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Fri, 10/28/2011 - 04:42
(Source: Liver Transplantation)
Categories: Publications

Preoperative fasting protects mice against hepatic ischemia/reperfusion injury: Mechanisms and Effects on liver regeneration

Fri, 10/28/2011 - 04:42
(Source: Liver Transplantation)

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Categories: Publications

Waitlist survival of patients with primary sclerosing cholangitis in the model for end‐stage liver disease era

Fri, 10/28/2011 - 04:42
AbstractThe ability of the Model for End‐Stage Liver Disease (MELD) score to capture the urgency of transplantation may not be generalizable to patients with primary sclerosing cholangitis (PSC) because these patients face unique risks of death or removal from the liver transplant waitlist due to disease‐specific complications (eg, repeated bouts of bacterial cholangitis and cholangiocarcinoma). We constructed Cox regression models to determine whether disease‐based differences exist in waitlist mortality before liver transplantation. We compared the times to death or withdrawal from the waitlist due to clinical deterioration among patients with or without PSC in the United States after the implementation of the MELD allocation score. Over an 8‐year period, 14,073 non‐PSC patient...
Categories: Publications

Cost of a quality‐adjusted life year in liver transplantation: The influence of the indication and the model for end‐stage liver disease score

Fri, 10/28/2011 - 04:42
AbstractCost issues in liver transplantation (LT) have received increasing attention, but the cost‐utility is rarely calculated. We compared costs per quality‐adjusted life year (QALY) from the time of placement on the LT waiting list to 1 year after transplantation for 252 LT patients and to 5 years after transplantation for 81 patients. We performed separate calculations for chronic liver disease (CLD), acute liver failure (ALF), and different Model for End‐Stage Liver Disease (MELD) scores. For the estimation of QALYs, the health‐related quality of life was measured with the 15D instrument. The median costs and QALYs after LT were €141,768 and 0.895 for 1 year and €177,618 and 3.960 for 5 years, respectively. The costs of the first year were 80% of the 5‐year costs. The ma...
Categories: Publications

Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1*

Fri, 10/28/2011 - 04:41
We examined a cohort of patients with access to liver transplantation from our previously published study of terlipressin plus albumin versus albumin alone in the treatment of HRS1. The purpose of this analysis was the quantification of the survival benefits of liver transplantation for patients with HRS1. Ninety‐nine patients were randomized to terlipressin or placebo. Thirty‐five patients (35%) received a liver transplant. Among those receiving terlipressin plus albumin, the 180‐day survival rates were 100% for transplant patients and 34% for nontransplant patients; among those receiving only albumin, the rates were 94% for transplant patients and 17% for nontransplant patients. The survival rate was significantly better for those achieving a reversal of hepatorenal syndrome (HRS) ...
Categories: Publications

Anemia is not predictive of sustained virological response in liver transplant recipients with hepatitis C virus who are treated with pegylated interferon and ribavirin

Fri, 10/28/2011 - 04:41
In conclusion, anemia is a very frequent complication in LT patients during antiviral therapy and is associated with increased RBV dose reduction but not with an SVR. Predictors of anemia include MMF or CSA immunosuppression, high viremia, and renal insufficiency. Liver Transpl 17:1318–1327, 2011. © 2011 AASLD. (Source: Liver Transplantation)
Categories: Publications

Safety of liver transplantation with chagas disease–seropositive donors for seronegative recipients

Fri, 10/28/2011 - 04:41
AbstractThe shortage of organs for transplantation has prompted the investigation of extended criteria donors, such as donors with transmissible infectious diseases. Here we report our recent experience with liver transplantation using organs from donors who were serologically positive for Chagas disease. We also provide a review of the literature and emphasize donor screening and preventive measures. Liver Transpl 17:1304–1308, 2011. © 2011 AASLD. (Source: Liver Transplantation)

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Categories: Publications

Schistosoma mansoni infection in the liver graft: The impact on donor and recipient outcomes after transplantation

Fri, 10/28/2011 - 04:41
In conclusion, using liver grafts infected with S. mansoni eggs did not compromise the results of LDLT in this pediatric cohort. Because of the parasite's life cycle and the therapeutic target of praziquantel, only donors should be treated for the infection. Three years of follow‐up showed an uneventful recovery for the living donors. Liver Transpl 17:1299–1303, 2011. © 2011 AASLD. (Source: Liver Transplantation)
Categories: Publications

Renal function in patients undergoing transplantation for nonalcoholic steatohepatitis cirrhosis: Time to reconsider immunosuppression regimens?

Fri, 10/28/2011 - 04:41
In conclusion, this study has identified NASH as an independent risk factor for renal dysfunction after LT. Renal‐sparing immunosuppression regimens should be considered at the time of LT to reduce the development of kidney injury in NASH patients. The optimization of such regimens requires a prospective study. Liver Transpl 17:1292–1298, 2011. © 2011 AASLD. (Source: Liver Transplantation)
Categories: Publications

Optimizing cost‐effectiveness in perioperative care for liver transplantation: A model for low‐ to medium‐income countries

Fri, 10/28/2011 - 04:41
AbstractAlthough liver transplantation (LT) is a highly effective treatment, it has been considered too costly for publicly funded health systems in many countries with low to medium average incomes. However, with economic growth and improving results, some governments are reconsidering this position. Cost‐effectiveness data for LT are limited, especially in perioperative care, and the techniques and costs vary widely between centers without overt differences in outcomes. Anesthesiologists working in new programs find it difficult to determine which modalities are essential, which are needed only in exceptional circumstances, and which may be omitted without effects on outcomes. We investigated key elements of preoperative evaluations, intraoperative management, and early postoperative c...
Categories: Publications

Region‐specific challenges for minimizing endemic donor‐transmitted infections

Fri, 10/28/2011 - 04:41
(Source: Liver Transplantation)
Categories: Publications

Of mice and men, calcineurin inhibitors and hepatitis C

Fri, 10/28/2011 - 04:40
(Source: Liver Transplantation)

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Categories: Publications

Regional Variability in Symptom‐Based MELD Exceptions: A Response to Organ Shortage?

Fri, 10/28/2011 - 04:32
MELD (model for end‐stage liver disease) exception awards affect the liver allocation process. Award rates of specific nonhepatocellular carcinoma exceptions, termed symptom‐based exceptions (SBE), differ across UNOS regions. We aimed to characterize the regional variability in SBE awards and examine predictive factors for receiving a SBE in the MELD era. The OPTN liver transplant and waiting list dataset was analyzed for waiting list registrants during the MELD allocation on February 27, 2002, until November 22, 2006. Competing risks proportional hazards regression analysis was used to examine predictors for receiving a SBE in 39 169 registrants. The hazard ratios for receiving a SBE differed significantly across regions when adjusted for multiple variables including age, gender, ethn...
Categories: Publications

Castleman disease in a pediatric liver transplant recipient: A case report and literature review

Fri, 10/28/2011 - 04:27
Bonatti HJR, Axt J, Hunter EB, Lott SL, Frangoul H, Gillis L, Correa H, Kelly B. Castleman disease in a pediatric liver transplant recipient: A case report and literature review.
Pediatr Transplantation 2011. © 2011 John Wiley & Sons A/S.Abstract:  Castleman disease is a rare hematologic disorder, closely linked to the HHV‐8, and most commonly observed in immunocompromised individuals. Thirteen months following a liver transplant for CPS‐1 defect, a 15‐month‐old boy presented with fevers, anemia, and growth retardation. Abdominal CT scan showed splenomegaly and generalized lymphadenopathy. Histology of chest wall lymph nodes revealed a mixed CD3+ T‐cell and CD20+ B‐cell population with atretic germinal centers consistent with multicentric Castleman disease. Qualitative...
Categories: Publications

Oxygen persufflation as adjunct in liver preservation (OPAL): Study protocol for a randomized controlled trial

Fri, 10/28/2011 - 03:00
Background: Early graft dysfunction due to preservation/reperfusion injury represents a dramatic event after liver transplantation. Enhancement of donor organ criteria, in order to cope with the ever increasing donor shortage, further increases graft susceptibility to ischemic alterations. Major parts of post-preservation injury, however, occur at the time of warm reperfusion but not during ischemic storage; successful reperfusion of ischemic tissue in turn depends on an adequate redox and intracellular signal homeostasis. The latter has been shown experimentally to be favorably influenced by oxygen persuffaltion within short time spans. Thus viability of marginally preserved liver grafts could still be augmented by transient hypothermic reconditioning even after normal procurement and sta...
Categories: Publications

Protective effects of L-type fatty acid-binding protein (L-FABP) in proximal tubular cells against glomerular injury in anti-GBM antibody-mediated glomerulonephritis

Fri, 10/28/2011 - 03:00
Conclusions. The present experimental model suggests that tubular enhancement of L-FABP may protect mice with anti-GBM GN from progression of both tubulointerstitial and glomerular injury. (Source: Nephrology Dialysis Transplantation)
Categories: Publications

Acute kidney injury in patients admitted to a liver intensive therapy unit with paracetamol-induced hepatotoxicity

Fri, 10/28/2011 - 03:00
Conclusions. AKI is very common in critically ill patients with paracetamol-induced hepatotoxicity requiring LITU admission. Although outcomes are poorer with AKI than with normal renal function, they are better than those found in other intensive therapy unit populations. Gradual recovery of renal function is seen in all patients. (Source: Nephrology Dialysis Transplantation)

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Categories: Publications

Multiorgan gadolinium (Gd) deposition and fibrosis in a patient with nephrogenic systemic fibrosis--an autopsy-based review

Fri, 10/28/2011 - 03:00
Conclusions. Vascular and extracellular Gd deposits are found in multiple organs of NSF patients, associated with calcification, and often in fibrotic areas. Gd deposits are not seen in patients with CRF unexposed to GBCAs but rarely may be seen in GBCA-exposed patients without clinical signs of NSF. Apart from diagnostic findings in skin, fibrosis of muscle and dura may be more prominent in NSF patients. Our findings should stimulate further investigation of mechanisms of fibrosis and pathologic calcification. (Source: Nephrology Dialysis Transplantation)
Categories: Publications

Comparison of Molecular Adsorbents Recirculating System (MARS) dialysis with combined plasma exchange and haemodialysis in children with acute liver failure

Fri, 10/28/2011 - 03:00
Conclusion. Our experience suggests superior efficacy of combined PE/HD as compared to intermittent MARS therapy for treating ALF. (Source: Nephrology Dialysis Transplantation)
Categories: Publications

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