Patrick S Kamath

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (217)1954.1 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: As MELD scores at the time of liver transplant increase nationwide, patients are at increased risk for delisting by becoming too sick or dying while awaiting transplantation. We quantified the risk, and defined the predictors of delisting or death in cirrhotic patients hospitalized with an infection. NACSELD (North American Consortium for the Study of End-Stage Liver Disease) is a 15-center consortium of tertiary-care Hepatology centers that prospectively enroll and collect data on infected cirrhotic patients. Of the 413 patients evaluated, 136 were listed for liver transplantation. Listed patients' median age was 55, 58% were male, 47% were HCV infected, with a mean MELD score of 23. At 6-month follow-up, 42% (57/136) of patients were delisted/died, 35% (47/136) were transplanted, and 23% (32/136) remained listed for transplant. The frequency and type of infection were similar among all 3 groups. MELD scores were highest in those who were delisted/died, and lowest in those remaining listed (25, 24, 17, respectively, p< 0.001). Those who were delisted or died had the highest proportion of 3 or 4 organ failures at hospitalization versus those transplanted or those continuing to await liver transplant (38%, 11%, & 3% respectively; p=0.003). Organ failures were dominated by respiratory (40%, 15%, & 3% respectively; p< 0.001) and circulatory failure (39%, 13%, and 3% respectively; p < 0.001). Liver transplant listed patients with end-stage liver disease and infection have a 42% risk of de-listing/death within a 6-month period following an admission. The number of organ failures was highly predictive of the risk for de-listing/death. Strategies focusing on prevention of infections and extra-hepatic organ failure in listed cirrhotic patients are required. This article is protected by copyright. All rights reserved. © 2015 American Association for the Study of Liver Diseases.
    Liver Transplantation 04/2015; DOI:10.1002/lt.24139 · 3.79 Impact Factor
  • Hepatology 04/2015; DOI:10.1002/hep.27852 · 11.19 Impact Factor
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    ABSTRACT: Identifying barriers to access to hepatitis C virus (HCV) treatment among screen detected subjects is critical for any public health strategy aimed at controlling HCV infection in the general population. Data from the National Health and Nutrition Examination Survey HCV Follow-up study from 2001 to 2010 were used. Participants who tested positive for HCV were sent a letter informing them of their test results and advised to pursue further evaluation. Information on HCV transmission and its potential complications was also provided to all positive participants. These subjects were recontacted 6 months after notification to determine what action they had taken regarding the positive result. Of 38,025 participants, 502 tested positive for HCV infection, giving a prevalence of 1.3% (95% confidence interval (CI) 0.8%, 1.8%). A total of 205 subjects participated in the 6-month follow-up interview. Those who could not be reached were more likely to be less educated, injecting drugs, and not to have health insurance. Half (50.2%) of the positive individuals were not aware of their status before notification. A total of 166 (81%) had pursued further evaluation. Only 18 (26.9%) received therapy. The main reason for not receiving treatment was high cost (19.4%). In adjusted analysis, the only barrier to pursuing downstream HCV care was the lack of health insurance (2.76, 95% CI 1.54, 7.69; P=0.007). This study suggests that the lack of health insurance may attenuate the theoretical benefits of a screening program that identifies asymptomatic HCV-infected individuals who are less likely to pursue downstream care.Am J Gastroenterol advance online publication, 10 March 2015; doi:10.1038/ajg.2015.31.
  • Hepatology 03/2015; DOI:10.1002/hep.27789 · 11.19 Impact Factor
  • Sakkarin Chirapongsathorn, Patrick S Kamath
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    ABSTRACT: To assess safety and outcomes (metabolic and liver) of bariatric surgery in patients with cirrhosis with or without portal hypertension. This study is a retrospective review of 14 patients with Child's A cirrhosis with or without portal hypertension who were prospectively enrolled from February 23, 2009, through November 9, 2011, with 6- to 24-month follow-up after bariatric surgery (11 patients underwent sleeve gastrectomy [78.6%] and 3 gastric bypass [21.4%]). Four patients had portal hypertension detected by esophagogastroduodenoscopy. The mean patient age was 55.5 years, and 10 of 14 patients were women. The mean weight decreased from 125±18 to 94±17 at 1 year (P<.001) and 93±17 kg at 2 years (P<.001) postsurgery. The prevalence of diabetes decreased from 10 of 14 patients to 4 of 12 (P=.01) and 1 of 6 (P=.02) at 1 and 2 years postsurgery. The frequency of dyslipidemia and hypertension decreased but was not statistically significant; however, the number of medications required to control them decreased. Hepatic steatosis was detected by perioperative liver biopsy in 13 of 14 patients (5%-30% steatosis in 6 patients, 31%-60% in 6, and >60% in 1). At 1 year postsurgery, only 1 of 8 patients who underwent follow-up ultrasound imaging showed evidence of steatosis. The bilirubin level was above 2 mg/dL in 1 patient at 1 year postsurgery. One patient had encephalopathy at 2 years postsurgery. None of the patients developed peri- or postoperative bleeding or surgical complications. Bariatric surgery in patients with compensated cirrhosis even with mild portal hypertension is well tolerated and safe with minimal risk of postoperative complications if performed in a large referral center. This population can experience the beneficial effects of weight loss and improved metabolic syndrome, as well as reduced hepatic steatosis. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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    ABSTRACT: Background: Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available as in the United States, midodrine and octreotide with albumin is used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial.Methods: Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group); 22 to receive midodrine and octreotide plus albumin (MID/OCT group). TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily with dose increased to a maximum of 12.5 mg tid, together with octreotide subcutaneously: initial dose 100 µg thrice daily, and up to 200 µg thrice daily. Both groups received albumin intravenously 1g/kg of body weight on day 1, and 20–40 g/day thereafter.Results: There was a significantly higher rate of recovery of renal function in TERLI group (19/27, 70.4%) as compared to the MID/OCT group (6/21, 28.6%), P =0.01. Improvement in renal function and lower baseline model for end-stage liver disease (MELD) score were associated with better survival.Conclusion: Terlipressin plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with HRS. This article is protected by copyright. All rights reserved.
    Hepatology 01/2015; DOI:10.1002/hep.27709 · 11.19 Impact Factor
  • Journal of Hepatology 12/2014; 62(3). DOI:10.1016/j.jhep.2014.10.047 · 10.40 Impact Factor
  • Sumit Kumar, Sumeet K. Asrani, Patrick S. Kamath
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    ABSTRACT: Acute variceal bleeding (AVB) is a potentially life-threatening complication of cirrhosis and portal hypertension. Combination therapy with vasoactive drugs and endoscopic variceal ligation is the first-line treatment in the management of AVB after adequate hemodynamic resuscitation. Short-term antibiotic prophylaxis, early resuscitation, early use of lactulose for prevention of hepatic encephalopathy, targeting of conservative goals for blood transfusion, and application of early transjugular intrahepatic portosystemic shunts in patients with AVB have further improved the prognosis of AVB. This article discusses the epidemiology, diagnosis, and nonendoscopic management of AVB. Copyright © 2014 Elsevier Inc. All rights reserved.
    Gastroenterology Clinics of North America 12/2014; DOI:10.1016/j.gtc.2014.08.007 · 1.92 Impact Factor
  • Sakkarin Chirapongsathorn, Patrick S. Kamath
    AASLD 2014, Boston; 11/2014
  • Source
    S. K. Asrani, P. S. Kamath
    Alimentary Pharmacology & Therapeutics 10/2014; 40(8). DOI:10.1111/apt.12915 · 4.55 Impact Factor
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    ABSTRACT: A subset of patients with non-variceal gastrointestinal bleeding fail, or are unsuitable candidates for, endoscopic, radiologic, and surgical interventions. Endoscopic ultrasound (EUS)-guided intervention might be effective in these patients. We performed EUS-guided hemostatic interventions for 17 patients with non-variceal gastrointestinal bleeding from June 2003 through May 2014 who failed, or were unsuitable candidates for, additional therapies. Indications for treatment included gastrointestinal stromal tumors, colorectal vascular malformations, duodenal masses or polyps, Dieulafoy lesions, duodenal ulcers, rectally invasive prostate cancer, pancreatic pseudoaneurysms, ulcerated esophageal cancer, and ulceration following Roux-en-Y gastric bypass. Following the procedure, 88% of patients have had no further bleeding related to the treated lesion, over a median follow-up period of 12 months. EUS-guided hemostatic therapy is therefore feasible and useful for select patients with clinically severe, refractory, or recurrent non-variceal gastrointestinal bleeding.
    Clinical Gastroenterology and Hepatology 09/2014; DOI:10.1016/j.cgh.2014.09.030 · 6.53 Impact Factor
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    ABSTRACT: Analysis of the National Health and Nutrition Evaluation Survey (NHANES) 1988-1994 dataset found a relatively high seroprevalence (21%) of hepatitis E virus (HEV) infection in the US general population. Using data obtained within the NHANES 2009-2010 survey where a high performance assay for HEV was utilized, we have estimated the weighted sero-prevalence of HEV infection among US individuals 6 years and older. We also evaluated factors associated with HEV sero-positivity. A total of 8,814 individuals were included in the analysis. The median age of study participants was 37 years (IQR 17-58 years), with 51.2% being female. The weighted national seroprevalence of HEV was 6% (95% CI 5.1%-6.9%). About 0.5% of those with HEV had evidence of recent exposure (IgM positive). In the univariate analyses, factors associated with HEV seropositivity were increasing age (P-trend <0.001), birth outside of the US, Hispanic race, and “meat” consumption (>10times/month). No significant association was observed with low socio-economic status, water source or level of education. In the multivariate analysis, only older age remained predictive of HEV seropositivity. Conclusions: The weighted national seroprevalence of HEV in the US is much less than previously reported. Using data obtained with a high performance assay, the sero-prevalence of HEV was estimated at 6.0% in the US. Based on these results, the sero-prevalence of HEV is only one-third as high as previously reported. (Hepatology 2014)
    Hepatology 09/2014; 60(3). DOI:10.1002/hep.27219 · 11.19 Impact Factor
  • Source
    H. Salameh, P. S. Kamath, A. K Singal
    Alimentary Pharmacology & Therapeutics 09/2014; 40(5). DOI:10.1111/apt.12882 · 4.55 Impact Factor
  • Hepatology 09/2014; DOI:10.1002/hep.27541 · 11.19 Impact Factor
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    ABSTRACT: Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients.
    Clinical Gastroenterology and Hepatology 08/2014; DOI:10.1016/j.cgh.2014.07.060 · 6.53 Impact Factor
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    ABSTRACT: Chronic passive hepatic congestion (congestive hepatopathy) leads to hepatic fibrosis; however the mechanisms involved in this process are not well understood. We developed a murine experimental model of congestive hepatopathy through partial ligation of the inferior vena cava (pIVCL). C57BL/6 and transgenic mice overexpressing tissue factor pathway inhibitor (SM22α -TFPI) were subjected to pIVCL or SHAM. Liver and blood samples were collected and analyzed in immunohistochemical, morphometric, real-time polymerase chain reaction and western blot assays. Hepatic fibrosis and portal pressure were significantly increased after pIVCL concurrent with hepatic stellate cell (HSC) activation. Liver stiffness, as assessed by magnetic resonance elastography, correlated with portal pressure and preceded fibrosis in our model. Hepatic sinusoidal thrombosis as evidenced by fibrin deposition was demonstrated both in mice after pIVCL as well as in humans with congestive hepatopathy. Warfarin treatment and TFPI overexpression both had a protective effect on fibrosis development and HSC activation after pIVCL. In vitro studies show that congestion stimulates HSC fibronectin (FN) fibril assembly through direct effects of thrombi as well as by virtue of mechanical strain. Pretreatment with either Mab13 or Cytochalasin-D, to inhibit β-integrin or actin polymerization, respectively, significantly reduced fibrin and stretch induced FN fibril assembly. Conclusion: Chronic hepatic congestion leads to sinusoidal thrombosis and strain, which in turn promote hepatic fibrosis. These studies mechanistically link congestive hepatopathy to hepatic fibrosis. (Hepatology 2014;)
    Hepatology 08/2014; 61(2). DOI:10.1002/hep.27387 · 11.19 Impact Factor
  • Gastroenterology 07/2014; 147(1):4–10. DOI:10.1053/j.gastro.2014.05.005 · 13.93 Impact Factor
  • A. K. Singal, H. Salameh, P. S. Kamath
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    ABSTRACT: Background Data on bacterial infections in hospitalised patients in the US with cirrhosis are derived largely from single centre data. Countrywide data in this population are lacking.AimTo assess prevalence of infections among hospitalised patients in the US and examine their impact on in-hospital mortality and health care resources utilisation.Methods Nationwide Inpatient Sample (1998–2007) was queried for hospitalisations with cirrhosis and examined for infections including spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI), skin and soft tissue infections, pneumonia and Clostridium difficile infections (CDI). In-hospital mortality, length of stay (LOS) and total charges were analysed.ResultsOf 742 391 admissions with cirrhosis, 168 654 (23%) had discharge diagnosis of any infection. Between 1998 and 2007, there was a trend towards increasing prevalence of infections (21–25%). Higher rates of infection were associated with ascites (22–25%) and renal insufficiency (RI) (38–43%). Infection with RI increased from 13% in 1998 to 27% in 2007. UTI was the most common infection (9–12%) followed by subcutaneous tissue infections (5–6%) and SBP (2–3%, around 12% in patients with ascites). Infection rate was similar among teaching and nonteaching hospitals with CDI and SBP being more common in teaching hospitals. In-hospital mortality was about 5%, over fivefold higher in infected cirrhotics, and associated with higher LOS and charges. Sepsis (38–42%), pneumonia (23–30%), SBP (16–23%) and CDI (11–16%) contributed most to in-hospital mortality.Conclusions The prevalence of infections among hospitalised patients with cirrhosis in the US is increasing and is associated with in-hospital mortality, renal insufficiency and costs.
    Alimentary Pharmacology & Therapeutics 05/2014; 40(1). DOI:10.1111/apt.12797 · 4.55 Impact Factor
  • Gastrointestinal Endoscopy 05/2014; 79(5):AB508-AB509. DOI:10.1016/j.gie.2014.02.798 · 4.90 Impact Factor

Publication Stats

8k Citations
1,954.10 Total Impact Points

Institutions

  • 1994–2015
    • Mayo Clinic - Rochester
      • • Department of Gastroenterology and Hepatology
      • • Department of Internal Medicine
      • • Department of Surgery
      Рочестер, Minnesota, United States
  • 2010
    • University of Newcastle
      Newcastle, New South Wales, Australia
  • 2009
    • Rochester College
      Rochester, New York, United States
  • 2006
    • University of California, San Francisco
      San Francisco, California, United States
  • 2004
    • Mayo Foundation for Medical Education and Research
      Rochester, Michigan, United States
  • 2001
    • University of Washington Seattle
      Seattle, Washington, United States
    • University of Barcelona
      Barcino, Catalonia, Spain