Cataldo Doria

Publications (57)134.29 Total impact

• Article: Reply to Role of Echocardiography in detecting portopulmonary hypertension in liver transplant candidates.

  M George Debusk, Yoogoo Kang, Cataldo Doria, Victor J Navarro, Ignazio R Marino, Howard R Doyle
  Liver Transplantation 10/2003; 9(9):1000-2. · 3.39 Impact Factor
• Source

  Available from: John Fung

  Article: Conversion from tacrolimus to cyclosporine--a based immunosuppression following liver transplantation.

  Cataldo Doria, Ashok Kumar B Jain, Victor L Scott, Salvatore Gruttadauria, Ignazio R Marino, Howard R Doyle, John J Fung
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  ABSTRACT: We examined the frequency, reasons and outcome after conversion from Tacrolimus to Cyclosporine A. From August 1989 to December 1992, 1000 consecutive liver transplantation patients were studied, which included 834 adults (age>18 yr.) and 166 children with mean follow-up of 77 months (range 56 to 96). A prospectively populated electronic database was queried to identify patients that underwent conversion, the clinical indication and outcomes. Thirty-seven out of 834 adult recipients (4.43%), mean age of 48.4+/-12.9 years, 19 male (51.35%) and 18 females (48.64%) required conversion from Tacrolimus to Cyclosporine A baseline immunosuppressive therapy. No pediatric patient required conversion. The mean time interval from liver transplantation to Cyclosporine A conversion was 443.45+/-441.44 days (range 22 to 1641). The clinical indications for conversion included: 20 neurological (54%), 6 gastrointestinal (16%), 5 hematological (14%), and 6 other (16%) scenarios. Seven of the 37 patients (18.9%) died. The causes of death were multi-organ failure (2), sepsis (2), pancreatitis (1), hepatic failure due to relapse of ethanol abuse (1), and unknown cause (1). Nine out of 37 patients (24.32%) had to be reconverted to Tacrolimus (mean 282.22+/-499.79 days; range 15 to 1583 day with a median of 135) after institution of Cyclosporine A; none showed recurrence of the original symptoms. The reasons for these re-conversions were acute cellular rejection (44%, n=4), chronic rejection (11%, n=1), increased hepatic enzymes (33%, n=3) and progressively worsening neurological symptoms (11%, n=1). The frequency of conversion from Tacrolimus to Cyclosporine A was 4.43%. Conversion is safe and efficacious if done in a controlled setting. Additionally, re-conversion to Tacrolimus for lack of efficacy of Cyclosporine A did not appear to be associated with a recurrence of the condition that caused the initial switch.
  Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 07/2003; 1(1):48-55. · 0.81 Impact Factor
• Article: Posttransplant lymphoproliferative disorders presenting at sites of previous surgical intervention.

  Cataldo Doria, Ignazio R Marino, Victor L Scott, Ronald Jaffe, Marta I Minervini, Albert Zajko, Michael A Nalesnik
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  ABSTRACT: Early diagnosis of posttransplant lymphoproliferative disorder (PTLD) requires a high level of clinical suspicion. PTLD occurs mainly in the lymphoid tissue, allograft organ, bowel, and central nervous system. The diagnosis may not be considered initially when disease is localized to other sites. Retrospective review of the PTLD series at the University of Pittsburgh Medical Center showed that 4 of 418 patients (1%) presented with signs and symptoms localized to sites of previous surgical intervention (choledochojejunostomy site, ileosigmoid anastomotic site, site of saphenous vein stripping, and intrabiliary site of percutaneous transhepatic catheter). All patients showed symptomatic, Epstein-Barr virus-positive B-cell PTLD of varying histology. Three of four patients ultimately died with tumor, and the fourth died of unrelated causes. PTLD should be included in the differential diagnosis when clinical signs and symptoms localize to anastomotic sites, surgical incision sites, or sites of longstanding catheter placement in immunosuppressed organ transplant recipients.
  Transplantation 05/2003; 75(7):1066-9. · 4.00 Impact Factor
• Article: Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus.

  Cataldo Doria, Lucio Mandalá, Jan Smith, Claudio H Vitale, Augusto Lauro, Salvatore Gruttadauria, Ignazio R Marino, Carlo Scotti Foglieni, Mario Magnone, Victor L Scott
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  ABSTRACT: Intractable pruritus is more common in cholestatic liver diseases and may be the presenting symptom and/or major complaint of hepatitis C and/or hepatitic C virus-related cirrhosis. From September 2000 to May 2002, three patients affected by intractable pruritus secondary to hepatitis C cirrhosis that failed medical treatment were treated with a molecular adsorbent recirculating system (MARS). MARS is an artificial liver support system that aims to clear the blood of metabolic waste products normally metabolized by the liver. Each patient underwent seven MARS sessions. Liver function tests, the 36-Item Short Form quality-of-life test, visual analog scale for itching, and bile acid measurement in the serum, albumin circuit and ultrafiltrate were performed before and after each MARS session. Moreover, at hospital admission, each patient underwent a psychological workup and abdominal imaging study. Subjective improvement in pruritus and quality of life, along with a decrease in serum bile acid concentration, was observed in every patient; no patient underwent retreatment and/or liver transplantation up to a 9-month follow-up. One patient died 201 days after MARS treatment. Although we observed a decreased level of serum bile acids, one cannot conclude that this was the mechanism of action for the reduction in pruritus intensity in patients in our series. Different toxins and/or a placebo effect might have had a role in this setting.
  Liver Transplantation 05/2003; 9(4):437-43. · 3.39 Impact Factor
• Article: Hepatic hydatid cyst causing thrombosis of the inferior vena cava and complicated by hemobilia: a multimodal sequential approach in the treatment.

  Salvatore Gruttadauria, Angelo Luca, Davide Cintorino, Cataldo Doria, Victor L Scott, Ignazio R Marino
  Digestive Diseases and Sciences 03/2003; 48(2):358-64. · 2.12 Impact Factor
• Article: Noncardiogenic pulmonary edema induced by a molecular adsorbent recirculating system: case report.

  Cataldo Doria, Lucio MandalA, Victor L Scott, Ignazio R Marino, Salvatore Gruttadauria, Roberto Miraglia, Claudio H Vitale, Jan Smith
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  ABSTRACT: Noncardiogenic pulmonary edema is a well-recognized manifestation of acute lung injury which has been related, among others, to blood or blood-product transfusion, intravenous contrast injection, air embolism, and drug ingestion. We describe two cases of noncardiogenic pulmonary edema after use of a molecular adsorbent recirculating system, a cell-free dialysis technique. Patients in this series presented at our institution to be evaluated for liver transplantation. Subsequently, they developed an indication for the molecular adsorbent recirculating system. Two patients of 30 (6.6%) treated with the molecular adsorbent recirculating system for acute-on-chronic liver failure and intractable pruritus had normal chest X-rays before treatment and developed severe pulmonary edema, in the absence of cardiogenic causes, following use of the molecular adsorbent recirculating system. For each patient we reviewed the history of blood or blood-product transfusion, echocardiograms if available, daily chest X-rays, and when available pre- and postmolecular adsorbent recirculating systemic blood pressure, central venous pressure, pulmonary arterial pressures, cardiac output, cardiac index, systemic vascular resistance index, and arterial blood gas. Our data suggest that the molecular adsorbent recirculating system may cause noncardiogenic pulmonary edema, possibly by an immune-mediated mechanism.
  Journal of Artificial Organs 02/2003; 6(4):282-5. · 1.59 Impact Factor
• Article: CASE REPORT: Hepatic Hydatid Cyst Causing Thrombosis of the Inferior Vena Cava and Complicated by Hemobilia: A Multimodal Sequential Approach in the Treatment

  Salvatore Gruttadauria, Angelo Luca, Davide Cintorino, Cataldo Doria, Victor L. Scott, Ignazio R. Marino
  Digestive Diseases and Sciences 01/2003; 48(2):358-364. · 2.12 Impact Factor
• Article: Hepatic artery anomalies: anatomy review.

  Salvatore Gruttadauria, Carlo Scotti Foglieni, Angelo Luca, Augusto Lauro, Cataldo Doria, Ignazio R Marino
  Liver Transplantation 11/2002; 8(10):981. · 3.39 Impact Factor
• Article: The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases

  Salvatore Gruttadauria, Carlo Scotti Foglieni, Cataldo Doria, Angelo Luca, Augusto Lauro, Ignazio R Marino
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  ABSTRACT: The purpose of this study is to report the variations in hepatic arterial supply of a mixed population of organ donors in which the anatomy was individually examined during the bench surgery, and patients who underwent a selective angiogram of the celiac axis and superior mesenteric artery. We reviewed the donor forms and/or angiograms of 701 patients. The donor forms were completed personally by one of the authors, while all the radiology images were obtained through studies performed by one single radiologist. The arterial anatomy was anomalous in 296 out of 701 cases with an overall incidence of hepatic artery anomalies of 42.22%. In this paper we describe previously unreported arterial anomalies of the hepatic artery, collecting the second largest series of hepatic artery anatomical variations of the English literature. This anatomical update can be useful for transplant and general surgeons, as well as vascular radiologists.
  Clinical Transplantation 01/2002; 15(5):359 - 363. · 1.67 Impact Factor
• Article: An automated and portable low-flow pulsatile perfusion system for organ preservation

  Marc J. Yland, Satoru Todo, Yue Zhu, Tomomi Suzuki, Nubuo Hamada, Shimin Zhang, Vladimir M. Subbotin, Izumi Takeyoshi, Cataldo Doria, Shigeki Hikida, Akiyoshi Nemoto, Raman Venkataramanan, Prasad Tata, Jose F. Bernardo
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  ABSTRACT: While machine preservation reduces the incidence of delayed graft function in renal transplant recipients, it is only used in 10% of kidney transplantations. The performance of our portable, lowflow-pulsatile organ perfusion system was examined in a canine kidney autotransplantation model. Grafts were stored for 72 h by simple cold preservation in University of Wisconsin (UW) solution, or by high or low-flow machine preservation. After preservation, the grafts were autotransplanted and the animals were followed for 15 days. Graft function was better in machine-preserved kidneys. Tissue biochemistry indicated that machine preservation resulted in higher levels of adenine nucleotides and better histological integrity than the cold storage. While histology and biochemistry of machine-preserved groups were similar, electromicroscopy of high-flow grafts showed mild accumulation of intravenous debris and endothelial swelling. This study shows that a simplified machine perfusion technique is effective for organ preservation.
  Transplant International 10/1996; 9(6):535-540. · 2.92 Impact Factor
• Article: Pregnancy Outcomes in Female Liver Recipients Transplanted under the Age of 21

  Carlo B Ramirez, Warren R Maley, Cataldo Doria, Lisa A Coscia, Michael J Moritz, Vincent T Armenti
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  ABSTRACT: Conclusions: Liver recipients transplanted under the age of 21 are able to maintain pregnancy with 75% resulting in a livebirth. Pregnancy, potential risks for mother and newborn, and long-term maternal survival should be discussed with the recipient and the parents of the recipient. Transplant centers are encouraged to report pregnancy outcomes in these recipients to the NTPR.
  Department of Surgery Faculty Papers & Presentations.
• Article: Pregnancy Outcomes in Female Liver Transplant Recipients with a Transplant-to-Conception Interval >- 5 years

  Carlo B Ramirez, Adam Frank, Warren R Maley, Cataldo Doria, Lisa A Coscia, Vincent T Armenti
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  ABSTRACT: Conclusions: Successful pregnancy outcomes have been reported in female liver recipients with a transplant-to-conception interval greater than or equal to 5 years. Long-term graft survival should be discussed with recipients as a component of preconception counseling. All transplant centers are encouraged to report pregnancies to the NTPR.
  Department of Surgery Faculty Papers & Presentations.
• Article: Role of quality improvement in prevention of inappropriate transfusions.

  Anita Mohandas, Kathleen A Foley, David B Nash, Cataldo Doria
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  ABSTRACT: Many different methods are used to manage surgical bleeding and reduce transfusion. Techniques vary by institution, resulting in inconsistent outcomes. We reviewed the current literature on the quality and costs of transfusions, focusing on prevention and management of transfusions during surgery, and provide recommendations on future directions for quality improvement (QI). Ovid, PubMed, and Scopus. Key words included QI, blood loss, transfusion, hemostasis, and costs. Inclusion criteria were English language, publication between 1999 and 2010, and primary end points of blood loss, transfusion, or hemostasis. A total of 1331 abstracts were reviewed; 43 met the inclusion criteria. A variety of bleeding management (BM) techniques were identified, with multiple studies suggesting that algorithms combining pre-, peri-, and postoperative interventions have the greatest potential to minimize transfusions. Most studies assessing the economic impact of BM interventions excluded resources beyond blood acquisition cost and longer-term complications, which may underestimate transfusion costs and bias estimates of the cost-effectiveness of interventions. Despite consensus on avoiding inappropriate transfusions, little agreement exists on optimal use of interventions. Multifaceted algorithms show promising results. Future QI should focus on reducing practice variation via evidence-based guidelines for effective use of BM interventions.
  Quality management in health care 20(4):298-310.
• Source

  Available from: Terry Hyslop

  Article: Impact of Obesity on Perioperative Morbidity and Mortality Following Pancreaticoduodenectomy

  Timothy K Williams, Ernest L Rosato, Eugune P. Kennedy, Karen A Chojnacki, Jocelyn Andrel, Terry Hyslop, Cataldo Doria, Patricia K Sauter, Jordan Bloom, Charles J Yeo, Adam C Berger
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  ABSTRACT: Background: Obesity has been implicated as a risk factor for perioperative and postoperative complications. The aim of this study was determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD).Study Design: Between January 2000 and July 2007, 262 patients underwent PD at Thomas Jefferson University Hospital (TJUH), of whom 240 had complete data, including body mass index (BMI) for analysis. Data on BMI, preoperative parameters, operative details, and post-operative course were collected. Patients were categorized as obese (BMI >30 kg/m2), overweight (25≤BMI<30), or normal weight (BMI<25). Complications were graded according to previous published scales. Other endpoints included length of postoperative hospital stay, blood loss, and operative duration. Analyses were performed using univariate and multivariable models. Results: There were 103 (42.9%) normal weight, 71 (29.6%) overweight and 66 (27.5%) obese patients. There were 5 perioperative deaths (2.1%) with no differences across BMI categories. A significant difference in median operative duration and blood loss between obese and normal weight patients was identified (439vs. 362.5minutes, p= 0.0004; 650 vs. 500 ml, p=0.0139). Furthermore, median length of stay was marginally significantly longer for by BMI (9.5 vs. 8 days, p=0.095). While there were no significant differences in superficial wound infections, obese patients did have an increased rate of serious complications compared to normal weight patients (24.2% vs. 13.6%, respectively; p=0.10). Conclusions: Obese patients undergoing PD have a significantly increased blood loss and longer operative time, but do not have a significantly increased length of postoperative hospital stay or rate of serious complications. These findings should be considered when assessing patients for operation and when counseling patients regarding operative risk, but do not preclude obese individuals from undergoing definitive pancreatic surgery.
  Department of Surgery Faculty Papers & Presentations.
• Source

  Available from: Diane Bergin

  Article: Paraumbilical collateral veins on MRI as possible protection against portal venous thrombosis in candidates for liver transplantation

  Sachit Verma, Donald G Mitchell, Yulia Lakhman, Diane Bergin, Ronald J. Dolin, Cataldo Doria, Laurence Parker
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  ABSTRACT: Background: We retrospectively evaluate the potential protective influence of patent paraumblical vein (PUV) collaterals against portal vein (PV) thrombosis and reduced PV diameter in candidates for orthotopic liver transplant (OLT) Methods: Dynamic 3D contrast-enhanced MRI at 1.5T was obtained in 309 patients with cirrhosis without evidence of malignancy. All MR studies were reviewed by one reader for PUV collaterals, PV thrombosis and PV diameter. Statistical analysis was performed by Fisher exact tests; 50 selected studies were reviewed independently by two additional readers to determine interobserver agreement via intraclass correlation coefficient (ICC). Results: Patent PUV was noted in 119 of 309 patients (38.5%). Mean PV diameter was 13.4 ± 3.0 mm in patients with PUV compared with 11.3 ± 3.6 mm without PUV (P < 0.01). Main PV thrombosis was present in 13 of 309 patients (4.2%) and significantly more frequent in those without PUV than with PUV (6.3% vs. 0.8%, P < 0.05). ICC indicated almost perfect agreement among three readers for presence of PUV collaterals (ICC = 0.91) and PV thrombosis (ICC = 0.96). Conclusion: Our results suggest that patients with patent PUV appear less likely to develop main PV thrombosis or small PV diameter, suggesting a protective effect of PUV on PV patency.
  Department of Radiology Faculty Papers.
• Article: Acute portal vein thrombosis secondary to donor/recipient portal vein diameter mismatch after orthotopic liver transplantation: a case report.

  Cataldo Doria, Ignazio R Marino
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  ABSTRACT: The incidence of portal vein thrombosis in end-stage liver disease is estimated as varying between 5% and 21%, whereas in candidates undergoing liver transplantation, this is 3-13%. Portal vein thrombosis occurring after liver transplantation can be managed surgically by thrombectomy, retransplantation, splenorenal shunt, or Wall-stent placement, or nonsurgically by angioplasty, local high-dose infusion of thrombolytic agents, combination of portal thrombolysis, or embolization of a pre-existing spontaneous splenorenal shunt. We report a case of portal vein thrombosis after liver transplantation diagnosed on postoperative day 1 in a 57-year-old patient who received a liver from an 8-year-old donor. The patient was successfully treated surgically with portal vein thrombectomy and systemic anticoagulation. Portal vein thrombosis, in this case, was considered to be secondary to size discrepancy between the donor and the recipient portal veins. Routine use of daily Doppler ultrasound was the key factor in early diagnosis.
  International surgery 88(4):184-7. · 0.36 Impact Factor
• Article: Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution -- the first step in multi-disciplinary team building

  Eugene P Kennedy, Ernest L Rosato, Patricia K Sauter, Laura M. Rosenberg, Cataldo Doria, Ignazio R Marino, Karen A Chojnacki, Adam C Berger, Charles Yeo
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  ABSTRACT: Objective: This study was designed to identify quantifiable parameters to track performance improvements brought about by the implementation of a critical pathway for complex alimentary tract surgery. Background: Pancreaticoduodenectomy (PD) is a complex general surgical procedure performed in varying numbers at many academic institutions. Originally associated with significant perioperative morbidity and mortality, multiple studies have now shown that this operation can be performed quite safely at high volume institutions that develop a particular expertise. Critical pathways are one of the key tools used to achieve consistently excellent outcomes as these institutions. It remains to be determined if implementation of a critical pathway at an academic institution with prior moderate experience with PD will result in performance gains and improved outcomes. Methods: Between January 1, 2004 and October 15, 2006 135 patients underwent PD, 44 before the implementation of a critical pathway on October 15, 2005, and 91 after. Perioperative and postoperative parameters were analyzed retrospectively to identify those that could be used to track performance improvement and outcomes. Key aspects of the pathway include spending the night of surgery in the intensive care unit with careful attention to fluid balance, early mobilization on post-operative day one, aggressive early removal of encumbrances such as nasogastric tubes and urinary catheters, early post-operative feeding, and targeting discharge for postoperative day 6 or 7. Results: The pre- and post-pathway implementation groups were not statistically different with regards to age, sex, race, or pathology (malignant versus benign). Perioperative mortality, operative blood loss, and number of transfused units of packed red blood cells were also similar. As compared to the pre-pathway group, the post-pathway group had a significantly shorter postoperative length of stay (13 versus 7 days, P ≤ 0.0001), operative time (435 ± 14 minutes versus 379 ± 12 minutes, P ≤ 0.0001), and in room non-operative time (95 ± 4 minutes versus 76 ± 2 minutes, P ≤ 0.0001). Total hospital charges were significantly reduced from $240,242 ± $32,490 versus $126,566 ± $4883 (P ≤ 0.0001) after pathway implementation. Postoperative complication rates remained constant (44% pre-pathway versus 37% after, P = NS). Readmission rates were not negatively affected by the reduction in length of stay, with a 7% readmission rate prior to implementation and a 7.7% rate after implementation. Conclusion: Implementation of a critical pathway for a complex procedure can be demonstrated to improve short-term outcomes at an academic institution. This improvement can be quantified and tracked and has implications for better utilization of resources (greater OR and hospital bed availability) and overall cost containment. With a very conservative estimate of 75 pancreaticoduodenectomies per year by this group, this translates to a savings of 450 hospital days and over $8,550,000 in hospital charges on an annual basis. As we enter the "pay for performance" era, institutions will be required to generate such data in order to retain patient volumes, attract new patients, and receive "incentive payments" for high quality services rendered.
  Department of Surgery Faculty Papers & Presentations.