT tests demonstrated SARS-CoV-2 infection before organ procurement. The second donor was a 16-month-old boy with cardiopulmonary arrest of unknown etiology. Three NAT tests (2 NP swab/1 BAL) prior to procurement failed to detect SARS-CoV-2. The diagnosis was made when the medical examiner repeated 2 NP swab NATs and an archive plasma NAT, all positive for SARS-CoV-2. Both 2-year-old recipients continue to do well 8 months post-transplant, with excellent graft function and no evidence of SARS-CoV-2 transmission.This is the first report to describe successful pediatric liver transplantation from SARS-CoV-2+ donors. These data reinforce the adult transplant experience and support the judicious use of SARS-CoV-2+ donors for liver transplantation in children. With SARS-CoV-2 becoming endemic, the concern for donor-derived viral transmission must now be weighed against the realized benefit of life-saving transplantation in the pediatric population as we continue to work toward donor pool maximization.
- Published
- 2022
26. Trends in marginal lung allograft survival: Advanced-age donors improve
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John James Miggins, Ross Michael Reul, Gabriel Loor, Liam D. Ferreira, Puneet S. Garcha, John A. Goss, and Abbas A. Rana
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Transplantation ,Tissue and Organ Procurement ,Treatment Outcome ,Age Factors ,Humans ,Middle Aged ,Allografts ,Lung ,Tissue Donors ,United States ,Lung Transplantation ,Retrospective Studies - Abstract
Although lung demand continues to outpace supply, 75% of potential donor lungs are discarded without being transplanted in the United States. To identify the discarded cohorts best suited to alleviate the lung shortage and reduce waitlist mortality, we explored changes in survival over time for five marginal donor definitions: age 60 years, smoking history 20 pack-years, PaOOur retrospective cohort study separated 27 803 lung recipients in the UNOS Database into three 5-year eras by transplant date: 2005-2009, 2010-2014, and 2015-2019. Multivariable Cox proportional hazards regression and Kaplan-Meier analysis with log-rank test were used to compare survival across the eras.Three definitions-low PaOAdvanced donor age, previously the most significant risk factor, has improved to near-benchmark levels, demonstrating the possibility for matching older donors to healthier non-elderly recipients in selected circumstances. Low PaO
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- 2022
27. Lead removal at trace concentrations from water by inactive yeast cells
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Patritsia M. Stathatou, Christos E. Athanasiou, Marios Tsezos, John W. Goss, L. Camron Blackburn, Filippos Tourlomousis, Andreas Mershin, Brian W. Sheldon, Nitin P. Padture, Eric M. Darling, Huajian Gao, and Neil Gershenfeld
- Subjects
General Earth and Planetary Sciences ,General Environmental Science - Abstract
Traces of heavy metals found in water resources, due to mining activities and e-waste discharge, pose a global threat. Conventional treatment processes fail to remove toxic heavy metals, such as lead, from drinking water in a resource-efficient manner when their initial concentrations are low. Here, we show that by using the yeast Saccharomyces cerevisiae we can effectively remove trace lead from water via a rapid mass transfer process, called biosorption, achieving an uptake of up to 12 mg lead per gram of biomass in solutions with initial lead concentrations below 1 part per million. Through spectroscopic analyses, we found that the yeast cell wall plays a crucial role in this process, with its mannoproteins and β-glucans being the key potential lead adsorbents. Furthermore, by employing nanomechanical characterization in the yeast biomass, we discovered that biosorption is linked to an increase in cell wall stiffness. These findings open new opportunities for using environmentally friendly and abundant biomaterials for advanced water treatment targeting emerging contaminants.
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- 2022
28. Transarterial Radioembolization Treatment as a Bridge to Surgical Resection in Pediatric Hepatocellular Carcinoma
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Kalyani R. Patel, Prakash Masand, Sanjeev A. Vasudevan, Andras Heczey, Kamlesh Kukreja, Osman Khan, Armeen Mahvash, Caitlyn Loo, John A. Goss, HaiThuy N Nguyen, Dolores Lopez-Terrada, Richard S. Whitlock, and Ranjan Bista
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Male ,Surgical resection ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Adolescent ,Tare weight ,Transarterial Radioembolization ,Humans ,Medicine ,Yttrium Radioisotopes ,Child ,neoplasms ,business.industry ,Liver Neoplasms ,Clinical course ,Hematology ,Prognosis ,medicine.disease ,Embolization, Therapeutic ,digestive system diseases ,Surgery ,Transplantation ,Bridge (graph theory) ,Oncology ,Hepatocellular carcinoma ,Pediatrics, Perinatology and Child Health ,business ,Pediatric Hepatocellular Carcinoma - Abstract
Background Children with unresectable hepatocellular carcinoma (HCC) have a poor prognosis and limited treatment options. Transarterial radioembolization (TARE) using Yttrium-90 (Y90) has emerged as a potential bridge therapy to hepatic resection or transplantation for HCC with very limited studies in children. Observations Here we present the clinical course of 2 children successfully treated with TARE Y90 for initially unresectable fibrolamellar HCC (FL-HCC) and bridged to partial hemihepatectomy with >1-year overall survival post-TARE. Conclusion Although there have been prior published reports of pediatric patients with HCC being treated with TARE Y90 and some being able to undergo subsequent orthotopic liver transplantation, this is the first report of pediatric HCC patients treated with TARE Y90 as a bridge to nontransplant resections and going on to have >1-year overall survival.
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- 2021
29. Prediction of Kidney Allograft Discard Before Procurement: The Kidney Discard Risk Index
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Thao Galvan, Gaibo Yan, Manasi Joshi, Ronald T. Cotton, Abbas Rana, Mathew Brent Price, Christine A. O'Mahony, Brian T Hickner, Theodore Zhang, and John A. Goss
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medicine.medical_specialty ,Percentile ,Tissue and Organ Procurement ,Kidney ,Logistic regression ,chemistry.chemical_compound ,fluids and secretions ,Internal medicine ,Humans ,Medicine ,health care economics and organizations ,Statistic ,Transplantation ,Creatinine ,business.industry ,Univariate ,food and beverages ,social sciences ,Allografts ,Tissue Donors ,humanities ,Logistic Models ,medicine.anatomical_structure ,chemistry ,Multivariate Analysis ,Cohort ,business - Abstract
Objectives There is an 18.9% discard rate among kidney allografts. Here, we aimed to determine predictors of kidney discard and construct an index to identify high-probability discard kidney allografts prior to procurement. Materials and methods A total of 102 246 potential kidney allograft donors from the Organ Procurement and Transplantation Network database were used in this analysis. The cohort was randomized into 2 groups. The training set included 67% of the cohort and was used to derive a predictive index for discard that comprised 21 factors identified by univariate and multivariate logistic regression analysis. The validation set included 33% and was used to internally validate the kidney discard risk index. Results In 77.3% of donors, at least 1 kidney was used for transplant, whereas in 22.7% of donors, both kidneys were discarded. The kidney discard risk index was highly predictive of discard with a C statistic of 0.89 (0.88-0.89). The bottom 10th percentile had a discard rate of 0.73%, whereas the top 10th percentile had a discard rate of 83.65%. The 3 most predictive factors for discard were age, creatinine level, and hepatitis C antibody status. Conclusions We identified 21 factors predictive of discard prior to donor procurement and used these to develop a kidney discard risk index with a C statistic of 0.89.
- Published
- 2021
30. Survey of public attitudes towards imminent death donation in the United States
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R. P. Wood, Priyanka Moolchandani, Ruth L. Ackah, Matthew Brent Price, Abbas Rana, Laura Washburn, Ryan P. Brown, Kevin A. Myers, Matthew B. Goss, Sandra Vaughan Parsons, Nhu Thao Nguyen Galvan, Elitza Ranova, John A. Goss, and Smruti Rath
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United Network for Organ Sharing ,Transplantation ,medicine.medical_specialty ,business.industry ,030230 surgery ,Likert scale ,03 medical and health sciences ,Organ procurement ,0302 clinical medicine ,Living organ donation ,Donation ,Family medicine ,Immunology and Allergy ,Medicine ,Pharmacology (medical) ,Organ donation ,business ,Public support - Abstract
Imminent death donation (IDD) is described as living organ donation prior to a planned withdrawal of life-sustaining care in an imminently dying patient. Although IDD was ethically justified by United Network for Organ Sharing, the concept remains controversial due to presumed lack of public support. The aim of this study was to evaluate the public's attitudes towards IDD. A cross-sectional survey was conducted of US adults age >18 years (n = 2644). The survey included a case scenario of a patient with a devastating brain injury. Responses were assessed on a 5-point Likert scale. Results showed that 68% - 74% of participants agreed or strongly agreed with IDD when posed as a general question and in relation to the case scenario. Participants were concerned about "recovery after a devastating brain injury" (34%), and that "doctors would not try as hard to save a patient's life" (33%). Only 9% of participants would be less likely to trust the organ donation process. In conclusion, our study demonstrates strong public support for IDD in the case of a patient with a devastating brain injury. Notably, participants were not largely concerned with losing trust in the organ donation process. These results justify policy change towards imminent death donation.
- Published
- 2021
31. Hepatic separation of conjoined twins: Operative technique and review of three-dimensional model utilization
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Nhu Thao Nguyen Galvan, Prakash Masand, Oluyinka O. Olutoye, Joshua A. Villarreal, John A. Goss, and Dor Yoeli
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Models, Anatomic ,medicine.medical_specialty ,Separation (statistics) ,Surgical planning ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,030225 pediatrics ,Chart review ,Conjoined twins ,medicine ,Humans ,Medical physics ,Twins, Conjoined ,business.industry ,General Medicine ,Evidence-based medicine ,medicine.disease ,Liver ,030220 oncology & carcinogenesis ,Printing, Three-Dimensional ,Pediatrics, Perinatology and Child Health ,Surgery ,business ,Preoperative imaging ,Three dimensional model - Abstract
Background The separation of conjoined twins is a challenging and rare operation. Recent technological advances in imaging and three-dimensional printing (3DP) have allowed for enhancements in preoperative surgical planning and intraoperative anatomical orientation for complex operations. This report aims to consolidate the current clinical evidence utilizing 3DP models as an effective tool for surgical planning of conjoined twin separation and to detail our surgical approach for complex hepatic separation and management. Methods A literature review was conducted for conjoined twin separations with preoperative use of 3D models including age at attempted separation, operative outcome, 3D modality, and postoperative course between 1998 and 2020. We also conducted a chart review of our electronic medical record for conjoined twin separations between January 2015 and December 2019. Results We report two cases of conjoined twin separation with preoperative use of 3DP models from our institution: one set in the thoracoomphaloischiopagus orientation and the other set in the thoracoomphalopagus orientation with the presence of intrahepatic vascular anomalies. The literature review produced 10 case reports of conjoined twin separation with use preoperative 3D models accounting for 17 individual separation procedures. We summarize our preoperative radiological planning, the evidence of 3DP models as an educational and preoperative tool, ideal timing for separation, and our surgical approach for complex hepatic separation. Conclusions Conjoined twin separation requires a multidisciplinary effort to address the multisystem surgical and medical needs of these patients. These complex patients require extensive preoperative imaging for planning separation, and we strongly recommend utilizing 3D printed models when possible for better surgeon understanding of complex variable anatomy. We have found numerous reports of successful conjoined twin separation using 3DP technology in preoperative planning. The use of three-dimensional printed models for preoperative assessments is an invaluable tool and is rapidly improving in fidelity. Type of study Operative technique and case series. Level of evidence Level IV.
- Published
- 2020
32. Significant improvements, but consistent disparities in survival for African Americans after liver transplantation
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Stephanie S. Keeling, Malcolm F. McDonald, Adrish Anand, Greta E. Handing, Lyndsey L. Prather, Caroline R. Christmann, Prasun K. Jalal, Fasiha Kanwal, George Cholankeril, John A. Goss, and Abbas Rana
- Subjects
Black or African American ,Transplantation ,Databases, Factual ,Humans ,Article ,United States ,White People ,Liver Transplantation ,Proportional Hazards Models ,Retrospective Studies - Abstract
Despite improvements in survival across races in the past 20 years, African Americans have worse liver transplant outcomes after orthotopic liver transplantation (OLT). This study aims at quantifying the change in disparities between African Americans and other races in survival after OLT. We retrospectively analyzed the United Network for Organ Sharing (UNOS) database for patient data for candidates who received a liver transplant between January 1, 2007 and December 31, 2017. Multivariate Cox proportional hazards regression indicated similar decreases in mortality over time for each race with a decrease in mortality for African Americans: 2010-2012 (HR = .930), 2012-2015 (HR = .882), and 2015-2017 (HR = .883) when compared to 2007-2010. Risk of mortality for African Americans compared to Caucasians varied across the 4 eras: 2007-2010 (HR = 1.083), 2010-2012 (HR = 1.090), 2012-2015 (HR = 1.070), and 2015-2017 (HR = 1.125). While African Americans have seen increases in survival in the past decade, a similar increase in survival for other races leaves a significant survival disparity in African Americans.
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- 2022
33. Our evolution in the treatment of hepatic artery and portal vein thrombosis in pediatric liver transplantation: Success with catheter-directed therapies
- Author
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Nicolas F. Moreno, Jose Alberto Hernandez, Chun‐Sing Huang, Moreshwar S. Desai, Allison B. Haug, Heather Cleveland, Ashley Upton, Sarah Koohmaraie, Matthew B. Goss, Daniel H. Leung, Anna M. Banc‐Husu, Henri Justino, John A. Goss, and Nhu Thao. N. Galvan
- Subjects
Venous Thrombosis ,Transplantation ,Catheters ,Portal Vein ,Liver Diseases ,Graft Survival ,Anticoagulants ,Thrombosis ,Liver Transplantation ,Hepatic Artery ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Humans ,Child ,Retrospective Studies - Abstract
In pediatric liver transplant recipients, hepatic artery thrombosis and portal vein thrombosis are major causes of acute graft failure and mortality within 30 days of transplantation. There is, however, a strong possibility of graft salvage if flow can be re-established to reduce ischemic injury. The current standard treatment is surgical revascularization, and if unsuccessful, retransplantation. Due to our success in treating these complications with catheter-directed therapies, we sought to summarize and publish the outcomes of all patients who experienced hepatic artery thrombosis or portal vein thrombosis within 30 days of liver transplantation.We conducted a retrospective cohort analysis of 27 pediatric liver transplant recipients who experienced hepatic artery thrombosis (n = 13), portal vein thrombosis (n = 9), or both (n = 5) between September 2012 and March 2021. We collected and tabulated data on the patients and therapies performed to treat them, including success rates, primary and secondary patency, and clinical outcomes.Among these patients, 6 were managed with anticoagulation and relisting for transplant and 21 had a primary revascularization attempt. Surgical recanalization was attempted in 7 patients of which 3 had successful recanalization (43%) and catheter-directed recanalization was attempted in 14 patients with 100% success in re-establishing blood flow to the graft. Additionally, patency was increased, and mortality was decreased in patients treated with catheter-directed recanalization compared to surgical revascularization or anticoagulation alone.This data illustrates the need to further investigate catheter-directed thrombolysis as a potential first-line treatment for postoperative HAT and PVT in pediatric liver transplant recipients.
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- 2022
34. Higher Waitlist Mortality in Pediatric Acute-on-chronic Liver Failure in the UNOS Database
- Author
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Tamir Miloh, Abbas Rana, Moreshwar S. Desai, Elizabeth L. Godfrey, Fong Lam, and John A. Goss
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Adult ,Liver Cirrhosis ,Waiting Lists ,medicine.medical_treatment ,Population ,Liver transplantation ,Chronic liver disease ,computer.software_genre ,Severity of Illness Index ,End Stage Liver Disease ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Biliary atresia ,030225 pediatrics ,medicine ,Humans ,Prospective Studies ,Child ,education ,education.field_of_study ,Database ,business.industry ,Mortality rate ,Hazard ratio ,Gastroenterology ,Acute-On-Chronic Liver Failure ,Prognosis ,medicine.disease ,Transplantation ,Pediatrics, Perinatology and Child Health ,030211 gastroenterology & hepatology ,business ,computer - Abstract
OBJECTIVES Acute-on-chronic liver failure (ACLF), whereas increasingly well-defined in adults, has been poorly characterized in pediatric patients other than having a poor prognosis. This study aimed to identify ACLF and evaluate prognosis in the American pediatric population. METHODS Modified ACLF definitions (p-CLIF) were applied to 11,300 children listed for liver transplantation from March 2002 through 2017 in the Organ Procurement and Transplantation Network (OPTN) database. RESULTS Pediatric ACLF patients have greater mortality within 90 days from listing (46.6% by p-CLIF) than other types of failure (
- Published
- 2020
35. Presentation and Outcomes of Autoimmune Hepatitis Type 1 and Type 2 in Children: A Single-center Study
- Author
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John M. Vierling, Isaiah G. Roepe, Tamir Miloh, and John A. Goss
- Subjects
medicine.medical_specialty ,Cholangitis, Sclerosing ,Autoimmune hepatitis ,Disease ,Single Center ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,030225 pediatrics ,Chart review ,Internal medicine ,Chronic liver failure ,Epidemiology ,medicine ,Humans ,Child ,Retrospective Studies ,business.industry ,Autoantibody ,medicine.disease ,Texas ,digestive system diseases ,Liver Transplantation ,Hepatitis, Autoimmune ,Pediatrics, Perinatology and Child Health ,Female ,030211 gastroenterology & hepatology ,Presentation (obstetrics) ,business - Abstract
OBJECTIVE Autoimmune hepatitis (AIH) is designated as type 1 or 2 (AIH-1/2) on the basis of serum autoantibody (Ab) profiles. In children, AIH may present as acute or chronic liver failure or cirrhotic AIH (ALF/CLF/CAIH) with or without overlap sclerosing cholangitis (SC). The aim of this study was to compare demographics, presentation, and outcomes between groups in children. METHODS A retrospective electronic chart review of children with AIH who met standard diagnostic criteria with histologic confirmation at Texas Children's Hospital was performed, with de novo AIH after liver transplant (LT) excluded. Patients were identified and divided into AIH-1, AIH-2, ALF, CAIH, AIH-SC, and LT and compared using chi-square analysis, Student t-test, and Mood median test. RESULTS Among 91 children with AIH, 72 (79.1%) had AIH-1, 19 (20.9%) had AIH-2, 13 (14.3%) had ALF, 25 (27.5%) had CAIH, and 14 (15.4%) had AIH-SC. Both AIH-1/2 had female and Hispanic predominance (72.2/89.5%, 40.3/57.9%). AIH-2 presented at younger mean age in years than AIH-1 (6.8, 12.1, P
- Published
- 2020
36. Most pediatric transplant centers are low volume, adult-focused, and in proximity to higher volume pediatric centers
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Ronald T. Cotton, Abbas Rana, Matthew Brent Price, Joshua A. Villarreal, John A. Goss, Thao Galvan, Tyler Nichols, Syed Shahyan Bakhtiyar, Christine A. O'Mahony, and John M. Vierling
- Subjects
Adult ,medicine.medical_specialty ,Tissue and Organ Procurement ,Pediatric transplant ,Waiting Lists ,medicine.medical_treatment ,Liver transplantation ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Humans ,Medicine ,Child ,Retrospective Studies ,Transplantation ,business.industry ,General Medicine ,Low volume ,Organ procurement ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Surgery ,Health Facilities ,Level iii ,business ,Solid organ transplantation ,Volume (compression) - Abstract
Background Independent studies provide evidence that low volume pediatric solid organ transplant centers have inferior outcomes compared to high volume pediatric centers. The study assessed whether patients treated at low volume pediatric centers have access to higher volume pediatric centers, which offer potentially better outcomes. Methods We analyzed center specific data on 467 pediatric solid organ transplant centers in the U.S using the Organ Procurement and Transplantation Network database from 2002 to 2014. The proximities of low volume pediatric centers to high volume pediatric centers were determined using Maptive, a tool based on Google Maps. Results Most low volume pediatric transplant centers focused on transplantation of adults (84% heart, 83% liver, and 93% kidney programs). A majority of low volume pediatric centers (77% for heart, 53% for lung, 68% for liver and 90% for kidney) were within 150 miles of high volume centers. Among all children listed for transplantation, 30.7% were listed in low volume pediatric centers. Most low volume pediatric centers are adult focused and near high volume pediatric centers. Conclusion We need greater scrutiny of outcomes, particularly waitlist outcomes, of low volume pediatric solid organ transplant centers located close to high volume pediatric solid organ transplant centers. Type of Study and Level of Evidence Retrospective Comparative Study, Level III.
- Published
- 2020
37. Biliary Atresia Patients With Successful Kasai Portoenterostomy Can Present With Features of Obliterative Portal Venopathy
- Author
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Kalyani R. Patel, Mihail Firan, Sadhna Dhingra, Norma M. Quintanilla, Zahida Khan, Sanjiv Harpavat, and John A. Goss
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Portoenterostomy, Hepatic ,Context (language use) ,Liver transplantation ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Biliary Atresia ,Biliary atresia ,Fibrosis ,030225 pediatrics ,Internal medicine ,Hypertension, Portal ,Humans ,Medicine ,business.industry ,Infant ,medicine.disease ,Liver Transplantation ,Stenosis ,Lymphatic system ,Pediatrics, Perinatology and Child Health ,Portal hypertension ,030211 gastroenterology & hepatology ,business ,Nodular regenerative hyperplasia - Abstract
OBJECTIVE Study of liver explants of biliary atresia (BA) patients with successful Kasai portoenterostomy (KP). METHODS Pathology and medical records of BA liver explants from January 2009 to June 2018 with successful KP were reviewed along with appropriate controls. RESULTS Fourteen out of 68 (20.6%) BA patients with LT had a successful KP. Median age at BA diagnosis, KP and LT was 60.5 days, 61 days, and 10 years, respectively, with conjugated bilirubin (c-bil) normalizing at 12.5 weeks after KP. Advanced fibrosis was diffuse in 2/14 (14.3%) explants, limited to periphery in 11/14 (78.6%) and absent in 1. Hilar partial nodular transformation (PNT) was seen in 11 explants (78.6%) and diffuse nodular regenerative hyperplasia (NRH) in 2 (14.3%). Areas of PNT and NRH showed diffuse portal sclerosis (100%), complete and incomplete portal vein (PV) stenosis (100%), PV herniation (100%), hypervascular portal tracts (20%), periportal abnormal vessels (100%), abundant lymphatic collaterals (100%), mild medial hepatic arterial hypertrophy (100%), and delicate fibrous septae (100%). Extrahepatic PVs showed variable luminal occlusion with mean PV intima to full thickness ratio of 0.6 +/- 0.11; significantly higher than age-matched noncirrhotic (n = 27, 0.08 +/- 0.09; P
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- 2020
38. Using Atomic Force Microscopy To Illuminate the Biophysical Properties of Microbes
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Catherine B. Volle and John W. Goss
- Subjects
Cantilever ,Materials science ,Atomic force microscopy ,Biochemistry (medical) ,technology, industry, and agriculture ,Biomedical Engineering ,Nanotechnology ,General Chemistry ,Adhesion ,Article ,Biomaterials ,Mechanobiology ,Cell stiffness ,Surface elasticity - Abstract
Since its invention in 1986, atomic force microscopy (AFM) has grown from a system designed for imaging inorganic surfaces to a tool used to probe the biophysical properties of living cells and tissues. AFM is a scanning probe technique and uses a pyramidal tip attached to a flexible cantilever to scan across a surface, producing a highly detailed image. While many research articles include AFM images, fewer include force-distance curves, from which several biophysical properties can be determined. In a single force-distance curve, the cantilever is lowered and raised from the surface, while the forces between the tip and the surface are monitored. Modern AFM has a wide variety of applications, but this review will focus on exploring the mechanobiology of microbes, which we believe is of particular interest to those studying biomaterials. We briefly discuss experimental design as well as different ways of extracting meaningful values related to cell surface elasticity, cell stiffness, and cell adhesion from force-distance curves. We also highlight both classic and recent experiments using AFM to illuminate microbial biophysical properties.
- Published
- 2019
39. The decreasing predictive power of MELD in an era of changing etiology of liver disease
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Ayse L. Mindikoglu, Elizabeth L. Godfrey, Abbas Rana, Christine A. O'Mahony, Ronald T. Cotton, Jennifer C. Lai, Tahir H Malik, N. Thao N. Galvan, and John A. Goss
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Concordance ,Fatty liver ,Immunosuppression ,Disease ,030230 surgery ,Liver transplantation ,medicine.disease ,body regions ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Internal medicine ,medicine ,Predictive power ,Etiology ,Immunology and Allergy ,Pharmacology (medical) ,business - Abstract
The field of liver transplantation has shifted considerably in the MELD era, including changing allocation, immunosuppression, and liver failure etiologies, as well as better supportive therapies. Our aim was to evaluate the predictive accuracy of the MELD score over time. The United Network for Organ Sharing provided de-identified data on 120 156 patients listed for liver transplant from 2002-2016. The ability of the MELD score to predict 90-day mortality was evaluated by a concordance (C-) statistic and corroborated with competing risk analysis. The MELD score's concordance with 90-day mortality has downtrended from 0.80 in 2003 to 0.70 in 2015. While lab MELD scores at listing and transplant climbed in that interval, score at waitlist death remained steady near 35. Listing age increased from 50 to 54 years. HCV-positive status at listing dropped from 33 to 17%. The concordance of MELD and mortality does not differ with age (>60 = 0.73
- Published
- 2019
40. Early Impact of MMaT-3 Policy on Liver Transplant Waitlist Outcomes for Hepatocellular Carcinoma
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Anjiya Shaikh, Karthik Goli, Nicole E. Rich, Jihane N. Benhammou, Saira Khaderi, Ruben Hernaez, Vatche G. Agopian, John M. Vierling, Donghee Kim, Aijaz Ahmed, John A. Goss, Abbas Rana, Fasiha Kanwal, and George Cholankeril
- Subjects
Transplantation - Abstract
To reduce the disparity in access to liver transplant (LT), United Network for Organ Sharing implemented an exception policy in May 2019, which capped hepatocellular carcinoma (HCC) exception score to the median Model for End-Stage Liver Disease (MELD) at transplant within the donor service area minus 3 points (MMaT-3) after the 6-mo wait period. We aimed to evaluate how this policy affected HCC waitlist outcomes.Using United Network for Organ Sharing data, we analyzed waitlist outcomes in HCC patients at the time they received exception points from in the pre-MMaT era (August 15, 2017, to November 15, 2018) and MMaT era (June 1, 2019, to August 30, 2020). Comparisons were made within the HCC group and HCC versus non-HCC (at time of listing) groups in the pre-MMaT and MMaT eras and regions were grouped as low, medium, and high MELD based on MMaT.HCC group: LT probability within HCC patients decreased by 20% (subhazard ratio [sHR], 0.78; 95% confidence interval [CI], 0.74-0.85) between the eras and decreased by 41% in low MELD regions (sHR, 0.59; 95% CI, 0.52-0.66). Waitlist dropout was unchanged. Matched HCC versus non-HCC groups: HCC patients had 80% higher LT probability (sHR, 1.84; 95% CI, 1.71-1.99) than non-HCC patients in the pre-MMaT era; which decreased to a 14% higher LT probability in MMaT era. In low and medium regions, HCC patients had over twofold higher LT probability in the pre-MMaT era, which decreased to a ~20% higher probability (sHR, 1.14; 95% CI, 1.06-1.23) in the MMaT era. After implementation of the acuity circle policy, HCC patients had lower LT probability (sHR, 0.84; 95% CI, 0.74-0.94) than non-HCC patients.The geographic disparity between HCC and non-HCC patients has improved with the MMaT-3 policy. Despite lower LT probability for HCC patients, waitlist dropout was not adversely impacted.
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- 2021
41. Health Expenditure Data, Analysis and Policy Relevance in Australia, 1967 to 2020
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John R. Goss
- Subjects
Health, Toxicology and Mutagenesis ,Health Policy ,Publications ,Public Health, Environmental and Occupational Health ,Academies and Institutes ,Australia ,Health Expenditures - Abstract
Since 1985, the Australian Institute of Health and Welfare (AIHW) has published 85 health expenditure publications. It has gradually extended the scope of these publications by extending the health accounts to detail expenditure by disease and age/sex, by State, Territory and remoteness and by Indigenous status. These enhanced health expenditure databases were then used to understand in detail the drivers of health expenditure. Understanding the drivers of health expenditure enables policy makers to understand where to intervene so as to maximise the health improvements that arise from health expenditure growth.
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- 2021
42. Marginal allografts in liver transplantation have a limited impact on length of stay
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Nhu Thao Nguyen Galvan, Malcolm F McDonald, Adrish Anand, George Cholankeril, Abbas Rana, Cameron R. Goff, Fasiha Kanwal, Theodore Zhang, John A. Goss, and Ruben Hernaez
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Transplantation ,medicine.medical_specialty ,Percentile ,Proportional hazards model ,business.industry ,medicine.medical_treatment ,Graft Survival ,Donation after cardiac death ,Length of Stay ,Liver transplantation ,Allografts ,Extended criteria ,Macrovesicular steatosis ,Tissue Donors ,Liver Transplantation ,surgical procedures, operative ,Internal medicine ,Risk index ,medicine ,Humans ,business ,Survival analysis ,Retrospective Studies - Abstract
The study of marginal liver transplant outcomes, including post-transplant length of stay (LOS), is necessary for determining the practicality of their use. 50,155 patients who received transplants from 2012 to 2020 were retrospectively analyzed with data from the Scientific Registry of Transplant Recipients database using Kaplan-Meier survival curves and multivariable Cox regression. Six different definitions were used to classify an allograft as being marginal: 90th percentile Donor Risk Index allografts, donation after cardiac death donors, national share donors, donors over 70, donors with >30% macrovesicular steatosis, or 90th percentile Discard Risk Index donors. 24% (n = 12,124) of subjects received marginal allografts. Average LOS was 15.6 days among those who received standard allografts. Among those who received marginal allografts, LOS was found to be highest in those who received 90th percentile Donor Risk Index allografts at 15.6 days, and lowest in those who received donation after cardiac death allografts at 12.7 days. Apart from fatty livers (95% CI 0.86 - 0.98), marginal allografts were not associated with a prolonged LOS. We conclude that accounting for experience and recipient matching, transplant centers may be more aggressive in their use of extended criteria donors with limited fear of increasing LOS and its associated costs. This article is protected by copyright. All rights reserved.
- Published
- 2021
43. Clinical Factors Associated With Lack of Serological Response to SARS‐CoV‐2 Messenger RNA Vaccine in Liver Transplantation Recipients
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Abbas Rana, Alsadiq Al-Hillan, Brandon Tarlow, John A. Goss, Jake S Jacobs, George Cholankeril, Norma P Flores, Fasiha Kanwal, and Daniela Abrams
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COVID-19 Vaccines ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,Booster dose ,Liver transplantation ,Antibodies, Viral ,Serology ,Immunity ,Medicine ,Humans ,RNA, Messenger ,Transplantation ,Messenger RNA ,Vaccines, Synthetic ,Hepatology ,business.industry ,SARS-CoV-2 ,Brief Report ,COVID-19 ,Transplant Recipients ,Liver Transplantation ,Vaccination ,Immunology ,Surgery ,mRNA Vaccines ,business ,Solid organ transplantation - Abstract
Recent preliminary data report lower serological response to SARS-CoV-2 mRNA vaccines in solid organ transplant (SOT) recipients (1, 2). There are no data on factors associated with lack of serological response in SOT recipients - information that could guide recommendations regarding booster dose and closer follow up. We evaluated the serological response to SARS-CoV-2 vaccination in liver transplant (LT) recipients.
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- 2021
44. The impact of diabetes on young transplant recipients: An American perspective
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Jackquelin M. Loera, Spencer C. Barrett, Theodore S. Zhang, Adrish Anand, Ahmed A. Y. Awan, Bhamidipati V. R. Murthy, Christine A. O'Mahony, John A. Goss, and Abbas A. Rana
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Adult ,Graft Rejection ,Adolescent ,Graft Survival ,General Medicine ,Transplant Recipients ,United States ,Cohort Studies ,Young Adult ,Treatment Outcome ,Nephrology ,Risk Factors ,Diabetes Mellitus ,Humans ,Retrospective Studies - Abstract
Despite advancements in diabetic care, diabetic kidney transplant recipients have significantly worse outcomes than non-diabetics.Our study aims to demonstrate the impact of diabetes, types I and II, on American young adults (18-40 years old) requiring kidney transplantation.Using the United Network for Organ Sharing database, we conducted a population cohort study that included all first-time, kidney-only transplant recipients during 2002-2019, ages 18-40 years old. Patients were grouped according to indication for transplant. Primary outcomes were cumulative all-cause mortality and death-censored graft failure. Death-censored graft failure and patient survival at 1, 5, and 10 years were calculated via the Kaplan-Meier method. Multivariate Cox regression was used to assess for potential confounders.Of 42 466 transplant recipients, 3418 (8.1%) had end-stage kidney disease associated with diabetes. At each time-point, cumulative mortality was higher in diabetics compared to patients with non-diabetic causes of renal failure. Conversely, cumulative graft failure was similar between the groups. Adjusted hazard ratios for all-cause mortality and graft failure in diabetics were 2.99 (95% CI 2.67-3.35; p .01) and 0.98 (95% CI 0.92-1.05, p .01), respectively.Diabetes mellitus in young adult kidney transplant recipients is associated with a nearly three-fold increase in mortality, reflecting a relatively vulnerable patient population. Identifying the underlying causes of poor outcomes in this population should be a priority for future study.
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- 2021
45. Three decades' analysis of pediatric liver transplantation outcomes reveals limited long‐term improvements
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Syed Bakhtiyar, Tahir H Malik, Abbas Rana, Ronald T. Cotton, N. Thao N. Galvan, Christine A. O'Mahony, Anjay Batra, and John A. Goss
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Male ,Pediatrics ,medicine.medical_specialty ,Orthotopic liver transplantation ,medicine.medical_treatment ,Liver transplantation ,Malignancy ,Risk Factors ,Outcome Assessment, Health Care ,medicine ,Humans ,In patient ,Child ,Retrospective Studies ,Cause of death ,Transplantation ,Proportional hazards model ,business.industry ,Immunosuppression ,medicine.disease ,Quality Improvement ,Liver Transplantation ,Survival Rate ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Background The aim of this study was to assess improvements in long-term survival of pediatric patients after liver transplantation by analyzing outcomes in transplant recipients who survived beyond 1 year after transplantation. There has been a marked increase in the 1-year survival of pediatric patients, from 78% in transplant recipients between 1987 and 1990 to 95% in transplant recipients between 2011 and 2017. The long-term outcomes have not seen a similar trend, creating a disparity that warrants analysis. Methods We analyzed 13 753 pediatric patients who survived for 1 year after receiving orthotopic liver transplantation between 1987 and 2017. The study period was divided into six eras. Outcomes were analyzed using the Kaplan-Meier method for time-to-event analysis, and multivariable Cox regression. Results There were no significant gains in long-term outcomes among 1-year survivors over the past three decades. Log-rank tests for equality of survivor functions between each era and 1987-1990 were not statistically significant. Cause of death analysis revealed that although infections caused 20.6% of deaths in patients transplanted between 1987 and 1990, this number dropped to 5.6% in those transplanted between 2011 and 2017 (p = .01). Malignancy caused 10.6% of deaths in 1987-1990 but caused 22.2% of the deaths in 2011-2017 (p = .04). Conclusion Despite the gratifying gains in short-term survival of pediatric patients, 1-year survivors have no significant improvements in long-term survival after undergoing a liver transplantation. Long-term sequelae of immunosuppression, such as malignancy and infection, continue to be the most common causes of death. This study highlights the necessity for better long-term management of immunosuppression.
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- 2021
46. Investigating lead removal at trace concentrations from water by inactive yeast cells
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Christos E. Athanasiou, Brian W. Sheldon, Nitin P. Padture, Camron Blackburn, John W. Goss, Andreas Mershin, Huajian Gao, Marios Tsezos, Patritsia Maria Stathatou, Eric M. Darling, Neil Gershenfeld, and Filippos Tourlomousis
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Adsorption ,Lead (geology) ,Chemistry ,Environmental chemistry ,Biosorption ,Biomass ,Water treatment ,Contamination ,Environmentally friendly ,Yeast - Abstract
Traces of heavy metals found in water resources, due to mining activities and e-waste discharge, pose a global threat. Conventional treatment processes fail to remove toxic heavy metals, such as lead, from drinking water in a resource-efficient manner when their initial concentrations are low. Here, we show that by using the yeast Saccharomyces cerevisiae we can effectively remove trace lead from water via a rapid mass transfer process, achieving an uptake of up to 12 mg lead per gram of biomass in solutions with initial lead concentrations below 1 part per million. We found that the yeast cell wall plays a crucial role in this process, with its mannoproteins and β-glucans being the key potential lead adsorbents. Furthermore, we discovered that biosorption is linked to a significant increase in cell wall stiffness. These findings open new opportunities for using environmentally friendly and abundant biomaterials for advanced water treatment targeting emerging contaminants.One-Sentence SummaryRemoving toxic heavy metals from water at challenging trace levels in an environmentally friendly, resource-efficient manner.
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- 2021
47. Trends in Survival for Pediatric Transplantation
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Brian Hickner, Adrish Anand, Elizabeth L. Godfrey, Jordan Dunson, Ross M. Reul, Ronald Cotton, Nhu Thao Nguyen Galvan, Christine O’Mahony, John A. Goss, and Abbas Rana
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Male ,Tissue and Organ Procurement ,Adolescent ,Waiting Lists ,Kidney Transplantation ,Tissue Donors ,Liver Transplantation ,Survival Rate ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Heart Transplantation ,Humans ,Female ,Child ,Follow-Up Studies ,Retrospective Studies - Abstract
OBJECTIVES Progress in pediatric transplantation measured in the context of waitlist and posttransplant survival is well documented but falls short of providing a complete perspective for children and their families. An intent-to-treat analysis, in which we measure survival from listing to death regardless of whether a transplant is received, provides a more comprehensive perspective through which progress can be examined. METHODS Univariable and multivariable Cox regression was used to analyze factors impacting intent-to-treat survival in 12 984 children listed for heart transplant, 17 519 children listed for liver transplant, and 16 699 children listed for kidney transplant. The Kaplan-Meier method and log-rank test were used to assess change in waitlist, posttransplant, and intent-to-treat survival. Wait times and transplant rates were compared by using χ2 tests. RESULTS Intent-to-treat survival steadily improved from 1987 to 2017 in children listed for heart (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.96–0.97), liver (HR 0.95, 95% CI 0.94–0.97), and kidney (HR 0.97, 95% CI 0.95–0.99) transplant. Waitlist and posttransplant survival also improved steadily for all 3 organs. For heart transplant, the percentage of patients transplanted within 1 year significantly increased from 1987 to 2017 (60.8% vs 68.7%); however, no significant increase was observed in liver (68.9% vs 72.5%) or kidney (59.2% vs 62.7%) transplant. CONCLUSIONS Intent-to-treat survival, which is more representative of the patient perspective than individual metrics alone, steadily improved for heart, liver, and kidney transplant over the study period. Further efforts to maximize the donor pool, improve posttransplant outcomes, and optimize patient care while on the waitlist may contribute to future progress.
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- 2021
48. The use of tracheostomy to support critically ill children receiving orthotopic liver transplantation: a single‐center experience
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Moreshwar S. Desai, Trung C. Nguyen, Muhammad Umair M. Mian, Fong Lam, Abbas Rana, Sanjiv Harpavat, Dalia Bashir, Buria Naeem, Ayse Akcan Arikan, Manpreet Virk, Jorge A. Coss-Bu, Tiffany Raynor, Thomas Fogarty, Daniel Leung, Curtis Kennedy, and John A. Goss
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Male ,medicine.medical_specialty ,Adolescent ,Critical Care ,Critical Illness ,Multiple Organ Failure ,medicine.medical_treatment ,Liver transplantation ,Single Center ,Perioperative Care ,End Stage Liver Disease ,Liver disease ,Tracheostomy ,medicine ,Humans ,Intubation ,Renal replacement therapy ,Child ,Retrospective Studies ,Mechanical ventilation ,Transplantation ,Critically ill ,business.industry ,Infant, Newborn ,Infant ,Perioperative ,medicine.disease ,Survival Analysis ,Liver Transplantation ,Surgery ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Background Children with end-stage liver disease and multi-organ failure, previously considered as poor surgical candidates, can now benefit from liver transplantation (LT). They often need prolonged mechanical ventilation (MV) post-LT and may need tracheostomy to advance care. Data on tracheostomy after pediatric LT are lacking. Method Retrospective chart review of children who required tracheostomy in the peri-LT period in a large, freestanding quaternary children's hospital from 2014 to 2019. Results Out of 205 total orthotopic LTs performed in 200 children, 18 (9%) required tracheostomy in the peri-transplant period: 4 (2%) pre-LT and 14 (7%) post-LT. Among those 14 needing tracheostomy post-LT, median age was 9 months [IQR = 7, 14] at LT and 10 months [9, 17] at tracheostomy. Nine (64%) were infants and 12 (85%) were cirrhotic at the time of LT. Seven (50%) were intubated before LT. Median MV days prior to LT was 23 [7, 36]. Eight (57%) patients received perioperative continuous renal replacement therapy (CRRT). The median MV days from LT to tracheostomy was 46 [33, 56]; total MV days from initial intubation to tracheostomy was 57 [37, 66]. Four (28%) children died, of which 3 (21%) died within 1 year of transplant. Total ICU and hospital length of stay were 92 days [I72, 126] and 177 days [115, 212] respectively. Among survivors, 3/10 (30%) required MV at home and 8/10 (80%) were successfully decannulated at 400 median days [283, 584]. Conclusion Tracheostomy though rare after LT remains a feasible option to support and rehabilitate critically ill children who need prolonged MV in the peri-LT period.
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- 2021
49. Practical Consideration for Drug Monitoring of Tacrolimus in Liver Transplantation Recipients with SARS-CoV-2 Infection
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Tejas P Joshi, Abbas Rana, George Cholankeril, Fasiha Kanwal, John A. Goss, and John M. Vierling
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medicine.medical_treatment ,Liver transplantation ,Tacrolimus ,medicine ,Humans ,Interleukin 6 ,Transplantation ,Hepatology ,CYP3A4 ,biology ,business.industry ,SARS-CoV-2 ,Brief Report ,COVID-19 ,Transplant Recipients ,Liver Transplantation ,Calcineurin ,Cytokine ,Immunology ,biology.protein ,Surgery ,Tumor necrosis factor alpha ,Drug Monitoring ,business ,Drug metabolism ,Immunosuppressive Agents - Abstract
Previous studies have shown that infection-related cytokine increase of interleukin 6 (IL-6) and tumor necrosis factor-α (TNF- α) can cause suppression of cytochrome P450 3A4 (CYP3A4) enzymes.1 SARS-CoV-2 infection has been associated with increased cytokine levels which may suggest suppression of CYP3A4 enzymes and downstream interaction with CYP-mediated drug metabolism including calcineurin inhibitors.
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- 2021
50. Allograft discard risk index for heart transplantation
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Christian N Keller, Todd K. Rosengart, Tahir H Malik, Ross M. Reul, John A. Goss, Abbas Rana, and Asad A Saleem
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medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,Donor Selection ,Risk Factors ,Risk index ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Child ,Heart transplantation ,Transplantation ,Ejection fraction ,business.industry ,Graft Survival ,Allografts ,medicine.disease ,Tissue Donors ,Mortality data ,Donation ,Heart Transplantation ,Heart donor ,business - Abstract
The number of patients awaiting heart transplantation (HTx) substantially exceeds the number of donor hearts transplanted each year, yet nearly 65% of eligible donor hearts are discarded rather than transplanted. Deceased organ donors listed within the UNOS Deceased Donor Database between 2010 and 2020 were reviewed. Those greater than 10 years old and consented for heart donation were included and randomly separated into training (n = 48,435) and validation (n = 24,217) cohorts. A discard risk index (DSRI) was created using the results of univariable and multivariable analyses. Discard data were assessed at DSRI value deciles, and stratum-specific likelihood ratio (SSLR) analysis and Kaplan-Meier survival function were used for mortality data. Factors associated with higher DSRI values included donor age > 45, LVEF, HBV-core antibodies, hypertension, and diabetes. The DSRI C-statistic was 0.906 in the training cohort and 0.904 in the validation cohort. The DSRI did not reliably predict 30-day or 1-year mortality after transplantation (C-statistic 0.539 & 0.532, respectively). The factors leading to heart allograft discard are not correlated to the same degree with post-transplant outcomes. This suggests that optimizing utilization of certain allografts with slightly higher risk of discard could increase the heart donor pool with limited impact on posttransplant mortality. This article is protected by copyright. All rights reserved.
- Published
- 2021
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