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ABSTRACT: OBJECTIVES:: Venovenous extracorporeal membrane oxygenation has been used to provide cardiopulmonary support in critically ill infants and children. Recently, dual-lumen venovenous extracorporeal membrane oxygenation has gained popularity in the pediatric population. Herein, we report our institutional experience using a bicaval dual-lumen catheter for pediatric venovenous extracorporeal membrane oxygenation support, which has been our unified approach for venovenous extracorporeal membrane oxygenation since 2009. DESIGN:: This study is a retrospective review. SETTING:: The setting is a tertiary children's hospital in a major metropolitan area. PATIENTS:: Between 2009 and 2011, 11 patients were cannulated using a dual-lumen bicaval venous catheter. Patient demographics, cannulation details, circuit complications, complications of catheter use, and patient outcomes were collected from a retrospective chart review. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Eleven of the patients were cannulated for venovenous extracorporeal membrane oxygenation using the dual-lumen bicaval cannula. The median age at the time of venovenous cannulation was 1.9 years (range, 0.14-17.1), and the median weight was 10.2 kg (range, 3-84). Three patients (27%) required conversion to venoarterial extracorporeal membrane oxygenation. The median duration of extracorporeal membrane oxygenation support was 10 days (2-38 days). Fifty-five percent of patients suffered from a bleeding complication (disseminated intravascular coagulation, pulmonary hemorrhage, or intraventricular hemorrhage), and 45% had a circuit complication. Adequate flow rates were achieved in all patients. The overall hospital mortality in the series was 55%. There were no cannula-related complications. CONCLUSIONS:: This review presents the first single-institution experience with the dual-lumen Avalon cannula in pediatric patients. Preliminary results indicate that the catheter can be safely placed and has an acceptable complication profile; however, continued study within larger trials is necessary to fully ascertain the clinical profile of this catheter.
Pediatric Critical Care Medicine 04/2013; · 3.13 Impact Factor
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ABSTRACT: PURPOSE: To identify prenatal diagnostic features that will help select fetuses with lung masses (LM) who may benefit from ex-utero intrapartum treatment (EXIT procedure) as the preferred mode of delivery. METHODS: The CCAM-volume ratio (CVR), fetal treatment, and outcomes of all fetuses with LM evaluated between 2001 and 2011 were reviewed retrospectively. Fetuses with hydrops or CVR>1.6 were classified as high risk. Indications for fetal interventions included hydrops and heart failure, and indication for EXIT-to-resection was the finding of persistent mediastinal compression (PMC) near birth. RESULTS: Of 110 fetuses evaluated for LM, 78 were classified as low-risk. No fetus in this group had PMC near birth and none required perinatal treatment. Of 32 high-risk fetuses, 8 developed heart failure of which 4 survived (3 following fetal surgery). Nine high-risk fetuses with no PMC near birth were asymptomatic postnatally and treated electively. Sixteen high-risk fetuses had PMC near birth. All 9 babies with PMC treated with EXIT-to-resection did well with discharge at a median of 10days post-operatively. All 7 fetuses treated without an EXIT developed respiratory distress following birth requiring an urgent operation; 2 died. CONCLUSION: The EXIT-to-resection procedure is a favorable delivery approach for those fetuses with large LM and PMC near birth.
Journal of Pediatric Surgery 01/2013; 48(1):138-144. · 1.45 Impact Factor
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ABSTRACT: Despite improvements in the management of persistent pulmonary hypertension of the newborn (PPHN), a number of infants with inadequate gas exchange are treated with extracorporeal membrane oxygenation (ECMO). The objectives of this study were to use the Extracorporeal Life Support Organization Registry to review the outcomes of neonates with PPHN receiving ECMO, and to identify pre-ECMO variables that may be associated with increased mortality.
The study is a retrospective analysis of all patients with PPHN supported with ECMO and reported to the Extracorporeal Life Support Organization registry from 2000 to 2010. Prematurity was defined as <37 wk gestation. Univariate analysis was performed using Student's t-test or Fisher's exact test. Variables found to be statistically significant underwent multivariate analysis by logistic regression. Kaplan-Meier survival curves were generated to analyze the relationship between duration of ECMO support and patient survival.
A total of 1569 neonates with PPHN received ECMO support during the study period, at an average age of 3.1 d of life and for a duration of 6.9 d. Survival among neonates with PPHN receiving ECMO support was 81%, and those receiving support for 7, 10, 14, and 21 d survived at rates of 88%, 78%, 55%, and 25%, respectively. By logistic regression, prematurity (P < 0.01), pre-ECMO pH ≤7.2 (P = 0.02), pre-ECMO SaO(2) ≤65% (P = 0.01), and duration of ECMO ≥7 d (P < 0.001) were independent predictors of death in this group. An average of 2.2 complications occurred per patient, with cardiovascular, mechanical, and renal complications being the most common.
Neonates with PPHN have high survival rates with ECMO support. Prematurity, acidosis, and profound hypoxemia are independently associated with increased mortality. Furthermore, prolonged ECMO support (>7 d) is associated with a higher risk of mortality in this cohort than in patients supported for <1 wk.
Journal of Surgical Research 08/2012; 177(2):263-7. · 2.25 Impact Factor
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ABSTRACT: Indications and timing for splenectomy in pediatric chronic immune thrombocytopenic purpura (cITP) are controversial because of high spontaneous remission rates and concern for overwhelming postsplenectomy infection. The objective of this study was to assess the risks, costs, and benefits of medical and surgical intervention for children with cITP.
After receiving institutional review board approval, medical records for all children with cITP who underwent splenectomy from 2002 through 2009 were retrospectively reviewed (n = 22). Preoperative and postoperative data were collected. Medical and surgical costs were calculated based on pharmacy charges per dose and hospital charges, respectively.
The median age at diagnosis was 11 years (range, 3-16 years). Medical management included steroids (n = 21), intravenous gamma globulin (n = 19), anti-D antibody (n = 19), or a combination of these therapies (n = 22). Nineteen patients (86%) reported side effects from medical therapy. Median age at splenectomy was 13 years (range, 6-18 years), and time to surgery was 23 months from diagnosis (range, 6-104 months). Splenectomy increased platelet counts in all children from a median of 25,500 to 380,000 postoperatively (P < .0001). One child experienced overwhelming postsplenectomy infection after a dog bite (n = 1). At the last follow-up (15 months; range, 1-79 months), 19 patients (86%) were asymptomatic with platelet counts greater than 50,000. Of the 3 children with persistent thrombocytopenia, 2 were diagnosed with secondary cITP. Median cost of splenectomy was significantly less than the cost of medical therapy ($20,803 vs $146,284; P < .0002).
Earlier surgical consultation for children with cITP may be justified given the high success rate and low morbidity, particularly given the significant complication rate and cost of continued medical treatment.
Journal of Pediatric Surgery 08/2012; 47(8):1537-41. · 1.45 Impact Factor
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ABSTRACT: The aim of the study was to evaluate the relationship between the degree of liver herniation and mortality or need for extracorporeal membrane oxygenation (ECMO) in isolated left-sided congenital diaphragmatic hernia (CDH).
This is a retrospective review of all fetuses with isolated left-sided Bochdalek-type CDH evaluated at our center with ultrafast fetal magnetic resonance imaging between January 2004 and December 2010. Percentage of liver herniation was defined as the ratio of herniated liver volume to total fetal liver volume. The liver/thoracic volume ratio was defined as the ratio of herniated liver volume to total thoracic volume. Data were analyzed using receiver operating characteristic curves and Fisher's Exact and Mann-Whitney U tests.
Fifty-three fetuses with isolated left-sided CDH were evaluated. Fetuses with "liver-up" (n = 32) and "liver-down" (n = 21) anatomy had similar rates of mortality (25% vs 14%, P = .49) and ECMO use (41% vs 29%, P = .40). The accuracy of liver-up (a dichotomous variable) to predict mortality or need for ECMO was 49% and 53%, respectively. Percentage of liver herniation greater than 21% was associated with mortality (P < .001) or need of ECMO (P < .001), with an accuracy of 87% and 79%, respectively. Liver/thoracic volume ratio of greater than 14% was also associated with mortality or ECMO use (P < .001 and P = .01, respectively), with an accuracy of 85% and 72%, respectively.
Increased amounts of liver herniation in fetuses with isolated left-sided CDH are associated with higher rates of mortality or the need for ECMO support. Quantification of liver herniation (a continuous variable) is superior to overall liver herniation as a dichotomous variable (liver-up vs liver-down) in the prediction of perinatal morbidity and mortality.
Journal of Pediatric Surgery 06/2012; 47(6):1058-62. · 1.45 Impact Factor
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ABSTRACT: With the advent of advanced imaging technologies, the field of prenatal diagnosis and counseling has grown rapidly. The use of fetal ultrasound and ultrafast magnetic resonance imaging has allowed for prenatal identification of structural anomalies as well as neoplasm. The differential diagnosis of a fetal mass is dependent upon its location and the tissue characteristics of the mass on imaging. The use of amniocentesis for chromosomal analysis and genetic testing for known tumor-related genetic abnormalities may aid in further refining the diagnosis. Herein we describe a general diagnostic algorithm for fetal masses based upon their location within the body and how the appropriate diagnostic modalities may be applied in the clinical setting.
Seminars in Fetal and Neonatal Medicine 03/2012; 17(4):185-91. · 3.91 Impact Factor
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ABSTRACT: Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been used as a management strategy for neonates with refractory pulmonary failure. However, VV-ECMO has been limited in neonates secondary to cannula design and patient size. Herein, we describe the use of a bicaval dual-lumen catheter for VV-ECMO in neonates.
The medical records of all neonates cannulated for ECMO support with a bicaval dual-lumen 13F catheter from 2008 to 2010 were reviewed.
Nine neonates cannulated with this dual-lumen catheter were identified. The median gestational age was 38 weeks (range, 31-40 weeks), the median weight was 3.4 kg (range, 2.2-5.5 kg), the median age at cannulation was 2 days (range, 1-64 days), and the median duration of ECMO support was 7 days (range, 5-23 days). There were no VV-to-VA conversions. The median pump flow both at 4 and 24 hours postcannulation was 300 mL/min (range, 240-370 mL/min). One patient developed cannula thrombosis, and one required cannula repositioning because of flow recirculation. Overall survival was 56%.
The dual-lumen bicaval catheter can be safely used in neonates with minimal complications and is our preferred method for VV-ECMO support in the neonatal population.
Journal of Pediatric Surgery 02/2012; 47(2):430-4. · 1.45 Impact Factor
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ABSTRACT: The aim of this study was to identify the most accurate prenatal predictors of outcomes and need for fetal surgery for fetuses with high-risk lung masses and vascular tumors.
The records of all fetuses with high-risk lung mass (congenital cystic adenomatoid malformation-volume ratio > 1.6 or findings of hydrops) and vascular tumor evaluated between July 2001 and March 2011 were reviewed retrospectively. Hydrops was defined as accumulation of fluid in 2 or more compartments.
Of fetuses with high-risk lung mass, hydrops was identified in 46% (11/24). Fetuses with hydrops and an abnormal echocardiogram (n = 8) demonstrated poor survival without fetal surgery (13%) compared with 100% survival in fetuses with hydrops and a normal echocardiogram (n = 3; P = .02). Of 21 fetuses with vascular tumor (11 sacrococcygeal and 8 cervical teratomas; 2 hemangioendotheliomas), hydrops was identified in 29% and an abnormal echocardiogram in 57%. All fetuses with hydrops had an abnormal echocardiogram and either died (n = 5) or required fetal surgery (n = 1). However, all fetuses with abnormal echocardiograms alone (n = 7) survived without fetal intervention.
For fetuses with lung mass, an abnormal echocardiogram in the setting of hydrops is the best predictor of mortality and need for fetal surgery. For fetuses with vascular tumor, hydrops in the setting of high-output physiology best predicts demise and need for fetal surgery.
Journal of Pediatric Surgery 01/2012; 47(1):40-5. · 1.45 Impact Factor
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ABSTRACT: There are no established selection guidelines to determine which fetuses with giant neck masses may benefit from delivery using an ex utero intrapartum treatment procedure. The purposes of this study were to describe the tracheoesophageal displacement index (TEDI), a novel measurement of fetal airway displacement, and to correlate this measurement and other prenatal findings to the extent of airway obstruction at birth.
The medical records of all fetuses with giant neck masses evaluated between 2001 and 2011 were reviewed. At birth, each infant's airway was categorized as uncomplicated or complicated. Prenatal variables were correlated with airway difficulty.
There were 24 fetuses with large neck masses (11 lymphatic malformations, 10 teratomas, 3 others). One fetus died in utero, and 3 underwent pregnancy termination. Variables associated with a complicated airway at birth included polyhydramnios, teratoma diagnosis, and tracheoesophageal displacement index. Tracheoesophageal displacement index greater than 12 correlated strongly with a complicated airway (area under the curve = 0.80). All fetuses classified with an uncomplicated airway (n = 7) had a diagnosis other than teratoma and normal amniotic fluid volume.
In fetuses with giant neck masses, the presence of polyhydramnios, teratoma diagnosis, or tracheoesophageal displacement index greater than 12 are predictive of a complicated airway at birth. Our data suggest that fetuses without any of these findings may be delivered safely without an ex utero intrapartum treatment approach.
Journal of Pediatric Surgery 01/2012; 47(1):46-50. · 1.45 Impact Factor
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ABSTRACT: The use of transinguinal laparoscopy for contralateral groin exploration during unilateral inguinal hernia repair has gained popularity. Controversy exists, however, regarding its use in older children. We report a large, single-surgeon series describing the safety and effectiveness of this procedure.
A retrospective review was completed of all cases of open inguinal hernia repair from 1997 to 2009 performed by the senior author. Patients were explored laparoscopically through the ipsilateral hernia sac to assess the contralateral groin. Exclusion criteria were an inadequate sac or preoperatively diagnosed bilateral inguinal hernia.
A total of 649 children underwent open inguinal hernia repair. A preoperative diagnosis of bilateral hernia was made in 18% (n = 117), and of the 532 unilateral cases, an inadequate sac was present in 15% (n = 79). Transinguinal laparoscopic exploration was performed on the remaining 453 children. A hernia or contralateral patent processus vaginalis (CPPV) was found in 38% of children (n = 173). In children older than 8 years, 32% demonstrated a hernia or CPPV on laparoscopic exploration. No complications occurred because of laparoscopy.
Transinguinal laparoscopic exploration is safe and effective and should be routinely performed in pediatric patients of all ages because of the high prevalence of contralateral hernia and CPPV.
Journal of Pediatric Surgery 12/2011; 46(12):2349-52. · 1.45 Impact Factor
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ABSTRACT: Neonates with an irreversible pulmonary dysplasia such as alveolar capillary dysplasia, surfactant protein deficiency, and pulmonary lymphangiectasis may have a deteriorating clinical course requiring cardiopulmonary support with extracorporeal membrane oxygenation. These neonates are often difficult to distinguish from those with persistent pulmonary hypertension of the newborn. The objective of this study was to identify clinical variables that distinguish infants with irreversible pulmonary dysplasia from those with persistent pulmonary hypertension of the newborn before, and while receiving, extracorporeal membrane oxygenation support.
A retrospective analysis of the Extracorporeal Life Support Registry from 2000 to 2010 was performed.
A total of 114 extracorporeal membrane oxygenation centers providing data to the Extracorporeal Life Support Registry.
All neonates day of life 0-31 reported to the Extracorporeal Life Support Registry with irreversible pulmonary dysplasia and persistent pulmonary hypertension of the newborn were identified.
None.
Patient demographics, pre-extracorporeal membrane oxygenation variables, and survival were analyzed. Univariate analysis was performed using Student's t test or Fisher's exact test, and variables found to be significant underwent multivariate analysis by logistic regression. Neonates with irreversible pulmonary dysplasia were placed on extracorporeal membrane oxygenation later (day of life 5.3 vs. 3.0, p = .045) and for a longer duration (11.1 vs. 6.8 days, p < .001) than those with persistent pulmonary hypertension of the newborn. Initiation of extracorporeal membrane oxygenation at day of life ≥5 (p = .026) and a duration of extracorporeal membrane oxygenation ≥10 days (p = .003) were independent predictors of irreversible pulmonary dysplasia by multivariate analysis. No differences in demographics, blood gas values, or vascular access were observed. Survival to discharge was significantly lower for neonates with irreversible pulmonary dysplasia (3%) vs. persistent pulmonary hypertension of the newborn (81%, p < .001).
Although neonates with irreversible pulmonary dysplasia and persistent pulmonary hypertension of the newborn have similar presentations, those with irreversible pulmonary dysplasia require extracorporeal membrane oxygenation support later in the perinatal period and for a longer duration. For neonates with a diagnosis of persistent pulmonary hypertension of the newborn, irreversible pulmonary dysplasia should be considered when extracorporeal membrane oxygenation is initiated on day of life ≥5 and/or the duration of extracorporeal membrane oxygenation ≥10 days.
Pediatric Critical Care Medicine 06/2011; 13(2):188-90. · 3.13 Impact Factor
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ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) has become a prevalent health issue for soft-tissue infections. In severe soft-tissue infections such as necrotizing fasciitis, MRSA has been identified as an increasingly common pathogen. Herein, we report a 5-year experience of MRSA necrotizing fasciitis at a large urban hospital.
All cases of necrotizing fasciitis between 2001 and 2006 were reviewed. All patients were taken for surgical debridement. MRSA patients were identified and compared with the non-MRSA patients to identify any clinical variables that impacted incidence or severity of disease. A P value of less than .05 was considered significant.
During the 5-year period, there were 74 cases of necrotizing fasciitis with a 39% prevalence of MRSA as the causative organism for the infection. The mean age of patients with MRSA fasciitis was 43 +/- 3 years. There were no discernible social variables (eg, smoking, ethanol use, intravenous drug use) that predisposed patients to MRSA infection. The overall mortality rate was 15%, with no significant difference between groups. One hundred percent of MRSA specimens were susceptible to vancomycin or rifampin, 93% were susceptible to sulfamethoxazole/trimethoprim, and only 62% were susceptible to clindamycin.
The incidence of MRSA fasciitis may be much higher than initially suspected and prompt MRSA-directed antibiotic therapy should be administered. Clinicians should maintain a high index of suspicion for this organism in necrotizing fasciitis.
American journal of surgery 01/2008; 194(6):809-12; discussion 812-3. · 2.36 Impact Factor
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ABSTRACT: Hepatic hemangioendothelioma (HHE) is a rare vascular tumor in neonates and may cause high-output cardiac failure and coagulopathy, and rarely has been associated with hypothyroidism. Hepatic hemangioendothelioma treatment options consist of corticosteroids, alpha-interferon, surgical resection, and liver transplantation. Herein, we report the case of a 6-week-old female neonate that presented with an HHE that involved all segments of the liver, resulting in respiratory failure and severe hypothyroidism that was recalcitrant to exogenous L-thyroxine therapy. After failure of medical and supportive therapy for the HHE, the patient underwent a cadaveric orthotopic liver transplantation that resulted in successful treatment of the severe hypothyroidism, respiratory failure, and cardiac symptoms. The patient is currently 1-year posttransplantation and disease free with normal thyroid function.
Journal of Pediatric Surgery 11/2006; 41(10):1783-5. · 1.45 Impact Factor
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ABSTRACT: Diabetes mellitus is a leading cause of morbidity and mortality in the Western world. Currently, the only forms of beta-cell replacement are whole organ pancreas transplantation and pancreatic islet transplantation. Whole organ transplantation has demonstrated benefits in prevention and reversal of diabetic complications with sustainable long-term outcomes. Pancreatic islet transplantation continues to be a field that needs further study to ascertain the true benefit of islet transplantation for diabetic complications. This can only be achieved with improvement in long-term islet allograft survival.
Current Diabetes Reports 09/2006; 6(4):323-7. · 2.50 Impact Factor
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ABSTRACT: Hepatitis C virus (HCV) infections are known to have a more benign course in children than in adults. Although the natural history of HCV recurrence after liver transplantation has been well studied in adult patients, much less is known about HCV recurrence after liver transplantation in pediatric patients. Herein, we report a case of a pediatric patient with HCV presumably acquired through vertical transmission. She underwent liver transplantation at 14 yr of age. The first three yr after liver transplantation were uneventful. However, in the past 12 months she has been hospitalized twice after developing ascites, hematemesis and esophagogastroduodenoscopy (EGD)-documented esophageal varices. Post-transplant biopsy has demonstrated chronic inflammation complicated with active hepatitis C and stage 2-3 scarring. This case report demonstrates the need for further epidemiologic studies to study the natural history of the rate of HCV recurrence after liver transplantation in the pediatric population.
Pediatric Transplantation 09/2006; 10(5):617-22. · 1.48 Impact Factor
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ABSTRACT: Although rare in the pediatric population, the natural history of hepatitis C virus (HCV) recurrence in pediatric patients undergoing orthotopic liver transplantation (OLT) for end-stage liver disease secondary to HCV has not been well described. We performed an analysis of all 67 pediatric patients (< 17 years old) who have undergone OLT for HCV in the United States between 1/1988 and 6/2005. The 67 pediatric patients received a total of 83 OLTs for HCV. Following initial OLTs performed for HCV, the patient and allograft survival rates were 71.6% and 55.0%, respectively, at 5 years. Following retransplantation these rates decreased to 55.0% and 33.8%, respectively, following retransplantation. Recipients were listed for retransplantation after 31.3% of all OLTs, and overall recipients were retransplanted after 19.3% of OLTs. The overwhelming majority of retransplants were performed for HCV recurrence. A mean of 1.2 OLTs were performed per patient for HCV. The median time between OLTs for HCV was 290 days. In conclusion, the risk of HCV recurrence in pediatric OLT recipients is high and is associated with a high rate of retransplantation. Still, OLT represents the only treatment option that may achieve long-term survival in pediatric patients with end-stage liver disease secondary to HCV that is recalcitrant to medical management.
Liver Transplantation 08/2006; 12(7):1119-23. · 3.39 Impact Factor
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ABSTRACT: The pediatric end-stage liver disease (PELD) model accurately estimates 90-day waitlist mortality for pediatric liver transplant candidates, but it has been unclear if PELD can identify patients who will derive survival benefit from undergoing liver transplantation (LT), if it correlates with posttransplant survival, or if it can identify patients for whom LT would be futile. Pediatric patients who underwent LT between 2001 and 2004 were enrolled through the United Network for Organ Sharing Organ Procurement and Transplant Network database. Survival benefit was measured in terms of life-years gained during the first year after LT. Complete data were available for 1,247 patients: 53% were listed as Status 1 at the time of orthotopic liver transplantation (OLT), while the remaining 47% had PELD scores. Only in patients with a PELD of 17+ or those designated as United Network for Organ Sharing Status 1 derived a survival benefit within 1 year of LT; patients with a PELD score of < or = 16 did not. In addition, a statistically significant association was seen between 1-year post-OLT survival and PELD at LT (P = 0.03). No "threshold" PELD score, beyond which risk of post-LT mortality increased dramatically, was apparent. In conclusion, pediatric patients with a PELD score of 17+ derive survival benefit early after LT, and increasing PELD scores are associated with increasing transplant benefit after liver transplantation. PELD does correlate with posttransplant survival but should not be used as a marker for futility.
Liver Transplantation 04/2006; 12(3):475-80. · 3.39 Impact Factor
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ABSTRACT: Orthotopic liver transplantation (OLT) is an effective treatment for fulminant hepatic failure (FHF), but postOLT mortality is higher for patients with FHF than for patients with other indications for OLT. In the current study, a large cohort of patients who underwent OLT for FHF was evaluated to develop and validate a system useful for estimating postOLT patient survival.
The 1,457 patients who underwent OLT for FHF in the United States between 1988 and 2003 were enrolled through the UNOS database. This group was divided into a modeling group (n=972) and a crossvalidation group (n=486). With a multivariate regression analysis, the modeling group was used to identify clinical parameters that had a significant association with postOLT survival. This regression analysis was used to create a scoring system that was subsequently assessed in the crossvalidation group.
Four risk factors were identified with the multivariate analysis: 1) body mass index > or = 30 kg/m2; 2) serum creatinine > 2.0 mg/dL; 3) recipient age > 50 years old; and 4) history of life support. By assigning points based on the number of risk factors present, the scoring system was able to differentiate between low-risk patients (5-year survival, 81%) and high-risk patients (5-year survival, 42%). The relative risk of postOLT mortality increased by approximately 150% for each additional point.
The scoring system risk-stratified the crossvalidation group and accurately predicted postOLT survival. A scoring system utilizing clinical and demographic information readily available prior to OLT may help predict the probability of survival after OLT for FHF.
Transplantation 01/2006; 81(2):195-201. · 4.00 Impact Factor
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Neal R Barshes,
Daniel J DiBardino,
E Dean McKenzie, Timothy C Lee,
Stephen A Stayer,
George B Mallory,
Saul J Karpen,
Ruben E Quiros-Tejeira,
Beth A Carter,
Charles D Fraser,
John A Goss
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ABSTRACT: Combined transplantation of the lungs and liver is indicated for patients who would not be expected to survive transplantation of either organ alone. No single center has accumulated a significant experience, and as a result the expectations for this operation in the current era are unknown.
Patients that have undergone combined lung-liver transplantation in the United States were enrolled through the United Network for Organ Sharing Organ Procurement and Transplantation Network database. In addition, the English-language literature was searched for additional cases of combined lung-liver transplantation.
Eleven patients have undergone combined lung and liver transplantation in the United States at different centers. The 1- and 5-year patient survival rates are of 79% and 63%, respectively, and no patient has required retransplantation. These patient survival rates are equivalent to similar a combined lung-liver case series from the United Kingdom (P=0.37, log-rank test) and isolated orthotopic liver transplantation in the United States (P=0.59, log-rank test), and are comparable to patient survival rates following isolated lung transplantation in the United States.
Patient survival of combined lung-liver transplantation is comparable to that of isolated liver and isolated bilateral lung transplantation. This option should be considered for patients with end-stage lung disease and liver disease when transplantation of a single organ transplantation is precluded by severe disease in the other organ system.
Transplantation 12/2005; 80(9):1161-7. · 4.00 Impact Factor
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ABSTRACT: Boerhaave syndrome is a condition described as spontaneous rupture of the esophagus that often results in mediastinitis, sepsis, and death. The authors report a case of Boerhaave syndrome in a child with acute lymphoblastic leukemia. At the time of diagnosis (10 days after rupture), the patient had an absolute neutrophil count of 0 and was treated with T-tube drainage of the perforation. The T-tube was removed 2 months after the operation. The patient has required three endoscopic esophageal dilatations of a mild esophageal stricture. He remains in remission from his leukemia, has normal growth and development, and is on a regular diet.
Journal of Pediatric Hematology/Oncology 12/2005; 27(11):616-7. · 1.16 Impact Factor
