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UCLA and transplant

James Stacey Taylor
The UCLA Medical Center has initiated a "voucher program" under which a person who donated a kidney would receive a voucher that she could provide to someone of her choosing who could then use it to move to the top of the renal transplantation waiting list. If the use of such vouchers as incentives for donors is morally permissible, then cash payments for kidneys are also morally permissible. But, that argument faces five objections. First, there are some goods whose nature allows them to be exchanged for similar goods but renders them monetarily inalienable...
October 1, 2017: Journal of Medicine and Philosophy
Myles T Taffel, Paul Nikolaidis, Michael D Beland, M Donald Blaufox, Vikram S Dogra, Stanley Goldfarb, John L Gore, Howard J Harvin, Marta E Heilbrun, Matthew T Heller, Gaurav Khatri, Glenn M Preminger, Andrei S Purysko, Andrew D Smith, Zhen J Wang, Robert M Weinfeld, Jade J Wong-You-Cheong, Erick M Remer, Mark E Lockhart
Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions...
May 2017: Journal of the American College of Radiology: JACR
Jeanne M Horowitz, Ihab R Kamel, Hina Arif-Tiwari, Sumeet K Asrani, Nicole M Hindman, Harmeet Kaur, Michelle M McNamara, Richard B Noto, Aliya Qayyum, Tasneem Lalani
Because liver fibrosis can be treated, it is important to diagnose liver fibrosis noninvasively and monitor response to treatment. Although ultrasound (grayscale and Doppler) can diagnose cirrhosis, it does so unreliably using morphologic and sonographic features and cannot diagnose the earlier, treatable stages of hepatic fibrosis. Transient elastography, ultrasound elastography with acoustic radiation force impulse, and MR elastography are modalities that can assess for hepatic fibrosis. Although all international organizations recommend ultrasound for screening for hepatocellular carcinoma, ultrasound is particularly limited for identifying hepatocellular carcinoma in patients with obesity, nonalcoholic fatty liver disease, and nodular cirrhotic livers...
May 2017: Journal of the American College of Radiology: JACR
Kit L Shaw, Elizabeth Garabedian, Suparna Mishra, Provaboti Barman, Alejandra Davila, Denise Carbonaro, Sally Shupien, Christopher Silvin, Sabine Geiger, Barbara Nowicki, E Monika Smogorzewska, Berkley Brown, Xiaoyan Wang, Satiro de Oliveira, Yeong Choi, Alan Ikeda, Dayna Terrazas, Pei-Yu Fu, Allen Yu, Beatriz Campo Fernandez, Aaron R Cooper, Barbara Engel, Greg Podsakoff, Arumugam Balamurugan, Stacie Anderson, Linda Muul, G Jayashree Jagadeesh, Neena Kapoor, John Tse, Theodore B Moore, Ken Purdy, Radha Rishi, Kathey Mohan, Suzanne Skoda-Smith, David Buchbinder, Roshini S Abraham, Andrew Scharenberg, Otto O Yang, Kenneth Cornetta, David Gjertson, Michael Hershfield, Rob Sokolic, Fabio Candotti, Donald B Kohn
BACKGROUND: Autologous hematopoietic stem cell transplantation (HSCT) of gene-modified cells is an alternative to enzyme replacement therapy (ERT) and allogeneic HSCT that has shown clinical benefit for adenosine deaminase-deficient (ADA-deficient) SCID when combined with reduced intensity conditioning (RIC) and ERT cessation. Clinical safety and therapeutic efficacy were evaluated in a phase II study. METHODS: Ten subjects with confirmed ADA-deficient SCID and no available matched sibling or family donor were enrolled between 2009 and 2012 and received transplantation with autologous hematopoietic CD34+ cells that were modified with the human ADA cDNA (MND-ADA) γ-retroviral vector after conditioning with busulfan (90 mg/m2) and ERT cessation...
May 1, 2017: Journal of Clinical Investigation
Karen M Winkfield, Ranjana H Advani, Leslie K Ballas, Bouthaina S Dabaja, Sughosh Dhakal, Christopher R Flowers, Chul Soo Ha, Bradford S Hoppe, David B Mansur, Nancy P Mendenhall, Monika L Metzger, John P Plastaras, Kenneth B Roberts, Ronald Shapiro, Sonali M Smith, Stephanie A Terezakis, Anas Younes, Louis S Constine
This topic addresses the management of recurrent Hodgkin lymphoma. While autologous stem cell transplantation may be appropriate for select cases of recurrent disease following comprehensive combined-modality therapy, other options exist for patients treated with lower-dose therapy for early-stage disease. Additionally, innovative targeted therapies provide newer salvage options to consider. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel...
December 15, 2016: Oncology (Williston Park, NY)
Michelle J Hickey, Ying Zheng, Nicole Valenzuela, Qiuheng Zhang, Carolyn Krystal, Erik Lum, Eileen W Tsai, Gerald S Lipshutz, H Albin Gritsch, Gabriel Danovitch, Jeffrey Veale, David Gjertson, Michael Cecka, Elaine F Reed
UNOS implemented a new Kidney Allocation System (New KAS) on December 4, 2014 with a primary goal of increasing equity to organ transplant for patients that were immunologically or socially disadvantaged by the previous allocation system (Previous KAS) that prioritized long wait times. We examined the effects of the New KAS on patients transplanted from the UCLA deceased donor waitlist during the first year and compared to the last year of the Previous KAS. The total number of deceased donor kidney transplants was increased in the New KAS as compared to the Previous KAS (178 vs 148)...
January 2017: Human Immunology
Nicholas A Kolaitis, Erin Duffy, Alice Zhang, Michelle Lo, David T Barba, Meng Chen, Teresa Soriano, Jenny Hu, Vishad Nabili, Rajeev Saggar, David M Sayah, Ariss DerHovanessian, Michael Y Shino, Joseph P Lynch, Bernie M Kubak, Abbas Ardehali, David J Ross, John A Belperio, David Elashoff, Rajan Saggar, S Samuel Weigt
Lung transplant recipients (LTR) are at high risk of cutaneous squamous cell carcinoma (SCC). Voriconazole exposure after lung transplant has recently been reported as a risk factor for SCC. We sought to study the relationship between fungal prophylaxis with voriconazole and the risk of SCC in sequential cohorts from a single center. We evaluated 400 adult LTR at UCLA between 7/1/2005 and 12/22/2012. On 7/1/2009, our center instituted a protocol switch from targeted to universal antifungal prophylaxis for at least 6 months post-transplant...
January 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
A Schlegel, M Linecker, P Kron, G Györi, M L De Oliveira, B Müllhaupt, P-A Clavien, P Dutkowski
Allocation of liver grafts triggers emotional debates, as those patients, not receiving an organ, are prone to death. We analyzed a high-Model of End-stage Liver Disease (MELD) cohort (laboratory MELD score ≥30, n = 100, median laboratory MELD score of 35; interquartile range 31-37) of liver transplant recipients at our center during the past 10 years and compared results with a low-MELD group, matched by propensity scoring for donor age, recipient age, and cold ischemia time. End points of our study were cumulative posttransplantation morbidity, cost, and survival...
April 2017: American Journal of Transplantation
Sjirk J Westra, Boaz K Karmazyn, Adina L Alazraki, Molly E Dempsey, Jonathan R Dillman, Matthew Garber, Sheila G Moore, Molly E Raske, Henry E Rice, Cynthia K Rigsby, Nabile Safdar, Stephen F Simoneaux, Peter J Strouse, Andrew T Trout, Sandra L Wootton-Gorges, Brian D Coley
The cause of fever in a child can often be determined from history, physical examination, and laboratory tests; infections account for the majority of cases. Yet in 20%, no apparent cause can be found, designated as fever without source (FWS). The yield of chest radiography in children with FWS is low, and it is usually not appropriate. However, in children with respiratory signs, high fever (>39°C), or marked leukocytosis (≥20,000/mm(3)), chest radiography is usually appropriate, as it has a higher yield in detecting clinically occult pneumonia...
August 2016: Journal of the American College of Radiology: JACR
Anna N Rahman
A seasoned gerontologist whose work has explored end-of-life care, I thought I knew what I was getting into when I undertook care for my brother Jim. In April 2014, Jim, whose health was then declining rapidly due to liver cancer, moved from his apartment in Minneapolis to my house in Santa Monica. Jim had come for a liver transplant evaluation at the University of California, Los Angeles (UCLA). When the UCLA team declined to list him-his cancer was just too widespread-Jim elected to stay with my family and me, enrolling in hospice...
February 2017: Gerontologist
Victoria Sheen, Heajung Nguyen, Melissa Jimenez, Vatche Agopian, Sitaram Vangala, David Elashoff, Sammy Saab
BACKGROUND AND AIMS: The aims of our study were to determine whether routine blood tests, the aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) and Fibrosis 4 (Fib-4) scores, were associated with advanced fibrosis and to create a novel model in liver transplant recipients with chronic hepatitis C virus (HCV). METHODS: We performed a cross sectional study of patients at The University of California at Los Angeles (UCLA) Medical Center who underwent liver transplantation for HCV...
March 28, 2016: Journal of Clinical and Translational Hepatology
Tiffany Simms-Waldrip, Galit Rosen, Karin Nielsen-Saines, Alan Ikeda, Berkley Brown, Theodore Moore
BACKGROUND: Pediatric hematopoietic stem cell transplant (HSCT) recipients are at high risk of invasive fungal infections (IFIs). METHODS: To characterize IFIs and changes in fungal organisms over time in pediatric HSCT patients, we performed a retrospective cohort study of all HSCTs performed in pediatric patients at UCLA between 1991 and 2006. RESULTS: In all, 318 patients underwent 324 HSCT transplants over the 15-year period and 69 unique fungal infections were identified in 47 transplant patients...
April 2015: Infectious Diseases
Amy D Waterman, Mark L Robbins, Andrea L Paiva, John D Peipert, Crystal S Kynard-Amerson, Christina J Goalby, LaShara A Davis, Jessica L Thein, Emily A Schenk, Kari A Baldwin, Stacy L Skelton, Nicole R Amoyal, Leslie A Brick
BACKGROUND: Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention...
October 14, 2014: BMC Nephrology
M S Lee, R Zimmer, J Kobashigawa
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease characterized by asymmetric or symmetric ventricular hypertrophy in the absence of an obvious clinical cause. Orthotopic heart transplantation (OHT) has been performed in patients who have refractory symptoms despite medical therapy and surgical septal myectomy. However, there is a paucity of data on outcomes of HCM patients who undergo OHT. METHODS: Data on 462 consecutive patients who underwent OHT at UCLA Medical Center from 1996 to 2004 were retrospectively collected...
June 2014: Transplantation Proceedings
Ulrik Sartipy, Ayumi Goda, Donna M Mancini, Lars H Lund
BACKGROUND: The 4-variable risk score from University of California, Los Angeles (UCLA) demonstrated superior discrimination in advanced heart failure, compared to established risk scores. However, the model has not been externally validated, and its suitability as a selection tool for heart transplantation (HT) and left ventricular assist device (LVAD) is unknown. METHODS AND RESULTS: We calculated the UCLA risk score (based on B-type natriuretic peptide, peak VO2, New York Heart Association class, and use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker) in 180 patients referred for HT...
June 2014: Journal of the American Heart Association
Christophe Charousset, Amine Zaoui, Laurence Bellaïche, Michel Piterman
PURPOSE: To evaluate the clinical and magnetic resonance imaging (MRI) outcome of arthroscopic rotator cuff repair with the use of leukocyte-platelet-rich plasma (L-PRP) in patients with large or massive rotator cuff tears. METHODS: A comparative cohort of patients with large or massive rotator cuff tears undergoing arthroscopic repair was studied. Two consecutive groups of patients were included: rotator cuff repairs with L-PRP injection (group 1, n = 35) and rotator cuff repairs without L-PRP injection (group 2, n = 35)...
April 2014: Arthroscopy: the Journal of Arthroscopic & related Surgery
Rumina A Zaman, Robert B Ettenger, Hay Cheam, Mohammed H Malekzadeh, Eileen W Tsai
BACKGROUND: BK viremia, a prerequisite for BK virus nephropathy (BKVN), affects 5% to 16% of pediatric renal transplant recipients (PRTR). We evaluated the safety and efficacy of a novel approach to treating BK viremia using fluoroquinolones and leflunomide in PRTR. METHODS: We studied 230 PRTR at Mattel Children's Hospital, UCLA, who underwent renal transplantation between January 2003 and October 2010. Nineteen patients were found to have BK viremia. Ciprofloxacin was started when the BK viral load was greater than 625 copies/mL, and patients were switched to leflunomide if BK viral load did not decrease after 2 months of ciprofloxacin therapy...
June 15, 2014: Transplantation
Natalie A van Venrooij, Renata C Pereira, Yin Tintut, Michael C Fishbein, Navdeep Tumber, Linda L Demer, Isidro B Salusky, Katherine Wesseling-Perry
BACKGROUND: Fibroblast growth factor 23 (FGF23) levels are elevated in chronic kidney disease (CKD) and elevated values have been associated with both heart disease and mortality. Recent studies show that FGF23, a protein synthesized by osteocytes, is also present in calcified atherosclerotic plaques and may be induced by heart disease. Whether vascular expression of FGF23 is associated with progressive CKD, however, remains unknown. Therefore, the relationship between kidney function, vascular calcification and FGF23 expression was evaluated in patients with heart disease...
August 2014: Nephrology, Dialysis, Transplantation
Jennifer Chyu, Gregg C Fonarow, Chi Hong Tseng, Tamara B Horwich
BACKGROUND: Risk stratification is an integral component of clinical decision making in heart failure (HF). Women with HF have unique characteristics compared with men, and it is unknown whether common prognostic factors are equally useful in both populations. We aimed to investigate whether sex-specific risk models are more accurate for risk prediction in patients with advanced HF. METHODS AND RESULTS: Patients with advanced HF referred to University of California, Los Angeles (UCLA; n=2255), were stratified by sex into derivation (referred in 2000-2007) and validation (referred in 2008-2011) cohorts...
January 2014: Circulation. Heart Failure
Soroush Zaghi, Jennifer Danesh, Leenoy Hendizadeh, Vishad Nabili, Keith E Blackwell
OBJECTIVES/HYPOTHESIS: To characterize the changing indications for osseous free flaps in maxillomandibular reconstruction at our institution. STUDY DESIGN: Retrospective chart review. METHODS: Database review of patients who underwent free-flap reconstruction of the jaws using vascularized bone-containing free tissue transfer from 1995 to 2012 at the University of California Los Angeles (UCLA). RESULTS: A total of 620 osseous free flaps were performed...
June 2014: Laryngoscope
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