121 results on '"Kristopher P. Croome"'
Search Results
2. Normothermic Regional Perfusion Can Improve Both Utilization and Outcomes in DCD Liver, Kidney, and Pancreas Transplantation
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Yuki Bekki, MD, PhD, Kristopher P. Croome, MD, Bryan Myers, MD, Kazunari Sasaki, MD, and Koji Tomiyama, MD
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Surgery ,RD1-811 - Abstract
Background. Normothermic regional perfusion (NRP) has gained widespread adoption in multiple European countries. The aim of this study was to examine the influence of thoracoabdominal-NRP (TA-NRP) on the utilization and outcomes of liver, kidney, and pancreas transplantation in the United States. Methods. Using the US national registry data between 2020 and 2021, donation after circulatory death (DCD) donors were separated into 2 groups: DCD with TA-NRP and without TA-NRP. There were 5234 DCD donors; among them 34 donors were with TA-NRP. After 1:4 propensity score matching, the utilization rates were compared between DCD with and without TA-NRP. Results. Although the utilization rates of kidney and pancreas were comparable (P = 0.71 and P = 0.06, 94.1% versus 95.6% and 8.8% versus 2.2%, respectively), that of liver in DCD with TA-NRP was significantly higher (P
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- 2023
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3. DCD Liver Grafts Can Safely Be Used for Recipients With Grade I–II Portal Vein Thrombosis: A Multicenter Analysis
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Lydia A. Mercado, MD, Harpreet K. Bhangu, MD, Esteban Calderon, MD, Amit K. Mathur, MD, Bashar Aqel, MD, Kaitlyn R. Musto, BSc, Kymberly D. Watt, MD, Charles B. Rosen, MD, Candice Bolan, MD, Jordan D. LeGout, MD, C. Burcin Taner, MD, Denise M. Harnois, DO, and Kristopher P. Croome, MD, MS
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Surgery ,RD1-811 - Abstract
Background. With donation after circulatory death (DCD) liver transplantation (LT), the goal of the recipient implantation procedure is to minimize surgical complexity to avoid a tenuous environment for an already marginal graft. The presence of portal vein thrombosis (PVT) at the time of LT adds surgical complexity, yet‚ to date, no studies have investigated the utilization of DCD liver grafts for patients with PVT. Methods. All DCD LT performed at Mayo Clinic-Florida, Mayo Clinic-Arizona, and Mayo Clinic-Rochester from 2006 to 2020 were reviewed (N = 771). Patients with PVT at the time of transplant were graded using Yerdel classification. A 1:3 propensity match between patients with PVT and those without PVT was performed. Results. A total of 91 (11.8%) patients with PVT undergoing DCD LT were identified. Grade I PVT was present in 62.6% of patients, grade II PVT in 27.5%, grade III in 8.8%, and grade 4 in 1.1%. At the time of LT, thromboendovenectomy was performed in 89 cases (97.8%). There was no difference in the rates of early allograft dysfunction (43.2% versus 52.4%; P = 0.13) or primary nonfunction (1.1% versus 1.1%; P = 0.41) between the DCD PVT and DCD without PVT groups, respectively. The rate of ischemic cholangiopathy was not significantly different between the DCD PVT (11.0%) and DCD without PVT groups (10.6%; P = 0.92). Graft (P = 0.58) and patient survival (P = 0.08) were similar between the 2 groups. Graft survival at 1-, 3-, and 5-y was 89.9%, 84.5%, and 79.3% in the DCD PVT group. Conclusions. In appropriately selected recipients with grades I–II PVT, DCD liver grafts can be utilized safely with excellent outcomes.
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- 2022
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4. The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center
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Hani M. Wadei, C. Burcin Taner, Andrew P. Keaveny, Martin L. Mai, David O. Hodge, Launia J. White, Denis M. Harnois, Shennen A. Mao, Tambi Jarmi, and Kristopher P. Croome
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Pre-LT renal dysfunction ,Liver transplant outcome ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction and Objectives: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. Materials and Methods: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver–kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998–2002, n = 488), era-2 (2003–2007, n = 889), era-3 (2008–2012, n = 703) and era-4 (2013–2018, n = 791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5 mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. Results: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (P
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- 2021
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5. Comparison of Supraceliac and Infrarenal Aortic Conduits in Liver Transplantation: Is There a Difference in Patency and Postoperative Renal Dysfunction?
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David Livingston, MD, David D. Lee, MD, Sarah Croome, RN, C. Burcin Taner, MD, and Kristopher P. Croome, MD, MS
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Surgery ,RD1-811 - Abstract
Background. Aorto-hepatic conduits can provide arterial inflow for liver transplants in cases where the native hepatic artery is unsuitable for use. Methods. Clinical outcomes of all patients undergoing liver transplantation (LT) with an aorto-hepatic conduit between 2000 and 2016 were included. Recipients were divided into 2 groups: those with a supraceliac (SC) aortic conduit (N = 22) and those with an infrarenal (IR) aortic conduit (N = 82). Results. There was no difference in calculated model for end-stage liver disease score between the 2 groups. The SC group received grafts with a higher mean donor risk index (1.69 versus 1.48; P = 0.02). Early allograft dysfunction was 18.2% in the SC group and 29.3% in the IR group (P = 0.30). In the SC group, 10.5% of patients required initiation of postoperative continuous renal replacement therapy compared to 12.1% of patients in the IR group (P = 0.69). No difference in the rate of postoperative acute kidney injury was seen between the 2 groups (P = 0.54). No significant difference in median creatinine at 1 year was seen between the SC (1.2 mg/dL; IQR 1–1.3) and IR (1.2 mg/dL; IQR 0.9–1.5) groups (P = 0.85). At a median follow-up of 5.3 years, thrombosis of the aortic conduit occurred in 0% of patients in the SC group and 6.1% of patients in the IR group (P = 0.24). Graft survival was not significantly different between the 2 groups (P = 0.47). Conclusions. No difference in renal dysfunction as demonstrated by need for post-LT continuous renal replacement therapy, acute kidney injury, or creatinine at 1 year post-LT was seen between SC and IR aortic conduits. A slight trend of higher conduit thrombosis rate was seen with IR compared to SC aortic conduits; however, this did not reach statistical significance. Both SC and IR aortic conduits represent reasonable options when the native hepatic artery is unsuitable for use.
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- 2019
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6. Simultaneous liver and kidney transplantation in elderly patients: Outcomes and validation of a clinical risk score for patient selection
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Kristopher P. Croome, David D. Lee, Justin M. Burns, Dana K. Perry, Justin H. Nguyen, Andrew P. Keaveny, Hani M. Wadei, and C. Burcin Taner, MD
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SLK ,Combined transplant ,Specialties of internal medicine ,RC581-951 - Abstract
Introduction and aim. Many transplant programs have expanded eligibility to include patients previously ineligible because of advanced age. Outcomes of simultaneous liver-kidney transplantation (SLK) in recipients with advanced age are not known.Material and methods. Data from patients undergoing transplantation between 2002 and 2015 were obtained from the UNOS Standard Analysis and Research file.Results. SLK recipients aged ≥ 65 years (N = 677), SLK recipients aged < 65 years (N = 4517), and recipients of liver transplant alone(LTA) aged ≥ 65 years(N = 8495) were compared. Recipient characteristics were similar between the SLK groups. Similar patient and graft survival were observed in SLK recipients aged ≥ 65 years compared to SLK recipients aged < 65 years and LTA recipients aged ≥ 65 years. Importantly, in a subgroup analysis, superior survival was seen in the SLK group aged ≥ 65 years compared to LTA recipients aged ≥ 65 years who underwent dialysis in the week prior to transplantation (p < 0.001). A prediction model of patient survival was developed for the SLK group aged ≥ 65 years with predictors including: age ≥ 70 years (3 points), calculated MELD score (-1 to 2 points), and recipient ventilator status at the time of SLK (4 points). The risk score predicted patient survival, with a significantly inferior survival seen in patients with a score ≥ 4 (p < 0.001).Conclusions. Age should not be used as a contraindication for SLK transplantation. The validated scoring system provides a guide for patient selection and can be used when evaluating elderly patients for SLK transplantation listing.
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- 2016
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7. Early allograft dysfunction after liver transplantation: an intermediate outcome measure for targeted improvements
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David D. Lee, Kristopher P. Croome, Jefree A. Shalev, Kaitlyn R. Musto, Meenu Sharma, Andrew P. Keaveny, and C. Burcin Taner, M.D.
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Liver transplantation ,Outcome ,Survival ,Specialties of internal medicine ,RC581-951 - Abstract
Background. The term early allograft dysfunction (EAD) identifies liver transplant (LT) allografts with initial poor function and portends poor allograft and patient survival. Aims of this study are to use EAD as an intermediate outcome measure in a large single center cohort and identify donor, recipient and peri-operative risk factors.Material and methods. In 1950 consecutive primary LT, donor, recipient and peri-operative data were collected. EAD was defined by the presence of one or more of the following: total bilirubin ≥ 10 mg/dL (171 μmol/L) or, INR ≥ 1.6 on day 7, and ALT/AST > 2,000 IU/L within the first 7 days.Results. The incidence of EAD was 26.5%. 1-, 3-, and 5-year allograft and patient survival for patients who developed EAD were significantly inferior to those who did not (P < 0.01 at all time points). Multivariate analysis demonstrated associations in the development of EAD with recipient pre-operative ventilator status, donation after cardiac death allografts, donor age, allograft size, degree of steatosis, operative time and intra-operative transfusion requirements (all P < 0.01). Patients with EAD had a significantly longer hospitalization at 20.9 ± 38.9 days (median: 9; range: 4-446) compared with 10.7 ± 13.5 days (median: 7; range: 3-231) in patients with no EAD (P < 0.01).Conclusions. This is the largest single center experience demonstrating incidence of EAD and identifying factors associated with development of EAD. EAD is a useful intermediate outcome measure for allograft and patient survival. Balancing recipient pretransplant conditions, donor risk factors and intra-operative conditions are necessary for avoiding EAD.
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- 2016
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8. Early Allograft Dysfunction Is Associated With Higher Risk of Renal Nonrecovery After Liver Transplantation
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Hani M. Wadei, MD, David D. Lee, MD, Kristopher P. Croome, MD, MS, Lorraine Mai, BSN, CDE, Deanne Leonard, MD, Martin L. Mai, MD, C. Burcin Taner, MD, and Andrew P. Keaveny, MD
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Surgery ,RD1-811 - Abstract
Abstract. Early allograft dysfunction (EAD) identifies allografts with marginal function soon after liver transplantation (LT) and is associated with poor LT outcomes. The impact of EAD on post-LT renal recovery, however, has not been studied. Data on 69 primary LT recipients (41 with and 28 without history of renal dysfunction) who received renal replacement therapy (RRT) for a median (range) of 9 (13-41) days before LT were retrospectively analyzed. Primary outcome was renal nonrecovery defined as RRT requirement 30 days from LT. Early allograft dysfunction developed in 21 (30%) patients, and 22 (32%) patients did not recover renal function. Early allograft dysfunction was more common in the renal nonrecovery group (50% vs 21%, P = 0.016). Multivariate logistic regression analysis demonstrated that EAD (odds ratio, 7.25; 95% confidence interval, 2.0-25.8; P = 0.002) and baseline serum creatinine (odds ratio, 3.37; 95% confidence interval, 1.4-8.1; P = 0.007) were independently associated with renal nonrecovery. History of renal dysfunction, duration of renal dysfunction, and duration of RRT were not related to renal recovery (P > 0.2 for all). Patients who had EAD and renal nonrecovery had the worst 1-, 3-, and 5-year patient survival, whereas those without EAD and recovered renal function had the best outcomes (P < 0.001). Post-LT EAD was independently associated with renal nonrecovery in LT recipients on RRT for a short duration before LT. Furthermore, EAD in the setting of renal nonrecovery resulted in the worst long-term survival. Measures to prevent EAD should be undertaken in LT recipients on RRT at time of LT.
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- 2018
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9. American Society of Transplant Surgeons recommendations on best practices in donation after circulatory death organ procurement
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Kristopher P. Croome, Andrew S. Barbas, Bryan Whitson, Ali Zarrinpar, Timucin Taner, Denise Lo, Malcolm MacConmara, Jim Kim, Peter T. Kennealey, Jonathan S. Bromberg, Kenneth Washburn, Vatche G. Agopian, Mark Stegall, and Cristiano Quintini
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Transplantation ,Immunology and Allergy ,Pharmacology (medical) - Published
- 2023
10. Reply: Development of a portable abdominal normothermic regional perfusion (A-NRP) program in the united states
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Kristopher P. Croome, Dana K. Perry, and C. Burcin Taner
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Transplantation ,Hepatology ,Surgery - Published
- 2023
11. Classification of Distinct Patterns of Ischemic Cholangiopathy Following DCD Liver Transplantation: Distinct Clinical Courses and Long-term Outcomes From a Multicenter Cohort
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Charles B. Rosen, Liu Yang, Kristopher P. Croome, C. Burcin Taner, Timucin Taner, Amit K. Mathur, Ricardo Paz-Fumagalli, Julie K. Heimbach, and Bashar Aqel
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Transplantation ,medicine.medical_specialty ,Tissue and Organ Procurement ,business.industry ,medicine.medical_treatment ,Graft Survival ,Clinical course ,Stent ,Disease ,Liver transplantation ,Tissue Donors ,Liver Transplantation ,Death ,End Stage Liver Disease ,Natural history ,Necrosis ,Ischemia ,Internal medicine ,Cohort ,medicine ,Long term outcomes ,RELT ,Humans ,business ,Retrospective Studies - Abstract
As the number of donation after circulatory death (DCD) liver transplants (LTs) performed in the United States continues to increase annually, there has been interest by policy makers to develop a more robust exception point safety net for patients who develop ischemic cholangiopathy (IC) following DCD LT. As such, there is a need for better understanding of the clinical course and long-term outcomes in patients who develop IC, as well as determining if IC can be classified into distinct categories with distinctly different clinical outcomes.All DCD LT performed at Mayo Clinic Florida, Mayo Clinic Arizona, and Mayo Clinic Rochester from January 1999 to March 2020 were included (N = 770). Outcomes were compared between 4 distinct radiologic patterns of IC: diffuse necrosis, multifocal progressive, confluence dominant, and minor form.In total, 88 (11.4%) patients developed IC, of which 42 (5.5%) were listed for retransplantation of liver (ReLT). Patients with diffuse necrosis and multifocal progressive patterns suffered from frequent hospital admissions for cholangitis in the first year following DCD LT (median 3 and 2), were largely stent dependent (100% and 85.7%), and almost universally required ReLT. Patients with confluence dominant disease were managed with multiple stents and frequently recovered, ultimately becoming stent free without need for ReLT. Patients with the minor form IC did well with limited need for stent placement or repeat procedures and did not require ReLT. Graft survival was different between the 4 distinct IC patterns (P 0.001).The present analysis provides a detailed analysis on the natural history and clinical course of IC. Patients developing IC can be classified into 4 distinct patterns with distinct clinical courses.
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- 2022
12. N-acetylcysteine and Reduction of Ischemia-reperfusion Injury in Liver Transplantation
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Kristopher P. Croome
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Transplantation - Published
- 2023
13. Development of a portable abdominal normothermic regional perfusion (A-NRP) program in the United States
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Kristopher P. Croome, Thomas E. Brown, Richard L. Mabrey, Sherry L. Sonnenwald, Justin M. Burns, Shennen A. Mao, Jacob N. Clendenon, Justin H. Nguyen, Dana K. Perry, Rebecca G. Maddox, and C. Burcin Taner
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Transplantation ,Hepatology ,Surgery - Published
- 2023
14. Hepatocellular carcinoma radiation segmentectomy treatment intensification prior to liver transplantation increases rates of complete pathologic necrosis: an explant analysis of 75 tumors
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S. Ali Montazeri, Cynthia De la Garza-Ramos, Andrew R. Lewis, Jason T. Lewis, Jordan D. LeGout, David M. Sella, Ricardo Paz-Fumagalli, Zlatko Devcic, Charles A. Ritchie, Gregory T. Frey, Lucas Vidal, Kristopher P. Croome, J. Mark McKinney, Denise Harnois, Sunil Krishnan, Tushar Patel, and Beau B. Toskich
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Radiology, Nuclear Medicine and imaging ,General Medicine - Published
- 2022
15. Local procurement surgeon recovery of donation after circulatory death liver grafts in the United States: Unsheathing the double‐edged sword
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Kristopher P, Croome
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Surgeons ,Brain Death ,Transplantation ,Tissue and Organ Procurement ,Hepatology ,Graft Survival ,Tissue Donors ,United States ,Liver Transplantation ,Death ,Liver ,Humans ,Surgery ,Retrospective Studies - Published
- 2022
16. Repeat hepatic resection for recurrent colorectal liver metastases: If at first you don’t succeed, try, try again?
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Kristopher P, Croome
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Surgery - Published
- 2023
17. The use of neoadjuvant lobar radioembolization prior to major hepatic resection for malignancy results in a low rate of post hepatectomy liver failure
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Justin M. Burns, Kristopher P. Croome, Jordan D. LeGout, Gregory T. Frey, John A. Stauffer, Beau Toskich, Ricardo Paz-Fumagalli, and Altan Ahmed
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medicine.medical_specialty ,Tare weight ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Gastroenterology ,Liver failure ,Perioperative ,030230 surgery ,Malignancy ,medicine.disease ,Single Center ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Original Article ,Hepatectomy ,business ,Adverse effect - Abstract
Background Neoadjuvant yttrium-90 transarterial radioembolization (TARE) is increasingly being used as a strategy to facilitate resection of otherwise unresectable tumors due to its ability to generate both tumor response and remnant liver hypertrophy. Perioperative outcomes after the use of neoadjuvant lobar TARE remain underinvestigated. Methods A single center retrospective review of patients who underwent lobar TARE prior to major hepatectomy for primary or metastatic liver cancer between 2007 and 2018 was conducted. Baseline demographics, radioembolization parameters, pre- and post-radioembolization volumetrics, intra-operative surgical data, adverse events, and post-operative outcomes were analyzed. Results Twenty-six patients underwent major hepatectomy after neoadjuvant lobar TARE. The mean age was 58.3 years (17-88 years). 62% of patients (n=16) had primary liver malignancies while the remainder had metastatic disease. Liver resection included right hepatectomy or trisegmentectomy, left or extended left hepatectomy, and sectorectomy/segmentectomy in 77% (n=20), 8% (n=2), and 15% (n=4) of patients, respectively. The mean length of stay was 8.3 days (range, 3-33 days) and there were no grade IV morbidities or 90-day mortalities. The incidence of post hepatectomy liver failure (PHLF) was 3.8% (n=1). The median time to progression after resection was 4.5 months (range, 3.3-10 months). Twenty-three percent (n=6) of patients had no recurrence. The median survival was 28.9 months (range, 16.9-46.8 months) from major hepatectomy and 37.6 months (range, 25.2-53.1 months) from TARE. Conclusions Major hepatectomy after neoadjuvant lobar radioembolization is safe with a low incidence of PHLF.
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- 2021
18. Sequential Protocol Biopsies Post–Liver Transplant From Donors With Moderate Macrosteatosis: What Happens to the Fat?
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Andrew P. Keaveny, C. Burcin Taner, Sarah Croome, Raouf E. Nakhleh, David Livingston, and Kristopher P. Croome
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medicine.medical_specialty ,Necrosis ,Biopsy ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Cholestasis ,Fibrosis ,Internal medicine ,Humans ,Medicine ,In patient ,Retrospective Studies ,Transplantation ,Hepatology ,medicine.diagnostic_test ,business.industry ,Graft Survival ,Perioperative ,medicine.disease ,Tissue Donors ,Liver Transplantation ,Cohort ,Florida ,030211 gastroenterology & hepatology ,Surgery ,medicine.symptom ,business - Abstract
The number of steatotic deceased donor livers encountered has continued to rise as a result of the obesity epidemic. Little is known about the histological characteristics of moderately macrosteatotic livers over time in the recipient following liver transplantation (LT). All recipients undergoing LT at Mayo Clinic Florida with donor livers with moderate macrosteatosis (30%-60%) from 2000-2017 were identified (n = 96). Routine protocol liver biopsies were performed 1-week and 6-months following LT. All liver donor and protocol biopsies were read by an experienced liver pathologist. Of the 96 moderate macrosteatosis LTs, 70 recipients had post-LT protocol liver biopsies available and comprised the study cohort. Median donor allograft macrosteatosis at the time of transplant was 33% (IQR, 30%-40%) compared with 0% (IQR, 0%-2%) at 1-week (P < 0.001) and 0% (IQR, 0%-0%) at 6-months (P < 0.001) following LT. Biopsies at 1-week post-LT displayed pericentral necrosis in 57.1% of recipients and lipopeliosis in 34.3% of recipients. In the 6-month post-LT biopsies, cholestasis was seen in 3 (4.3%) of the recipients, whereas grade 2 fibrosis was seen in 6 recipients (8.6%). Graft survival at 5 years in the present cohort was 74.0%. Moderate macrosteatosis (30%-60%) in the donor allograft demonstrates complete reversal on liver biopsies performed as early as 7 days following LT and remains absent at 6-months following LT. Both pericentral necrosis and lipopeliosis are common features on day 7 biopsies. Despite these encouraging findings, the perioperative risks of using these livers (postreperfusion cardiac arrest and primary nonfunction) should not be understated. Long-term graft survival is acceptable in patients who are able to overcome the immediate perioperative risk of using moderately steatotic donor livers.
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- 2021
19. Significance of proximal ductal margin status after resection of hilar cholangiocarcinoma
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Kristopher P. Croome, Kristin C. Mara, Lavanya Yohanathan, Sean P. Cleary, Carlos A. Puig, David M. Nagorney, and Michael D. Traynor
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medicine.medical_specialty ,Hepatic resection ,Gastroenterology ,Resection ,Cholangiocarcinoma ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Retrospective Studies ,Frozen section procedure ,Hepatology ,Postoperative chemotherapy ,Bile duct ,business.industry ,Postoperative radiation ,Margin status ,Bile Ducts, Intrahepatic ,Treatment Outcome ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Neoplasm Recurrence, Local ,business ,Median survival ,Klatskin Tumor - Abstract
Background The impact of additional resection for positive proximal bile duct margins during hepatic resection of hilar cholangiocarcinoma (HCCA) on survival and disease progression remains unclear. We asked how re-resection of positive proximal bile duct margins affected outcomes. Methods Patients undergoing resection between 1993–2017 were reviewed. Both frozen section and final margin status were reviewed. Overall survival was the primary outcome. Results 153 patients underwent surgical resection for HCCA. Median survival (months) for initial margin negative (M−), margin-positive to margin-negative (M+/M−) and margin-positive to margin-positive (M+/M+) was 45, 33, and 35 months respectively. Nodal metastases increased with margin positivity: 32% with M−, 49% with M+/M− and 63% with M+/M+ (p = 0.016). Local/regional progression more frequently occurred in M+/M− (27.3%) and M+/M+ (33.3%) patients (M+/M- vs. M-: p = 0.41, M+/M+ vs. M-: p = 0.27). Patients receiving postoperative chemotherapy were 33% M−, 46% M+/M− and 63% in M+/M+. Postoperative radiation was used in 13% of M−, 31% of M+/M− and 63% of M+/M+. Most frequent initial recurrences were within the liver and hepaticojejunostomy site. Conclusion Competing risk for systemic disease based on primary characteristics of HCCA outweighs the impact of re-resection to achieve R0 status. Improved survival will likely depend on future regional and systemic therapy.
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- 2021
20. A 3-Decade Analysis of Pancreatic Adenocarcinoma After Solid Organ Transplant
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Juan E, Corral, Kristopher P, Croome, Andrew P, Keaveny, Bhaumik, Brahmbhatt, Michael J, Bartel, Paul T, Kröner, Karn, Wijarnpreecha, Rohan M, Goswami, Massimo, Raimondo, Michael B, Wallace, Yan, Bi, and Omar Y, Mousa
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Tissue and Organ Procurement ,Databases, Factual ,Endocrinology, Diabetes and Metabolism ,Adenocarcinoma ,Risk Assessment ,Organ transplantation ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Cancer Survivors ,Risk Factors ,Pancreatic cancer ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Aged ,Retrospective Studies ,Hepatology ,business.industry ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,Cancer ,Retrospective cohort study ,Organ Transplantation ,Middle Aged ,medicine.disease ,United States ,Pancreatic Neoplasms ,Treatment Outcome ,030220 oncology & carcinogenesis ,Cohort ,Female ,030211 gastroenterology & hepatology ,business - Abstract
OBJECTIVE Solid organ transplant (SOT) recipients have moderately increased risk of pancreatic adenocarcinoma (PAC). We evaluated the incidence and survival of PAC in 2 cohorts and aimed to identify potential risk factors. METHODS This study performed a retrospective cohort analysis. Cohort A was extracted from the United Network of Organ Sharing data set and cohort B from SOT recipients evaluated at 3 Mayo Clinic transplant centers. The primary outcome was age-adjusted annual incidence of PAC. Descriptive statistics, hazard ratios, and survival rates were compared. RESULTS Cohort A and cohort B included 617,042 and 29,472 SOT recipients, respectively. In cohort A, the annual incidence rate was 12.78 per 100,000 in kidney-pancreas, 13.34 in liver, and 21.87 in heart-lung transplant recipients. Receiving heart-lung transplant, 50 years or older, and history of cancer (in either recipient or donor) were independent factors associated with PAC. Fifty-two patients developed PAC in cohort B. Despite earlier diagnosis (21.15% with stage I-II), survival rates were similar to those reported for sporadic (non-SOT) patients. CONCLUSIONS We report demographic and clinical risk factors for PAC after SOT, many of which were present before transplant and are common to sporadic pancreatic cancer. Despite the diagnosis at earlier stages, PAC in SOT portends a very poor survival.
- Published
- 2021
21. Perioperative and long-term outcomes of utilizing donation after circulatory death liver grafts with macrosteatosis: A multicenter analysis
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Peter A. Senada, Bashar Aqel, Adyr A. Moss, Charles B. Rosen, Julie K. Heimbach, C. Burcin Taner, Jacob Piatt, Kristopher P. Croome, Amit K. Mathur, and Shennen A. Mao
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Brain Death ,medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Long term outcomes ,Humans ,Immunology and Allergy ,Pharmacology (medical) ,Retrospective Studies ,Transplantation ,business.industry ,Graft Survival ,Arizona ,Acute kidney injury ,Patient survival ,Perioperative ,medicine.disease ,Circulatory death ,Tissue Donors ,Death ,Stenosis ,Treatment Outcome ,Liver ,Florida ,Steatosis ,business - Abstract
BACKGROUND Given the potentially additive risk from using donor livers that are both steatotic and from a donation after circulatory death (DCD) donor, there is a paucity of data on the outcome of DCD liver transplantation (LT) utilizing livers with macrosteatosis. METHODS All DCD LT performed at Mayo Clinic-Florida, Mayo Clinic-Arizona, and Mayo Clinic-Rochester from 1999 to 2019 were included (N = 714). Recipients of DCD LT were divided into 3 groups: those with moderate macrosteatosis (30%-60%), mild macrosteatosis (5%-30%), and no steatosis (
- Published
- 2020
22. Donation after Circulatory Death: Potential Mechanisms of Injury and Preventative Strategies
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Kristopher P. Croome
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Graft Rejection ,High rate ,medicine.medical_specialty ,Time Factors ,Tissue and Organ Procurement ,Hepatology ,business.industry ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Circulatory death ,Tissue Donors ,Liver Transplantation ,Review article ,Clinical Practice ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Donation ,Humans ,Medicine ,030211 gastroenterology & hepatology ,Graft survival ,business ,Intensive care medicine - Abstract
Donation after circulatory death (DCD) donors represent a potential means to help address the disparity between the number of patients awaiting liver transplantation (LT) and the availability of donor livers. While initial enthusiasm for DCD LT was high in the early 2000s, early reports of high rates of biliary complications and inferior graft survival resulted in reluctance among many transplant centers to use DCD liver grafts. As with all innovations in transplant practice, there is undoubtedly a learning curve associated with the optimal utilization of liver grafts from DCD donors. More contemporary data has demonstrated that results with DCD LT are improving and the number of DCD LT performed annually has been steadily increasing. In this concise review, potential mechanisms of injury for DCD livers are discussed along with strategies that have been employed in clinical practice to improve DCD LT outcomes.
- Published
- 2020
23. Hepatocellular carcinoma radiation segmentectomy treatment intensification prior to liver transplantation increases rates of complete pathologic necrosis: an explant analysis of 75 tumors
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S Ali, Montazeri, Cynthia, De la Garza-Ramos, Andrew R, Lewis, Jason T, Lewis, Jordan D, LeGout, David M, Sella, Ricardo, Paz-Fumagalli, Zlatko, Devcic, Charles A, Ritchie, Gregory T, Frey, Lucas, Vidal, Kristopher P, Croome, J Mark, McKinney, Denise, Harnois, Sunil, Krishnan, Tushar, Patel, and Beau B, Toskich
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Cohort Studies ,Necrosis ,Carcinoma, Hepatocellular ,Treatment Outcome ,Liver Neoplasms ,Humans ,Yttrium Radioisotopes ,Pneumonectomy ,Liver Transplantation ,Retrospective Studies - Abstract
To verify the correlation between yttrium-90 glass microsphere radiation segmentectomy treatment intensification of hepatocellular carcinoma (HCC) and complete pathologic necrosis (CPN) at liver transplantation.A retrospective, single center, analysis of patients with HCC who received radiation segmentectomy prior to liver transplantation from 2016 to 2021 was performed. The tumor treatment intensification cohort (n = 38) was prescribed radiation segmentectomy as per response recommendations identified in a previously published baseline cohort study (n = 37). Treatment intensification and baseline cohort treatment parameters were compared for rates of CPN. Both cohorts were then combined for an overall analysis of treatment parameter correlation with CPN.Sixty-three patients with a combined 75 tumors were analyzed. Specific activity, dose, and treatment activity were significantly higher in the treatment intensification cohort (all p 0.01), while particles per cubic centimeter of treated liver were not. CPN was achieved in 76% (n = 29) of tumors in the treatment intensification cohort compared to 49% (n = 18) in the baseline cohort (p = 0.013). The combined cohort CPN rate was 63% (n = 47). ROC analysis showed that specific activity ≥ 327 Bq (AUC 0.75, p 0.001), dose ≥ 446 Gy (AUC 0.69, p = 0.005), and treatment activity ≥ 2.55 Gbq (AUC 0.71, p = 0.002) were predictive of CPN. Multivariate logistic regression demonstrated that a specific activity ≥ 327 Bq was the sole independent predictor of CPN (p = 0.013).Radiation segmentectomy treatment intensification for patients with HCC prior to liver transplantation increases rates of CPN. While dose strongly correlated with pathologic response, specific activity was the most significant independent radiation segmentectomy treatment parameter associated with CPN.
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- 2021
24. Variation in opioid prescribing patterns after abdominal transplant surgery
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Adyr A. Moss, Amit K. Mathur, Elizabeth B. Habermann, Kristopher P. Croome, Esteban Calderon, C. Burcin Taner, Daniel S. Ubl, Julie K. Heimbach, and Jon D Sussman
- Subjects
Transplantation ,medicine.medical_specialty ,Pain, Postoperative ,business.industry ,Length of Stay ,Opioid prescribing ,Patient Discharge ,Analgesics, Opioid ,Transplant surgery ,Opioid ,Prescription opioid ,Internal medicine ,Cohort ,medicine ,Humans ,Guideline development ,Oral morphine ,Medical prescription ,Practice Patterns, Physicians' ,business ,medicine.drug ,Aged ,Retrospective Studies - Abstract
BACKGROUND Opioids are associated with negative transplant outcomes. We sought to identify patient and center effects on over-prescribing of opioids (> 200 OME (oral morphine equivalents)). STUDY DESIGN Clinical and opioid prescription data (2014-2017) were collected from three academic transplant centers for kidney (KT), liver (LT), and simultaneous liver-kidney transplant (SLK) patients. Multivariable models were used to identify predictors of opioid over-prescribing at discharge and the occurrence of refill prescriptions at 90 days. RESULTS Three-thousand seven-hundred and two patients underwent transplant in the cohort (KT: n = 2358, LT: n = 1221, SLK: n = 123). More than 80% of recipients were over-prescribed opioids at discharge (Median OME (mOME) = 300 (IQR 225-375). LT and SLK had the largest prescription size (LT mOME 338 (IQR 300-450); SLK mOME 338 (IQR 225-450) and refill rate (LT: 64%, SLK 59%) (all, P
- Published
- 2021
25. Donor Warm Ischemia Time in DCD Liver Transplantation-Working Group Report From the ILTS DCD, Liver Preservation, and Machine Perfusion Consensus Conference
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Kristopher P. Croome, Miriam Cortes-Cerisuelo, Eduardo Miñambres, Roberto Hernandez-Alejandro, Peter L. Abt, Jacques Pirenne, and Marit Kalisvaart
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Time Factors ,medicine.medical_treatment ,Ischemia ,Context (language use) ,030230 surgery ,Liver transplantation ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Hepatectomy ,Humans ,Warm Ischemia ,Liver preservation ,Tissue Survival ,Transplantation ,Machine perfusion ,Warm Ischemia Time ,business.industry ,Organ Preservation ,medicine.disease ,Tissue Donors ,Liver Transplantation ,Perfusion ,Life support ,Anesthesia ,Tissue and Organ Harvesting ,030211 gastroenterology & hepatology ,business ,Reperfusion injury - Abstract
Donation after circulatory death (DCD) grafts are commonly used in liver transplantation. Attributable to the additional ischemic event during the donor warm ischemia time (DWIT), DCD grafts carry an increased risk for severe ischemia/reperfusion injury and postoperative complications, such as ischemic cholangiopathy. The actual ischemia during DWIT depends on the course of vital parameters after withdrawal of life support and varies widely between donors. The ischemic period (functional DWIT) starts when either Spo2 or blood pressure drop below a certain point and lasts until the start of cold perfusion during organ retrieval. Over the years, multiple definitions and thresholds of functional DWIT duration have been used. The International Liver Transplantation Society organized a Consensus Conference on DCD, Liver Preservation, and Machine Perfusion on January 31, 2020 in Venice, Italy. The aim of this conference was to reach consensus about various aspects of DCD liver transplantation in context of currently available evidence. Here we present the recommendations with regards to the definitions used for DWIT and functional DWIT, the importance of vital parameters after withdrawal of life support, and acceptable thresholds of duration of functional DWIT to proceed with liver transplantation. ispartof: TRANSPLANTATION vol:105 issue:6 pages:1156-1164 ispartof: location:United States status: published
- Published
- 2021
26. Expanding Role of Donation After Circulatory Death Donors in Liver Transplantation
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C. Burcin Taner and Kristopher P. Croome
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medicine.medical_specialty ,Heel ,Tissue and Organ Procurement ,Hepatology ,business.industry ,medicine.medical_treatment ,Graft Survival ,Hemodynamics ,Liver transplantation ,Liver transplants ,Circulatory death ,Liver Transplantation ,medicine.anatomical_structure ,Risk Factors ,Life support ,Donation ,medicine ,Humans ,lipids (amino acids, peptides, and proteins) ,Intensive care medicine ,business ,Retrospective Studies - Abstract
Better understanding of how to utilize donation after circulatory death (DCD) liver grafts has resulted in improved national outcomes and expansion in the number of DCD liver transplants (LTs). This improvement has been driven by better donor and recipient matching, careful evaluation of hemodynamics during withdrawal of life support, and refinement of the procurement operation. Changes to liver allocation likely will result in increased utilization of DCD liver grafts. Ischemic cholangiopathy remains the Achilles heel of DCD LTs and, although rates have fallen with improved protocols, a certain rate likely is unavoidable. This review discusses contemporary issues with DCD LTs.
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- 2021
27. Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors
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Stephen Aniskevich, Sher-Lu Pai, Kristopher P. Croome, Ryan M Chadha, C. Burcin Taner, Justin M. Burns, Justin H. Nguyen, and Dana K. Perry
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Male ,Tissue and Organ Procurement ,Blood transfusion ,Hyperkalemia ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,End Stage Liver Disease ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,medicine ,Humans ,Prospective Studies ,Cardiopulmonary resuscitation ,Intraoperative Complications ,Aged ,Retrospective Studies ,Transplantation ,Hepatology ,medicine.diagnostic_test ,business.industry ,Incidence ,Graft Survival ,Middle Aged ,medicine.disease ,Tissue Donors ,Thromboelastography ,Liver Transplantation ,Anesthesia ,Female ,030211 gastroenterology & hepatology ,Surgery ,medicine.symptom ,Packed red blood cells ,business - Abstract
Liver grafts from donation after circulatory death (DCD) are a source of organs to decrease wait-list mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors. We collected data for 235 DCD liver recipients between 2006 and 2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included recipient age, liver disease etiology, biological Model for End-Stage Liver Disease (MELD) score, allocation MELD score, diagnosis of hepatocellular carcinoma, and year of transplantation. DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (P = 0.75), arrhythmia requiring cardiopulmonary resuscitation (P = 0.66), and treatments for hyperkalemia (P = 0.84). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products (with exception of postreperfusion packed red blood cells) utilized (P < 0.05 for all products), significant differences in postreperfusion thromboelastography parameters, as well as inotropes and vasopressors used (P < 0.05 for all infusions). There was no difference in patient (P = 0.49) and graft survival (P = 0.10) at 1, 3, and 5 years. In conclusion, DCD grafts compared with a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in longterm outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.
- Published
- 2019
28. The impact of postreperfusion syndrome during liver transplantation using livers with significant macrosteatosis
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Andrew P. Keaveny, David D. Lee, Peter Abader, Ryan M Chadha, C. Burcin Taner, Sarah Croome, Kristopher P. Croome, and David Livingston
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Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Perioperative ,030230 surgery ,Liver transplantation ,medicine.disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Increased risk ,Internal medicine ,Propensity score matching ,medicine ,Immunology and Allergy ,Pharmacology (medical) ,Graft survival ,Renal replacement therapy ,Steatosis ,business - Abstract
The impact of postreperfusion syndrome (PRS) during liver transplantation (LT) using donor livers with significant macrosteatosis is largely unknown. Clinical outcomes of all patients undergoing LT with donor livers with moderate macrosteatosis (30%-60%) (N = 96) between 2000 and 2017 were compared to propensity score matched cohorts of patients undergoing LT with donor livers with mild macrosteatosis (10%-29%) (N = 96) and no steatosis (N = 96). Cardiac arrest at the time of reperfusion was seen in eight (8.3%) of the patients in the moderate macrosteatosis group compared to one (1.0%) of the patients in the mild macrosteatosis group (P = .02) and zero (0%) of the patients in the no steatosis group (P = .004). Patients in the moderate macrosteatosis group had a higher rate of PRS (37.5% vs 18.8%; P = .004), early allograft dysfunction (EAD) (76.4% vs 25.8%; P
- Published
- 2019
29. The 'Skinny' on Assessment and Utilization of Steatotic Liver Grafts: A Systematic Review
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Kristopher P. Croome, C. Burcin Taner, and David D. Lee
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Graft Rejection ,medicine.medical_specialty ,medicine.medical_treatment ,Clinical Decision-Making ,030230 surgery ,Liver transplantation ,Severity of Illness Index ,Simple steatosis ,Donor Selection ,End Stage Liver Disease ,03 medical and health sciences ,0302 clinical medicine ,Clinical decision making ,medicine ,Humans ,Survival rate ,Transplantation ,Deceased donor ,Hepatology ,business.industry ,Graft Survival ,Allografts ,medicine.disease ,Liver Transplantation ,Surgery ,Fatty Liver ,Survival Rate ,Treatment Outcome ,Liver ,030211 gastroenterology & hepatology ,Steatosis ,Living donor liver transplantation ,business ,Liver pathology - Abstract
The frequency at which steatotic deceased donor liver grafts are encountered will likely continue to increase. Utilization of liver grafts with moderate-to-severe steatosis for liver transplantation (LT) has been previously shown to be associated with increased rates of primary nonfunction and decreased recipient survival. In order to better inform clinical decision making and guide future research, critical evaluation of the literature on donor liver steatosis and posttransplantation outcome is needed. This literature review aims to provide the "skinny" on using deceased donor steatotic livers for LT.
- Published
- 2019
30. Radiation Segmentectomy for the Treatment of Solitary Hepatocellular Carcinoma: Outcomes Compared with Those of Surgical Resection
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Cynthia De la Garza-Ramos, S. Ali Montazeri, Kristopher P. Croome, Jordan D. LeGout, David M. Sella, Sean Cleary, Justin Burns, Amit K. Mathur, Cameron J. Overfield, Gregory T. Frey, Andrew R. Lewis, Ricardo Paz-Fumagalli, Charles A. Ritchie, J. Mark McKinney, Kabir Mody, Tushar Patel, Zlatko Devcic, and Beau B. Toskich
- Subjects
Carcinoma, Hepatocellular ,Treatment Outcome ,Liver Neoplasms ,Hepatectomy ,Humans ,Radiology, Nuclear Medicine and imaging ,Pneumonectomy ,Cardiology and Cardiovascular Medicine ,Fibrosis ,Retrospective Studies - Abstract
To investigate the outcomes of radiation segmentectomy (RS) versus standard-of-care surgical resection (SR).A multisite, retrospective analysis of treatment-naïve patients who underwent either RS or SR was performed. The inclusion criteria were solitary hepatocellular carcinoma ≤8 cm in size, Eastern Cooperative Oncology Cohort performance status of 0-1, and absence of macrovascular invasion or extrahepatic disease. Target tumor and overall progression, time to progression (TTP), and overall survival rates were assessed. Outcomes were censored for liver transplantation.A total of 123 patients were included (RS, 57; SR, 66). Tumor size, Child-Pugh class, albumin-bilirubin score, platelet count, and fibrosis stage were significantly different between cohorts (P ≤ .01). Major adverse events (AEs), defined as grade ≥3 per the Clavien-Dindo classification, occurred in 0 patients in the RS cohort vs 13 (20%) patients in the SR cohort (P .001). Target tumor progression occurred in 3 (5%) patients who underwent RS and 5 (8%) patients who underwent SR. Overall progression occurred in 19 (33%) patients who underwent RS and 21 (32%) patients who underwent SR. The median overall TTP was 21.9 and 29.4 months after RS and SR, respectively (95% confidence interval [CI], 15.5-28.2 and 18.5-40.3, respectively; P = .03). Overall TTP subgroup analyses showed no difference between treatment cohorts with fibrosis stages 3-4 (P = .26) and a platelet count of150 × 10RS and SR were performed in different patient populations, which limits comparison. RS approached SR outcomes, with a lower incidence of major AEs, in patients who were not eligible for hepatectomy.
- Published
- 2022
31. Post-Liver Transplant Early Allograft Dysfunction Modifies the Effect of Pre-Liver Transplant Renal Dysfunction on Post-Liver Transplant Survival
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Tambi Jarmi, Launia J. White, Kristopher P. Croome, Shennen A. Mao, Martin L. Mai, Liu Yang, Hani M. Wadei, David O. Hodge, C. Burcin Taner, and Andrew P. Keaveny
- Subjects
medicine.medical_specialty ,Bilirubin ,medicine.medical_treatment ,Renal function ,Liver transplantation ,Kidney ,Gastroenterology ,chemistry.chemical_compound ,Risk Factors ,Internal medicine ,medicine ,Humans ,Renal replacement therapy ,Retrospective Studies ,Transplantation ,Creatinine ,Hepatology ,business.industry ,Hazard ratio ,Graft Survival ,Allografts ,Confidence interval ,Liver Transplantation ,chemistry ,Liver ,Surgery ,Kidney Diseases ,business - Abstract
Pre-liver transplantation (LT) renal dysfunction is associated with poor post-LT survival. We studied whether early allograft dysfunction (EAD) modifies this association. Data on 2,856 primary LT recipients who received a transplant between 1998 and 2018 were retrospectively reviewed. Patients who died within the first post-LT week or received multiorgan transplants and previous LT recipients were excluded. EAD was defined as (1) total bilirubin ≥ 10 mg/dL on postoperative day (POD) 7, (2) international normalized ratio ≥1.6 on POD 7, and/or (3) alanine aminotransferase or aspartate aminotransferase ≥2000 IU/mL in the first postoperative week. Pre-LT renal dysfunction was defined as serum creatinine >1.5 mg/dL or on renal replacement therapy at LT. Patients were divided into 4 groups according to pre-LT renal dysfunction and post-LT EAD development. Recipients who had both pre-LT renal dysfunction and post-LT EAD had the worst unadjusted 1-year, 3-year, and 5-year post-LT patient and graft survival, whereas patients who had neither renal dysfunction nor EAD had the best survival (P
- Published
- 2021
32. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation
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Bart van Hoek, Riccardo De Carlis, Philipp Dutkowski, Gonzalo Sapisochin, Luciano De Carlis, Danny van der Helm, Juan Carlos Caicedo, Erin Winter, Wojciech G. Polak, Humberto Bohorquez, Gabriel C. Oniscu, Fabrizio Di Benedetto, Amna Daud, Paolo Muiesan, V. Lucidi, Daniel Borja-Cacho, C. Burcin Taner, Nicolas Meurisse, Jacques Pirenne, Jeannette Widmer, Amelia J. Hessheimer, Matteo Ravaioli, Wayel Jassem, Mauricio Flores Carvalho, Aad P. van der Berg, Ahmed Sherif, Michele Colledan, Amit Nair, Renato Romagnoli, Diethard Monbaliu, Desislava Germanova, Cristiano Quintini, Andre Gorgen, Matteo Cescon, Sofie Vets, Marco P. A. W. Claasen, Massimo Malagó, Peter Lodge, Stefania Camagni, Kristopher P. Croome, Giorgio Rossi, Robert J. Porte, Ian P.J. Alwayn, Rebecca Panconesi, Maite Paolucci, Philipp Kron, Andrea Schlegel, Vincent E de Meijer, Annalisa Dolcet, Ina Jochmans, Charles Miller, Margherita Carbonaro, Pierre-Alain Clavien, Jan Nm Ijzermans, Constantino Fondevila, Damiano Patrono, Daniele Dondossola, Olivier Detry, Mohamed Elsharif, Koji Tomiyama, Alessandro Parente, Nigel Heaton, Herold J. Metselaar, Matteo Mueller, Tiziana Olivieri, George E. Loss, Marjolein van Reeven, Sarah Croome, Magdy Attia, Roberto Hernandez-Alejandro, Otto B. van Leeuwen, Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Surgery, Gastroenterology & Hepatology, Schlegel A., van Reeven M., Croome K., Parente A., Dolcet A., Widmer J., Meurisse N., De Carlis R., Hessheimer A., Jochmans I., Mueller M., van Leeuwen O.B., Nair A., Tomiyama K., Sherif A., Elsharif M., Kron P., van der Helm D., Borja-Cacho D., Bohorquez H., Germanova D., Dondossola D., Olivieri T., Camagni S., Gorgen A., Patrono D., Cescon M., Croome S., Panconesi R., Carvalho M.F., Ravaioli M., Caicedo J.C., Loss G., Lucidi V., Sapisochin G., Romagnoli R., Jassem W., Colledan M., De Carlis L., Rossi G., Di Benedetto F., Miller C.M., van Hoek B., Attia M., Lodge P., Hernandez-Alejandro R., Detry O., Quintini C., Oniscu G.C., Fondevila C., Malago M., Pirenne J., IJzermans J.N.M., Porte R.J., Dutkowski P., Taner C.B., Heaton N., Clavien P.-A., Polak W.G., Muiesan P., Alwayn I.P.J., van der Berg A.P., Carbonaro M., Claasen M., Daud A., de Meijer V.E., Metselaar H.J., Monbaliu D., Paolucci M., Vets S., and Winter E.
- Subjects
Male ,Organ Dysfunction Scores ,benchmarking ,Donation after circulatory death ,liver transplantation ,morbidity ,organ perfusion ,risk analysis ,IMPACT ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Liver transplantation ,GUIDELINES ,ALLOCATION ,law.invention ,Cohort Studies ,Postoperative Complications ,PROPOSAL ,Interquartile range ,law ,Outcome Assessment, Health Care ,risk analysi ,Mortality rate ,EXTENDED-CRITERIA DONORS ,Shock ,Middle Aged ,Editorial from the ACHBPT ,Intensive care unit ,CARDIAC DEATH ,Area Under Curve ,Cohort ,Female ,medicine.medical_specialty ,Tissue and Organ Procurement ,BILIARY COMPLICATIONS ,Cold storage ,CLASSIFICATION ,Internal medicine ,SCORE ,medicine ,Humans ,Renal replacement therapy ,Aged ,Proportional Hazards Models ,GRAFT-SURVIVAL ,Hepatology ,business.industry ,ROC Curve ,Complication ,business - Abstract
BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups.METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered.RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk.CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials.LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort.
- Published
- 2021
33. Multi-Center Analysis of Liver Transplantation for Combined Hepatocellular Carcinoma-Cholangiocarcinoma Liver Tumors
- Author
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Kristopher P. Croome, Erin H. Baker, David M. Nagorney, Charles A. Rickert, Cristina R. Ferrone, Shoko Kimura, Sander Florman, Marc Najjar, Joohyun Kim, Jennifer Pasko, Alan Hemming, Johnny C. Hong, Jessica Lindemann, Parissa Tabrizian, Erin Maynard, Karim J. Halazun, Ronald W. Busuttil, Jane Cheng, Leigh Anne Dageforde, M.B. Majella Doyle, Lavanya Yohanathan, Rami Srouji, William C. Chapman, Gabriel T. Schnickel, Matthew L. Holzner, David A. Lee, Vatche G. Agopian, William R. Jarnagin, Ju Dong Yang, Neeta Vachharajani, and Hiral Amin
- Subjects
Male ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Liver transplantation ,Gastroenterology ,Cholangiocarcinoma ,0302 clinical medicine ,Model for End-Stage Liver Disease ,Neoplasms ,Medicine ,Cancer ,education.field_of_study ,Liver Disease ,Liver Neoplasms ,Hazard ratio ,Middle Aged ,Tumor Burden ,Local ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Liver Cancer ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Chronic Liver Disease and Cirrhosis ,Clinical Trials and Supportive Activities ,Clinical Sciences ,Population ,Milan criteria ,Disease-Free Survival ,Article ,03 medical and health sciences ,Rare Diseases ,Clinical Research ,Internal medicine ,Hepatectomy ,Humans ,education ,Digestive Diseases - (Gallbladder) ,Survival analysis ,Aged ,Retrospective Studies ,Transplantation ,business.industry ,Prevention ,Complex and Mixed ,Carcinoma ,Hepatocellular ,Organ Transplantation ,medicine.disease ,Neoplasms, Complex and Mixed ,Liver Transplantation ,Neoplasm Recurrence ,Surgery ,Neoplasm Recurrence, Local ,Digestive Diseases ,business - Abstract
BackgroundCombined hepatocellular-cholangiocarcinoma liver tumors (cHCC-CCA) with pathologic differentiation of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma within the same tumor are not traditionally considered for liver transplantation due to perceived poor outcomes. Published results are from small cohorts and single centers. Through a multicenter collaboration, we performed the largest analysis to date of the utility of liver transplantation for cHCC-CCA.Study designLiver transplant and resection outcomes for HCC (n= 2,998) and cHCC-CCA (n= 208) were compared in a 12-center retrospective review (2009 to 2017). Pathology defined tumor type. Tumor burden was based on radiologic Milan criteria at time of diagnosis and applied to cHCC-CCA for uniform analysis. Kaplan-Meier survival curves and log-rank test were used to determine overall survival and disease-free survival. Cox regression was used for multivariate survival analysis.ResultsLiver transplantation for cHCC-CCA (n= 67) and HCC (n= 1,814) within Milan had no significant difference in overall survival (5-year cHCC-CCA 70.1%, HCC 73.4%, p=0.806), despite higher cHCC-CCA recurrence rates (23.1% vs 11.5% 5 years, p 
- Published
- 2020
34. Post-Cardiac Injury Following Liver Transplantation for Budd-Chiari Syndrome
- Author
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Pablo Moreno-Franco, Courtney L. Scott, Ryan M Chadha, Juan M. Canabal, Pamela Wong-Lucio, Philip Lowman, and Kristopher P. Croome
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Liver transplantation ,Budd-Chiari Syndrome ,medicine.disease ,Surgery ,Liver Transplantation ,Pericarditis ,Postoperative Complications ,Liver ,Recurrence ,medicine ,Budd–Chiari syndrome ,Humans ,business - Published
- 2020
35. The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center
- Author
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Martin L. Mai, Andrew P. Keaveny, Hani M. Wadei, Launia J. White, David O. Hodge, Denis M. Harnois, C. Burcin Taner, Tambi Jarmi, Shennen A. Mao, and Kristopher P. Croome
- Subjects
Male ,medicine.medical_specialty ,Multivariate analysis ,Time Factors ,medicine.medical_treatment ,Urology ,Separate analysis ,Specialties of internal medicine ,Kaplan-Meier Estimate ,Liver transplantation ,Single Center ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Renal Dialysis ,Risk Factors ,medicine ,Humans ,Renal Insufficiency ,Dialysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Creatinine ,Hepatology ,business.industry ,Liver Diseases ,Graft Survival ,Patient survival ,General Medicine ,Middle Aged ,Post transplant ,Liver Transplantation ,Survival Rate ,Liver transplant outcome ,chemistry ,Pre-LT renal dysfunction ,RC581-951 ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Glomerular Filtration Rate - Abstract
Introduction and Objectives: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. Materials and Methods: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver–kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998–2002, n = 488), era-2 (2003–2007, n = 889), era-3 (2008–2012, n = 703) and era-4 (2013–2018, n = 791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5 mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. Results: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (P
- Published
- 2020
36. Neoadjuvant Radiation Lobectomy and Immunotherapy for Angioinvasive HCC Resulting in Complete Pathologic Response
- Author
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Andrew P. Keaveny, Tushar Patel, Beau Toskich, Kristopher P. Croome, Denise M. Harnois, Kabir Mody, Ashton W. Boyle, Harris Liou, and Justin M. Burns
- Subjects
Ablation Techniques ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Biopsy ,medicine ,Pathologic Response ,Hepatectomy ,Humans ,Neoplasm Invasiveness ,Yttrium Radioisotopes ,Immune Checkpoint Inhibitors ,Aged ,Hepatology ,business.industry ,Liver Neoplasms ,Immunotherapy ,Chemoradiotherapy, Adjuvant ,Middle Aged ,Microspheres ,Neoadjuvant Therapy ,Nivolumab ,Treatment Outcome ,Liver ,Radiology ,business - Published
- 2020
37. Pathologic Response of Hepatocellular Carcinoma Treated with Yttrium-90 Glass Microsphere Radiation Segmentectomy Prior to Liver Transplantation: A Validation Study
- Author
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Ricardo Paz-Fumagalli, Andrew R. Lewis, Zlatko Devcic, Jason T. Lewis, Tushar Patel, S. Ali Montazeri, Kristopher P. Croome, Charles Ritchie, Lucas Lauar Cortizo Vidal, Beau Toskich, David M. Sella, Greg T. Frey, Jordan D. LeGout, and Matthew T. Olson
- Subjects
Adult ,Male ,Validation study ,Necrosis ,Carcinoma, Hepatocellular ,Time Factors ,medicine.medical_treatment ,Liver transplantation ,Gross examination ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Yttrium Radioisotopes ,Aged ,Retrospective Studies ,business.industry ,Liver Neoplasms ,Histology ,Middle Aged ,medicine.disease ,Microspheres ,Liver Transplantation ,Tumor Burden ,Transplantation ,Treatment Outcome ,Response Evaluation Criteria in Solid Tumors ,Hepatocellular carcinoma ,Female ,medicine.symptom ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
PURPOSE To evaluate the pathologic outcomes of hepatocellular carcinoma (HCC) treated with Yttrium-90 radiation segmentectomy using glass microspheres prior to liver transplantation and explore parameters associated with pathologic necrosis. MATERIALS AND METHODS A single-institution retrospective analysis of HCC patients who received radiation segmentectomy prior to liver transplantation from November 2016 to May 2020 was performed. Patients were included if the treatment angiosome encompassed the entire tumor and could be correlated with available gross pathology. Archived histology slides were reviewed for percentage of pathologic necrosis. Thirty-three patients with 37 tumors were evaluated. The median tumor size was 2.3 cm (range, 1-6.7 cm). RESULTS All tumors received a single treatment. The median time from radiation segmentectomy to transplantation was 206 days (range, 58-550 days). Objective response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was 92% (complete response, 76%; partial response, 16%). A total of 68% (n = 25) of tumors demonstrated ≥99% pathologic necrosis. Complete pathologic necrosis was present in 53% and 75% of tumors treated with >190 Gy (n = 18) and >500 Gy (n = 8) single-compartment Medical Internal Radiation Dose, respectively. Complete response per mRECIST, posttreatment angiosome T1 hypointensity, dose >190 Gy, microsphere specific activity >297 Bq, and a longer time between treatment and transplant were associated with ≥99% tumor necrosis (P < .05). No posttransplant tumor recurrences occurred within a median follow-up of 604 days (range, 138-1,223 days). CONCLUSIONS Radiation segmentectomy can serve as an ablative modality for the treatment of HCC prior to liver transplant.
- Published
- 2020
38. Successfully sharing the sandbox: A perspective on combined DCD liver and heart donor procurement
- Author
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Kristopher P. Croome and Mani A. Daneshmand
- Subjects
medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,030230 surgery ,Key issues ,03 medical and health sciences ,0302 clinical medicine ,Procurement ,Immunology and Allergy ,Medicine ,Humans ,Pharmacology (medical) ,Warm Ischemia ,Intensive care medicine ,Heart transplantation ,Transplantation ,business.industry ,Circulatory death ,Tissue Donors ,United States ,Liver Transplantation ,Clinical trial ,Death ,Liver ,Donation ,Heart donor ,business - Abstract
Donation after circulatory death (DCD) heart transplantation is currently being performed in the United States as part of a clinical trial. As with all donor procurements, effective coordination between all involved teams is vital for successful organ recovery and maximal utilization of donor organs. The current discussion relays a viewpoint on combined DCD liver and heart donor procurement. Key issues highlighted include the vital importance of donor warm ischemia time (DWIT) on outcome for both recipients as well as issues pertaining to DWIT that may arise when performing combined DCD liver and heart donor procurement.
- Published
- 2020
39. Simultaneous liver transplant and sleeve gastrectomy not associated with worse index admission outcomes compared to liver transplant alone - a retrospective cohort study
- Author
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Elizabeth S. Aby, Surakit Pungpapong, Karn Wijarnpreecha, C.B. Taner, Kristopher P. Croome, Paul T. Kroner, and Christopher C. Thompson
- Subjects
medicine.medical_specialty ,Sleeve gastrectomy ,medicine.medical_treatment ,Length of hospitalization ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Gastrectomy ,Internal medicine ,medicine ,Humans ,In patient ,Retrospective Studies ,Transplantation ,Inpatient mortality ,business.industry ,Mortality rate ,Retrospective cohort study ,Liver Transplantation ,Obesity, Morbid ,Hospitalization ,Treatment Outcome ,030211 gastroenterology & hepatology ,Laparoscopy ,business ,Resource utilization - Abstract
Sleeve gastrectomy (SG) at the time of liver transplant (LT) has been argued to decrease resource utilization. However, larger studies examining outcomes are lacking. We aim to determine the outcomes of simultaneous SG and LT compared to LT alone. This is a retrospective cohort study using the 2011-2017 National Inpatient Sample (NIS). The primary outcome was the odds of inpatient mortality in patients undergoing simultaneous SG and LT compared with LT alone. Secondary outcomes included inpatient morbidity, resource utilization, hospital length of stay (LOS), and inflation-adjusted total hospital costs and charges. A total of 45 361 patients underwent LT in the study period, 49 underwent simultaneous SG. Patients undergoing simultaneous LT and SG had lower crude mortality (0.0%) compared to LT alone (2.97%; P = 0.52). There were no statistically significant differences in morbidity, resource utilization, and hospital costs and charges. Patients undergoing simultaneous LT and SG did not have significantly different mortality rates, morbidity, resource utilization, or LOS during the index admission when compared to LT alone. SG may be feasible at the time of LT in very carefully selected patients. Studies should focus in determining which patients are the optimal candidates to undergo simultaneous LT and SG.
- Published
- 2020
40. Ethics and Law of DCD Transplant
- Author
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Nigel Heaton, Annalisa Dolcet, and Kristopher P. Croome
- Subjects
business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,Declaration ,Liver transplantation ,Transplantation ,Law ,Medicine ,In patient ,Organ donation ,business ,Autonomy ,media_common ,Equity (law) - Abstract
Throughout the world, the practice of organ donation for transplantation is governed by the dead donor rule, that is, non-paired vital organs can be retrieved only from patients who are dead. While this principle is constant, the specifics surrounding the laws and cultural practices relating to death and organ donation vary significantly between countries. Key ethical concepts include autonomy, non-maleficence, futility, equity, and utility. This chapter covers a number of ethical considerations encountered with DCD liver transplantation including timing of the decision to withdrawal treatment in patients who may be potential donors, donor treatment prior to death, site for withdrawal of treatment, declaration of death, and stand-off time prior to starting retrieval and organ allocation/sharing. This chapter also provides country-specific information on both laws and practices surrounding DCD organ donation.
- Published
- 2020
41. Warm Ischemia Time
- Author
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Kristopher P. Croome and C. Burcin Taner
- Subjects
Aorta ,medicine.medical_specialty ,Warm Ischemia Time ,business.industry ,medicine.medical_treatment ,Hemodynamics ,Liver transplantation ,medicine.disease ,Donation ,medicine.artery ,Internal medicine ,Life support ,medicine ,Cardiology ,Asystole ,business ,Perfusion - Abstract
Donation after circulatory death (DCD) donors differ from donation after brain death (DBD) donors in that they experience a period of obligatory donor warm ischemia time (DWIT) prior to initiation of cold perfusion of organs. While most authors agree that prolonged DWIT results in hepatic ischemic injury, debate exists on the length of DWIT or hemodynamic parameters following withdrawal of life support that determine whether a liver graft can be used with reasonable safety. As such, the concept of a functional warm ischemia time (f-DWIT) arose from the notion that individual events during DCD procurement, such as variations in hemodynamics, mandatory wait period, and time from incision to cannulation of the aorta and cross clamp, all of which are included in total DWIT, may have different impact on the outcome of the liver graft. The present chapter reviews the various definitions relevant to warm ischemia time in liver transplantation using DCD donors in an attempt to clarify the existing ambiguity. The chapter also provides a comprehensive view of the literature by describing studies that have investigated various parameters of warm ischemia time and their associations with outcomes following liver transplant using DCD donors, such as graft failure and ischemic cholangiopathy (IC). Finally the chapter reviews potential reasons for the variability in previous studies as well as discusses the limitations associated with using various hemodynamic parameters to evaluate hepatic ischemic injury.
- Published
- 2020
42. Ischemic Cholangiopathy
- Author
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Kristopher P. Croome and C. Burcin Taner
- Published
- 2020
43. Indications and Perioperative Outcomes for Pancreatectomy with Arterial Resection
- Author
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May C. Tee, Rory L. Smoot, Michael B. Farnell, Michael L. Kendrick, Ryan T. Groeschl, Kristopher P. Croome, Adam C. Krajewski, David M. Nagorney, Mark J. Truty, and Sean P. Cleary
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Fistula ,Perioperative ,Odds ratio ,030230 surgery ,medicine.disease ,Revascularization ,Intensive care unit ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic fistula ,law ,030220 oncology & carcinogenesis ,Pancreatectomy ,medicine ,business ,Survival rate - Abstract
Background Pancreatectomy with arterial resection (AR) is performed infrequently. As indications evolve, we evaluated indications, outcomes, and predictors of mortality, morbidity, and survival after AR. Study Design We performed a single-institution review of elective pancreatectomies with AR (from July1990 to July 2017). Univariate and multivariate analyses were performed for predictors of outcomes and survival. Results A total of 111 patients underwent pancreatectomy with AR including any hepatic (54%), any celiac (44%), any superior mesenteric (14%), or multiple ARs (14%), with revascularization in 55%. The majority of cases were planned (77%) and performed post-2010 (78%). Overall 90-day major morbidity (≥grade III) and mortality were 54% and 13%, respectively, due to post-pancreatectomy hemorrhage (PPH), postoperative pancreatic fistula (POPF), or ischemia in the majority of cases. There was a significant decrease in mortality post-2010 (9% vs 29%, p = 0.02), and this was protective on multivariate analysis (odds ratio [OR] 0.1, p = 0.004); PPH increased mortality (OR 6.1, p Conclusions Regardless of indication or type, pancreatectomy with AR is associated with risks greater than standard resections. Mortality has decreased in the modern era; however, morbidity remains high from hemorrhagic, fistula, or ischemia-related complications. Mitigation measures are needed if advanced resections are considered with increasing frequency given the potential oncologic benefit of AR in selected cases after modern chemotherapy.
- Published
- 2018
44. Liver transplantation for intrahepatic cholangiocarcinoma
- Author
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Jose Melendez, Kaitlyn R. Musto, Ghassan Tranesh, C. Burcin Taner, Kristopher P. Croome, Tushar Patel, Raouf E. Nakhleh, David D. Lee, Denise M. Harnois, and Justin H. Nguyen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Bile Duct Neoplasm ,Liver transplantation ,Milan criteria ,Single Center ,Gastroenterology ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,parasitic diseases ,medicine ,Humans ,Neoplasm Invasiveness ,Diagnostic Errors ,Intrahepatic Cholangiocarcinoma ,Aged ,Neoplasm Staging ,Retrospective Studies ,Transplantation ,Hepatology ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,digestive system diseases ,Liver Transplantation ,Clinical trial ,Treatment Outcome ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Florida ,Female ,030211 gastroenterology & hepatology ,Surgery ,Neoplasm Grading ,Neoplasm Recurrence, Local ,business - Abstract
Although hepatocellular carcinoma (HCC) has become a common indication for liver transplantation (LT), intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) are historically contraindicated due to their aggressive behavior. On the basis of recent experiences, some groups have proposed a clinical trial investigating the role of LT for patients with early cholangiocarcinoma (CCA), defined as a single lesion ≤ 2 cm. The purpose of this study is to assess the clinicopathologic features and outcomes following LT for patients who were initially diagnosed with HCC and subsequently found to have either ICC or cHCC-CCA on explant. Patients with the diagnosis of primary liver cancer (PLC) after LT from a single center were retrospectively reviewed. Outcomes for patients with early CCA were compared with patients with HCC within Milan criteria (MC). Out of 618 patients transplanted with PLC, 44 patients were found to have CCA on explant. On the basis of preoperative imaging, 12 patients met criteria for early CCA and were compared with 319 patients who had HCC within MC. The 1- and 5-year overall survival for early CCA versus HCC was 63.6% versus 90.0% and 63.6% versus 70.3% (log-rank, P = 0.25), respectively. Overall recurrence was 33.3% for early CCA versus 11% for HCC. On explant the patients with CCA were more likely understaged with higher tumor grade and vascular invasion. In conclusion, patients with CCA present a diagnostic challenge, which often leads to the finding of more aggressive lesions on explant after LT, higher recurrence rates, and worse post-LT survival. Careful consideration of this diagnostic conundrum needs to be made before a clinical trial is undertaken. Liver Transplantation 24 634-644 2018 AASLD.
- Published
- 2018
45. Waitlist Outcomes for Patients Relisted Following Failed Donation After Cardiac Death Liver Transplant: Implications for Awarding Model for End-Stage Liver Disease Exception Scores
- Author
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C.B. Taner, Kristopher P. Croome, David D. Lee, Andrew P. Keaveny, and Justin H. Nguyen
- Subjects
Graft Rejection ,Male ,Reoperation ,medicine.medical_specialty ,Tissue and Organ Procurement ,Waiting Lists ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Decision Support Techniques ,End Stage Liver Disease ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Model for End-Stage Liver Disease ,Risk Factors ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,Pharmacology (medical) ,In patient ,Hepatopulmonary syndrome ,Transplantation ,Models, Statistical ,business.industry ,Liver Diseases ,Patient Selection ,Graft Survival ,Donation after cardiac death ,Middle Aged ,Prognosis ,medicine.disease ,Tissue Donors ,Transplant Recipients ,Liver Transplantation ,Surgery ,Death ,Hepatic artery thrombosis ,Hepatocellular carcinoma ,Female ,030211 gastroenterology & hepatology ,business ,Follow-Up Studies - Abstract
Understanding of outcomes for patients relisted for ischemic cholangiopathy following a donation after cardiac death (DCD) liver transplant (LT) will help standardization of a Model for End-Stage Liver Disease exception scheme for retransplantation. Early relisting (E-RL) for DCD graft failure caused by primary nonfunction (PNF) or hepatic artery thrombosis (HAT) was defined as relisting ≤14 days after DCD LT, and late relisting (L-RL) due to biliary complications was defined as relisting 14 days to 3 years after DCD LT. Of 3908 DCD LTs performed nationally between 2002 and 2016, 540 (13.8%) patients were relisted within 3 years of transplant (168 [4.3%] in the E-RL group, 372 [9.5%] in the L-RL group). The E-RL and L-RL groups had waitlist mortality rates of 15.4% and 10.5%, respectively, at 3 mo and 16.1% and 14.3%, respectively, at 1 year. Waitlist mortality in the L-RL group was higher than mortality and delisted rates for patients with exception points for both hepatocellular carcinoma (HCC) and hepatopulmonary syndrome (HPS) at 3- to 12-mo time points (p < 0.001). Waitlist outcomes differed in patients with early DCD graft failure caused by PNF or HAT compared with those with late DCD graft failure attributed to biliary complications. In L-RL, higher rates of waitlist mortality were noted compared with patients listed with exception points for HCC or HPS.
- Published
- 2017
46. Noneligible Donors as a Strategy to Decrease the Organ Shortage
- Author
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Kristopher P. Croome, C. B. Taner, David D. Lee, and Andrew P. Keaveny
- Subjects
Male ,Organ procurement organization ,United Network for Organ Sharing ,Brain Death ,medicine.medical_specialty ,Tissue and Organ Procurement ,Economic shortage ,030230 surgery ,03 medical and health sciences ,Match model ,Liver disease ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Pharmacology (medical) ,Aged ,Transplantation ,business.industry ,Graft Survival ,Organ Transplantation ,Prognosis ,medicine.disease ,Tissue Donors ,Donation after brain death ,Surgery ,Death ,Survival Rate ,Organ procurement ,Liver donors ,Female ,030211 gastroenterology & hepatology ,business ,Follow-Up Studies - Abstract
Organ procurement organization (OPO) performance is generally evaluated by the number of organ procurement procedures divided by the number of eligible deaths (donation after brain death [DBD] donors aged70 years), whereas the number of noneligible deaths (including donation after cardiac death donors and DBD donors aged70 years) is not tracked. The present study aimed to investigate the variability in the proportion of noneligible liver donors by the 58 donor service areas (DSAs). Patients undergoing liver transplant (LT) between 2011 and 2015 were obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research file. LTs from noneligible and eligible donors were compared. The proportion of noneligible liver donors by DSA varied significantly, ranging from 0% to 19.6% of total liver grafts used. In transplant programs, the proportion of noneligible liver donors used ranged from 0% to 35.3%. On linear regression there was no correlation between match Model for End-Stage Liver Disease score for programs in a given DSA and proportion of noneligible donors used from the corresponding DSA (p = 0.14). Noneligible donors remain an underutilized resource in many OPOs. Policy changes to begin tracking noneligible donors and learning from OPOs that have high noneligible donor usage are potential strategies to increase awareness and pursuit of these organs.
- Published
- 2017
47. Interpreting Outcomes in DCDD Liver Transplantation
- Author
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Richard Gilroy, Mark Levstik, Aos S. Karim, Humberto E. Bohorquez, Seth J. Karp, Julie K. Heimbach, David P. Foley, Sean C. Kumer, Ari Cohen, C. Burcin Taner, Kristopher P. Croome, Roberto Hernandez-Alejandro, Maureen McCauley, James F. Markmann, Michael D. Leise, Jonathan P. Fryer, David S. Goldberg, and Peter L. Abt
- Subjects
Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Bile Duct Diseases ,030230 surgery ,Outcome assessment ,Liver transplantation ,Donor Selection ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ischemia ,Risk Factors ,Cause of Death ,Outcome Assessment, Health Care ,medicine ,Humans ,Intensive care medicine ,Aged ,Retrospective Studies ,Cause of death ,Transplantation ,business.industry ,Retrospective cohort study ,Middle Aged ,Tissue Donors ,United States ,Liver Transplantation ,Bile Ducts, Intrahepatic ,Multicenter study ,Donation ,Multivariate Analysis ,Female ,030211 gastroenterology & hepatology ,Adult liver ,business - Abstract
In the United States, 5% of adult liver transplant recipients receive a graft donation after circulatory determination of death (DCDD). Concerns for ischemic cholangiopathy (IC), a disease of diffuse intrahepatic stricturing limits broader DCDD use. Single-center reports demonstrate large variation in outcomes.Retrospective deidentified data collected between 2005 and 2013 were entered electronically by 10 centers via a Research Electronic Data Capture database. Our primary outcome was development of intrahepatic biliary strictures consistent with IC.Within 6 months post-DCDD transplant, 162 (21.8%) patients developed a biliary stricture, of which 88 (11.8%) exhibited intrahepatic structuring consistent with IC. Unadjusted 6-month IC rate among the 10 centers varied significantly (P = 0.006) from 6.3% to 25.9%. The only factor associated with increased risk of IC within 6 months was Roux-en-Y hepaticojejunostomy (vs duct-to-duct) (odds ratio, 3.06; 95% confidence interval, 1.52-6.16; P = 0.002). Graft failure by 6 months was more than 3 times higher for DCDD recipients with IC (odds ratio for IC, 3.36; 95% confidence interval, 1.95-5.79).This first report of the large combined experience with DCDD from the Improving DCDD Outcomes in Liver Transplant consortium demonstrates significant differences in IC among centers, the importance of biliary strictures as a risk factor for graft failure, and does not validate other risk factors for IC found in smaller studies.
- Published
- 2017
48. Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensity‐matched cohort
- Author
-
Kristopher P. Croome, David D. Lee, Andrew P. Keaveny, Justin H. Nguyen, Justin M. Burns, Dana K. Perry, and C. Burcin Taner
- Subjects
Graft Rejection ,Male ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030230 surgery ,Liver transplantation ,Severity of Illness Index ,Gastroenterology ,0302 clinical medicine ,Matched cohort ,Quality of life ,Ischemia ,Surveys and Questionnaires ,Prospective Studies ,Prospective cohort study ,Cold Ischemia ,Graft Survival ,Middle Aged ,Allografts ,Treatment Outcome ,Liver ,Tissue and Organ Harvesting ,Female ,030211 gastroenterology & hepatology ,Adult ,medicine.medical_specialty ,Adolescent ,Biliary Tract Diseases ,Donor Selection ,End Stage Liver Disease ,03 medical and health sciences ,Internal medicine ,Severity of illness ,medicine ,Humans ,Propensity Score ,Aged ,Retrospective Studies ,Transplantation ,Hepatology ,business.industry ,Retrospective cohort study ,Donation after cardiac death ,Transplant Recipients ,Liver Transplantation ,Surgery ,Propensity score matching ,Quality of Life ,business ,Follow-Up Studies - Abstract
Background: The use of liver grafts from donation after cardiac death donors (DCD LT) has been limited due to the increased rate of graft failure, mostly related to ischemic cholangiopathy(IC). It is our hypothesis that long term outcomes and quality of life similar to patients undergoing liver transplantation with donation after brain death donors (DBD LT) can be achieved. Methods: Clinical outcomes of all patients undergoing DCD LT (n = 300) between 1998-2015 were compared to a propensity score matched cohort of patients undergoing DBD LT (n = 300). Patients were contacted for a follow-up questionnaire and SF-12 Quality of Life Survey administration. All patients had at least 1 year follow-up. Results: Graft survival at 1-,3- and 5-years was 83.8%,75.5% and 70.1% in the DCD LT group and 88.4%,80.3% and 73.9% in the DBD LT group (p = 0.27). Patient survival at 1-,3- and 5-years was 92.3%, 86.1% and 80.3% in the DCD LT group and 92.3%,85.1% and 79.5% in the DBD LT group(p = 0.81). IC developed in 12% and 2% of patients in the DCD LT group and DBD LT group, respectively (p
- Published
- 2017
49. Is mandatory routine caudate lobe resection indicated in hilar cholangiocarcinoma ?
- Author
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Travis E. Grotz, Sean P. Cleary, Michael L. Kendrick, Thomas Szabo Yamashita, Kristopher P. Croome, Rory L. Smoot, Mark J. Truty, David M. Nagorney, and Lavanya Yohanathan
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,medicine ,Caudate lobe ,Radiology ,business ,Resection - Published
- 2020
50. Improving National Results in Liver Transplantation Using Grafts From Donation After Cardiac Death Donors
- Author
-
Kristopher P. Croome, C. Burcin Taner, David D. Lee, and Andrew P. Keaveny
- Subjects
Adult ,Male ,Brain Death ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Tissue and Organ Procurement ,Databases, Factual ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Outcome assessment ,Severity of Illness Index ,Body Mass Index ,Donor Selection ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Cold ischemia ,Intensive care medicine ,Aged ,Transplantation ,business.industry ,Donor selection ,Cold Ischemia ,Graft Survival ,Liver Neoplasms ,Age Factors ,Donation after cardiac death ,Hepatitis C ,Middle Aged ,medicine.disease ,Tissue Donors ,United States ,Liver Transplantation ,Death ,Multivariate Analysis ,Female ,030211 gastroenterology & hepatology ,Graft survival ,business - Abstract
Published reports describing the national experience with liver grafts from donation after cardiac death (DCD) donors have resulted in reservations with their widespread utilization. The present study aimed to investigate if temporal improvements in outcomes have been observed on a national level and to determine if donor and recipient selection have been modified in a fashion consistent with published data on DCD use in liver transplantation (LT).Patients undergoing DCD LT between 2003 and 2014 were obtained from the United Network of Organ Sharing Standard Transplant Analysis and Research file and divided into 3 equal eras based on the date of DCD LT: era 1 (2003-2006), era 2 (2007-2010), and era 3 (2011-2014).Improvement in graft survival was seen between era 1 and era 2 (P = 0.001) and between era 2 and era 3 (P0.001). Concurrently, an increase in the proportion of patients with hepatocellular carcinoma and a decrease in critically ill patients, retransplant recipients, donor age, warm ischemia time greater than 30 minutes and cold ischemic time also occurred over the same period. On multivariate analysis, significant predictors of graft survival included: recipient age, biologic MELD score, recipient on ventilator, recipient hepatitis C virus + serology, donor age and cold ischemic time. In addition, even after adjustment for all of the aforementioned variables, both era 2 (hazard ratio, 0.81; confidence interval, 0.69-0.94; P = 0.007), and era 3 (hazard ratio, 0.61; confidence interval, 0.5-0.73; P0.001) had a protective effect compared to era 1.The national outcomes for DCD LT have improved over the last 12 years. This change was associated with modifications in both recipient and donor selection. Furthermore, an era effect was observed, even after adjustment for all recipient and donor variables on multivariate analysis.
- Published
- 2016
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