Jeffrey Crippin - Academia.edu (original) (raw)

Papers by Jeffrey Crippin

Digestive Diseases and Sciences, 2014

Clinics in liver disease, 2006

Each year, 5000 to 6000 liver transplantations are performed in the United States, 40% of which a... more Each year, 5000 to 6000 liver transplantations are performed in the United States, 40% of which are for hepatitis C-related end-stage liver disease. Infection of liver allograft is universal and is associated with an accelerated rate of disease progression. Unfortunately, antiviral therapy after transplantation is less effective and often is beset with complications. This article reviews antiviral therapies and the factors that may influence the response in patients who have HCV infection both immediately before and after liver transplantation.

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2000

The time progression of allograft damage in patients with recurrent hepatitis C after orthotopic ... more The time progression of allograft damage in patients with recurrent hepatitis C after orthotopic liver transplantation (OLT) is not precisely determined. The aim of this analysis is to study the progression of disease recurrence and its impact on patient and graft survival. Data for 300 patients who underwent OLT for hepatitis C were analyzed regarding the incidence of histological recurrence, risk factors, immunosuppressive regimen, rejection episodes, and survival. For patients with histological recurrence, the timing and risks for disease progression were analyzed. Data for 30 patients who underwent retransplantation were studied. Histological recurrence occurred in 40.3% of patients, 27.2% of whom progressed to bridging fibrosis or cirrhosis. Eighty-seven percent of the patients experienced recurrence of disease within 24 months of OLT. Patients with histological recurrence within 6 months of OLT had an increased risk for progression to cirrhosis compared with patients with recu...

Digestive diseases and sciences, 2003

To determine if an intensive regimen of daily, high-dose interferon would improve the initial res... more To determine if an intensive regimen of daily, high-dose interferon would improve the initial response rates to therapy for hepatitis C genotype 1 among African American and Caucasian patients, we conducted a retrospective analysis of a treatment trial conducted between October 1995 and June 1997. Patients were randomized to 24 weeks of therapy with interferon--alpha-2b at either 5 MU daily or 3 MU three times a week. On the standard interferon regimen (3 MU three times a week) African Americans and Caucasians had similar initial response rates. However, unlike Caucasians, African Americans did not have an increased initial virological response when treated with an intensive, daily dose regimen. Levels of HCV RNA decreased more slowly during the first 12 weeks of therapy among African Americans. Nelson-Aalen cumulative hazard estimates for the different race and dose combinations revealed that Caucasians who received daily interferon were most likely to have an initial response (log...

Annals of internal medicine, Jan 17, 2002

Because acute liver failure is rare, related data have been sparse. Studies have suggested that v... more Because acute liver failure is rare, related data have been sparse. Studies have suggested that viral hepatitis is the most common underlying cause of this condition. To describe the clinical features, presumed causes, and short-term outcomes of acute liver failure. Prospective cohort study. 17 tertiary care centers participating in the U.S. Acute Liver Failure Study Group. 308 consecutive patients with acute liver failure, admitted over a 41-month period. Detailed clinical and laboratory data collected during hospitalization, including outcome 3 weeks after study admission. 73% of patients were women; median age was 38 years. Acetaminophen overdose was the most common apparent cause of acute liver failure, accounting for 39% of cases. Idiosyncratic drug reactions were the presumptive cause in 13% of cases, viral hepatitis A and B combined were implicated in 12% of cases, and 17% of cases were of indeterminate cause. Overall patient survival at 3 weeks was 67%. Twenty-nine percent o...

Annals of surgery, 2008

To evaluate outcomes of downstaging patients with advanced (American liver tumor study group stag... more To evaluate outcomes of downstaging patients with advanced (American liver tumor study group stage III/IV) hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) to allow eligibility for orthotopic liver transplant (OLT). From 1999 to 2006, 202 patients with HCC were referred for transplant evaluation. Seventy-six (37.6%) patients with stage III/IV HCC were potential transplant candidates if downstaging was achieved by TACE. OLT was considered based on follow-up imaging findings. The number of patients who were successfully downstaged within the Milan criteria, tumor response using Response Evaluation Criteria in Solid Tumors criteria, findings at explant, and outcomes after transplant were tracked. Eighteen of 76 (23.7%) patients had adequate downstaging to qualify for OLT under the Milan criteria. By Response Evaluation Criteria in Solid Tumors, 27/76 (35.5%) patients had a partial response, 22/76 (29%) had stable disease, and 27/76 (35.5%) had progressive dise...

Case reports in cardiology, 2014

The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and... more The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In thi...

Transplantation, 2007

This pilot trial was designed to assess the safety and efficacy of SRL in liver transplant recipi... more This pilot trial was designed to assess the safety and efficacy of SRL in liver transplant recipients with renal dysfunction. Forty patients with renal dysfunction (24-hr CrCl 40-80 mL/min) were randomized to be withdrawn from the calcineurin inhibitor (CNI) and receive sirolimus (SRL) or to continue CNI (control arm). Improvement in 24-hour CrCl was seen in the SRL arm at 3 months (75 mL/min SRL vs. 56 mL/min control, P=0.012), whereas at 12 months there was a trend toward improvement in the SRL arm (72 mL/min SRL vs. 58 mL/min control, P=0.09). Two patients, one in each arm, developed steroid-sensitive rejection. Side effects of SRL were limited and included hyperlipidemia requiring treatment (15%), pruritus (5%), and mouth sores (25%). In this trial, SRL-based immunosuppression was a safe alternative to CNI. Although early improvements were observed, withdrawing CNI and replacing it with SRL did not result in a statistically significant improvement in renal function at 12 months of follow-up.

Transplantation Journal, 2004

Liver Transplantation, 2008

Two-hour postdose cyclosporine (C2) monitoring is becoming an accepted method of therapeutic drug... more Two-hour postdose cyclosporine (C2) monitoring is becoming an accepted method of therapeutic drug monitoring, although it is not known whether C2 monitoring is superior to tacrolimus (FK)-based immunosuppression. The purpose of this trial was to compare the safety, efficacy, and pharmacoeconomics of cyclosporine A (CsA) monitored by C2 levels versus FK monitored by trough levels in de novo liver transplant recipients. After informed consent, 60 de novo liver transplant recipients were randomized in a 1:1 fashion to receive either FK (trough, 6-10 ng/mL) or CsA (C2, 600-1200 ng/mL) and corticosteroids. The 2 groups were similar for gender, race, indication for liver disease, and age. At 1 year, patient survival was similar (93% for FK versus 90% for C2). One patient in the FK arm was retransplanted because of recurrent hepatitis C virus (HCV). Early acute rejection occurred in 27% of FK-treated patients and 23% of CsA-treated recipients [P = not significant (NS)]. Recurrent HCV occurred in 21% of FK-treated patients and 61% of CsA-treated patient (P = 0.04). The incidence of other infections, new onset diabetes mellitus, requirement for antihypertensives, and requirement for cholesterol medications were similar between the groups. Annual calcineurin inhibitor costs were lower in the C2 arm ($5432 +/- 2091 for C2 versus 8291+/−3948forFK,P=0.001).Annualpretransplantdrugcosts(8291 +/- 3948 for FK, P = 0.001). Annual pretransplant drug costs (8291+/−3948forFK,P=0.001).Annualpretransplantdrugcosts(2292 +/- 2331 for C2 versus 2831+/−2358forFK,P=NS)and1−yearposttransplantdrugcosts(2831 +/- 2358 for FK, P = NS) and 1-year posttransplant drug costs (2831+/−2358forFK,P=NS)and1−yearposttransplantdrugcosts(17,214 +/- 16,600 for C2 versus $15,151 +/- 11,699 for FK, P = NS) were similar. In conclusion, immunosuppression with CsA, monitored by C2 levels, is safe, effective, and economical in liver transplant recipients and provides immunosuppression at least equivalent to that of FK.

$Research paper thumbnail of Serial measurements of bone density at the lumbar spine do not predict fracture risk after liver transplantation$

Liver Transplantation, 2003

Bone disease has emerged as a serious and complex complication after liver transplantation. The p... more Bone disease has emerged as a serious and complex complication after liver transplantation. The purpose of this study is to determine risk factors for fracture and bone loss after liver transplantation. Dual-energy x-ray absorptiometry (DEXA) of the lumbar spine was performed routinely pretransplantation, 6 months posttransplantation, and at yearly intervals thereafter at our center. We followed up patients who underwent transplantation in the past 10 years and compared bone mineral density (BMD) and fracture rate with known risk factors for bone loss in primary transplant recipients who met the inclusion criteria of a pretransplantation DEXA and at least one follow-up DEXA scan postoperatively (n = 153). We observed a 15% (n = 23) prevalence of symptomatic fractures at a mean of 2.2 +/- 1.8 years after transplantation. Change in BMD was greatest from pretransplantation to 6 months posttransplantation (-4.2%; P =.006), then increased at a rate of 1.4% per year. Logistic regression analysis showed an association of fracture risk with several factors, including number of acute rejection episodes (P =.045), smoking (P =.02), and female sex (P =.02). Stepwise logistic regression analysis reported female sex (P =.004) as the only factor associated with fracture after transplantation. Age, time listed for transplantation, race, menopause, chronic renal insufficiency, loss of height, family history of osteoporosis, BMD, and T score did not predict fracture or bone loss after transplantation. In conclusion, serial measurements of BMD at the lumbar spine do not appear to predict fracture risk; however, data suggest that female sex is the strongest predictor of fracture after liver transplantation.