Bradley Collins - Academia.edu (original) (raw)
Papers by Bradley Collins
World Journal of Surgery, 2021
BACKGROUND: "Textbook outcome" (TO) is a novel composite quality measure that encompasses multipl... more BACKGROUND: "Textbook outcome" (TO) is a novel composite quality measure that encompasses multiple postoperative endpoints, representing the ideal "textbook" hospitalization for complex surgical procedures. We defined TO for kidney transplantation using a cohort from a high-volume institution. METHODS: Adult patients who underwent isolated kidney transplantation at our institution between 2016 and 2019 were included. TO was defined by clinician consensus at our institution to include freedom from intraoperative complication, postoperative reintervention, 30-day intensive care unit or hospital readmission, length of stay >75 th percentile of kidney transplant patients, 90day mortality, 30-day acute rejection, delayed graft function, and discharge with a Foley catheter. Recipient, operative, financial characteristics, and post-transplant patient, graft, and rejection-free survival were compared between patients who achieved and failed to achieve TO. RESULTS: A total of 557 kidney transplant patients were included. Of those, 245 (44%) achieved TO. The most common reasons for TO failure were delayed graft function (N=157, 50%) and hospital readmission within 30 days (N=155, 50%); the least common was mortality within 90 days (N=6, 2%). Patient, graft, and rejection-free survival were significantly improved among patients who achieved TO. On average, patients who achieved TO incurred approximately $50,000 less in total inpatient charges compared to those who failed TO. CONCLUSIONS: TO in kidney transplantation was associated with favorable post-transplant outcomes and significant cost-savings. TO may offer transplant centers a detailed performance breakdown to identify aspects of perioperative care in need of process improvement.
American Journal of Gastroenterology, 2006
Current Problems in Surgery, 2005
Over the last 4 decades, liver transplantation has evolved into the treatment option of choice fo... more Over the last 4 decades, liver transplantation has evolved into the treatment option of choice for a variety of patients with acute or chronic end-stage liver disease. 1 Improvements in surgical techniques coupled with advances in intensive care practices and immunosuppressive therapy have resulted in 1-year patient survival rates of greater than 90% following liver transplantation. The rapid expansion in the number of centers providing liver transplantation, in conjunction with a previously unrecognized epidemic of liver disease, has placed an inordinate demand on liver transplant services in general. During the past decade, waiting times for liver transplantation and the rate of death on the transplant waiting list have increased by 10-fold. 2 The synergy of these factors has resulted in a critical shortage of cadaveric or deceased donor organs for adults and children in need of liver transplantation. The use of living donors for liver transplantation was introduced into surgical practice in the late 1980s. 3,4 Since that time, the application of living donor liver transplantation (LDLT) has been widespread and rapid. 5-8 Its early evolution was the result of a critical shortage of deceased donor organs of suitable size for infants, children, and small adults awaiting liver transplantation. With refinements in surgical techniques, transplantation of segments 2 and 3 (left lateral segment) from a living donor was associated with 1-year patient survival rates of 94% compared with 88% for patients who received deceased donor grafts. 9 Moreover, donor morbidity and mortality rates were low. 9,10 The increased demand for liver transplantation experienced in the United States has been observed worldwide. 1 It has been driven primarily by an epidemic of end-stage liver disease arising from chronic hepatitis C virus (HCV) infection and the dramatic increase in hepatocellular carcinoma (HCC) associated with HCV infection, also an indication for transplantation in selected patients. 11 Despite efforts to expand the deceased donor pool, the demand for livers far exceeds the supply. Despite the increased application of novel surgical techniques such as
Current problems in surgery, 2003
O rgan transplantation is currently the standard therapy for end organ failure in those patients ... more O rgan transplantation is currently the standard therapy for end organ failure in those patients who are suitable medically for transplantation. At present, there are more than 80,000 patients who are listed for transplantation in the United States (Table 1). 1 The United States organ transplant waiting list grows an average of 16% to 20% per year. In the past 10 years, the number of registrants has increased from 23,901 registrants to more than 80,000 registrants. In contrast, the number of cadaveric organ donors that are available increased from 4526 donors in 1991 to 5985 donors in 2001 (Fig 1). 2 The number of transplantations that were performed in the United States has also increased from 12,626 transplantations in 1988 to more than 22,000 transplantations in 2000, with the significant increase being related to broader use of living donors and expanded acceptable criteria for cadaveric donors (Fig 2). 2 Of those registrants who are listed for life-saving organs (such as heart, lung, and liver), the 1-year mortality rate while awaiting a transplant ranges from 10% to 25%. The overall mortality rate for all patients on the waiting list is 7.5% and continues to grow yearly. 1 Patients who have irreversible loss of all brain function, but who are maintained on ventilators (ie, brain dead) are the single largest source of transplantable organs. It has been estimated that between 6900 and 10,700 potential donors are available annually in the United States (28.5 to 43.7 donors per million population). Unfortunately, organ procurement efforts are between 37% and 59% efficient in terms of the actual recovery of organs. Efficiency varies greatly by state and organ procurement organization. 3 The most realistic estimates of donor supply place the number of potential donors between 43 and 55 per million population. The range of potential donors is therefore somewhere between 7088 and 25,865. Realistically, estimates must be adjusted on the basis of public attitudes toward donation. Between 53% and 68% of the public is willing to donate the organs of relatives under appropriate circumstances. Subsequently, between 5700 and 9300 donors may be
Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease, 2013
Transplantation, Jan 15, 2003
Acute humoral rejection (AHR) has been associated with enhanced graft loss. Our study compared th... more Acute humoral rejection (AHR) has been associated with enhanced graft loss. Our study compared the renal allograft survival of patients with AHR treated with plasmapheresis (PP) and intravenous immunoglobulin (IVIG) with allograft survival in patients with acute cellular rejection (ACR). We retrospectively analyzed all kidney transplants performed at our institution between January 1999 and August 2001 (n=286). Recipients were classified into three groups according to biopsy reports: AHR, ACR, or no rejection. The ACR group was further divided into early and late rejection (<90 and >90 days posttransplant, respectively). After a mean follow-up of 569+/-19 days, the incidence of AHR was 5.6% (n=16). Recipient presensitization, delayed graft function, early rejection, and higher creatinine at diagnosis were characteristic of AHR. Most AHR patients (14/16) were treated with PP and IVIG. One patient received only IVIG, whereas another received only…
Transplantation Proceedings, 2005
Purpose. We sought to evaluate the role of recipient body mass index (BMI) on postoperative compl... more Purpose. We sought to evaluate the role of recipient body mass index (BMI) on postoperative complications in patients receiving pancreas transplants. Methods. A single-institution retrospective study of 145 consecutive patients undergoing either simultaneous kidney pancreas (SPK) or pancreas after kidney (PAK) transplantation from January 1997 through December 2003. Variables analyzed included: age, sex, BMI, number of prior transplants, cytomegalovirus status of donor and recipient, postoperative insulin resistance, complications, and overall patient and graft survival. Differences in continuous variables and dichotomous variables were evaluated using two-tailed t test and Fisher exact test, respectively. Univariate and multivariate logistic regression analyses were employed to identify predictors of overall complications following surgery. Results. Obesity was defined by a BMI Ն 30. Of the 145 patients, 33 (23%) had a BMI Ն 30 and 112 (77%) had a BMI Ͻ 30. There was no significant difference in age or sex between obese and nonobese patients (P ϭ .98 and P ϭ .56, respectively). The type of transplantation, SPK or PAK, did not affect the complication rate (P ϭ .36). Overall complications (infection, dehiscence, evisceration, ventral hernia, allograft failure, gangrene, necrotizing fasciitis, postoperative bleeding, or death) were significantly higher in the obese group (81% vs 40%, P Ͻ .001). Obesity was specifically associated with increased frequency of dehiscence, ventral hernia, intra-abdominal infection, gangrene, necrotizing fasciitis, and repeat laparotomy. Obese patients also had a threefold higher rate of graft pancreatitis/enteric leak. Multivariate logistic regression analysis identified age Ն 50 and BMI Ն 30 as independent predictors of overall complications following surgery (odds ratio 4.0, P ϭ .014 and OR 6.8, P Ͻ .001, respectively). There was no difference identified between groups with regards to allograft failure, posttransplant insulin resistance, and death. Conclusion. Obese patients are at increased risk of overall complications following pancreas transplantation. Specifically, obese patients experience higher frequency of dehiscence, ventral hernia, intra-abdominal infection, gangrene, and necrotizing fasciitis. This study demonstrates the need for careful postoperative monitoring in the obese patient.
Transplantation, 1999
Hypoalbuminemia is associated with poorer outcomes in renal transplantation. Diabetes can compoun... more Hypoalbuminemia is associated with poorer outcomes in renal transplantation. Diabetes can compound hypoalbuminemia&amp;#39;s detrimental effects. Kidney-pancreas transplantation alters the diabetic milieu; yet, some patients continue to be hypoalbuminemic. We retrospectively analyzed 232 patients who underwent simultaneous kidney-pancreas transplantation (SPK) between 1993 and 1997 to determine the incidence and clinical correlates of hypoalbuminemia in SPK recipients. Post-SPK hypoalbuminemia was defined as a serum albumin level &amp;lt; or =3.5 g/dl. Univariate analyses were performed to determine whether post-SPK hypoalbuminemia was associated with pre-SPK variables. The effect of albumin level and hypoalbuminemia on the risk of post-SPK events (cardiac events, cytomegalovirus [CMV] infection, rejection, readmission, kidney and pancreas graft failure, and death) was examined with a Cox proportional hazards model. The study population consisted of 149 men and 83 women. Average follow-up was 2.0+/-1.3 years. Hypoalbuminemia (serum albumin level &amp;lt; or =3.5 g/dL) was most common early after SPK (3 months: 44% of evaluable patients were hypoalbuminemic; 12 months: 15.3%; 36 months: 8.3%). Acute rejection episodes and readmission were the most common adverse events after SPK transplantation. There were 24 episodes of renal allograft loss and only 5 cardiac events. Ten SPK recipients died during the study time period. SPK-related hypoalbuminemia was associated with an increased risk for CMV infection (risk ratio [RR] 2.5; P&amp;lt;0.02), renal graft failure (RR 2.41; P=0.05), pancreas graft failure (RR 3.66; P=0.01), and a trend toward an increased risk for death (RR 2.8; P=0.19). Post-SPK hypoalbuminemia resolves over time in many patients. Persistent post-SPK hypoalbuminemia is associated with an increased risk for CMV infection, graft loss, and a trend toward decreased survival. Efforts to improve nutrition, as it may affect hypoalbuminemia in SPK recipients, may be one strategy for improving SPK outcomes.
Transplantation, 1998
Renal transplant artery stenosis (RTAS) is a relatively rare complication of renal transplantatio... more Renal transplant artery stenosis (RTAS) is a relatively rare complication of renal transplantation, especially with the current techniques for vascular anastomoses. However, older patients (pts) prone to peripheral vascular disease (PVD), are more frequently being ...
Transplantation, 1999
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > April 15, ...
Pediatric Transplantation, 2014
The most common identifiable causes of acute liver failure in pediatric patients are infection, d... more The most common identifiable causes of acute liver failure in pediatric patients are infection, drug toxicity, metabolic disease, and autoimmune processes. In many cases, the etiology of acute liver failure cannot be determined. Acute leukemia is an extremely rare cause of acute liver failure, and liver transplantation has traditionally been contraindicated in this setting. We report a case of acute liver failure in a previously healthy 15‐yr‐old male from pre‐B‐cell acute lymphoblastic leukemia. He underwent liver transplantation before the diagnosis was established, and has subsequently received chemotherapy for pre‐B‐cell acute lymphoblastic leukemia. He is currently alive 31 months post‐transplantation. The published literature describing acute lymphoblastic leukemia as a cause of acute liver failure is reviewed.
Human Immunology, 2012
Aim With availability of specific and sensitive HLA antibody assays, the importance of donor spec... more Aim With availability of specific and sensitive HLA antibody assays, the importance of donor specific antibodies (DSA) in liver transplant has grown. Patients undergoing 2nd liver transplant are at high risk of DSA. We present contrasting outcomes in 2 patients. Methods We retrospectively reviewed the DSA in 2 liver recipients and compared them to the clinical outcomes. Results Pt #1: A 28 year old woman with PBC underwent a living donor liver transplant in 2006. In the next 4 years she received her 2nd, 3rd and 4th liver transplants due to graft failures. Plasmapheresis and IVIG were used at the 3rd & 4th transplants due to high PRA. A positive B cell flow crossmatch was noted at the last transplant. DSA monitoring was initiated after the 4th transplant. Elevated levels of class II antibodies to DR4, DR53 and DQ8 persisted. Patient had recurrence of jaundice after 6 months and showed short lived response to thymoglobulin, plasmapheresis, IVIG and Rituximab with rebound of DSA within a month of antibody therapy. Coincidentally, donors 2, 3 and 4 all had DR4, DR53 and DQ8. The patient underwent Bortezomib therapy as liver biopsy continued to show mixed portal infiltrate & bile duct injury. Pt #2: A 25 yr old woman with autoimmune hepatitis underwent liver transplant in 2006. Graft function deteriorated following steroid non-responsive rejection treated with Thymoglobulin & OK T3. Retransplant was done in early 2011. B cell crossmatch was positive and patient received thymoglobulin, plasmapheresis and IVIG. DSA assay showed the presence of anti-A2, -A11, -DR53, and -DQ8. During a follow up of 11 months, graft function was excellent despite the persistence of high titers of Class II antibodies. In contrast, level of class I antibodies remain under cutoff. Conclusions Sensitization status needs serious consideration in retransplantation of liver. Avoidance of donors with unacceptable antigens may be crucial in some liver retransplant recipients. A positive B cell crossmatch may portend a poor outcome.
Dialysis & Transplantation, 2010
Clinical Transplantation, 2005
Transplantation, Oct 1, 1998
World Journal of Surgery, 2021
BACKGROUND: "Textbook outcome" (TO) is a novel composite quality measure that encompasses multipl... more BACKGROUND: "Textbook outcome" (TO) is a novel composite quality measure that encompasses multiple postoperative endpoints, representing the ideal "textbook" hospitalization for complex surgical procedures. We defined TO for kidney transplantation using a cohort from a high-volume institution. METHODS: Adult patients who underwent isolated kidney transplantation at our institution between 2016 and 2019 were included. TO was defined by clinician consensus at our institution to include freedom from intraoperative complication, postoperative reintervention, 30-day intensive care unit or hospital readmission, length of stay >75 th percentile of kidney transplant patients, 90day mortality, 30-day acute rejection, delayed graft function, and discharge with a Foley catheter. Recipient, operative, financial characteristics, and post-transplant patient, graft, and rejection-free survival were compared between patients who achieved and failed to achieve TO. RESULTS: A total of 557 kidney transplant patients were included. Of those, 245 (44%) achieved TO. The most common reasons for TO failure were delayed graft function (N=157, 50%) and hospital readmission within 30 days (N=155, 50%); the least common was mortality within 90 days (N=6, 2%). Patient, graft, and rejection-free survival were significantly improved among patients who achieved TO. On average, patients who achieved TO incurred approximately $50,000 less in total inpatient charges compared to those who failed TO. CONCLUSIONS: TO in kidney transplantation was associated with favorable post-transplant outcomes and significant cost-savings. TO may offer transplant centers a detailed performance breakdown to identify aspects of perioperative care in need of process improvement.
American Journal of Gastroenterology, 2006
Current Problems in Surgery, 2005
Over the last 4 decades, liver transplantation has evolved into the treatment option of choice fo... more Over the last 4 decades, liver transplantation has evolved into the treatment option of choice for a variety of patients with acute or chronic end-stage liver disease. 1 Improvements in surgical techniques coupled with advances in intensive care practices and immunosuppressive therapy have resulted in 1-year patient survival rates of greater than 90% following liver transplantation. The rapid expansion in the number of centers providing liver transplantation, in conjunction with a previously unrecognized epidemic of liver disease, has placed an inordinate demand on liver transplant services in general. During the past decade, waiting times for liver transplantation and the rate of death on the transplant waiting list have increased by 10-fold. 2 The synergy of these factors has resulted in a critical shortage of cadaveric or deceased donor organs for adults and children in need of liver transplantation. The use of living donors for liver transplantation was introduced into surgical practice in the late 1980s. 3,4 Since that time, the application of living donor liver transplantation (LDLT) has been widespread and rapid. 5-8 Its early evolution was the result of a critical shortage of deceased donor organs of suitable size for infants, children, and small adults awaiting liver transplantation. With refinements in surgical techniques, transplantation of segments 2 and 3 (left lateral segment) from a living donor was associated with 1-year patient survival rates of 94% compared with 88% for patients who received deceased donor grafts. 9 Moreover, donor morbidity and mortality rates were low. 9,10 The increased demand for liver transplantation experienced in the United States has been observed worldwide. 1 It has been driven primarily by an epidemic of end-stage liver disease arising from chronic hepatitis C virus (HCV) infection and the dramatic increase in hepatocellular carcinoma (HCC) associated with HCV infection, also an indication for transplantation in selected patients. 11 Despite efforts to expand the deceased donor pool, the demand for livers far exceeds the supply. Despite the increased application of novel surgical techniques such as
Current problems in surgery, 2003
O rgan transplantation is currently the standard therapy for end organ failure in those patients ... more O rgan transplantation is currently the standard therapy for end organ failure in those patients who are suitable medically for transplantation. At present, there are more than 80,000 patients who are listed for transplantation in the United States (Table 1). 1 The United States organ transplant waiting list grows an average of 16% to 20% per year. In the past 10 years, the number of registrants has increased from 23,901 registrants to more than 80,000 registrants. In contrast, the number of cadaveric organ donors that are available increased from 4526 donors in 1991 to 5985 donors in 2001 (Fig 1). 2 The number of transplantations that were performed in the United States has also increased from 12,626 transplantations in 1988 to more than 22,000 transplantations in 2000, with the significant increase being related to broader use of living donors and expanded acceptable criteria for cadaveric donors (Fig 2). 2 Of those registrants who are listed for life-saving organs (such as heart, lung, and liver), the 1-year mortality rate while awaiting a transplant ranges from 10% to 25%. The overall mortality rate for all patients on the waiting list is 7.5% and continues to grow yearly. 1 Patients who have irreversible loss of all brain function, but who are maintained on ventilators (ie, brain dead) are the single largest source of transplantable organs. It has been estimated that between 6900 and 10,700 potential donors are available annually in the United States (28.5 to 43.7 donors per million population). Unfortunately, organ procurement efforts are between 37% and 59% efficient in terms of the actual recovery of organs. Efficiency varies greatly by state and organ procurement organization. 3 The most realistic estimates of donor supply place the number of potential donors between 43 and 55 per million population. The range of potential donors is therefore somewhere between 7088 and 25,865. Realistically, estimates must be adjusted on the basis of public attitudes toward donation. Between 53% and 68% of the public is willing to donate the organs of relatives under appropriate circumstances. Subsequently, between 5700 and 9300 donors may be
Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease, 2013
Transplantation, Jan 15, 2003
Acute humoral rejection (AHR) has been associated with enhanced graft loss. Our study compared th... more Acute humoral rejection (AHR) has been associated with enhanced graft loss. Our study compared the renal allograft survival of patients with AHR treated with plasmapheresis (PP) and intravenous immunoglobulin (IVIG) with allograft survival in patients with acute cellular rejection (ACR). We retrospectively analyzed all kidney transplants performed at our institution between January 1999 and August 2001 (n=286). Recipients were classified into three groups according to biopsy reports: AHR, ACR, or no rejection. The ACR group was further divided into early and late rejection (<90 and >90 days posttransplant, respectively). After a mean follow-up of 569+/-19 days, the incidence of AHR was 5.6% (n=16). Recipient presensitization, delayed graft function, early rejection, and higher creatinine at diagnosis were characteristic of AHR. Most AHR patients (14/16) were treated with PP and IVIG. One patient received only IVIG, whereas another received only…
Transplantation Proceedings, 2005
Purpose. We sought to evaluate the role of recipient body mass index (BMI) on postoperative compl... more Purpose. We sought to evaluate the role of recipient body mass index (BMI) on postoperative complications in patients receiving pancreas transplants. Methods. A single-institution retrospective study of 145 consecutive patients undergoing either simultaneous kidney pancreas (SPK) or pancreas after kidney (PAK) transplantation from January 1997 through December 2003. Variables analyzed included: age, sex, BMI, number of prior transplants, cytomegalovirus status of donor and recipient, postoperative insulin resistance, complications, and overall patient and graft survival. Differences in continuous variables and dichotomous variables were evaluated using two-tailed t test and Fisher exact test, respectively. Univariate and multivariate logistic regression analyses were employed to identify predictors of overall complications following surgery. Results. Obesity was defined by a BMI Ն 30. Of the 145 patients, 33 (23%) had a BMI Ն 30 and 112 (77%) had a BMI Ͻ 30. There was no significant difference in age or sex between obese and nonobese patients (P ϭ .98 and P ϭ .56, respectively). The type of transplantation, SPK or PAK, did not affect the complication rate (P ϭ .36). Overall complications (infection, dehiscence, evisceration, ventral hernia, allograft failure, gangrene, necrotizing fasciitis, postoperative bleeding, or death) were significantly higher in the obese group (81% vs 40%, P Ͻ .001). Obesity was specifically associated with increased frequency of dehiscence, ventral hernia, intra-abdominal infection, gangrene, necrotizing fasciitis, and repeat laparotomy. Obese patients also had a threefold higher rate of graft pancreatitis/enteric leak. Multivariate logistic regression analysis identified age Ն 50 and BMI Ն 30 as independent predictors of overall complications following surgery (odds ratio 4.0, P ϭ .014 and OR 6.8, P Ͻ .001, respectively). There was no difference identified between groups with regards to allograft failure, posttransplant insulin resistance, and death. Conclusion. Obese patients are at increased risk of overall complications following pancreas transplantation. Specifically, obese patients experience higher frequency of dehiscence, ventral hernia, intra-abdominal infection, gangrene, and necrotizing fasciitis. This study demonstrates the need for careful postoperative monitoring in the obese patient.
Transplantation, 1999
Hypoalbuminemia is associated with poorer outcomes in renal transplantation. Diabetes can compoun... more Hypoalbuminemia is associated with poorer outcomes in renal transplantation. Diabetes can compound hypoalbuminemia&amp;#39;s detrimental effects. Kidney-pancreas transplantation alters the diabetic milieu; yet, some patients continue to be hypoalbuminemic. We retrospectively analyzed 232 patients who underwent simultaneous kidney-pancreas transplantation (SPK) between 1993 and 1997 to determine the incidence and clinical correlates of hypoalbuminemia in SPK recipients. Post-SPK hypoalbuminemia was defined as a serum albumin level &amp;lt; or =3.5 g/dl. Univariate analyses were performed to determine whether post-SPK hypoalbuminemia was associated with pre-SPK variables. The effect of albumin level and hypoalbuminemia on the risk of post-SPK events (cardiac events, cytomegalovirus [CMV] infection, rejection, readmission, kidney and pancreas graft failure, and death) was examined with a Cox proportional hazards model. The study population consisted of 149 men and 83 women. Average follow-up was 2.0+/-1.3 years. Hypoalbuminemia (serum albumin level &amp;lt; or =3.5 g/dL) was most common early after SPK (3 months: 44% of evaluable patients were hypoalbuminemic; 12 months: 15.3%; 36 months: 8.3%). Acute rejection episodes and readmission were the most common adverse events after SPK transplantation. There were 24 episodes of renal allograft loss and only 5 cardiac events. Ten SPK recipients died during the study time period. SPK-related hypoalbuminemia was associated with an increased risk for CMV infection (risk ratio [RR] 2.5; P&amp;lt;0.02), renal graft failure (RR 2.41; P=0.05), pancreas graft failure (RR 3.66; P=0.01), and a trend toward an increased risk for death (RR 2.8; P=0.19). Post-SPK hypoalbuminemia resolves over time in many patients. Persistent post-SPK hypoalbuminemia is associated with an increased risk for CMV infection, graft loss, and a trend toward decreased survival. Efforts to improve nutrition, as it may affect hypoalbuminemia in SPK recipients, may be one strategy for improving SPK outcomes.
Transplantation, 1998
Renal transplant artery stenosis (RTAS) is a relatively rare complication of renal transplantatio... more Renal transplant artery stenosis (RTAS) is a relatively rare complication of renal transplantation, especially with the current techniques for vascular anastomoses. However, older patients (pts) prone to peripheral vascular disease (PVD), are more frequently being ...
Transplantation, 1999
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > April 15, ...
Pediatric Transplantation, 2014
The most common identifiable causes of acute liver failure in pediatric patients are infection, d... more The most common identifiable causes of acute liver failure in pediatric patients are infection, drug toxicity, metabolic disease, and autoimmune processes. In many cases, the etiology of acute liver failure cannot be determined. Acute leukemia is an extremely rare cause of acute liver failure, and liver transplantation has traditionally been contraindicated in this setting. We report a case of acute liver failure in a previously healthy 15‐yr‐old male from pre‐B‐cell acute lymphoblastic leukemia. He underwent liver transplantation before the diagnosis was established, and has subsequently received chemotherapy for pre‐B‐cell acute lymphoblastic leukemia. He is currently alive 31 months post‐transplantation. The published literature describing acute lymphoblastic leukemia as a cause of acute liver failure is reviewed.
Human Immunology, 2012
Aim With availability of specific and sensitive HLA antibody assays, the importance of donor spec... more Aim With availability of specific and sensitive HLA antibody assays, the importance of donor specific antibodies (DSA) in liver transplant has grown. Patients undergoing 2nd liver transplant are at high risk of DSA. We present contrasting outcomes in 2 patients. Methods We retrospectively reviewed the DSA in 2 liver recipients and compared them to the clinical outcomes. Results Pt #1: A 28 year old woman with PBC underwent a living donor liver transplant in 2006. In the next 4 years she received her 2nd, 3rd and 4th liver transplants due to graft failures. Plasmapheresis and IVIG were used at the 3rd & 4th transplants due to high PRA. A positive B cell flow crossmatch was noted at the last transplant. DSA monitoring was initiated after the 4th transplant. Elevated levels of class II antibodies to DR4, DR53 and DQ8 persisted. Patient had recurrence of jaundice after 6 months and showed short lived response to thymoglobulin, plasmapheresis, IVIG and Rituximab with rebound of DSA within a month of antibody therapy. Coincidentally, donors 2, 3 and 4 all had DR4, DR53 and DQ8. The patient underwent Bortezomib therapy as liver biopsy continued to show mixed portal infiltrate & bile duct injury. Pt #2: A 25 yr old woman with autoimmune hepatitis underwent liver transplant in 2006. Graft function deteriorated following steroid non-responsive rejection treated with Thymoglobulin & OK T3. Retransplant was done in early 2011. B cell crossmatch was positive and patient received thymoglobulin, plasmapheresis and IVIG. DSA assay showed the presence of anti-A2, -A11, -DR53, and -DQ8. During a follow up of 11 months, graft function was excellent despite the persistence of high titers of Class II antibodies. In contrast, level of class I antibodies remain under cutoff. Conclusions Sensitization status needs serious consideration in retransplantation of liver. Avoidance of donors with unacceptable antigens may be crucial in some liver retransplant recipients. A positive B cell crossmatch may portend a poor outcome.
Dialysis & Transplantation, 2010
Clinical Transplantation, 2005
Transplantation, Oct 1, 1998