H. Blazey - Academia.edu (original) (raw)
Papers by H. Blazey
The European respiratory journal, 2006
Hepatic veno-occlusive disease is defined as nonthrombotic fibrous obliterative endophlebitis of ... more Hepatic veno-occlusive disease is defined as nonthrombotic fibrous obliterative endophlebitis of small centrilobular hepatic venules. Clinically, patients present with elevated liver enzymes and a triad of jaundice, hepatomegaly and ascites. Although reported as a complication of other solid organ and stem cell transplantation, there have been no reported cases to date of veno-occlusive disease following lung transplantation. The present authors report a case of veno-occlusive disease following single-lung transplantation in a patient on a triple-drug immunosuppressive regimen composed of tacrolimus, mycophenolate mofetil and prednisone. The diagnosis was established by transjugular liver biopsy and by discontinuing tacrolimus; there was clinical regression of symptoms and serological return to baseline.
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Transplant Infectious Disease, 2008
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The Journal of Heart and Lung Transplantation, 2007
Hepatitis C virus (HCV) infects 4 million people in the USA, with a prevalence of 1.4%. The serop... more Hepatitis C virus (HCV) infects 4 million people in the USA, with a prevalence of 1.4%. The seropositivity rate among potential lung transplant candidates is 1.9%, yet little information is available regarding outcomes of lung transplantation in HCV-positive lung transplant recipients. Our study reports outcomes of lung transplantation in HCV-positive recipients and compares them to HCV-negative controls. A retrospective analysis of the Cleveland Clinic Foundation's lung transplant database (465 patients) identified six HCV-positive patients. Demographic data, etiology of HCV infection, HCV viral load pre- and post-transplant, pre-transplant hepatic pathology, serial transaminases, incidence of acute hepatitis, graft function data and patient survival data were obtained by chart extraction. Five HCV-positive recipients had a pre-transplant liver biopsy, none of whom had evidence of cirrhosis pre-transplant. Although HCV RNA levels markedly increased post-transplant, no concomitant increase in transaminases was noted. There was no significant difference in the incidence of acute rejection at 1 year in our HCV-positive cohort compared with the HCV-negative lung transplant recipients from our institution. One patient developed bronchiolitis obliterans syndrome (BOS) during the follow-up period. Two patient deaths occurred, one at 8 months and the other at 2 years post-transplant. No evidence of hepatic dysfunction was noted in either deceased patient. The four surviving patients are alive at a median 3.2 years (range 1 to 6 years). No significant difference in patient or graft survival was noted between the HCV-positive lung transplant recipients and the HCV-negative recipients.
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The Journal of Heart and Lung Transplantation, 2013
ABSTRACT Long term outcomes of LT in HCV + recipients is not known. We report our findings in thi... more ABSTRACT Long term outcomes of LT in HCV + recipients is not known. We report our findings in this unique cohort of patients.Methods and MaterialsRetrospective chart review of all LT recipients from 1990 to 2011 was performed to identify HCV + prior to LT. Demographic data, HCV RNA load pre & post LT, liver biopsy, and hepatic malignancy, antimetabolite use, BOS and survival was collected.Results11 patients were identified as having HCV + status out of 1165 patients. 8/11 (4 male) had a positive HCV qualitative RNA PCR, [Mean age±SD] 49.25±9.22; 2/8 patients received antiviral therapy pre LT. HCV Genotype was identified in 5/8 patients, HCV genotype 1 [n=3] & HCV genotype 2 [n=2]. CT scan of abdomen in all patients showed cirrhosis but no portal hypertension. All patients underwent a liver biopsy prior to LT. [Minimal periportal fibrosis – 7, no cirrhosis – 8, granulomatous hepatitis - 1]. The median duration from HCV diagnosis to transplantation was 4.25 years [range 0.6 – 12]. The pre LT median quantitative HCV RNA level was 50,000 IU/ml. Post LT median quantitative HCV RNA levels increased [34,950 to 2,755,000 IU/ml] without an associated increase in the liver function tests. The post LT immunosuppression included calcineurin inhibitor + prednisone but only 3 patients were on an antimetabolite. Median survival for this group was 4.5 years post LT with the longest survival 10 years post transplant. Causes of death included BOS, lung cancer, and sepsis but no patient died of progressive liver disease. The average survival at 1, 3, & 5 years post LT was 75%, 62.5%, and 50%.ConclusionsHCV + patients can successfully undergo LT and achieve comparable survival to non HCV + status. Viral loads after transplant will increase but is not associated with worsening liver function or outcomes. BOS still remains the leading cause of death in this population long term.
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CHEST Journal, 2005
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The European respiratory journal, 2006
Hepatic veno-occlusive disease is defined as nonthrombotic fibrous obliterative endophlebitis of ... more Hepatic veno-occlusive disease is defined as nonthrombotic fibrous obliterative endophlebitis of small centrilobular hepatic venules. Clinically, patients present with elevated liver enzymes and a triad of jaundice, hepatomegaly and ascites. Although reported as a complication of other solid organ and stem cell transplantation, there have been no reported cases to date of veno-occlusive disease following lung transplantation. The present authors report a case of veno-occlusive disease following single-lung transplantation in a patient on a triple-drug immunosuppressive regimen composed of tacrolimus, mycophenolate mofetil and prednisone. The diagnosis was established by transjugular liver biopsy and by discontinuing tacrolimus; there was clinical regression of symptoms and serological return to baseline.
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Transplant Infectious Disease, 2008
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The Journal of Heart and Lung Transplantation, 2007
Hepatitis C virus (HCV) infects 4 million people in the USA, with a prevalence of 1.4%. The serop... more Hepatitis C virus (HCV) infects 4 million people in the USA, with a prevalence of 1.4%. The seropositivity rate among potential lung transplant candidates is 1.9%, yet little information is available regarding outcomes of lung transplantation in HCV-positive lung transplant recipients. Our study reports outcomes of lung transplantation in HCV-positive recipients and compares them to HCV-negative controls. A retrospective analysis of the Cleveland Clinic Foundation's lung transplant database (465 patients) identified six HCV-positive patients. Demographic data, etiology of HCV infection, HCV viral load pre- and post-transplant, pre-transplant hepatic pathology, serial transaminases, incidence of acute hepatitis, graft function data and patient survival data were obtained by chart extraction. Five HCV-positive recipients had a pre-transplant liver biopsy, none of whom had evidence of cirrhosis pre-transplant. Although HCV RNA levels markedly increased post-transplant, no concomitant increase in transaminases was noted. There was no significant difference in the incidence of acute rejection at 1 year in our HCV-positive cohort compared with the HCV-negative lung transplant recipients from our institution. One patient developed bronchiolitis obliterans syndrome (BOS) during the follow-up period. Two patient deaths occurred, one at 8 months and the other at 2 years post-transplant. No evidence of hepatic dysfunction was noted in either deceased patient. The four surviving patients are alive at a median 3.2 years (range 1 to 6 years). No significant difference in patient or graft survival was noted between the HCV-positive lung transplant recipients and the HCV-negative recipients.
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The Journal of Heart and Lung Transplantation, 2013
ABSTRACT Long term outcomes of LT in HCV + recipients is not known. We report our findings in thi... more ABSTRACT Long term outcomes of LT in HCV + recipients is not known. We report our findings in this unique cohort of patients.Methods and MaterialsRetrospective chart review of all LT recipients from 1990 to 2011 was performed to identify HCV + prior to LT. Demographic data, HCV RNA load pre & post LT, liver biopsy, and hepatic malignancy, antimetabolite use, BOS and survival was collected.Results11 patients were identified as having HCV + status out of 1165 patients. 8/11 (4 male) had a positive HCV qualitative RNA PCR, [Mean age±SD] 49.25±9.22; 2/8 patients received antiviral therapy pre LT. HCV Genotype was identified in 5/8 patients, HCV genotype 1 [n=3] & HCV genotype 2 [n=2]. CT scan of abdomen in all patients showed cirrhosis but no portal hypertension. All patients underwent a liver biopsy prior to LT. [Minimal periportal fibrosis – 7, no cirrhosis – 8, granulomatous hepatitis - 1]. The median duration from HCV diagnosis to transplantation was 4.25 years [range 0.6 – 12]. The pre LT median quantitative HCV RNA level was 50,000 IU/ml. Post LT median quantitative HCV RNA levels increased [34,950 to 2,755,000 IU/ml] without an associated increase in the liver function tests. The post LT immunosuppression included calcineurin inhibitor + prednisone but only 3 patients were on an antimetabolite. Median survival for this group was 4.5 years post LT with the longest survival 10 years post transplant. Causes of death included BOS, lung cancer, and sepsis but no patient died of progressive liver disease. The average survival at 1, 3, & 5 years post LT was 75%, 62.5%, and 50%.ConclusionsHCV + patients can successfully undergo LT and achieve comparable survival to non HCV + status. Viral loads after transplant will increase but is not associated with worsening liver function or outcomes. BOS still remains the leading cause of death in this population long term.
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CHEST Journal, 2005
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