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UCLA and liver transplant

Andrea Schlegel, Michael Linecker, Philipp Kron, Georg Györi, Michelle L De Oliveira, Beat Müllhaupt, Pierre-Alain Clavien, Philipp Dutkowski
Allocation of liver grafts triggers emotional debates, as those patients, not receiving an organ, are prone to death. We analyzed a high MELD cohort (lab MELD≥30, n=100, median lab MELD of 35 (IQR: 31-37) of liver transplant recipients at our center over the last ten years, and compared results with a low MELD group, matched by propensity scoring for donor age, recipient age and cold ischemia. Endpoints of our study were cumulative post-transplant morbidity, cost, and survival. Six different prediction models, including D-MELD, Delta MELD, DRI, SOFT, BAR, and UCLA-FRS, were applied in both cohorts to identify risk for poor outcome and high cost...
September 27, 2016: American Journal of Transplantation
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...
April 21, 2016: 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
Nicole M Walker, Katherine A Stuart, Rebecca J Ryan, Shireena Desai, Sammy Saab, Jennifer A Nicol, Linda M Fletcher, Darrell H G Crawford
UNLABELLED: Additional markers are required to identify patients on the orthotopic liver transplant (OLT) waiting list at increased risk of death and adverse clinical events. Serum ferritin concentration is a marker of varied pathophysiological events and is elevated with increased liver iron concentration, hepatic necroinflammation, and systemic illness, all of which may cause a deterioration in liver function and clinical status. The aim of this study was to determine whether serum ferritin concentration is an independent prognostic factor in subjects awaiting OLT...
May 2010: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Francisco de la Cerda, Walter A Jimenez, David W Gjertson, Robert Venick, Eileen Tsai, Robert Ettenger
Although it has been described in adults that renal grafts in the context of CLKT have a lower number of AR episodes and improved renal allograft survival, this has never been examined in pediatrics. We performed a single center retrospective case-control study examining 10 patients aged 10+/-6 yr with a CLKT that survived the post-surgery period of six months, and compared outcomes to a group of 20 KO transplants matched for age, era, and immunosuppression. We observed a significant reduction in the incidence of AR episodes in the CLKT group...
June 2010: Pediatric Transplantation
Elise H Lawson, Elizabeth Benjamin, Ronald W Busuttil, Jonathan R Hiatt
We report on 43 groin herniorrhaphy operations, 18 in 18 patients with documented cirrhosis and 25 in 24 patients after liver transplantation (LT), over a 10-year period at UCLA. Average follow up was 33 months. Most patients were males (84%) with reducible inguinal hernias (70%). Child's class of cirrhotic patients was B in 66 per cent and A and C in 17 per cent each; 7 patients (39%) went on to LT. Compared with post-LT patients, patients with cirrhosis had significantly lower platelets and significantly higher bilirubin, international normalized ratio, and Model for Endstage Liver Disease scores...
October 2009: American Surgeon
Myron J Tong, Disaya Chavalitdhamrong, David S K Lu, Steven S Raman, Antoinette Gomes, John P Duffy, Johnny C Hong, Ronald W Busuttil
BACKGROUND/RATIONALE: Hepatocellular carcinoma (HCC) is a common malignancy in Asians and is related to the high incidence of chronic viral hepatitis in this ethnic population. The aims of this study were to examine the tumor characteristics and liver disease status in HCC patients of Asian ancestry and determine their survival after treatments for HCC. RESULTS: Between September 2000 and December 2007, 278 patients, mean age 61.5 years, presented with HCC to the University of California Los Angeles (UCLA) Liver Cancer Center...
March 2010: Journal of Clinical Gastroenterology
G Santori, I Fontana, R Valente, R Ghirelli, U Valente
In the mid-1980s, RAND Corporation and University of California Los Angeles (UCLA) developed the RAND/UCLA Appropriateness Method (RAM) to evaluate the correctness of medical and surgical procedures. In this study, the RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of a dataset concerning kidney transplantation in adult and pediatric recipients for an information system funded by the Italian Ministry of Health. The original dataset was obtained using an interdisciplinary pool of regional experts (n=60)...
July 2008: Transplantation Proceedings
John P Duffy, Douglas G Farmer, Ronald W Busuttil
Orthotopic liver transplant (OLT) has become the best and most durable treatment for end stage liver disease (ESLD) of any etiology. The UCLA program, established in 1984, has accumulated one of the world's most extensive experiences with this procedure. The UCLA experience has been built on the classical techniques of Starzl, yet has forged innovations such as split liver transplantation and use of extended criteria donor organs. The UCLA program also reports one of the largest experiences in pediatric liver transplantation and has demonstrated that recipient renal function is a main predictor of post-transplant survival...
2007: Clinical Transplants
Margaret L Stuber, Eyal Shemesh, Debra Seacord, James Washington, Gerhard Hellemann, Susan McDiarmid
Non-adherence with recommended immunosuppressant medications is common post-pediatric liver transplant and is the most important reason for organ rejection in long-term survivors. However, there is currently no validated, standard method to measure adherence, with a well-defined threshold, making it extremely difficult to evaluate interventions to improve adherence. Previous studies have suggested that the degree of fluctuation of medication blood levels over time can provide an idea about how regularly the medication is being taken...
May 2008: Pediatric Transplantation
John P Duffy, Andrew Vardanian, Elizabeth Benjamin, Melissa Watson, Douglas G Farmer, Rafik M Ghobrial, Gerald Lipshutz, Hasan Yersiz, David S K Lu, Charles Lassman, Myron J Tong, Jonathan R Hiatt, Ronald W Busuttil
OBJECTIVE: To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the impact of current staging criteria on long term survival. SUMMARY BACKGROUND DATA: HCC is becoming an increasingly common indication for OLT. Medicare approves OLT only for HCCs meeting the Milan criteria, thus limiting OLT for an expanding pool of potential liver recipients. We analyzed our experience with OLT for HCC to determine if expansion of criteria for OLT for HCC is warranted...
September 2007: Annals of Surgery
G Santori, E Andorno, R Valente, R Ghirelli, U Valente
The Delphi Method (DM) is the most frequently used technique to acquire structured expert-opinion elicitation (EOE). It has been increasingly applied to construct guidelines in medicine and to evaluate the appropriateness of clinical procedures. In this study, the RAND/UCLA appropriateness method was used as a structured EOE process to evaluate the appropriateness of a dataset concerning liver transplantation in adult and pediatric recipients for an information system funded by the Italian Ministry of Health...
July 2007: Transplantation Proceedings
Andrew M Cameron, Ronald W Busuttil
The hepatitis C virus (HCV) infects 3% of the world's population, or approximately 170 million people. Most of those acutely infected progress to chronic infection and are unresponsive to existing antiviral treatment. Over a 20-year period, chronic HCV infection leads to cirrhosis and the sequelae of end-stage liver disease, including hepatic encephalopathy, ascites, variceal haemorrhage and hepatocellular carcinoma. Orthotopic liver transplantation (OLT) is the optimal treatment for decompensated HCV cirrhosis, but is limited by organ availability and universal graft reinfection...
October 2006: Expert Opinion on Biological Therapy
S Saab, A Shpaner, Y Zhao, I Brito, F Durazo, S Han, D G Farmer, R M Ghobrial, H Yersiz, L I Goldstein, M J Tong, R W Busuttil
The prevalence and risk factors for diabetes mellitus after liver transplantation are not well understood. Thus, we sought to identify independent risk factors for the development of diabetes after liver transplantation using currently accepted medical criteria. We studied the prevalence and risk factors in 253 adult recipients transplanted at UCLA between January 1998 and December 2002. Analysis of the retrospective data was performed using demographic, immunosuppression and liver disease variables. Factors found to be significant on a univariate analysis were further studied in a multivariate analysis...
August 2006: American Journal of Transplantation
Sammy Saab, Carmen Landaverde, Ayman B Ibrahim, Francisco Durazo, Steven Han, Hasan Yersiz, Douglas G Farmer, R Mark Ghobrial, Leonard I Goldstein, Myron J Tong, Ronald W Busuttil
BACKGROUND: The Model for End-Stage Liver Disease (MELD) score is a measure of chronic liver disease severity. Patients awaiting transplantation are assessed using this score. However, it has recently been suggested that changes in MELD score may be as important as the absolute MELD score in predicting short-term survival. However, clinical factors that affect the MELD score are unknown. We sought to identify predictors of mortality for potential transplant patients and examine factors that might predict changes in MELD score...
June 2006: Experimental and Clinical Transplantation
Nir Hoftman, Michelle Braunfeld, Gil Hoftman, Aman Mahajan
STUDY OBJECTIVE: To assess the reliability of peripheral venous pressure (PVP) as a predictor of central venous pressure (CVP) in the setting of rapidly fluctuating hemodynamics during orthotopic liver transplant surgery. DESIGN: Prospective clinical trial. SETTING: UCLA Medical Center, main operating room-liver transplant surgery. PATIENTS: Nine adult patients with liver failure undergoing orthotopic liver transplant surgery...
June 2006: Journal of Clinical Anesthesia
J Odim, A Banerji, S Bahrami, H Laks
Since repeat heart transplantation traditionally carries higher risk than primary engraftment, we tested the hypothesis that third-time cardiac allograft transplantation is associated with prohibitive mortality and morbidity. The cohort of all third-time cardiac retransplants performed at our institution (n=3) and reported to UNOS from 1987 to 2002 (n=10) was reviewed. The primary endpoints were early and late mortality. Extending the study frame through 2003 captures a total of 5 and 15 third-time heart transplant recipients in UCLA and UNOS databases, respectively...
June 2006: Transplantation Proceedings
Andrew M Cameron, R Mark Ghobrial, Hasan Yersiz, Douglas G Farmer, Gerald S Lipshutz, Sherilyn A Gordon, Michael Zimmerman, Johnny Hong, Thomas E Collins, Jeffery Gornbein, Farin Amersi, Michael Weaver, Carlos Cao, Tony Chen, Jonathan R Hiatt, Ronald W Busuttil
OBJECTIVE: Severely limited organ resources mandate maximum utilization of donor allografts for orthotopic liver transplantation (OLT). This work aimed to identify factors that impact survival outcomes for extended criteria donors (ECD) and developed an ECD scoring system to facilitate graft-recipient matching and optimize utilization of ECDs. METHODS: Retrospective analysis of over 1000 primary adult OLTs at UCLA. Extended criteria (EC) considered included donor age (>55 years), donor hospital stay (>5 days), cold ischemia time (>10 hours), and warm ischemia time (>40 minutes)...
June 2006: Annals of Surgery
Aaron Savar, Jonathan R Hiatt, Ronald W Busuttil
Appendicitis has rarely been reported following solid organ transplantation and never following liver transplantation. We reviewed records of all patients who received solid organ transplants at UCLA between 1989 and 2002 and subsequently underwent appendectomy for presumed acute appendicitis. Of nearly 8000 transplant patients, 17 (nine male, eight female) subsequently underwent appendectomy for presumed acute appendicitis. Average age at appendectomy was 37 yrs (range 6-73 yrs). Organ transplants included liver (seven patients), heart (four), kidney (three), kidney-pancreas (two), and heart-kidney (one)...
January 2006: Clinical Transplantation
H Yersiz, A M Cameron, I Carmody, M A Zimmerman, B S Kelly, R M Ghobrial, D G Farmer, R W Busuttil
Seventy-five thousand Americans develop organ failure each year. Fifteen percent of those on the list for transplantation die while waiting. Several possible mechanisms to expand the organ pool are being pursued including the use of extended criteria donors, living donation, and split deceased donor transplants. Cadaveric organ splitting results from improved understanding of the surgical anatomy of the liver derived from Couinaud. Early efforts focused on reduced-liver transplantation (RLT) reported by both Bismuth and Broelsch in the mid-1980s...
March 2006: Transplantation Proceedings
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