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4. Leaking Umbilical Hernias in Cirrhotic Patients, Repair or Observe?

Author

Torabi, Julia, Florman, Sander, and Divino, Celia

Abstract

Background: Umbilical hernias (UHs) in cirrhotic patients are common, can be quite complicated and are associated with significant morbidity and mortality. Leakage of ascites is a challenging entity and poses significant risks. Methods: This is a retrospective study of patients with cirrhosis and UHs with ascitic leakage. Patients were divided into two groups: patients managed operatively during index admission (Group 1) and those managed non-surgically during index admission (Group 2). Group 2 was further divided into those that subsequently underwent repair of UH and those managed medically. Results: Of 47 cirrhotic patients with leaking UHs, 19 patients were managed surgically during index admission (Group 1). In Group 2, 15 patients were managed non-surgically and 13 subsequently underwent surgery. The groups had comparable demographics, MELD-Na and Child-Pugh class. Group 2 had a higher rate of emergency surgery (92% vs 58%, P = .04) and higher rate of recurrence (31 vs. 0%, P = .02). The non-surgical patients in Group 2 had higher 1-year mortality (67%) compared to Group 1 (21%) and surgical patients in Group 2 (31%, P = .007). Multi-variable logistic regression for 1-year mortality demonstrated MELD-Na as the most significant risk factor (OR = 1.2, P = .05) and undergoing UH repair as the most significant protective factor (OR = .16, P = .02). Conclusions: Cirrhotic patients with leaking UHs should undergo urgent repair. Non-operative management confers high risk of continued or increased ascitic leakage necessitating more emergent surgery. Despite high rate of postoperative complications related to cirrhosis, there is a clear mortality benefit to the repair of leaking UHs in cirrhotic patients. [ABSTRACT FROM AUTHOR]

Published
2023
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10. Shifting Pancreas Transplantation Rates and Demographics are the Culmination of Many Strategic Policy Changes

Author

Rechnitzer, Alma, primary, Teo, Richard, additional, Brooks, Abigail, additional, Rocca, Juan, additional, Mudhi, Nidal, additional, Torabi, Julia, additional, Ajaimy, Maria, additional, Liriano-Ward1, Luz, additional, Azzi, Yorg, additional, Pynadath, Cindy, additional, Loarte-Campos, Pablo, additional, Akalin, Enver, additional, Le, Marie, additional, Kinkhabwala, Milan, additional, and Graham, Jay, additional

Published
2022
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15. Commercial insurance delays direct‐acting antiviral treatment for hepatitis C kidney transplantation into uninfected recipients

Author

Torabi, Julia, primary, Rocca, Juan P., additional, Ajaimy, Maria, additional, Melvin, Jeffrey, additional, Campbell, Alesa, additional, Akalin, Enver, additional, Liriano, Luz E., additional, Azzi, Yorg, additional, Pynadath, Cindy, additional, Greenstein, Stuart M., additional, Le, Marie, additional, Goldstein, Doctor Y., additional, Fox, Amy S., additional, Carrero, Jin, additional, Weiss, Jeffrey M., additional, Powell, Tia, additional, Racine, Andrew D., additional, Reinus, John F., additional, Kinkhabwala, Milan M., additional, and Graham, Jay A., additional

Published
2020
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16. Preoperative C-Peptide Predicts Weight Gain After Pancreas Transplantation

Author

Torabi, Julia, primary, Rocca, Juan P., additional, Kestenbaum, Elizabeth, additional, Ajaimy, Maria, additional, DeFeo, Monica, additional, Konicki, Athena, additional, Liriano-Ward, Luz, additional, Azzi, Yorg, additional, Pynadath, Cindy, additional, Akalin, Enver, additional, Kinkhabwala, Milan, additional, and Graham, Jay A., additional

Published
2020
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18. Transplantation of viral‐positive hepatitis C‐positive kidneys into uninfected recipients offers an opportunity to increase organ access

Author

Graham, Jay A., primary, Torabi, Julia, additional, Ajaimy, Maria, additional, Akalin, Enver, additional, Liriano, Luz E., additional, Azzi, Yorg, additional, Pynadath, Cindy, additional, Greenstein, Stuart M., additional, Goldstein, Doctor Y., additional, Fox, Amy S., additional, Weiss, Jeffery M., additional, Powell, Tia P., additional, Reinus, John F., additional, Kinkhabwala, Milan M., additional, and Rocca, Juan P., additional

Published
2020
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22. Predicting the broadly neutralizing antibody susceptibility of the HIV reservoir

Author

Yu, Wen-Han, primary, Su, David, additional, Torabi, Julia, additional, Fennessey, Christine M., additional, Shiakolas, Andrea, additional, Lynch, Rebecca, additional, Chun, Tae-Wook, additional, Doria-Rose, Nicole, additional, Alter, Galit, additional, Seaman, Michael S., additional, Keele, Brandon F., additional, Lauffenburger, Douglas A., additional, and Julg, Boris, additional

Published
2019
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26. Ketorolac Use for Pain Management in Trauma Patients With Rib Fractures Does not Increase of Acute Kidney Injury or Incidence of Bleeding.

Author

Torabi, Julia, Kaban, Jody M., Lewis, Erin, Laikhram, Dana, Simon, Rachel, DeHaan, Skylar, Jureller, Michael, Edward Chao, Reddy, Srinivas H., Stone Jr, Melvin E., Chao, Edward, and Stone, Melvin E Jr

Subjects
*RIB fractures, *ACUTE kidney failure, *PAIN management, *KETOROLAC, *SYSTOLIC blood pressure, *TRAUMA registries, *RESEARCH, *NONSTEROIDAL anti-inflammatory agents, *RESEARCH methodology, *RETROSPECTIVE studies, *DISEASE incidence, *MEDICAL cooperation, *EVALUATION research, *TREATMENT effectiveness, *COMPARATIVE studies, *LOGISTIC regression analysis, *HEMORRHAGE, *DISEASE complications
Abstract

Introduction: Ketorolac is useful in acute pain management to avoid opiate-related complications; however, some surgeons fear associated acute kidney injury (AKI) and bleeding despite a paucity of literature on ketorolac use in trauma patients. We hypothesized that our institution's use of intravenous ketorolac for rib fracture pain management did not increase the incidence of bleeding or AKI.Methods: Rib fracture patients aged 15 years and above admitted between January 2016-June 2018 were identified in our trauma registry along with frequency of bleeding events. AKI was defined as ≥ 1.5x increase in serum creatinine from baseline measured on the second day of admission (after 24 hours of resuscitation) or an increase of ≥ .3 mg/dL over a 48-hour period. Patients receiving ketorolac were compared to patients with no ketorolac use.Results: Two cohorts of 199 control and 205 ketorolac patients were found to be similar in age, gender, admission systolic blood pressure (SBP), injury severity score, intravenous radiocontrast received, and transfusion requirements. Analysis revealed no difference in frequency of AKI using both definitions (8% vs. 7.3%, P = .79) and (19.6% vs. 15.1%, P = .24), respectively, or bleeding events (2.5% vs. 0%, P = .03). Logistic regression demonstrated that ketorolac use was not an independent predictor for AKI but age and admission SBP < 90 were.Conclusion: Use of ketorolac in this cohort of trauma patients with rib fractures did not increase the incidence of AKI or bleeding events. [ABSTRACT FROM AUTHOR]

Published
2021
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27. Commercial insurance delays direct‐acting antiviral treatment for hepatitis C kidney transplantation into uninfected recipients.

Author

Torabi, Julia, Rocca, Juan P., Ajaimy, Maria, Melvin, Jeffrey, Campbell, Alesa, Akalin, Enver, Liriano, Luz E., Azzi, Yorg, Pynadath, Cindy, Greenstein, Stuart M., Le, Marie, Goldstein, Doctor Y., Fox, Amy S., Carrero, Jin, Weiss, Jeffrey M., Powell, Tia, Racine, Andrew D., Reinus, John F., Kinkhabwala, Milan M., and Graham, Jay A.

Subjects
*HEPATITIS C, *KIDNEY transplantation, *BUSINESS insurance, *HEPATITIS C virus, *POSTOPERATIVE period, *VIRAL load
Abstract

Introduction: The advent of direct‐acting antivirals (DAAs) has created an avenue for transplantation of hepatitis C virus (HCV)‐infected donors into uninfected recipients (D+/R−). The donor transmission of HCV is then countered by DAA administration during the post‐operative period. However, initiation of DAA treatment is ultimately dictated by insurance companies. Methods: A retrospective chart review of 52 D+/R− kidney recipients who underwent DAA treatment post‐transplant was performed. Patients were grouped according to their prescription coverage plans, managed by either commercial or government pharmacy benefit managers (PBMs). Results: Thirty‐nine patients had government PBMs and 13 had commercial PBMs. Demographics were similar between the two groups. All patients developed HCV viremia, but cleared the virus after treatment with DAA. Patients with government PBMs were treated earlier compared to those with commercial PBMs (11 days vs 26 days, P =.01). Longer time to DAA initiation resulted in higher peak viral loads (β = 0.39, R2 =.15, P =.01) and longer time to HCV viral load clearance (β = 0.41, R2 =.17, P =.01). Conclusions: D+/R− transplantation offers patients an alternative strategy to increase access. However, treatment can be profoundly delayed by a third‐party payer authorization process that may be subjecting patients to unnecessary risks and worsened outcomes. [ABSTRACT FROM AUTHOR]

Published
2021
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30. Improving pancreas graft utilization through importation

Author

Torabi, Julia, primary, Rocca, Juan P., additional, Choinski, Krystina, additional, Lorenzen, Katherine, additional, Yongue, Camille, additional, Lubetzsky, Michelle L., additional, Herbert, Melvon E., additional, Chokechanachaisakul, Attasit, additional, Ajaimy, Maria, additional, Kamal, Layla, additional, Akalin, Enver, additional, Kinkhabwala, Milan, additional, and Graham, Jay A., additional

Published
2017
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31. Protective Efficacy of Broadly Neutralizing Antibodies with Incomplete Neutralization Activity against Simian-Human Immunodeficiency Virus in Rhesus Monkeys

Author

Julg, Boris, primary, Sok, Devin, additional, Schmidt, Stephen D., additional, Abbink, Peter, additional, Newman, Ruchi M., additional, Broge, Thomas, additional, Linde, Caitlyn, additional, Nkolola, Joseph, additional, Le, Khoa, additional, Su, David, additional, Torabi, Julia, additional, Pack, Melissa, additional, Pegu, Amarendra, additional, Allen, Todd M., additional, Mascola, John R., additional, Burton, Dennis R., additional, and Barouch, Dan H., additional

Published
2017
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