81 results on '"Kim-Schluger L"'
Search Results
2. Reanimating the hepatectomized liver: a novel use for normothermic machine preservation
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Todd, R., primary, van Leeuwen, L., additional, Puleston, D., additional, Holzner, M., additional, Tabrizian, P., additional, DiNorcia, J., additional, Rocha, C., additional, Arvelakis, A., additional, Facciuto, M., additional, Schwartz, M., additional, Kim-Schluger, L., additional, Florman, S., additional, and Akhtar, Z., additional
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- 2024
- Full Text
- View/download PDF
3. Early Liver Transplantation for Severe Alcoholic Hepatitis in the United States—A Single-Center Experience
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Im, G.Y., Kim-Schluger, L., Shenoy, A., Schubert, E., Goel, A., Friedman, S.L., Florman, S., and Schiano, T.D.
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- 2016
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4. Six Week Visit With Multidisciplinary Team Improves Long Term Adherence to Live Kidney Donor Follow-Up.: Abstract# A315
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Rudow, LaPointe D., Weinberg, A., Sahn, C., Davis, M., Kim-Schluger, L., Haydel, B., and Rocca, J.
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- 2014
5. Life or Death Awaiting Liver Transplantation at One Center in Region 9: An Accident of Geography Based upon Socioeconomic Factors.: Abstract# 1654: Poster Board #-Session: P216-IV
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Schwartz, A., Kim-Schluger, L., and Florman, S.
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- 2012
6. Midline Mini-Laparotomy for Living Donor Hepatectomy.: Abstract# 1400: Poster Board #-Session: P267-III
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Singh, M., Contreras-Saldivar, A., Rudow, D., Rocca, J., Kim-Schluger, L., Florman, S., Schwartz, M., and Facciuto, M.
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- 2012
7. Accurate method for clinical assessment of right lobe liver weight in adult living-related liver transplant
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Gondolesi, G.E., Yoshizumi, T., Bodian, C., Kim-Schluger, L., Schiano, T., Fishbein, T., Schwartz, M., Miller, C., and Emre, S.
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- 2004
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8. Use of mycophenolate mofetil in liver transplant recipients experiencing renal dysfunction on cyclosporine or tacrolimus—randomized, prospective, multicenter study results
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Hodge, E.E, Reich, D.J, Clavien, P.A, and Kim-Schluger, L
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- 2002
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9. Six Week Visit With Multidisciplinary Team Improves Long Term Adherence to Live Kidney Donor Follow-Up.
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Rudow, LaPointe D., primary, Weinberg, A., additional, Sahn, C., additional, Davis, M., additional, Kim-Schluger, L., additional, Haydel, B., additional, and Rocca, J., additional
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- 2014
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10. Isolated intestinal transplantation in adults with nonreconstructible GI tracts
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Fishbein, T, Schiano, T, Jaffe, D, Kim-Schluger, L, Facciuto, M, Emre, S, Sheiner, P, Schwartz, M, O’Rourke, M, and Miller, C
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- 2000
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11. A combination of capecitabine and thalidomide in patients with hepatocellular carcinoma
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Jeong, W., primary, Chun, H. G., additional, Cer, D., additional, Sekhri, V., additional, Kim-Schluger, L., additional, and Wolf, D., additional
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- 2006
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12. A pilot trial of chemo-embolization of hepatocellular carcinoma using a mixture of docetaxel and polyvinyl alcohol particles
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Chun, H. G., primary, Rozenblit, G. N., additional, Crea, G. A., additional, Maddineni, S., additional, Sauerland, C., additional, Kim-Schluger, L., additional, and Wolf, D. C., additional
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- 2005
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13. Transmission of factor VII deficiency through liver transplantation
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Guy, S.R., primary, Magliocca, J. F., additional, Fruchtman, S., additional, McDonough, P., additional, Emre, S., additional, Kim-Schluger, L., additional, Sheiner, P. A., additional, Fishbein, T. M., additional, Schwartz, M. E., additional, Miller, C. M., additional, Schwartz, M.E., additional, and Miller, CM., additional
- Published
- 1999
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14. LIVER TRANSPLANTATION USING LEFT LOBE GRAFTS FROM LIVING ADULT DONORS IN ADULT RECIPIENTS: PRELIMINARY EXPERIENCE
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Miller, C. M., primary, Emre, S., additional, Ben-Haim, M., additional, Sheiner, P. A., additional, Fishbein, T. M., additional, Kim-Schluger, L., additional, and Schwartz, M. E., additional
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- 1999
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15. Autoimmune hepatitis in the liver allografts of patients transplanted for PBC and overlap syndrome
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Saxena, R., primary, Kim Schluger, L., additional, Klion, F., additional, Scheiner, P., additional, Thung, S., additional, and Bodenheimer, H.C., additional
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- 1998
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16. 201Tolerability and efficacy of interferon-ribavirin therapy for recurrent hepatitis C
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Sheiner, P.A., Busittil, A., Matsumoto, C.S., Kim-Schluger, L., Emre, S., Fishbein, T.M., Facciulo, M., Schwartz, M.E., and Miller, C.M.
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- 2000
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17. 18 Impact of portal vein thrombosis on liver transplantation: Long-term follow-up of a large series
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Fishbein, T.M., Ben-Haim, M., Hiltzig, D., Emre, S., Sheiner, P.A., Kim-Schluger, L., Schwartz, M.E., and Miller, C.M.
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- 2000
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18. Unsuspected bile duct paucity in donors for living-related liver transplantation: two case reports.
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Gurkan, A., Emre, S., Fishbein, T.M., Brady, L., Millis, M., Birnbaum, A., Kim-Schluger, L., and Sheiner, P.A.
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- 1999
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19. Age added to MELD or ACLF predicts survival in patients with alcohol-associated hepatitis declined for liver transplantation.
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Rutledge SM, Nathani R, Wyatt BE, Eschbach E, Trivedi P, Kerznerman S, Chu L, Schiano TD, Kim-Schluger L, Florman S, and Im GY
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- Humans, Male, Female, Middle Aged, Adult, Age Factors, Retrospective Studies, Patient Selection, Prognosis, Liver Transplantation mortality, Hepatitis, Alcoholic mortality, Hepatitis, Alcoholic surgery, Hepatitis, Alcoholic complications, Acute-On-Chronic Liver Failure mortality, Acute-On-Chronic Liver Failure surgery, Waiting Lists mortality, Severity of Illness Index
- Abstract
Background: Severe alcohol-associated hepatitis (AH) that is nonresponsive to corticosteroids is associated with high mortality, particularly with concomitant acute-on-chronic liver failure (ACLF). Most patients will not be candidates for liver transplantation (LT) and their outcomes are largely unknown. Our aim was to determine the outcomes of these declined candidates and to derive practical prediction models for transplant-free survival applicable at the time of the waitlist decision., Methods: We analyzed a database of patients with severe AH who were hospitalized at a LT center from January 2012 to July 2021, using the National Death Index for those lacking follow-up. Clinical variables were analyzed based on the endpoints of mortality at 30, 60, 90, and 180 days. Logistic and Cox regression analyses were used for model derivation., Results: Over 9.5 years, 206 patients with severe AH were declined for LT, mostly for unfavorable psychosocial profiles, with a mean MELD of 33 (±8), and 61% with ACLF. Over a median follow-up of 521 (17.5-1368) days, 58% (119/206) died at a median of 21 (9-124) days. Of 32 variables, only age added prognostic value to MELD and ACLF grade. CLIF-C ACLF score and 2 new models, MELD-Age and ACLF-Age, had similar predictability (AUROC: 0.73, 0.73, 0.72, respectively), outperforming Lille and Maddrey's (AUROC: 0.63, 0.62). In internal cross-validation, the average AUROC was 0.74. ACLF grade ≥2, MELD score >35, and age >45 years were useful cutoffs for predicting increased 90-day mortality from waitlist decision. Only two patients initially declined for LT for AH subsequently underwent LT (1%)., Conclusions: Patients with severe AH declined for LT have high short-term mortality and rare rates of subsequent LT. Age added to MELD or ACLF grade enhances survival prediction at the time of waitlist decision in patients with severe AH declined for LT., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.)
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- 2024
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20. The Potential of Machine Learning to Predict Early Allograft Dysfunction after Normothermic Machine Perfusion in Liver transplantation.
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van Leeuwen LL, Irizar H, Kim-Schluger L, Florman S, and Akhtar MZ
- Abstract
Competing Interests: Conflict of interest statement: No conflicts of interests to declare.
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- 2024
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21. Impact of race-neutral eGFR calculations on African American kidney transplant candidate wait time: A single center retrospective analysis.
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Khaim R, Todd R, Rosowicz A, Shapiro R, Florman S, Kim-Schluger L, and Tedla F
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- Humans, Black or African American, Glomerular Filtration Rate, Retrospective Studies, United States, Kidney Transplantation, Tissue and Organ Procurement, Waiting Lists
- Abstract
Race-inclusive estimated glomerular filtration rate (eGFR) could contribute to racial disparity in access to kidney transplantation. The Organ Procurement and Transplantation Network (OPTN) issued a policy allowing waiting time modification for candidates affected by race-inclusive eGFR calculations. Implementation of the new OPTN policy at the kidney transplant program of the Mount Sinai Hospital involved review of 921 African American candidates, of whom 240 (26%) candidates gained a median of 1 year and 10 months. The duration of time candidates gained varied from a minimum of 5 days to a maximum of 12 years and 3 months; 45.4% gained at least 2 years, and 12% gained at least 4 years of wait time. Among those who gained wait time, 20 (8.3%) candidates received deceased donor kidney transplants. Candidates who gained wait time had similar sociodemographic characteristics as those who did not, except that the median age for the former was higher by 3 years (59 vs. 56). Our early data suggest that the current policy on waiting time modification for candidates affected by race-inclusive estimation of GFR has the potential to improve racial disparity in access to kidney transplantation. However, the generalizability of our findings to other centers requires further study., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2024
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22. Outcomes for salvage abdominal stereotactic body radiation therapy for hepatocellular carcinoma after liver transplantation.
- Author
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Stephens CR, Bloom JR, Lehrer EJ, Sheu RD, Tabrizian P, Rocha C, Kim-Schluger L, Florman SS, and Buckstein MH
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- Humans, Salvage Therapy, Retrospective Studies, Treatment Outcome, Carcinoma, Hepatocellular radiotherapy, Carcinoma, Hepatocellular surgery, Liver Neoplasms radiotherapy, Liver Neoplasms surgery, Liver Transplantation adverse effects, Radiosurgery adverse effects
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- 2023
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23. Recurrent Liver Allograft Injury in Patients With Donor-Derived Malignancy Treated With Immunosuppression Cessation and Retransplantation.
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Lee BT, Ganjoo N, Fiel MI, Hechtman JF, Sarkar SA, Kim-Schluger L, Florman SS, and Schiano TD
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- Allografts, Graft Rejection pathology, Humans, Immunosuppression Therapy, Liver pathology, Reoperation, Liver Transplantation adverse effects, Neoplasms pathology
- Abstract
Objectives: Donor-derived malignancy of the liver allograft is a rare but serious condition in the setting of necessary immunosuppression. Retransplantation after abrupt immunosuppression cessation has been performed with durable cancer-free survival., Methods: We present 2 cases of patients with donor-derived malignancy who were treated with complete immunosuppression cessation, which induced rapidly progressive liver allograft rejection and failure, with a need for subsequent retransplantation. We reviewed all serial liver biopsies and explants from both patients and performed C4d immunostaining., Results: Initial explants of both patients showed severe allograft rejection, with unusual features of sinusoidal obstruction syndrome and C4d positivity. Malignant tumors in the explants were necrotic, related to rejection of donor-derived cancer cells and tissue. Follow-up of both patients has shown long-term cancer-free survival but issues with recurrent allograft failure requiring a third transplant. The reasons for retransplantation in both cases were related to allograft failure from antibody-mediated rejection., Conclusions: Clinicians should be aware of a potentially increased risk of rejection and recurrent allograft failure when strategizing treatment of donor-derived malignancy with immunosuppression cessation and retransplantation., (© The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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24. Two hundred and fifty-one right hepatectomies for living donation: Association between preoperative risk factors, hepatic dysfunction, and complications.
- Author
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Mahamid A, Fenig Y, Amodeo S, Kozato A, Facciuto M, Ahmad J, Kim-Schluger L, Florman S, Schiano T, and Facciuto M
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- Adult, Female, Hepatectomy adverse effects, Hepatectomy methods, Humans, Liver diagnostic imaging, Liver surgery, Living Donors, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Liver Diseases surgery, Liver Transplantation adverse effects, Liver Transplantation methods
- Abstract
Background: Donor safety is essential in living donor liver transplantation. In this study we assessed the association among perioperative factors, liver dysfunction, and complications in 251 consecutives right hepatectomies for living donation., Methods: Retrospectively collected data from a prospectively assembled cohort of 251 consecutive living donors who underwent right hepatectomy between 1999 and 2020 were evaluated., Results: Median age was 36 years; 54% were men. There was a statistically significant relationship between standardized liver volume by body surface area and the volumes calculated by imaging, weighting, and volume displacement. (r
2 = 0.40, r2 = 0.34, and r2 = 0.34, respectively), with the relationship between standardized liver volume and liver volume by imaging being the strongest. The median remnant liver volume was 35%. Fifty-eight donors (23%) developed postoperative hepatic dysfunction, which was associated with increased length of stay (P = .04), and complications (P < .01). Men had a 2.5 times higher chance of developing postoperative hepatic dysfunction. Age >50 years was an independent predictor of increased bilirubin at postoperative day 4 (P < .01), and remnant liver volume was inversely associated with higher peak international normalized ratio (P < .01). Eighty-one donors (32%) experienced complications. Postoperative hepatic dysfunction was associated with 2.4 times higher chances of complications (odds ratio = 2.4, P < .01)., Conclusion: Early postoperative hepatic dysfunction is associated with the development of post-live liver donor complications. A thoughtful balancing of preoperative risk factors for postoperative hepatic dysfunction may indeed and by association reduce postoperative complications., (Copyright © 2022 Elsevier Inc. All rights reserved.)- Published
- 2022
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25. Extensive Health Care Utilization and Costs of an Early Liver Transplantation Program for Alcoholic Hepatitis.
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Im GY, Vogel AS, Florman S, Nahas J, Friedman SL, Aqui S, Ford L, Mirza O, Kim-Schluger L, and Schiano TD
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- Databases, Factual, Delivery of Health Care, Humans, Patient Acceptance of Health Care, Hepatitis, Alcoholic diagnosis, Hepatitis, Alcoholic surgery, Liver Transplantation adverse effects
- Abstract
Early liver transplantation (LT) for severe alcoholic hepatitis (AH) is a rescue therapy for highly selected patients with favorable psychosocial profiles not responding to medical therapy. Given the expected increase of AH candidate referrals requiring complex care and comprehensive evaluations, increased workload and cost might be expected from implementing an early LT program for AH but have not been determined. Some centers may also view AH as a strategy to expeditiously increase LT volume and economic viability. The aim of this study was to determine the health care use and costs of an early LT program for AH. Analyses of prospective databases of AH, interhospital transfers, and the hospital accounting system at a single center were performed from July 2011 to July 2016. For 5 years, 193 patients with severe AH were evaluated at our center: 143 newly referred transfers and 50 direct admissions. Annual increases of 13% led to 2 to 3 AH transfers/month and AH becoming the top reason for transfer. There were 169 (88%) nonresponders who underwent psychosocial evaluations; 15 (9%) underwent early LT. The median cost of early LT was $297,422, which was highly correlated with length of stay (r = 0.83; P < 0.001). Total net revenue of the program from LT admission to 90 days after LT was -$630,305 (-5.0% revenue), which was inversely correlated with MELD score (r = -0.70; P = 0.004) and yielded lower revenue than a contemporaneous LT program for acute-on-chronic liver failure (ACLF; $118,168; 1.4% revenue; P = 0.001). The health care use and costs of an early LT program for AH are extensive and lifesaving with marginally negative net revenue. Significantly increasing care of severe AH patients over 5 years resulted in increased LT volume, but at a lower rate than ACLF, and without improving economic outcomes due to high MELD and prolonged length of stay., (Copyright © 2021 American Association for the Study of Liver Diseases.)
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- 2022
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26. The International Liver Transplant Society Guideline on Living Liver Donation.
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Miller CM, Durand F, Heimbach JK, Kim-Schluger L, Lee SG, Lerut J, Lo CM, Quintini C, and Pomfret EA
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- Biopsy, Evidence-Based Medicine, Graft Survival, Hepatectomy methods, Hepatic Veins surgery, Humans, Informed Consent, International Cooperation, Laparoscopy, Randomized Controlled Trials as Topic, Risk, Tissue and Organ Procurement standards, Treatment Outcome, Liver Transplantation methods, Liver Transplantation standards, Living Donors, Tissue and Organ Procurement methods
- Abstract
The following guideline represents the position of the International Liver Transplantation Society (ILTS) on key preoperative, operative, and postoperative aspects surrounding living liver donation. These recommendations were developed from experts in the field from around the world. The authors conducted an analysis of the National Library of Medicine indexed literature on "living donor liver transplantation" [Medline search] using Grading of Recommendations Assessment, Development and Evaluation methodology. Writing was guided by the ILTS Policy on the Development and Use of Practice Guidelines (www.ilts.org). ILTS members, and many more nonmembers, were invited to comment. Recommendations have been based on information available at the time of final submission (March 2016). The lack of randomized controlled trials in this field to date is acknowledged and is reflected in the grading of evidence. Intended for use by physicians, these recommendations support specific approaches to the diagnostic, therapeutic, and preventive aspects of care.
- Published
- 2016
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27. Hepatic decompensation/serious adverse events in post-liver transplantation recipients on sofosbuvir for recurrent hepatitis C virus.
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Patel N, Bichoupan K, Ku L, Yalamanchili R, Harty A, Gardenier D, Ng M, Motamed D, Khaitova V, Bach N, Chang C, Grewal P, Bansal M, Agarwal R, Liu L, Im G, Leong J, Kim-Schluger L, Odin J, Ahmad J, Friedman S, Dieterich D, Schiano T, Perumalswami P, and Branch A
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- Adult, Aged, Anemia chemically induced, Drug Therapy, Combination, End Stage Liver Disease diagnosis, End Stage Liver Disease virology, Female, Hepacivirus pathogenicity, Hepatitis C diagnosis, Hepatitis C virology, Humans, Kaplan-Meier Estimate, Liver Failure diagnosis, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Recurrence, Ribavirin adverse effects, Risk Factors, Time Factors, Treatment Outcome, Virus Activation drug effects, Antiviral Agents adverse effects, End Stage Liver Disease surgery, Hepacivirus drug effects, Hepatitis C drug therapy, Liver Failure chemically induced, Liver Transplantation adverse effects, Sofosbuvir adverse effects
- Abstract
Aim: To determine the safety profile of new hepatitis C virus (HCV) treatments in liver transplant (LT) recipients with recurrent HCV infection., Methods: Forty-two patients were identified with recurrent HCV infection that underwent LT at least 12 mo prior to initiating treatment with a Sofosbuvir-based regimen during December 2013-June 2014. Cases were patients who experienced hepatic decompensation and/or serious adverse events (SAE) during or within one month of completing treatment. Controls had no evidence of hepatic decompensation and/or SAE. HIV-infected patients were excluded. Cumulative incidence of decompensation/SAE was calculated using the Kaplan Meier method. Exact logistic regression analysis was used to identify factors associated with the composite outcome., Results: Median age of the 42 patients was 60 years [Interquartile Range (IQR): 56-65 years], 33% (14/42) were female, 21% (9/42) were Hispanic, and 9% (4/42) were Black. The median time from transplant to treatment initiation was 5.4 years (IQR: 2.1-8.8 years). Thirteen patients experienced one or more episodes of hepatic decompensation and/or SAE. Anemia requiring transfusion, the most common event, occurred in 62% (8/13) patients, while 54% (7/13) decompensated. The cumulative incidence of hepatic decompensation/SAE was 31% (95%CI: 16%-41%). Risk factors for decompensation/SAE included lower pre-treatment hemoglobin (OR = 0.61 per g/dL, 95%CI: 0.40-0.88, P < 0.01), estimated glomerular filtration rate (OR = 0.95 per mL/min per 1.73 m(2), 95%CI: 0.90-0.99, P = 0.01), and higher baseline serum total bilirubin (OR = 2.43 per mg/dL, 95%CI: 1.17-8.65, P < 0.01). The sustained virological response rate for the cohort of 42 patients was 45%, while it was 31% for cases., Conclusion: Sofosbuvir/ribavirin will continue to be used in the post-transplant population, including those with HCV genotypes 2 and 3. Management of anemia remains an important clinical challenge.
- Published
- 2016
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28. Utility of the low-accelerating-dose regimen in 182 liver recipients with recurrent hepatitis C virus.
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Lim KB, Sima HR, Fiel MI, Khaitova V, Doucette JT, Chernyiak M, Ahmad J, Bach N, Chang C, Grewal P, Kim-Schluger L, Liu L, Odin J, Perumalswami P, Florman SS, and Schiano TD
- Subjects
- Antiviral Agents adverse effects, Biopsy, Disease Progression, Drug Therapy, Combination, End Stage Liver Disease diagnosis, End Stage Liver Disease virology, Female, Genotype, Graft Survival, Hepacivirus genetics, Hepacivirus growth & development, Hepatitis C complications, Hepatitis C diagnosis, Hepatitis C genetics, Hepatitis C mortality, Humans, Interferon-alpha adverse effects, Interferons, Interleukins genetics, Liver Transplantation mortality, Male, Middle Aged, New York City, Polyethylene Glycols adverse effects, Proportional Hazards Models, Recombinant Proteins administration & dosage, Recombinant Proteins adverse effects, Recurrence, Retrospective Studies, Ribavirin adverse effects, Risk Factors, Time Factors, Treatment Outcome, Viral Load, Virus Activation drug effects, Antiviral Agents administration & dosage, End Stage Liver Disease surgery, Hepacivirus drug effects, Hepatitis C drug therapy, Interferon-alpha administration & dosage, Liver Transplantation adverse effects, Polyethylene Glycols administration & dosage, Ribavirin administration & dosage
- Abstract
Aim: To describe our experience using a low-accelerating-dose regimen (LADR) with pegylated interferon alpha-2a and ribavirin in treatment of hepatitis C virus (HCV) recurrence., Methods: From 2003, a protocolized LADR strategy was employed to treat liver transplant (LT) recipients with recurrent HCV at our institution. Medical records of 182 adult patients with recurrent HCV treated with LADR between 1/2003 and 1/2011 were reviewed. Histopathology from all post-LT liver biopsies were reviewed in a blinded fashion. Paired recipient and donor IL28B status were assessed. A novel technique was employed to ascertain recipient and donor IL28B (rs12979860) Gt data using DNA extracted from archival FFPE tissue from explanted native livers and donor gallbladders respectively. The primary endpoint was SVR; secondary endpoints examined include (1) patient and graft survival; (2) effect of anti-viral therapy on liver histology (fibrosis and inflammation); (3) incidence of on-treatment development of ACR, CDR, or PCH; (4) association of recipient and donor IL28B genotype with SVR; and (5) incidence of anti-viral therapy-associated adverse events (anemia, leukopenia, thrombocytopenia, depression) and hepatic decompensation., Results: The overall SVR rate was 38% (29% Gt1, 67% Gt2, 86% Gt3 and 58% Gt4). HCV Gt (P < 0.0001), donor age (P = 0.003), cytomegalovirus mismatch (P = 0.001), baseline serum bilirubin (P = 0.002), and baseline viral load (P = 0.04) were independent predictors for SVR. SVR rates were significantly higher in the recipient-CC/donor-non CC pairs (P = 0.007). Neither baseline fibrosis nor change in fibrosis stage after anti-viral therapy were associated with SVR. Fibrosis progressed in 72% of patients despite SVR. Median graft survival was 91 mo. Five-year patient survival was superior in patients who achieved SVR (97% vs 82%, P = 0.001). Pre-treatment ALP ≥ 150 U/L (P = 0.01), total bilirubin ≥ 1.5 mg/dL (P = 0.001) and creatinine ≥ 2 mg/dL (P = 0.001) were independently associated with patient survival. Only 13% of patients achieving SVR died during the follow-up period. Treatment discontinuation and treatment-related mortality occurred in 35% and 2.2% of patients, respectively. EPO, G-CSF and blood transfusion were needed in 89%, 40% and 23% of patients, respectively. Overall hospitalization rate for treatment-related serious adverse events was 21%. Forty-six (25%) of the patients were deceased; among those who died, 25 (54%) were due to liver-related complications, and 4 deaths (9%) occurred while receiving therapy (2 patients experienced hepatic decompensation and 2 sepsis)., Conclusion: LADR strategy remains relevant in managing post-LT recurrent HCV where access to DAAs is limited. SVR is associated with improved survival, but fibrosis progression still occurs.
- Published
- 2015
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29. Segment 4 and the left lateral segment regeneration pattern after resection of the middle hepatic vein in a living donor right hepatectomy.
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Lubezky N, Oyfe I, Contreras AG, Rocca JP, Rudow DL, Keegan T, Taouli B, Kim-Schluger L, Florman S, Schiano T, and Facciuto M
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- Adult, Body Mass Index, Female, Hepatic Veins diagnostic imaging, Hepatic Veins physiopathology, Humans, Liver diagnostic imaging, Liver pathology, Liver Circulation, Liver Transplantation adverse effects, Magnetic Resonance Imaging, Male, Organ Size, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Sex Factors, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Hepatectomy adverse effects, Hepatic Veins surgery, Liver blood supply, Liver surgery, Liver Regeneration, Liver Transplantation methods, Living Donors
- Abstract
Background: Inclusion of the middle hepatic vein (MHV) with a right hepatectomy (RH) in live donor liver transplantation improves venous drainage of the anterior sector of the graft. Its long-term effects on donor left liver (LL) regeneration are not well described., Methods: Donors who underwent RH with MHV (MHV+, n = 12) were compared with donors who underwent RH with preservation of the MHV (MHV-, n = 24). Peri-operative complications and volume of the entire liver and individual segments were evaluated at 1 year post-donation., Results: There was a trend towards a higher complication rate in the MHV+ group (41% versus 25%), without reaching statistical significance (P = 0.3). Males, high body mass index (BMI) and a smaller residual liver volume (RLV) were predictors for greater LL regeneration. MHV+ donors had impaired regeneration of segment 4 (S4) at 1 year, and compensatory greater left lateral segment regeneration. The absence of venous drainage of S4 (V4) to left hepatic vein (LHV) was a predictor of impaired S4 regeneration., Conclusions: Regeneration of S4 is impaired in MHV+ donors. Caution should be taken when considering MHV removal on donors with dominant S4, especially on those with potential increased demand for liver regeneration, such as males, higher BMI and a smaller RLV., (© 2014 International Hepato-Pancreato-Biliary Association.)
- Published
- 2015
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30. Tumors with intrahepatic bile duct differentiation in cirrhosis: implications on outcomes after liver transplantation.
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Facciuto ME, Singh MK, Lubezky N, Selim MA, Robinson D, Kim-Schluger L, Florman S, Ward SC, Thung SN, Fiel M, and Schiano TD
- Subjects
- Bile Duct Neoplasms etiology, Bile Duct Neoplasms mortality, Bile Duct Neoplasms pathology, Bile Ducts, Intrahepatic pathology, Carcinoma, Hepatocellular etiology, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Cholangiocarcinoma etiology, Cholangiocarcinoma mortality, Cholangiocarcinoma pathology, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Liver Cirrhosis complications, Liver Cirrhosis diagnosis, Liver Cirrhosis mortality, Liver Neoplasms etiology, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Bile Duct Neoplasms surgery, Bile Ducts, Intrahepatic surgery, Carcinoma, Hepatocellular surgery, Cell Differentiation, Cholangiocarcinoma surgery, Liver Cirrhosis surgery, Liver Neoplasms surgery, Liver Transplantation adverse effects, Liver Transplantation mortality, Neoplasms, Complex and Mixed
- Abstract
Background: The role of liver transplantation (LT) in the management of cirrhotic patients with tumors exhibiting intrahepatic bile duct differentiation remains controversial. The objective of this study was to characterize the spectrum of these tumors and analyze post-LT outcomes., Methods: Retrospective pathology database search of explant histology analysis of liver transplants between April 1993 and November 2013., Results: Thirty-two patients were analyzed, 75% were men with a mean age of 60 years. Seven patients had nodules demonstrating intrahepatic cholangiocarcinoma (I-CCA), nine had I-CCA nodules occurring concomitantly with hepatocellular carcinoma (HCC), and 16 had mixed HCC-CCA nodules. The median number of tumors was 1 and size was 2.5 cm. Overall patient survival post-LT at 1 and 5 years was 71% and 57%, respectively. Patients within Milan criteria, especially with I-CCA features, showed a 5-year tumor recurrence rate (10%) and 5-year survival rate (78%) comparable with other patients having HCC within Milan criteria., Conclusion: This series showed that patients with CCA within Milan criteria may be able to achieve acceptable long-term post-LT survival.
- Published
- 2015
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31. Geographic disparity: the dilemma of lower socioeconomic status, multiple listing, and death on the liver transplant waiting list.
- Author
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Schwartz A, Schiano T, Kim-Schluger L, and Florman S
- Subjects
- Female, Follow-Up Studies, Humans, Liver Diseases surgery, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Survival Rate, Tissue and Organ Procurement, Healthcare Disparities, Liver Diseases mortality, Liver Transplantation, Social Class, Waiting Lists
- Abstract
Due to the current regionally based allocation system, some patients list for and are transplanted away from home in regions with shorter waits and higher transplant rates. Of 147 included patients, 120 died waiting and 27 received transplants at outside centers during the study (32.5 months). Those transplanted elsewhere had higher median incomes than patients dying on the waitlist ($84 946 vs. $55 250, p = 0.0001). Those with median incomes <$60 244 were more likely to die than those with incomes >$60 244 (94% vs. 70%, RR: 1.35, 95% CI: 1.14-1.59). Patients with Medicaid were more likely to die waiting than those with other insurance (100% vs. 77%, RR: 1.30, 95% CI: 1.18-1.44). Our analysis demonstrates that those who died waiting were more likely to have lower incomes and Medicaid compared with those transplanted elsewhere. Even when we controlled for Medicaid status, patients who died waiting had lower incomes compared with those transplanted elsewhere. Increased organ sharing over geographically broader regions, as recommended by the Institute of Medicine in 1999, may reduce incentives for patients to travel to receive a liver and reduce inequities. Current efforts to address this disparity continue to fall short of the Institute of Medicine recommendations, United States Department of Health and Human Services regulations and the Final Rule., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2014
- Full Text
- View/download PDF
32. Right hepatectomy for living donation: role of remnant liver volume in predicting hepatic dysfunction and complications.
- Author
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Facciuto M, Contreras-Saldivar A, Singh MK, Rocca JP, Taouli B, Oyfe I, LaPointe Rudow D, Gondolesi GE, Schiano TD, Kim-Schluger L, Schwartz ME, Miller CM, and Florman S
- Subjects
- Adult, Age Factors, Female, Hepatic Insufficiency epidemiology, Hepatic Insufficiency prevention & control, Humans, Linear Models, Logistic Models, Male, Patient Safety, Postoperative Complications epidemiology, Postoperative Complications prevention & control, Retrospective Studies, Risk Factors, Sex Factors, Hepatectomy methods, Hepatic Insufficiency etiology, Liver Transplantation, Living Donors, Postoperative Complications etiology, Tissue and Organ Harvesting methods
- Abstract
Background: Extensive attention has been placed on remnant liver volume (RLV) above other factors to ensure donor safety., Methods: We performed a retrospective review of 137 right hepatectomies in live donors between June 1999 and November 2010., Results: Median right lobe volume was 1,029 cm(3), which correlated with its actual weight (r = 0.63, P < .01); median RLV was 548 cm(3). Of the donors, 32 (24%) developed postoperative hepatic dysfunction (bilirubin >3 mg/dL or prothrombin time >18 s on postoperative day 4). RLV did not predict postoperative hepatic dysfunction (P = .9), but it was associated with peak international normalized ratio (INR) (P = .04). Donor age and male gender were predictors of increased bilirubin at postoperative day 4 (age, P = .03; gender, P = .02). Of the donors, 45 (33%) experienced complications, and 24 donors had RLVs <30%; 42% experienced complications compared to 31% of donors whose RLVs were greater than 30% (P = .3). Cell-saver utilization and aspartate-aminotransferase (AST) levels (OR = 3) were associated with complications. Volumetric assessment can predict RLV accurately., Conclusion: Although no demonstrable association between RLV <30% and complications was found, an RLV of 30% should remain the threshold for donor safety. Age and gender should be balanced in donors with a near threshold RLV of 30%. Surgical complexity, suggested by the need for intraoperative autoinfusion of blood and postoperative levels of AST, remained the independent predictor of complications., (Copyright © 2013 Mosby, Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
33. Quality of life after living donor liver transplantation: what we have learned and how we can do better.
- Author
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Kim-Schluger L and Florman S
- Subjects
- Female, Humans, Male, Liver Failure therapy, Liver Transplantation methods, Living Donors, Quality of Life
- Published
- 2012
- Full Text
- View/download PDF
34. Organ transplantation update, part II: heart and kidney.
- Author
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Florman S and Kim-Schluger L
- Subjects
- Heart Transplantation trends, Humans, Immunosuppressive Agents, Kidney Transplantation trends, Treatment Outcome, Heart Transplantation methods, Kidney Transplantation methods
- Published
- 2012
- Full Text
- View/download PDF
35. Organ transplantation update, part I: liver, intestine, and pancreas.
- Author
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Florman S and Kim-Schluger L
- Subjects
- History, 20th Century, Humans, Intestines transplantation, Liver Transplantation history, Pancreas Transplantation
- Published
- 2012
- Full Text
- View/download PDF
36. Liver transplantation for hepatocellular carcinoma: defining the impact of using extended criteria liver allografts.
- Author
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Facciuto ME, Singh MK, Katta U, Samaniego S, Sharma J, Rodriguez-Davalos M, Sheiner P, Kim-Schluger L, and Wolf DC
- Subjects
- Donor Selection, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Retrospective Studies, Safety Management, Time Factors, Treatment Outcome, Waiting Lists, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation mortality, Tissue Donors
- Abstract
Background: This series compares outcomes of patients with hepatocellular carcinoma (HCC) listed for orthotopic liver transplantation (OLT) within and outside Milan criteria, and determines the impact of extended criteria liver allografts (ECD)., Methods: Records of patients listed for liver transplantation at a single center from 1998 to 2007 were reviewed retrospectively., Results: Ninety-seven HCC patients were listed for OLT, 77 underwent transplantation; 47 received ECDs and 30 standard organs. ECDs were more frequently allocated to outside Milan recipients. Wait time for OLT was shorter for outside Milan patients (4 vs. 7 months P=0.04) but hazard rate of dropout was higher (26%, 46%, and 73% at 6,12, and 24 months compared with 2%, 14%, and 60% P<0.01). Tumor size more than 3 cm (P=0.02) and model for end-stage liver disease score at listing more than 11 (P=0.04) were independent predictors of dropout. Hazard rate of OLT was similar within and outside Milan (61%, 80%, and 90% at 6, 12, and 24 months vs. 60%, 70%, and 86% P=0.38). Post-OLT survival at 1 year and 4 years were 88% and 63% within Milan compared with 79% and 62% among Milan out recipients (P=0.95). No significant post-OLT survival predictor was found., Conclusion: The use of ECD organs provided patients with HCCs outside Milan criteria access to liver transplant at a rate comparable to patients within Milan and model for end-stage liver disease HCC priority. Similar patient survival post-OLT can be achieved using standard or ECD organs. The higher risk of drop out in patients outside Milan, and even within Milan, with tumors more than 3 cm justifies the use of ECD organs for timely transplantation.
- Published
- 2011
- Full Text
- View/download PDF
37. Massive pulmonary and intracardiac embolism during liver transplantation.
- Author
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Martins PN, Kim-Schluger L, Rodriguez-Davalos M, Martins AB, Krachkova N, Facciuto M, and Sheiner P
- Subjects
- Aged, Echocardiography, Transesophageal, Embolism blood, Embolism diagnostic imaging, Fatal Outcome, Female, Heart Arrest etiology, Heart Diseases blood, Heart Diseases diagnostic imaging, Humans, Liver Cirrhosis blood, Pulmonary Embolism blood, Pulmonary Embolism diagnostic imaging, Blood Coagulation, Embolism etiology, Heart Diseases etiology, Liver Cirrhosis surgery, Liver Transplantation adverse effects, Pulmonary Embolism etiology
- Abstract
Despite prolonged coagulation times and thrombocytopenia associated with end-stage liver disease, formation of thrombi in the circulation seems to occur more frequently during liver transplant than during any other type of major surgery. Here, we report a case of massive pulmonary and intracardiac embolism that resulted in cardiac arrest and intraoperative death. This was diagnosed by transesophageal echocardiography and occurred shortly after induction of anesthesia and initiation of continuous veno-venous hemofiltration without the concomitant use of antifibrinolytic drugs. We discuss the physiologic changes associated with cirrhosis and liver transplant, and review the literature.
- Published
- 2010
38. A peer-based intervention to educate liver transplant candidates about living donor liver transplantation.
- Author
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Delair S, Feeley TH, Kim H, Del Rio Martin J, Kim-Schluger L, Lapointe Rudow D, Orloff M, Sheiner PA, and Teperman L
- Subjects
- Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, New York, Peer Group, Quality of Life, Self Efficacy, Liver Transplantation education, Living Donors
- Abstract
The number of liver donors has not measurably increased since 2004 and has begun to decrease. Although many waitlisted patients may be suitable candidates to receive a living donor graft, they are often reticent to discuss living donation with close friends and family, partly because of a lack of knowledge about donor health and quality of life outcomes after donation. The objective of this study was to test the effectiveness of an educational intervention that uses testimonials and self-report data from living donors in New York State. The study had an independent sample pretest (n = 437) and posttest (n = 338) design with posttest, between-subjects comparison for intervention exposure. All waitlisted patients at 5 liver transplant centers in New York were provided a peer-based educational brochure and DVD either by mail or at the clinic. The outcome measures were liver candidates' knowledge and self-efficacy to discuss living donation with family and friends. The number and proportion of individuals who presented to centers for living liver donation evaluation were also measured. Liver transplant candidates' self-efficacy to discuss living donation and their knowledge increased from the pretest period to the posttest period. Those exposed to the peer-based intervention reported significantly greater knowledge, a greater likelihood of discussing donation, and increased self-efficacy in comparison with those not exposed to the intervention. The results did not differ by age, length of time on the waiting list, education, or ethnicity. In comparison with the preintervention period, living donation increased 42%, and the number of individuals who presented for donation evaluation increased by 74%.
- Published
- 2010
- Full Text
- View/download PDF
39. Surgical dilemma: liver resection or liver transplantation for hepatocellular carcinoma and cirrhosis. Intention-to-treat analysis in patients within and outwith Milan criteria.
- Author
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Facciuto ME, Rochon C, Pandey M, Rodriguez-Davalos M, Samaniego S, Wolf DC, Kim-Schluger L, Rozenblit G, and Sheiner PA
- Abstract
Background: The optimal role of surgery in the management of hepatocellular carcinoma (HCC) is in continuous evolution., Objective: The objective of this study was to analyse survival rates after liver resection (LR) and orthotopic liver transplantation (OLT) for HCC within and outwith Milan criteria in an intention-to-treat analysis., Methods: During 1997-2007, 179 patients with cirrhosis and HCC either underwent LR (n= 60) or were listed for OLT (n= 119). Patients with incidental HCC after OLT, preoperative macrovascular invasion before LR, non-cirrhosis and Child-Pugh class C cirrhosis prior to OLT were eliminated, leaving 51 patients primarily treated with LR and 106 patients listed for primary OLT (84 of whom were transplanted) to be included in this analysis. A total of 66 patients fell outwith Milan criteria (26 LR, 40 OLT) and 91 continued to meet Milan criteria (25 LR, 66 OLT)., Results: The median length of follow-up was 26 months. The mean waiting time for OLT was 7 months. During that time, 21 patients were removed from the waiting list as a result of tumour progression. Probabilities of dropout were 2% and 13% at 6 and 12 months, respectively, for patients within Milan criteria, and 34% and 57% at 6 and 12 months, respectively, for patients outwith Milan criteria (P < 0.01). Tumour size >3 cm was found to be the independent factor associated with dropout (hazard ratio [HR] 6.0). Postoperative survival was slightly higher after OLT, but this was not statistically significant (64% for OLT vs. 57% for LR). Overall survival from time of listing for OLT or LR did not differ between the two groups (P= 0.9); for patients within Milan criteria, 1- and 4-year survival rates after LR were 88% and 61%, respectively, compared with 92% and 62%, respectively, after OLT (P= 0.54). For patients outwith Milan criteria, 1- and 4-year survival rates after LR were 69% and 54%, respectively, compared with 65% and 40%, respectively, after OLT (P= 0.42). Tumour size >3 cm was again found to be an independent factor for poor outcome (HR 2.4) in the intention-to-treat analysis., Conclusions: Survival rates for patients with HCC are similar in LR and OLT. Liver resection can potentially decrease the dropout rate and serve as a bridge for future salvage LT, particularly in patients with tumours >3 cm.
- Published
- 2009
- Full Text
- View/download PDF
40. Surgical treatment of hepatocellular carcinoma beyond Milan criteria. Results of liver resection, salvage transplantation, and primary liver transplantation.
- Author
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Facciuto ME, Koneru B, Rocca JP, Wolf DC, Kim-Schluger L, Visintainer P, Klein KM, Chun H, Marvin M, Rozenblit G, Rodriguez-Davalos M, and Sheiner PA
- Subjects
- Carcinoma, Hepatocellular secondary, Cohort Studies, Disease-Free Survival, Female, Humans, Liver Cirrhosis pathology, Liver Neoplasms pathology, Living Donors, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prognosis, Retrospective Studies, Survival Rate, Treatment Outcome, Carcinoma, Hepatocellular surgery, Hepatectomy, Liver Cirrhosis surgery, Liver Neoplasms surgery, Liver Transplantation, Neoplasm Recurrence, Local surgery, Salvage Therapy methods
- Abstract
Background: There is no clear consensus regarding the best treatment strategy for patients with advanced hepatocellular carcinoma (HCC)., Methods: Patients with cirrhosis and HCC beyond Milan who had undergone liver resection (LR) or primary orthotopic liver transplantation (OLT) between November 1995 and December 2005 were included in this study. Pathological tumor staging was based on the American Liver Tumor Study Group modified Tumor-Node-Metastasis classification., Results: A total of 23 HCC patients were primarily treated by means of LR, 5 of whom eventually underwent salvage OLT. An additional 32 patients underwent primary OLT. The overall actuarial survival rates at 3 and 5 years were 35% after LR, and 69% and 60%, respectively, after primary OLT. Recurrence-free survival at 5 years was significantly higher after OLT (65%) than after LR (26%). Of the patients who underwent LR, 11 (48%) experienced HCC recurrence only in the liver; 6 of these 11 presented with advanced HCC recurrence, poor medical status, or short disease-free intervals and were not considered for transplantation. Salvage OLT was performed in 5 patients with early stage recurrence (45% of patients with hepatic recurrence after LR and 22% of all patients who underwent LR). At a median of 18 months after salvage OLT, all 5 patients are alive, 4 are free of disease, and 1 developed HCC recurrence 16 months after salvage OLT., Conclusion: For patients with HCC beyond Milan criteria, multimodality treatment-including LR, salvage OLT, and primary OLT-results in long-term survival in half of the patients. When indicated, LR can optimize the use of scarce donor organs by leaving OLT as a reserve option for early stage HCC recurrence.
- Published
- 2008
- Full Text
- View/download PDF
41. Hepatitis in association with rickettsialpox.
- Author
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Madison G, Kim-Schluger L, Braverman S, Nicholson WL, and Wormser GP
- Subjects
- Animals, Diagnosis, Differential, Disease Reservoirs veterinary, Female, Humans, Mice microbiology, Middle Aged, Rickettsia Infections diagnosis, Rickettsia Infections transmission, Rickettsiaceae Infections diagnosis, Rickettsiaceae Infections transmission, Hepatitis diagnosis, Hepatitis microbiology, Rickettsia Infections complications, Rickettsia akari pathogenicity, Rickettsiaceae Infections complications
- Abstract
Rickettsialpox is an acute, self-limited, febrile illness caused by Rickettsia akari and transmitted by Liponyssoides sanguineus, a mite that infests the common house mouse, Mus musculus. Liver involvement in rickettsialpox has received little attention, although hepatitis has been reported in several other rickettsial infections. In this report, we describe two patients with rickettsialpox who had acute hepatitis that resolved completely. In the appropriate clinical setting, rickettsialpox should be considered in the differential diagnosis of hepatitis.
- Published
- 2008
- Full Text
- View/download PDF
42. Gynecologic symptoms and sexual function before and after liver transplantation.
- Author
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Gomez-Lobo V, Burgansky A, Kim-Schluger L, and Berkowitz R
- Subjects
- Amenorrhea etiology, Female, Humans, Liver Diseases complications, Liver Diseases surgery, Middle Aged, Severity of Illness Index, Surveys and Questionnaires, Urinary Incontinence etiology, Liver Diseases psychology, Liver Transplantation, Sexual Behavior
- Abstract
Objective: To determine gynecologic symptoms and sexual function in a group of patients awaiting liver transplantation and a second group after liver transplantation., Study Design: A questionnaire was mailed to 524 women. Of these, 233 had had transplants, and 291 were on a waiting list. The Transplant Database was used to obtain demographic information regarding these patients, and data were analyzed based on population age, Child's classification, type of liver disease, and pretransplant or posttransplant status., Results: The response rate was 53%. There was no difference in ethnic or age distribution between pretransplant and posttransplant patients. There were no significant differences in rates of amenorrhea, but there was a greater prevalence of amenorrhea in patients with hepatocellular vs. cholestatic diseases (60% vs. 19%, p = 0.009). There was a higher incidence of pad use for urinary incontinence in pretransplant vs. posttransplant patients (14% vs. 7%, p = 0.04). There was no difference in availability of a sexual partner, sexual activity, orgasm experience, dyspareunia, satisfaction with sex life, symptoms of organ prolapse or dysmenorrhea based on transplant status, disease etiology or Child's classification., Conclusion: Liver failure patients differed in some of their gynecologic symptoms depending on their disease etiology and transplant status, but sexuality remained unchanged.
- Published
- 2006
43. Prevalence and prognosis of intrapulmonary shunts in patients with hepatic cirrhosis.
- Author
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Langiulli M, Aronow WS, Das M, Salomon P, McClung JA, Kim-Schluger L, Wolf DC, and Belkin RN
- Subjects
- Cross-Sectional Studies, Echocardiography, Female, Follow-Up Studies, Humans, Liver Cirrhosis diagnostic imaging, Liver Cirrhosis mortality, Male, Middle Aged, Prevalence, Prognosis, Arteriovenous Anastomosis diagnostic imaging, Liver Cirrhosis complications, Lung diagnostic imaging
- Abstract
We investigated the prevalence of intrapulmonary shunts in 82 patients with hepatic cirrhosis referred for echocardiography as part of liver transplantation evaluation. Intrapulmonary shunts were present in 49 of 82 patients (60%). Baseline characteristics were similar in patients with and without intrapulmonary shunts. Mean follow up was 41 +/- 15 months in patients with intrapulmonary shunts and 42 +/- 15 months in patients without intrapulmonary shunts (P not significant). At follow up, 8 of 49 patients (16%) with intrapulmonary shunts and 4 of 33 patients (12%) without intrapulmonary shunts had died (P not significant).
- Published
- 2006
- Full Text
- View/download PDF
44. Potentiation of acetaminophen hepatotoxicity by phenytoin, leading to liver transplantation.
- Author
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Suchin SM, Wolf DC, Lee Y, Ramaswamy G, Sheiner PA, Facciuto M, Marvin MR, Kim-Schluger L, and Lebovics E
- Subjects
- Adult, Drug Synergism, Humans, Liver Failure, Acute surgery, Liver Transplantation, Male, Acetaminophen poisoning, Analgesics, Non-Narcotic poisoning, Anticonvulsants pharmacology, Liver Failure, Acute chemically induced, Phenytoin pharmacology
- Abstract
We report the case of a 22-year-old man who developed fulminant hepatic failure 3 days after an intentional acetaminophen overdose. The patient had a history of a seizure disorder for which he was taking phenytoin. The acetaminophen level at presentation was in the "nontoxic" range. Emergent liver transplantation was performed 4 days after the ingestion. This is the first reported case of successful liver transplantation for acetaminophen-induced fulminant hepatic failure in the setting of phenytoin therapy.
- Published
- 2005
- Full Text
- View/download PDF
45. Fulminant and fatal gas gangrene of the stomach in a healthy live liver donor.
- Author
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Miller C, Florman S, Kim-Schluger L, Lento P, De La Garza J, Wu J, Xie B, Zhang W, Bottone E, Zhang D, and Schwartz M
- Subjects
- Fatal Outcome, Gas Gangrene complications, Gas Gangrene microbiology, Gastritis etiology, Humans, Male, Middle Aged, Polymerase Chain Reaction, Stomach Diseases complications, Stomach Diseases microbiology, Tissue and Organ Procurement, Clostridium perfringens isolation & purification, Gas Gangrene etiology, Hematemesis etiology, Liver Transplantation, Living Donors, Stomach Diseases etiology
- Abstract
A 57-year-old male with a history of hypercholesterolemia and anxiety but otherwise in good health volunteered to donate the right lobe of his liver to his brother. The operation was performed uneventfully, without transfusion. Postoperatively he did well, until he developed tachycardia, profound hypotension, and coffee ground emesis on postoperative day 3. Despite resuscitative measures, he arrested and expired. Autopsy demonstrated gas gangrene of the stomach as the underlying cause of the hemorrhage and numerous colonies of Gram-positive bacilli were identified. Subsequent polymerase chain reaction (PCR) analysis identified these bacteria to be Clostridium perfringens (C. perfringens) type D. This patient's death was devastating, both to his family and his medical team. The impact of his death has transcended that of an individual occurrence. In conclusion, herein we present the facts and discuss this extraordinary example of florid clostridial infection and toxin-mediated shock. It was completely unexpected and probably unpreventable, and its cause was almost inconceivable.
- Published
- 2004
- Full Text
- View/download PDF
46. Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria.
- Author
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Gondolesi GE, Roayaie S, Muñoz L, Kim-Schluger L, Schiano T, Fishbein TM, Emre S, Miller CM, and Schwartz ME
- Subjects
- Adult, Aged, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular secondary, Female, Humans, Liver Neoplasms mortality, Male, Middle Aged, Neoplasm Recurrence, Local, Survival Rate, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation adverse effects, Living Donors, Waiting Lists
- Abstract
Introduction: For patients with hepatocellular carcinoma (HCC) in particular, living donor liver transplant (LDLT) improves access to transplant. We report our results in 36 patients with HCC who underwent LDLT with a median follow-up >1 year. METHODS Underlying diagnoses included: hepatitis C (24), hepatitis B (9), cryptogenic cirrhosis (1), hemochromatosis (1), and primary biliary cirrhosis (1). Patients with tumors >or= 5 cm received IV doxorubicin intraoperatively and 6 cycles of doxorubicin at 3-week intervals. Patients were followed with CT scan and alpha-fetoprotein levels every 3 months for 2 years posttransplant. Mean waiting time, pretransplant treatment, tumor variables, and survival were analyzed. Univariate and multivariate analysis were done to analyze tumor variables; Kaplan-Meier and log rank were used to compare survivals. P < 0.05 was considered significant. RESULTS Mean wait for LDLT was 62 days, compared with 459 days in 50 patients with HCC transplanted with cadaveric organs during the same time period (P = 0.0001). At median follow-up of 450 days, there have been 10 deaths due to non-tumor-related causes and 3 deaths from recurrence; recurrence has also been observed in 3 other patients. On univariate and multivariate analysis, bilobar distribution was the only significant tumor variable (P = 0.03, log rank = 0.02). Fifty-three percent of patients exceeded UNOS priority criteria. One- and two-year patient survivals were 75% and 60%, respectively. Freedom from recurrence at 365 and 730 days was 82% and 74%, respectively. Overall and in patients with HCC > 5 cm (n = 12), there were no statistically significant differences in survival or in freedom from recurrence between recipients of living donor and cadaveric grafts. CONCLUSION Although one third of patients had tumors > 5 cm, the incidence of recurrence as well as patient survival and freedom from recurrence are comparable to results after cadaveric transplant. LDLT allows timely transplantation in patients with early or with large HCC.
- Published
- 2004
- Full Text
- View/download PDF
47. Unresectable squamous cell carcinoma of donor origin treated with immunosuppression withdrawal and liver retransplantation.
- Author
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Florman S, Bowne W, Kim-Schluger L, Sung MW, Huang R, Fotino M, Thung S, Schwartz M, and Miller C
- Subjects
- Adult, Female, Humans, Liver Neoplasms pathology, Middle Aged, Reoperation, Carcinoma, Squamous Cell pathology, Liver Transplantation immunology, Liver Transplantation pathology, Tissue Donors
- Abstract
Posttransplantation allograft malignancy of donor origin is a rare complication after liver transplantation. In the case described, subjective fevers and nonspecific abdominal complaints nearly 6 months following cadaveric liver transplantation in a young woman prompted an evaluation which was remarkable for a large central liver mass. A poorly differentiated squamous cell carcinoma was diagnosed, but was unresectable at exploration. The tumor was confined to the liver. Histocompatibility testing using polymerase chain reaction (PCR) amplification techniques identified both donor and recipient HLA alleles. The patient was treated with chemoembolization, systemic chemotherapy and cessation of immunosuppression. Repeat biopsy 2 months later showed the tumor to be completely necrotic. With decompensated liver disease, she was relisted and retransplanted. More than 2 years later she remains disease-free with complete pathological remission. This is the only reported case of squamous cell carcinoma of donor origin arising in a transplanted liver.
- Published
- 2004
- Full Text
- View/download PDF
48. Isolated intestinal transplantation: proof of clinical efficacy.
- Author
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Fishbein TM, Kaufman SS, Florman SS, Gondolesi GE, Schiano T, Kim-Schluger L, Magid M, Harpaz N, Tschernia A, Leibowitz A, and LeLeiko NS
- Subjects
- Adult, Child, Child, Preschool, Female, Graft Rejection, Graft Survival, Humans, Infant, Male, Parenteral Nutrition, Intestines transplantation
- Abstract
Background and Aims: Isolated intestinal transplantation has been limited by poor patient and graft survival. If high survival could be achieved and if parenteral nutrition-associated liver disease were reversible, this procedure could be more widely applied, with early liver dysfunction indicating the need for transplant evaluation., Methods: Twenty-six patients who had failed parenteral nutrition received 28 isolated intestinal transplants. We analyzed patient and graft survival, the effect of sirolimus on the severity and frequency of rejection, and the reversibility of liver dysfunction after transplant., Results: Three-year actuarial patient and primary graft survival were 88% and 71%, respectively. Two patients underwent successful retransplants. Twenty-two patients are alive at a mean of 21+/-15 (median 18; range 3-51) months. Actuarial survival with freedom from parenteral support is 81% at 3 years (21 of 26 patients). Actuarial freedom from parenteral support among survivors is 95.5% at 3 years (21 of 22 patients). Early rejection was less frequent with sirolimus (34% vs. 70% without sirolimus) (P=0.007). Moderate and severe rejection was less frequent with sirolimus (1/11 episodes vs. 9/17 episodes without sirolimus) (P=0.05). No grafts were lost after introduction of sirolimus. In all four patients with advanced liver dysfunction, fibrosis and cholestasis regressed within 1 year., Conclusions: High patient survival and parenteral nutrition-free survival can be achieved after isolated intestinal transplantation. Sirolimus treatment has eliminated graft loss. Parenteral nutrition-associated liver disease is reversible with intestinal transplantation. Refractory liver dysfunction in patients receiving parenteral nutrition should prompt consideration for isolated intestinal transplantation.
- Published
- 2003
- Full Text
- View/download PDF
49. Syngeneic living-donor liver transplantation without the use of immunosuppression.
- Author
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Liu LU, Schiano TD, Min AD, Kim-Schluger L, Schwartz ME, Emre S, Fishbein TM, Bodenheimer HC Jr, and Miller CM
- Subjects
- Adult, Female, Graft Survival immunology, Humans, Male, Middle Aged, Immunosuppression Therapy, Liver Transplantation immunology, Living Donors, Twins, Monozygotic
- Abstract
Transplantation between monozygotic twins has been successfully performed using the kidney, small intestine, and pancreas. Identical HLA matching has enabled these individuals to be transplanted without the need for immunosuppressive medication. Liver transplantation without immunosuppression would lessen the risk of recurrent viral hepatitis and eliminate much of the morbidity associated with long-term use of immunosuppressive medication. Living-donor liver transplantation (LDLT) has been performed with increasing success in recent years without an opportunity arising to use a monozygotic twin as a donor. We report 2 cases of LDLT between identical twins wherein perfect haploidentity has allowed these recipients to be transplanted without the need for immunosuppression. Although HLA matched genotypically, there may be differences in anatomy between donor and recipient. Mild liver chemistry test abnormalities may occur after transplant despite the absence of immunosuppression.
- Published
- 2002
- Full Text
- View/download PDF
50. Quality of life after lobectomy for adult liver transplantation.
- Author
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Kim-Schluger L, Florman SS, Schiano T, O'Rourke M, Gagliardi R, Drooker M, Emre S, Fishbein TM, Sheiner PA, Schwartz ME, and Miller CM
- Subjects
- Adult, Educational Status, Female, Health Status, Health Surveys, Hepatectomy psychology, Humans, Interpersonal Relations, Male, Mental Health, Racial Groups, Reference Values, Time Factors, United States, Hepatectomy rehabilitation, Liver Transplantation, Living Donors psychology
- Abstract
Introduction: Adult-to-adult living donor liver transplants are being increasingly performed. Although considerable data are available on the quality of life after kidney donation, there is little comparable information on liver donors., Methods: Between August 1998 and July 2000, 48 adults received liver grafts from living donors. At least 2 months after donation, donors were mailed a structured questionnaire and the standardized Medical Outcomes Study Short-Form Health Survey (SF-36), a generic measure assessing health-related quality of life outcomes using eight scales: mental health, emotional limits, vitality, social function, physical function, physical limits, pain, general health., Results: Thirty donors (62.5%) responded at a mean of 280+/-157 days after donation. Fifteen (50%) of their recipients had major complications (two deaths, four retransplants, nine biliary complications). Regarding overall satisfaction, all said they would donate again. Compared to published U.S. norms (n=2474), our group of donors scored higher than the general population in seven of eight domains on the SF-36. Donors whose recipients had no complications scored significantly higher in mental health (P<0.007) and general health (P<0.008) compared with U.S. norms. Donors whose recipients had major complications scored significantly lower on the mental health scale than those with recipients without major complications., Conclusions: Donors did not regret their decision to donate; several felt the experience had changed their lives for the better. Donors scored as well as or better than U.S. norms in general health. Quality of life after donation must remain a primary outcome measure when we consider the utility of living-donor liver transplants.
- Published
- 2002
- Full Text
- View/download PDF
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