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https://www.readbyqxmd.com/read/28685914/rates-of-liver-re-transplantation-in-the-united-states-are-declining-in-the-era-of-direct-acting-antiviral-agents
#1
George Cholankeril, Eric R Yoo, Menghan Hu, Chiranjeevi Gadiparthi, Muhammad Ali Khan, Ryan B Perumpail, C Andrew Bonham, Aijaz Ahmed
BACKGROUND & AIMS: Chronic hepatitis C virus (HCV) infection is the leading indication for liver transplantation (LT) and liver re-transplantation (re-LT) in the United States (US). Following LT, the recurrence of HCV infection is universal, with 40% of grafts developing cirrhosis within five years, often necessitating re-LT. Until recently, treatment strategies for liver transplant recipients with recurrent HCV infection were less than ideal; however, the recent development and approval of direct-acting antiviral (DAA) agents have shifted the treatment paradigm in this difficult-to-treat cohort...
July 7, 2017: Journal of Viral Hepatitis
https://www.readbyqxmd.com/read/28660150/expanding-treatment-access-for-chronic-hepatitis-c-with-task-shifting-in-the-era-of-direct-acting-antivirals
#2
REVIEW
Eric R Yoo, Ryan B Perumpail, George Cholankeril, Channa R Jayasekera, Aijaz Ahmed
In the United States, the fight to eradicate hepatitis C virus (HCV) infection has been ongoing for many years, but the results have been less than ideal. Historically, patients with chronic hepatitis C (CHC) were treated with interferon-based regimens, which were associated with frequent adverse effects, suboptimal response rates, and long durations of treatment - of up to 48 weeks. Expertise from specialist-physicians, such as hepatologists and gastroenterologists, was needed to closely follow patients on these medications so as to monitor laboratory values and manage adverse effects...
June 28, 2017: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/28507922/sofosbuvir-use-in-the-setting-of-end-stage-renal-disease-a-single-center-experience
#3
Avin Aggarwal, Eric R Yoo, Ryan B Perumpail, George Cholankeril, Radhika Kumari, Tami J Daugherty, Alex S Lapasaran, Aijaz Ahmed
Background and Aims: Patients with chronic hepatitis C (CHC) and end-stage renal disease (ESRD) who are dialysis-dependent form a unique group, in which safety, tolerability and efficacy of sofosbuvir (SOF)-based direct-acting antivirals (DAAs) need further evaluation. Methods: We performed a retrospective analysis of 14 patients with CHC and ESRD on dialysis who received 15 courses of SOF-based therapy. We evaluated dose escalation to standard-dose SOF in this proof-of-principle experience. Results: Sustained virological response (defined as undetectable viral load at 12 weeks, SVR-12) was achieved in 13 out of the 15 (86...
March 28, 2017: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/28507921/sofosbuvir-based-regimens-with-task-shifting-is-cost-effective-in-expanding-hepatitis-c-treatment-access-in-the-united-states
#4
Channa R Jayasekera, Rachel Beckerman, Nathaniel Smith, Ryan B Perumpail, Robert J Wong, Zobair M Younossi, Aijaz Ahmed
Background and Aims: The current paradigm of specialist physician-managed treatment of chronic hepatitis C virus infection (HCV) is inefficient in absorbing the approximately 3 million patients awaiting treatment in the United States. Task shifting-whereby specialist physicians screen patients for treatment eligibility but on-treatment monitoring is devolved to more abundant non-physician clinicians-achieves non-inferior treatment outcomes with second generation direct-acting antivirals (2(nd) Gen DAAs), may increase treatment capacity, and may facilitate greater treatment access...
March 28, 2017: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/28392702/hepatic-encephalopathy-what-the-multidisciplinary-team-can-do
#5
REVIEW
Andy Liu, Eric R Yoo, Osama Siddique, Ryan B Perumpail, George Cholankeril, Aijaz Ahmed
Hepatic encephalopathy (HE) is a complex disease requiring a multidisciplinary approach among specialists, primary care team, family, and caregivers. HE is currently a diagnosis of exclusion, requiring an extensive workup to exclude other possible etiologies, including mental status changes, metabolic, infectious, traumatic, and iatrogenic causes. The categorization of HE encompasses a continuum, varying from the clinically silent minimal HE (MHE), which is only detectable using psychometric tests, to overt HE, which is further divided into four grades of severity...
2017: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/28375820/the-role-of-e-health-in-optimizing-task-shifting-in-the-delivery-of-antiviral-therapy-for-chronic-hepatitis-c
#6
Eric R Yoo, Ryan B Perumpail, George Cholankeril, Channa R Jayasekera, Aijaz Ahmed
PURPOSE: Recently, we reported the successful application of task-shifting to improve the management of patients with chronic hepatitis C virus (HCV) infection receiving treatment with direct-acting antiviral (DAA) agents in underserved areas of California. We assessed the impact of e-health on task-shifting in our treatment model. METHODS: In a retrospective analysis, we reviewed the impact of e-health on optimizing the delivery of DAA-based regimen to HCV-infected patients in outreach clinics in medically underserved areas of California...
April 4, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28360525/the-importance-of-a-multidisciplinary-approach-to-hepatocellular-carcinoma
#7
REVIEW
Osama Siddique, Eric R Yoo, Ryan B Perumpail, Brandon J Perumpail, Andy Liu, George Cholankeril, Aijaz Ahmed
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one that utilizes a core multidisciplinary liver tumor board, consisting of hepatologists, pathologists, interventional radiologists, oncologists, hepatobiliary and transplant surgeons, nurses, and general practitioners...
2017: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/28257591/treatment-of-patients-waitlisted-for-liver-transplant-with-all-oral-direct-acting-antivirals-is-a-cost-effective-treatment-strategy-in-the-united-states
#8
Aijaz Ahmed, Stevan A Gonzalez, George Cholankeril, Ryan B Perumpail, Justin McGinnis, Sammy Saab, Rachel Beckerman, Zobair M Younossi
All-oral direct acting antivirals (DAAs) have been shown to have high safety and efficacy in treating patients with hepatitis C virus (HCV) awaiting liver transplant (LT). However, there is limited empirical evidence comparing the health and economic outcomes associated with treating patients pre-LT versus post-LT. The objective of this study was to analyze the cost-effectiveness of pre-LT versus post-LT treatment with an all-oral DAA regimen among HCV patients with hepatocellular carcinoma (HCC) or decompensated cirrhosis (DCC)...
July 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/27917363/future-therapy-for-hepatitis-b-virus-role-of-immunomodulators
#9
REVIEW
Edward A Pham, Ryan B Perumpail, Benjamin J Fram, Jeffrey S Glenn, Aijaz Ahmed, Robert G Gish
Although currently available therapies for chronic hepatitis B virus infection can suppress viremia and provide long-term benefits for patients, they do not lead to a functional cure for most patients. Advances in our understanding of the virus-host interaction and the recent remarkable success of immunotherapy in cancer offer new and promising strategies for developing immune modulators that may become important components of a total therapeutic approach to hepatitis B, some of which are now in clinical development...
2016: Current Hepatology Reports
https://www.readbyqxmd.com/read/27852658/indications-for-antiviral-therapy-for-chronic-hepatitis-b-in-pregnant-mothers
#10
Eric Raeyoon Yoo, Ryan Babu Perumpail, George Cholankeril, Aijaz Ahmed
The use of antiviral therapy for chronic hepatitis B virus (HBV) infection in the setting of pregnancy needs to be individualised based on limited data. We report a case of a 34-year-old Korean-American woman with a history of pregnancy with emergent caesarean section due to prolonged labour in the setting of HBV e-antigen (HBeAg) positive chronic HBV with a pretreatment baseline HBV DNA level of 110000 000 million copies per mL. Her first delivery was complicated by mother-to-child transmission (MTCT) of HBV infection to her daughter despite standard active and passive immunoprophylaxis...
November 15, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27847658/direct-acting-antivirals-in-patients-with-chronic-hepatitis-c-and-down-syndrome
#11
Eric R Yoo, Ryan B Perumpail, George Cholankeril, Aijaz Ahmed
Patients with Down syndrome who received blood transfusions, likely in conjunction with cardiothoracic surgery for congenital heart disease and prior to the implementation of blood-donor screening for hepatitis C virus infection, face a substantial risk of acquiring the infection. In the past, interferon-based therapy for chronic hepatitis C infection in patients with Down syndrome was noted to have lower efficacy and potentially higher risk of adverse effects. Recently, the treatment for chronic hepatitis C has been revolutionized with the introduction of interferon-free direct acting antivirals with favorable safety, tolerability, and efficacy profile...
2016: Case Reports in Infectious Diseases
https://www.readbyqxmd.com/read/27777886/underutilization-of-living-donor-liver-transplantation-in-the-united-states-bias-against-meld-20-and-higher
#12
Ryan B Perumpail, Eric R Yoo, George Cholankeril, Lupe Hogan, Melodie Deis, Waldo C Concepcion, C Andrew Bonham, Zobair M Younossi, Robert J Wong, Aijaz Ahmed
Background and Aims: Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.). We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT. Methods: All U.S. adult LDLT recipients with MELD < 25 were evaluated using the 1995-2012 United Network for Organ Sharing registry. Survival following LDLT was stratified into three MELD categories (MELD < 15 vs...
September 28, 2016: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/27652299/colonoscopy-with-polypectomy-is-associated-with-a-low-rate-of-complications-in-patients-with-cirrhosis
#13
Robert J Huang, Ryan B Perumpail, Nirav Thosani, Ramsey Cheung, Shai Friedland
BACKGROUND AND STUDY AIMS: Cirrhotic patients are at a theoretically increased risk of bleeding. The safety of polypectomy in cirrhosis is poorly defined. PATIENTS AND METHODS: We performed a retrospective review of patients with cirrhosis who underwent colonoscopic polypectomy at a tertiary-care hospital. Patient characteristics and polyp data were collected. Development of complications including immediate bleeding, delayed bleeding, hospitalization, blood transfusion, perforation, and death were recorded to 30-day follow-up...
September 2016: Endoscopy International Open
https://www.readbyqxmd.com/read/27609705/disparities-in-liver-transplantation-resulting-from-variations-in-regional-donor-supply-and-multiple-listing-practices
#14
George Cholankeril, Eric R Yoo, Ryan B Perumpail, Zobair M Younossi, Aijaz Ahmed
No abstract text is available yet for this article.
February 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27497192/task-shifting-a-practical-strategy-to-improve-the-global-access-to-treatment-for-chronic-hepatitis-c
#15
EDITORIAL
Eric R Yoo, Ryan B Perumpail, George Cholankeril, Channa R Jayasekera, Aijaz Ahmed
No abstract text is available yet for this article.
October 2016: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/27456386/trends-in-liver-transplantation-multiple-listing-practices-associated-with-disparities-in-donor-availability-an-endless-pursuit-to-implement-the-final-rule
#16
EDITORIAL
George Cholankeril, Ryan B Perumpail, Zeynep Tulu, Channa R Jayasekera, Stephen A Harrison, Menghan Hu, Carlos O Esquivel, Aijaz Ahmed
No abstract text is available yet for this article.
September 2016: Gastroenterology
https://www.readbyqxmd.com/read/27388553/nonalcoholic-fatty-liver-disease-epidemiology-natural-history-and-diagnostic-challenges
#17
George Cholankeril, Ryan B Perumpail, Edward A Pham, Aijaz Ahmed, Stephen A Harrison
No abstract text is available yet for this article.
September 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/27084385/chronic-hepatitis-b-is-associated-with-higher-inpatient-resource-utilization-and-mortality-versus-chronic-hepatitis-c
#18
COMPARATIVE STUDY
George Cholankeril, Ryan B Perumpail, Menghan Hu, Gail Skowron, Zobair M Younossi, Aijaz Ahmed
BACKGROUND: Chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections remain one of the leading causes of chronic liver disease and hepatocellular carcinoma. Healthcare initiatives for chronic viral hepatitis to facilitate early diagnosis and linkage to care in an effort to reduce inpatient resource utilization associated with late diagnosis and end-stage liver disease have been partially successful. AIMS: Our objective was to determine the impact of liver-related complications from chronic HBV and HCV infections on inpatient cost of care, length of stay, and mortality...
September 2016: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/26807207/hepatitis-e-virus-infection-in-the-liver-transplant-recipients-clinical-presentation-and-management
#19
REVIEW
Avin Aggarwal, Ryan B Perumpail, Swetha Tummala, Aijaz Ahmed
Hepatitis E virus (HEV) is an emerging pathogen and an increasingly recognized cause of graft hepatitis, especially in the post-orthotopic liver transplantation immunocompromised population. The exact incidence and prevalence of HEV infection in this population remains unclear but is certainly greater than historical estimates. Identifying acute HEV infection in this population is imperative for choosing the right course of management as it is very difficult to distinguish histologically from acute rejection on liver biopsy...
January 18, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/26783422/treatment-strategies-for-chronic-hepatitis-c-prior-to-and-following-liver-transplantation
#20
REVIEW
Ryan B Perumpail, Thomas A Hahambis, Avin Aggarwal, Zobair M Younossi, Aijaz Ahmed
Hepatitis C virus (HCV)-related liver disease is the leading indication for liver transplantation (LT) worldwide. However, HCV is an independent predictor of lower survival following LT, and recurrence of HCV post-LT is virtually universal. The historic standard of care during the interferon era of HCV therapy was expectant management-initiation of antiviral therapy in the setting of documented disease progression following LT. With the advent of new direct acting antiviral (DAA) therapies for HCV, the paradigm of expectant treatment for recurrent HCV infection post-LT is shifting...
January 8, 2016: World Journal of Hepatology
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