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  • Ovid Technologies (Wolters Kluwer Health)  (58)
  • 1
    Online Resource
    Online Resource
    Disease recurrence after gut transplantation
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Current Opinion in Organ Transplantation Vol. 26, No. 2 ( 2021-04), p. 207-219
    Details
    In: Current Opinion in Organ Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 26, No. 2 ( 2021-04), p. 207-219
    Abstract: Despite three decades of clinical experience, this article is the first to comprehensively address disease recurrence after gut transplantation. Pertinent scientific literature is reviewed and management strategies are discussed with new insights into advances in gut pathobiology and human genetics. Recent findings With growing experience and new perspectives in the field of gut transplantation, the topic of disease recurrence continues to evolve. The clinicopathologic spectrum and diagnostic criteria are better defined in milieu of the nature of the primary disease. In addition to neoplastic disorders, disease recurrence is suspected in patients with pretransplant Crohn's disease, gut dysmotility, hypercoagulability and metabolic syndrome. There has also been an increased awareness of the potential de-novo development of various disorders in the transplanted organs. For conventionally unresectable gastrointestinal and abdominal malignancies, ex-vivo excision and autotransplantation are advocated, particularly for the nonallotransplant candidates. Summary Similar to other solid organ and cell transplantations, disease recurrence has been suspected following gut transplantation. Despite current lack of conclusive diagnostic criteria, recurrence of certain mucosal and neuromuscular disorders has been recently described in a large single-centre series with an overall incidence of 7%. Disease recurrence was also observed in recipients with pretransplant hypercoagulability and morbid obesity with respective incidences of 4 and 24%. As expected, tumour recurrence is largely determined by type, extent and biologic behaviour of the primary neoplasm. With the exception of high-grade aggressive malignancy, disease recurrence is still of academic interest with no significant impact on overall short and long-term outcome.
    Type of Medium: Online Resource
    ISSN: 1087-2418 , 1531-7013
    URL: Article
    DOI: 10.1097/MOT.0000000000000856
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2026382-X
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  • 2
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    Living Donor Liver Transplantation With Augmented Venous Outflow and Splenectomy : A Promised Land for Small Left Lobe Grafts
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Annals of Surgery Vol. 276, No. 5 ( 2022-11), p. 838-845
    Details
    In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 276, No. 5 ( 2022-11), p. 838-845
    Abstract: Living donor liver transplantation (LDLT) using small grafts, especially left lobe grafts (H1234-MHV) (LLG), continues to be a challenge due to small-for-size syndrome (SFSS). We herein demonstrate that with surgical modifications, outcomes with small grafts can be improved. Methods: Between 2012 and 2020, we performed 130 adult LDLT using 61 (47%) LLG (H1234-MHV) in a single Enterprise. The median graft-to-recipient weight ratio was 0.84%, with graft-to-recipient weight ratio 〈 0.7% accounting for 22%. Splenectomy was performed in 72 (56%) patients for inflow modulation before (n=50) or after (n=22) graft reperfusion. In LLG-LDLT, venous outflow was achieved using all three recipient hepatic veins. In right lobe graft (H5678) (RLG)-LDLT, the augmented graft right hepatic vein was anastomosed to the recipient’s cava with a large cavotomy. Outcome measures include SFSS, early allograft dysfunction (EAD), and survival. Results: Graft survival rates at 1, 3, and 5 years were 94%, 90%, and 83%, respectively, with no differences between LLG (H1234-MHV) and RLG (H5678). Splenectomy significantly reduced portal flow without increasing the complication rate. Despite the aggressive use of small grafts, SFSS and EAD developed in only 1 (0.8%) and 18 (13.8%) patients, respectively. Multivariable logistic regression revealed model for end-stage liver disease score and LLG (H1234-MHV) as independent risk factors for EAD and splenectomy as a protective factor (odds ratio: 0.09; P =0.03). For LLG (H1234-MHV)-LDLT, patients who underwent prereperfusion splenectomy tended to have better 1-year graft survival than those receiving postreperfusion splenectomy. Conclusions: LLG (H1234-MHV) are feasible in adult LDLT with excellent outcomes comparable to RLG (H5678). Venous outflow augmentation and splenectomy help lower the threshold of using small-for-size grafts without compromising graft survival.
    Type of Medium: Online Resource
    ISSN: 0003-4932
    URL: Article
    DOI: 10.1097/SLA.0000000000005630
    RVK:
    XA 23900
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2002200-1
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  • 3
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    Safety and effectiveness of renoportal bypass in patients with complete portal vein thrombosis: An analysis of 10 patients
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Liver Transplantation Vol. 21, No. 3 ( 2015-03), p. 344-352
    Details
    In: Liver Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 21, No. 3 ( 2015-03), p. 344-352
    Abstract: The presence of portal vein thrombosis (PVT) is still considered by many transplantation centers to be an absolute contraindication to liver transplantation because of the technical difficulties that it can present and its association with a higher rate of patient morbidity and mortality. Renoportal bypass (RPB) can help to remove these barriers. This study describes our institution's experience with RPB through the description of a new and successful simplified surgical strategy, a patient and graft outcome analysis, intraoperative vascular flow measurements, and the use of splenic artery embolization (SAE) as an effective adjunct for treating sporadic cases of unrelieved portal hypertension. Between January 2004 and January 2013, 10 patients with grade 4 PVT underwent RPB. At the last follow‐up (42.2 ± 21.1 months), the patient and graft survival rates were 100%. Five patients (50%) experienced posttransplant ascites, and 2 of those underwent proximal SAE to modulate the liver inflow and overcome the ascites. Three patients (30%) experienced transient kidney injury in the early posttransplant period and were treated efficiently with medical therapy. The renoportal flows were close to the desirable 100 mL/100 g of liver tissue in all cases. The experience and data support RPB as a feasible and easily reproducible technique without the risks and technical challenges associated with the tedious dissection of a cavernous hilum. Liver Transpl 21:344–352, 2015 . © 2015 AASLD.
    Type of Medium: Online Resource
    ISSN: 1527-6465 , 1527-6473
    URL: Article
    DOI: 10.1002/lt.24053
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2002186-0
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  • 4
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    Safety and efficacy of splenic artery embolization for portal hyperperfusion in liver transplant recipients: A 5‐year experience
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Liver Transplantation Vol. 21, No. 4 ( 2015-04), p. 435-441
    Details
    In: Liver Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 21, No. 4 ( 2015-04), p. 435-441
    Abstract: Severe portal hyperperfusion (PHP) after liver transplantation has been shown to cause intrahepatic arterial vasoconstriction secondary to increased adenosine washout (hepatic artery buffer response). Clinically, posttransplant PHP can cause severe cases of refractory ascites and hydrothorax. In the past, we reported our preliminary experience with the use of splenic artery embolization (SAE) as a way to reduce PHP. Here we present our 5‐year experience with SAE in orthotopic liver transplantation (OLT). Between January 2007 and December 2011, 681 patients underwent OLT at our institution, and 54 of these patients underwent SAE for increased hepatic arterial resistance and PHP (n = 42) or refractory ascites/hepatic hydrothorax (n = 12). Patients undergoing SAE were compared to a control group matched by year of embolization, calculated Model for End‐Stage Liver Disease score, and liver weight. SAE resulted in improvements in hepatic artery resistive indices (0.92 ± 0.14 and 0.76 ± 0.10 before and after SAE, respectively; P   〈  0.001) and improved hepatic arterial blood flow (HAF; 15.6 ± 9.69 and 28.7 ± 14.83, respectively; P   〈  0.001). Calculated splenic volumes and spleen/liver volume ratios were correlated with patients requiring SAE versus matched controls ( P  = 0.002 and P  = 0.001, respectively). Among the 54 patients undergoing SAE, there was 1 case of postsplenectomy syndrome. No abscesses, significant infections, or bleeding was noted. We thus conclude that SAE is a safe and effective technique able to improve HAF parameters in patients with elevated portal venous flow and its sequelae. Liver Transpl 21:435‐441, 2015 . © 2015 AASLD.
    Type of Medium: Online Resource
    ISSN: 1527-6465 , 1527-6473
    URL: Article
    DOI: 10.1002/lt.24081
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2002186-0
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  • 5
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    Elevated Risk of Split‐Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast?
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Liver Transplantation Vol. 25, No. 5 ( 2019-05), p. 741-751
    Details
    In: Liver Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 25, No. 5 ( 2019-05), p. 741-751
    Abstract: A recent study using US national registry data reported, using Cox proportional hazards (PH) models, that split‐liver transplantation (SLT) has improved over time and is no more hazardous than whole‐liver transplantation (WLT). However, the study methods violated the PH assumption, which is the fundamental assumption of Cox modeling. As a result, the reported hazard ratios (HRs) are biased and unreliable. This study aimed to investigate whether the risk of graft survival (GS) in SLT has really improved over time, ensuring attention to the PH assumption. This study included 80,998 adult deceased donor liver transplantation (LT) (1998‐2015) from the Scientific Registry Transplant Recipient. The study period was divided into 3 time periods: era 1 (January 1998 to February 2002), era 2 (March 2002 to December 2008), and era 3 (January 2009 to December 2015). The PH assumption was tested using Schoenfeld’s test, and where the HR of SLT violated the assumption, changes in risk for SLT over time from transplant were assessed. SLT was performed in 1098 (1.4%) patients, whereas WLT was used in 79,900 patients. In the Cox PH analysis, the P values of Schoenfeld’s global tests were  〈 0.05 in all eras, which is consistent with deviation from proportionality. Assessing HRs of SLT with a time‐varying effect, multiple Cox models were conducted for post‐LT intervals. The HR curves plotted according to time from transplant were higher in the early period and then decreased at approximately 1 year and continued to decrease in all eras. For 1‐year GS, the HRs of SLT were 1.92 in era 1, 1.52 in era 2, and 1.47 in era 3 (all P   〈  0.05). In conclusion, the risk of SLT has a time‐varying effect and is highest in the early post‐LT period. The risk of SLT is underestimated if it is evaluated by overall GS. SLT was still hazardous if the PH assumption was considered, although it became safer over time.
    Type of Medium: Online Resource
    ISSN: 1527-6465 , 1527-6473
    URL: Article
    DOI: 10.1002/lt.25409
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 6
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    Biliary complications following split liver transplantation in adult recipients: a matched pair analysis on single-center experience
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Liver Transplantation Vol. 29, No. 3 ( 2023-03), p. 279-289
    Details
    In: Liver Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 3 ( 2023-03), p. 279-289
    Type of Medium: Online Resource
    ISSN: 1527-6465
    URL: Article
    DOI: 10.1097/LVT.0000000000000058
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 7
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    Successful Liver, Pancreas and Intestinal Transplantation for RFX6 Mutation Associated Syndrome : insights into disease pathophysiology
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Transplantation Vol. 101, No. 6S2 ( 2017-06), p. S109-S110
    Details
    In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 101, No. 6S2 ( 2017-06), p. S109-S110
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/01.tp.0000521447.99508.bf
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2035395-9
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  • 8
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    Growing experience of surgical gut rehabilitation: essential role in the management of gut failure in adult patients
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Current Opinion in Organ Transplantation Vol. 28, No. 3 ( 2023-06), p. 228-236
    Details
    In: Current Opinion in Organ Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 3 ( 2023-06), p. 228-236
    Abstract: With the inherent therapeutic limitations of gut transplantation, the concept of surgical gut rehabilitation was introduced to restore nutritional autonomy in pediatric patients. With favorable outcomes in these young patients, there has been increasing interest in the applicability of gut rehabilitative surgery to a growing population of adults with gut failure due to various etiologies. We aim to review the current status of surgical gut rehabilitation for adult gut failure patients in the era of multidisciplinary gut rehabilitation and transplantation. Recent findings Indications for surgical gut rehabilitation have been gradually expanding, with gut failure after bariatric surgery recently added. Serial transverse enteroplasty (STEP) has been used with favorable outcomes in adult patients, including those with intrinsic intestinal disease. Autologous gut reconstruction (AGR) is the most frequently used surgical rehabilitative method; its outcome is further improved with conjunctive use of bowel lengthening and enterocyte growth factor as a part of comprehensive gut rehabilitation. Summary Accumulated experiences have validated the efficacy of gut rehabilitation for survival, nutritional autonomy, and quality of life in adults with gut failure of various etiology. Further progress is expected with growing experience around the world.
    Type of Medium: Online Resource
    ISSN: 1087-2418 , 1531-7013
    URL: Article
    DOI: 10.1097/MOT.0000000000001070
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2026382-X
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  • 9
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    Five Hundred Patients With Gut Malrotation : Thirty Years of Experience With the Introduction of a New Surgical Procedure
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Annals of Surgery Vol. 274, No. 4 ( 2021-10), p. 581-596
    Details
    In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 274, No. 4 ( 2021-10), p. 581-596
    Abstract: Define clinical spectrum and long-term outcomes of gut malrotation. With new insights, an innovative procedure was introduced and predictive models were established. Methods: Over 30-years, 500 patients were managed at 2 institutions. Of these, 274 (55%) were children at time of diagnosis. At referral, 204 (41%) patients suffered midgut-loss and the remaining 296 (59%) had intact gut with a wide range of digestive symptoms. With midgut-loss, 189 (93%) patients underwent surgery with gut transplantation in 174 (92%) including 16 of 31 (16%) who had autologous gut reconstruction. Ladd's procedure was documented in 192 (38%) patients with recurrent or de novo volvulus in 41 (21%). For 80 patients with disabling gastrointestinal symptoms, gut malrotation correction (GMC) surgery “Kareem's procedure” was offered with completion of the 270° embryonic counterclockwise-rotation, reversal of vascular-inversion, and fixation of mesenteric-attachments. Concomitant colonic dysmotility was observed in 25 (31%) patients. Results: The cumulative risk of midgut-loss increased with volvulus, prematurity, gastroschisis, and intestinal atresia whereas reduced with Ladd's and increasing age. Transplant cumulative survival was 63% at 10-years and 54% at 20-years with best outcome among infants and liver-containing allografts. Autologous gut reconstruction achieved 78% and GMC had 100% 10-year survival. Ladd's was associated with 21% recurrent/de novo volvulus and worsening ( P 〉 0.05) of the preoperative National Institute of Health patient-reported outcomes measurement information system gastrointestinal symptom scales. GMC significantly ( P ≤ 0.001) improved all of the symptomatology domains with no technical complications or development of volvulus. GMC improved quality of life with restored nutritional autonomy ( P 〈 0.0001) and daily activities ( P 〈 0.0001). Conclusions: Gut malrotation is a clinicopathologic syndrome affecting all ages. The introduced herein definitive correction procedure is safe, effective, and easy to perform. Accordingly, the current standard of care practice should be redefined in this orphan population.
    Type of Medium: Online Resource
    ISSN: 0003-4932 , 1528-1140
    URL: Article
    DOI: 10.1097/SLA.0000000000005072
    RVK:
    XA 23900
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2641023-0
    detail.hit.zdb_id: 2002200-1
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  • 10
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    Resources Utilization After Liver Transplantation in Patients With and Without Hepatopulmonary Syndrome: Cleveland Clinic Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Transplantation Direct Vol. 6, No. 4 ( 2020-03-27), p. e545-
    Details
    In: Transplantation Direct, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 4 ( 2020-03-27), p. e545-
    Type of Medium: Online Resource
    ISSN: 2373-8731
    URL: Article
    DOI: 10.1097/TXD.0000000000000990
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2890276-2
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