Patrick G Northup

Publications (38)180.57 Total impact

• Article: Established and new-generation antithrombotic drugs in patients with cirrhosis - possibilities and caveats.

  Ton Lisman, Pieter W Kamphuisen, Patrick G Northup, Robert J Porte
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  ABSTRACT: Until recently, it was widely accepted that patients with cirrhosis have a bleeding tendency related to the changes in the hemostatic system that occur as a consequence of the disease. However, it has now been well established that patients with cirrhosis are at risk for both bleeding and thrombotic complications. These thrombotic complications include portal vein thrombosis, deep vein thrombosis and pulmonary embolism, and coronary or cerebrovascular infarctions. Antithrombotic drugs to prevent or treat thrombotic complications in patients with cirrhosis have been used only minimally in the past due to the perceived bleeding risk. As the thrombotic complications and the necessity of antithrombotic treatment in these patients is increasingly recognized, the use of antithrombotic drugs in this population is likely increasing. Moreover, given the rising incidence of fatty liver disease and generally longer survival times of patients with chronic liver diseases, it would be reasonable to presume that some of these thrombotic complications may be increasing in incidence over time. In this review we will outline the indications for antithrombotic treatment in patients with cirrhosis. Furthermore, we will discuss the available antithrombotic drugs and indicate possible applications, advantages, and caveats. Since for many of these drugs, very little experience in patients with cirrhosis exists, these data are essential in the design of future clinical and laboratory studies on mechanisms, efficacy, and safety of the various antithrombotic strategies in these patients.
  Journal of Hepatology 03/2013; · 9.26 Impact Factor
• Article: Coagulation in Liver Disease: A Guide for the Clinician.

  Patrick G Northup, Stephen H Caldwell
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  ABSTRACT: The human hemostasis system is complex and poorly understood after decades of intense scientific study. Despite multiple defects in routine coagulation laboratory studies in patients with chronic liver disease, there is growing evidence that these patients are effectively "rebalanced" with regard to procoagulant and anticoagulant activity and that most of these patients remain in a tenuous but balanced state of hemostasis. A major difficulty in the assessment of these patients is that there are no established laboratory tests that accurately reflect the changes in both the procoagulant and anticoagulant systems and therefore routine laboratory testing is misleading to the clinician and may prompt inappropriate or risky therapies with little real benefit to the patient. The international normalized ratio (INR) is an example of this type of misleading test. While the INR is inextricably linked to prognosis and severity of protein synthetic dysfunction in acute and chronic liver disease, it is a very poor marker for bleeding risk and should not be used in isolation for this purpose. Coagulation disorders are critical in the management of frequent clinical scenarios such as esophageal variceal bleeding, invasive and percutaneous procedures, portal vein thrombosis, venous thromboembolism, and acute liver failure. This article summarizes the pathophysiology of hemostasis in liver disease, describes the strengths and weaknesses of various laboratory tests in assessment of these patients, and outlines the optimal management of hemostasis for some common clinical scenarios. Further research is needed for proper understanding of hemostasis in liver disease in order to optimally and safely manage these complex patients.
  Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2013; · 5.64 Impact Factor
• Article: Peripheral platelet count correlates with liver atrophy and predicts long-term mortality on the liver transplant waiting list.

  Wissam Bleibel, Stephen H Caldwell, Michael P Curry, Patrick G Northup
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  ABSTRACT: Several studies have shown a direct role of liver atrophy in the pathogenesis of thrombocytopenia of cirrhosis via reduced production of thrombopoeitin. About 181 patients listed for liver transplantation at a single transplant center were evaluated at the time of listing with laboratory tests and volumetric liver measurements using computed tomography. Expected normal liver volume was calculated using the Heinemann formula. Liver volume ratio (LVR) was calculated as actual liver volume over expected liver volume. Patients were predominantly male (70.7%), with viral hepatitis (60.2%), had a mean age of 51.8 years (SD 8.7), model for end stage liver disease (MELD) of 14 (SD 6.4), LVR of 0.95 (SD 0.3), and platelet count of 105 000/mcL (SD 66 000). Platelet count (P < 0.0001) correlated more strongly with LVR than MELD, MELD components (P = 0.27) or serum albumin (P = 0.003). Platelet count (HR 0.987, 95% CI 0.979-0.994, P = 0.001) was a strong independent predictor of mortality. Patients with platelet count < 100 000/mcL had a shorter survival (935 vs. 1396 days, P = 0.002) and higher death rate (42.2% vs. 23.6%, P = 0.01), but no different transplantation rate (36.7% vs. 33.3%, P = 0.64) compared to those with platelet count ≥ 100 000/mcL. Low platelet count corresponds to higher waiting list mortality and is a sign of advanced liver atrophy.
  Transplant International 01/2013; · 2.92 Impact Factor
• Article: Multimodality endoscopic treatment of pancreatic duct disruption with stenting and pseudocyst drainage: How efficacious is it?

  Charles W Shrode, Patrick Macdonough, Monica Gaidhane, Patrick G Northup, Bryan Sauer, Jennifer Ku, Kristi Ellen, Vanessa M Shami, Michel Kahaleh
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  ABSTRACT: BACKGROUND: Few studies have described the role of multimodality therapy and the complexity of endoscopic management of pancreatic duct disruption. Our study aim was to analyse and confirm factors associated with the resolution of pancreatic duct disruption. METHODS: Over 6 years, retrospective data on patients with pancreatic duct disruption managed endoscopically were retrieved. Success was defined as resolution of the pancreatic duct disruption at 12 months. Logistic regression analysis was performed to determine factors associated with resolution. RESULTS: 113 patients (78 male) with a mean age 51.3 year were included. Resolution of the pancreatic duct leak occurred in 80 cases (70.2%). 72 cases received transpapillary pancreatic duct stents, with 51 demonstrating resolution of pancreatic duct leak (71%) cystenterostomy was performed in 68 patients with 51 resolved (75%). In partial duct disruptions, pancreatic duct stenting combined with endoscopic drainage of fluid collections resulted in an increased rate of resolution (80%) compared to complete disruptions treated in a similar manner (57%). In complete pancreatic ductal disruptions, transpapillary pancreatic duct stenting had no additional benefit (9/17, 52.9%) compared to cystenterostomy or percutaneous drainage alone (24/34, 70.6%; P=0.61). CONCLUSION: Pancreatic duct disruptions require multimodality treatment, addressing not only the integrity of the pancreatic duct but also any fluid collections associated. Partial ductal disruption should be managed by a bridging stent.
  Digestive and Liver Disease 10/2012; · 3.05 Impact Factor
• Article: A clinical survey of bleeding, thrombosis, and blood product use in decompensated cirrhosis patients.

  Neeral L Shah, Patrick G Northup, Stephen H Caldwell
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  ABSTRACT: Background. The relative incidence of bleeding and thrombotic events and the use of blood products in hospitalized cirrhosis patients have not been widely reported. We aimed to estimate the magnitude of bleeding events and venous thrombosis in consecutive hospitalized cirrhotic patients over a finite time period and to examine the amount and indications for blood product use in cirrhosis patients admitted to a tertiary care center. Results. Among patients admitted with decompensated liver disease, 34 (40%) suffered bleeding events (about one-half non-variceal) and 6 patients (7%) suffered deep venous thrombosis. In the blood product survey, 168 patients were transfused with plasma or platelets during the survey inter- vals. Liver disease patients accounted for 7.7% of the total but disproportionately consumed 32.4% (46 of 142) of the units of plasma mostly administered as prophylaxis. In contrast, cirrhosis patients received only 7 of the 53 units of platelets transfused (13.2%) during the survey intervals. Conclusions. Coagulation issues constitute a common problem in patients with liver disease. Recent advances in laboratory testing have shown that stable cirrhosis patients are relatively hypercoagulable. The result of this prospective survey among decompensated (unstable) cirrhosis patients shows that, while DVT is not uncommon, bleeding (non-variceal in one half) remains the dominant clinical problem. This situation likely sustains the common practice of plasma infusion in these patients although its use is of unproven and questionable benefit. Better clinical tools are needed to refine clinical practice in this setting.
  Annals of hepatology: official journal of the Mexican Association of Hepatology 09/2012; 11(5):686-90. · 1.81 Impact Factor
• Article: Editorial: Beta-blockers and the prevention of decompensation in cirrhosis: worth the trouble.

  Patrick G Northup, Zachary H Henry
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  ABSTRACT: Non-selective beta-blockers have been a cornerstone of therapy for prevention of esophageal variceal bleeding in cirrhosis patients for more than two decades. When lowering the hepatic vein portal pressure gradient (HVPG) below 12 mm Hg or decreasing the pressure by 20% from baseline, these drugs are of proven benefit in reducing variceal bleeding and improving survival in this patient population. The recent work by Hendández-Gea et al., suggests that initiation of the beta-blocker nadolol in cirrhosis patients with high-risk varices can delay or prevent the first occurrence of clinically evident ascites. This finding comes with some caveats, however. The beneficial effect was only seen in patients who had an improvement by 10% or more from baseline HVPG pressure (only 51% of the treated patients in this study). This class of medications has some risk and tolerance issues, and many patients do not respond, even when the heart rate is optimally decreased. Despite this, the use of beta-blockers may be beneficial in the primary prevention of the formation of ascites and further decompensation of cirrhosis.
  The American Journal of Gastroenterology 03/2012; 107(3):428-30. · 7.28 Impact Factor
• Article: Hepatocellular carcinoma and model for end-stage liver disease exceptions: the more we understand, the more challenging the allocation gets.

  Patrick G Northup, Carl L Berg
  Liver Transplantation 02/2012; 18(4):381-3. · 3.39 Impact Factor
• Article: Hypercoagulation and thrombophilia in nonalcoholic fatty liver disease: mechanisms, human evidence, therapeutic implications, and preventive implications.

  Patrick G Northup, Curtis K Argo, Neeral Shah, Stephen H Caldwell
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  ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is a spectrum of disorders with a high prevalence in the industrialized world. Despite the high prevalence, the etiology and fundamental pathophysiology for the disease process is poorly understood. There is now a growing fund of knowledge suggesting that the ongoing inflammatory state associated with NAFLD leads to a low-level activation of the coagulation system. Although the data supporting this activation of the coagulation system are significant, the link with end-organ disease, mainly cardiovascular disease, is less firm and mostly epidemiological. In this review, we will explore the evidence for and against a hypercoagulable or thrombophilic state in NAFLD. We will examine possible pathophysiologic explanations and mechanisms, human epidemiologic and population-based data, and the possible therapeutic and preventative implications for treatment of thrombophilia in patients with this disease process.
  Seminars in Liver Disease 02/2012; 32(1):39-48. · 7.05 Impact Factor
• Article: Does external beam radiation therapy improve survival following transarterial chemoembolization for unresectable hepatocellular carcinoma?

  Andrew C Cupino, Clark D Hair, John F Angle, Stephen H Caldwell, Tyvin A Rich, Carl L Berg, Patrick G Northup, Abdullah M S Al-Osaimi, Curtis K Argo
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  ABSTRACT: Transcatheter arterial chemoembolization (TACE) improves survival in patients with unresectable hepatocellular carcinoma (HCC). Partial liver radiotherapy with modern techniques has been shown to be safe. The purpose of this study was to evaluate the survival value of external beam radiation therapy (EBRT) with concurrent chemotherapy combined with TACE. A University of Virginia Interventional Radiology patient log was used to identify patients treated with TACE ± another modality from 1999 through 2005. During this time, 44 patients received TACE for unresectable HCC, and 7 of these received adjuvant EBRT. Univariate analysis and multivariable proportional hazards survival modeling were used to identify factors impacting survival. We compared 37 patients receiving TACE alone to 7 receiving TACE and EBRT (5 with concurrent capecitabine). Unadjusted mean transplant-free survival times were TACE only = 376 days (standard error [SE] = 63 days), TACE + EBRT = 879 days (SE = 100 days). EBRT, TNM stage, and MELD score were important predictors for survival on univariate analysis (p < .10). The adjusted hazard ratio for transplant or death in the TACE + EBRT group was 0.15 (0.02-0.95, p = .026). EBRT with concurrent chemotherapy following TACE is feasible and well tolerated with modern treatment techniques. Further research should be directed toward determining the potential overall survival benefit of adjuvant EBRT with chemotherapy following TACE for hepatocellular carcinoma.
  Gastrointestinal cancer research: GCR 01/2012; 5(1):13-7.
• Article: Sorafenib therapy for hepatocellular carcinoma prior to liver transplant is associated with increased complications after transplant.

  Aimee E Truesdale, Stephen H Caldwell, Neeral L Shah, Curtis K Argo, Abdullah M S Al-Osaimi, Timothy M Schmitt, Patrick G Northup
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  ABSTRACT: This study compared post-transplant outcomes of patients with hepatocellular carcinoma (HCC) who took sorafenib prior to orthotopic liver transplantation (OLT) with those patients who were not treated with sorafenib. Thirty-three patients with HCC who were listed for liver transplantation were studied: 10 patients were treated with sorafenib prior to transplantation in an attempt to prevent progression of HCC while awaiting transplant. The remaining 23 patients were considered controls. The mean duration of sorafenib use was 19.2 (SD 25.2) weeks. Overall death rates were similar between the sorafenib group and control group (20% vs. 8.7%, respectively, P = 0.56). However, the patients in the sorafenib group had a higher incidence of acute cellular rejection following transplantation (67% vs. 22%, OR = 7.2, 95% CI 1.3-39.6, P = 0.04). The sorafenib group also had a higher rate of early biliary complications (67% vs. 17%, OR = 9.5, 1.6-55.0, P = 0.01). The use of sorafenib was found to be an independent predictor of post-transplant biliary complications (OR 12.6, 1.4-116.2, P = 0.03). Sorafenib administration prior to OLT appears to be associated with an increase in biliary complications and possibly in acute rejection following liver transplantation. Caution should be taken in this setting until larger studies are completed.
  Transplant International 07/2011; 24(10):991-8. · 2.92 Impact Factor
• Article: Bleeding after percutaneous endoscopic gastrostomy is linked to serotonin reuptake inhibitors, not aspirin or clopidogrel.

  James A Richter, James T Patrie, Robert P Richter, Zachary H Henry, George H Pop, Kara A Regan, David A Peura, Robert G Sawyer, Patrick G Northup, Andrew Y Wang
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  ABSTRACT: Percutaneous endoscopic gastrostomy (PEG) is an invasive procedure that can result in bleeding. Guidelines recommend discontinuing clopidogrel for 7 to 10 days, but not withholding aspirin, before PEG. Serotonin reuptake inhibitors (SRIs) have been associated with an increased risk of GI bleeding. To determine whether there is an association between periprocedural aspirin, clopidogrel, or SRI use and bleeding in patients who underwent PEG tube placement. Retrospective cohort study. Large quaternary-care academic medical center. A total of 990 patients (525 men) with a median age of 69.8 years who underwent PEG from January 1999 to April 2009. PEG tube placement. GI bleeding. Sixteen patients (1.6%) had evidence of bleeding during the first 48 hours after PEG, and 12 patients (1.2%) had evidence of bleeding between 48 hours and 14 days after PEG. Thirty-six patients (3.6%) received high-dose aspirin (>325 mg), 27 patients (2.7%) received clopidogrel (75 mg), and 99 patients (10%) received an SRI before PEG. Twenty-four patients (2.4%) received high-dose aspirin, 25 patients (2.5%) received clopidogrel, and 130 patients (13.1%) received an SRI after PEG. Multivariate analysis demonstrated no association between periprocedural use of aspirin (at any dose) or clopidogrel and post-PEG bleeding. However, SRIs administered 24 hours or less before PEG were associated with a significantly higher odds of post-PEG bleeding (adjusted odds ratio 4.1; 95% CI, 1.1-13.4; P = .04). Retrospective, single-center study with limited statistical power despite a relatively large cohort of patients. Use of aspirin or clopidogrel before or after PEG was not associated with procedure-related bleeding. SRI use in the 24 hours before PEG was associated with an increased risk of bleeding.
  Gastrointestinal endoscopy 07/2011; 74(1):22-34.e1. · 6.71 Impact Factor
• Article: Closure of ascites leaks with fibrin glue injection in patients with end-stage liver disease.

  Karim W Sadik, Sarah Laibstain, Patrick G Northup, David Kashmer, Timothy M Schmitt, Hugo J R Bonatti
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  ABSTRACT: Ascites leaks (AL) in patients with end-stage liver disease (ESLD) are associated with significant morbidity and mortality regardless if they are medically or surgically managed. In a pilot study, 14 ESLD patients with AL underwent treatment with fibrin glue injection around the leak after failing conservative therapy. The end point of this study was the cessation of AL in the short term and the maintenance of a leak-free abdomen in the long term, allowing for medical optimization of the patients. Median age of the 10 men and 4 women was 50 (range 26-67) years. Underlying ESLDs were chronic hepatitis C (n=5), alcoholic LD (n=2), cryptogenic cirrhosis (n=2), and miscellaneous (n=5). There were six leaking incisions posthernia repair (three umbilical and three inguinal), two leaking/ruptured umbilical hernias, four leaking paracentesis sites, one leaking Jackson-Pratt (JP) drain canal, and one leaking laparoscopic trocar site. Average AL volume per day was 1000 (range 400-2000) mL. All leaks were immediately resolved with a 3-5 mL fibrin glue injection. Five recurred and required a second injection (four within 24 hours). Mental status improved in 7 patients (West Haven Criteria: grade II to I [n=6], grade III to I [n=1]). Median model of end-stage liver disease scores improved from 23 (range 8-33) to 20 (range 14-26). There were no infections, bleeds, or other injection-related complications. Average follow-up for these patients was 441.6 days (range 2-852). Five patients underwent liver transplant (LT) median 15 (range 4-270) days postinjection; 2 of them died. Another 3 patients died (2 from sepsis and 1 from metastatic cancer). Fibrin glue injection for the control of AL is a simple and safe bedside procedure that quickly controls AL, allowing for patient recovery in anticipation of further care.
  Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2011; 21(7):609-14. · 1.40 Impact Factor
• Article: Comparison between endoscopic ultrasound and magnetic resonance imaging for the staging of pancreatic cancer.

  Vanessa M Shami, Anshu Mahajan, Michelle M Loch, Alejandro C Stella, Patrick G Northup, Grace E White, Andrew S Brock, Indu Srinivasan, Eduard E de Lange, Michel Kahaleh
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  ABSTRACT: Preoperative staging of pancreatic cancer is crucial for proper therapy. Through this study, we aimed to compare the ability of endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) to effectively detect and stage pancreatic cancer. One hundred twenty-seven patients undergoing EUS-fine-needle aspiration and MRI for the workup of pancreatic cancer were captured in a prospective database for comparison. The final surgical stage was recorded in patients who went to surgery. Of 127 patients, 48 were surgically explored, and of these, 22 (46%) underwent pancreaticoduodenectomy. Agreement in the patients' staging between EUS and MRI was 94 (74%) of 127. Magnetic resonance imaging was more likely to report metastatic disease or arterial involvement. The overall correlation between EUS and MRI was marginal (κ = 0.42; 95% CI, 0.26-0.58). Of the 48 surgically explored patients, 12 (25%) were understaged by MRI, 13 (27%) were understaged by EUS, and 1 (2%) were overstaged. Endoscopic US and MRI had a sensitivity of 34 (97.2%) of 35 for stage II tumors and 35 (100%) of 35 for lower-stage tumors, respectively. Endoscopic US and MRI had marginal correlation for staging, especially the more advanced tumors. Although EUS has the added advantage of tissue acquisition for confirmation, the tumors understaged by both the modalities were different. Therefore, both tests should be performed for accurate staging.
  Pancreas 05/2011; 40(4):567-70. · 2.39 Impact Factor
• Article: Mortality after percutaneous endoscopic gastrostomy in patients with cirrhosis: a case series.

  Joseph G Baltz, Curtis K Argo, Abdullah M S Al-Osaimi, Patrick G Northup
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  ABSTRACT: Percutaneous endoscopic gastrostomy (PEG) tube placement can improve the nutritional status and the ability of a patient with cirrhosis to recover from surgery such as orthotopic liver transplantation. However, cirrhosis has been considered a significant contraindication to PEG tube placement. Our aim in this study was to describe the mortality and complications in a series of cirrhotic patients who underwent PEG at our institution. Retrospective, single-institution case series. This study involved 26 consecutive patients with cirrhosis who underwent PEG between 1995 and 2005. PEG tube placement. The 30-day mortality of the series of patients was 10 of 26 (38.5%), whereas the 90-day mortality was 11 of 26 (42.3%). Nine of the 10 patients who died in the first 30 days had ascites at the time of PEG tube placement. Two patients died as a direct consequence of complications from the PEG procedure, whereas the other deaths were related to progression of liver disease or factors not directly related to the PEG. The patients in this case series had varying levels of illness and reasons for PEG tube placement such that a generalization of outcomes may not be possible. The overall mortality of patients with cirrhosis who underwent PEG is high. Although there is an increased risk, PEG tube placement in cirrhotic patients without ascites may be less risky. The benefits of PEG tube placement in patients with cirrhosis should be weighed heavily against the risks.
  Gastrointestinal endoscopy 11/2010; 72(5):1072-5. · 6.71 Impact Factor
• Article: Bleeding complication with liver biopsy: is it predictable?

  Stephen Caldwell, Patrick G Northup
  Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 10/2010; 8(10):826-9. · 5.64 Impact Factor
• Source

  Available from: Sean C Kumer

  Article: Liver transplantation for T3 lesions has higher waiting list mortality but similar survival compared to T1 and T2 lesions.

  Timothy M Schmitt, Sean C Kumer, Neeral Shah, Curtis K Argo, Patrick G Northup
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  ABSTRACT: Restrictive staging criteria for liver transplant (LT) patients with HCC in the U.S. have resulted in favorable long-term recurrence-free survival, but these criteria exclude a subgroup of patients who, despite tumor size beyond T2 stage, demonstrate an acceptable outcome. The aim of this study was to assess the waiting list and post-transplant mortality of patients with HCC tumors greater than Milan T2 stage. The U.S. OPTN standard transplant dataset was analyzed for patients with a diagnosis of HCC who were listed for liver transplantation between February 2002 and 2008. Those patients with Milan T3 stage tumors were compared to patients with T1 and T2 lesions. Multivariate survival models were developed to investigate independent predictors of death or tumor recurrence post-transplant. 7,391 patients with HCC were identified. 351 (4.75%) had T3 lesions. Compared to non-T3 patients, total tumor burden was greater and total alpha-fetoprotein (AFP) was higher in the T3 patients. T3 patients also were more likely to receive pretransplant locoregional therapy. There were no significant differences between T3 patients and non-T3 patients in demographic variables or physiologic MELD score at the time of transplant, waiting time, or donor risk index. Waiting list mortality was increased for T3 patients compared to non-T3 and tumor progression while waiting was higher. Independent predictors of waiting list mortality included physiologic MELD score at the time of listing, total tumor burden, and serum AFP. There was significant regional variation in the utilization of exceptions for T3 patients and UNOS regions 4, 9, and 10 performed a higher percentage of their transplants in T3 patients compared to other regions. There was no difference in post transplant survival between T3 and non-T3 patients. Independent predictors of post-transplant mortality included physiologic MELD score at the time of transplant, recipient age, and donor risk index. In patients with T3 tumors, total tumor burden was not an independent predictor of post transplant survival. Patients who are listed for liver transplantation with Milan stage T3 HCC have higher waiting list mortality but have similar post-transplant survival compared to patients with T1 and T2 HCC.
  Annals of hepatology: official journal of the Mexican Association of Hepatology 10/2010; 9(4):390-6. · 1.81 Impact Factor
• Article: Hemostasis and thrombosis in patients with liver disease: the ups and downs.

  Ton Lisman, Stephen H Caldwell, Andrew K Burroughs, Patrick G Northup, Marco Senzolo, R Todd Stravitz, Armando Tripodi, James F Trotter, Dominique-Charles Valla, Robert J Porte
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  ABSTRACT: Patients with chronic or acute liver failure frequently show profound abnormalities in their hemostatic system. Whereas routine laboratory tests of hemostasis suggest these hemostatic alterations result in a bleeding diathesis, accumulating evidence from both clinical and laboratory studies suggest that the situation is more complex. The average patient with liver failure may be in hemostatic balance despite prolonged routine coagulation tests, since both pro- and antihemostatic factors are affected, the latter of which are not well reflected in routine coagulation testing. However, this balance may easily tip towards a hypo- or hypercoagulable situation. Indeed, patients with liver disease may encounter both hemostasis-related bleeding episodes as well as thrombotic events. During the 3rd International Symposium on Coagulopathy and Liver disease, held in Groningen, The Netherlands (18-19 September 2009), a multidisciplinary panel of experts critically reviewed the current data concerning pathophysiology and clinical consequences of hemostatic disorders in patients with liver disease. Highlights of this symposium are summarized in this review.
  Journal of Hepatology 08/2010; 53(2):362-71. · 9.26 Impact Factor
• Article: Liver allografts from hepatitis C positive donors can offer good outcomes in hepatitis C positive recipients: a US National Transplant Registry analysis.

  Patrick G Northup, Curtis K Argo, Dennis T Nguyen, Maureen A McBride, Sean C Kumer, Timothy M Schmitt, Timothy L Pruett
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  ABSTRACT: Organ donors are screened for the hepatitis C antibody (anti-HCV) and those with positive tests can be used under extended criteria donation. However, there is still a question of long-term organ viability. The aim of this study was to assess the long-term outcomes of anti-HCV positive (HCV+) liver grafts. The US Organ Procurement and Transplantation Network Scientific Registry was reviewed for the period from April 1994 to February 6, 2008 and 56,275 liver transplantations were analyzed. In total, there were 19,496 HCV+ recipients and 934 HCV+ donors. Patient and graft survival were assessed accounting for both donor and recipient anti-HCV status. Multivariable proportional hazards survival models were developed to adjust for factors known to affect post-transplant survival. With anti-HCV negative (HCV-) recipient/HCV- donor as the reference, the adjusted hazard ratio for death was similar for HCV+ recipient/HCV- donor compared with HCV+ recipient/HCV+ donor (1.176 vs. 1.165, P = 0.91). Our results suggest that HCV+ liver donors do not subject the HCV+ recipient to an increased risk for death over the HCV- donor, keeping in mind that careful donor and recipient selection is critical for the proper use of these extended criteria donors.
  Transplant International 04/2010; 23(10):1038-44. · 2.92 Impact Factor
• Article: New concepts of coagulation and bleeding in liver disease.

  Patrick G Northup, Stephen H Caldwell
  Internal and Emergency Medicine 02/2010; 5(1):3-6. · 2.06 Impact Factor
• Article: Pretransplant predictors of recovery of renal function after liver transplantation.

  Patrick G Northup, Curtis K Argo, Mihir R Bakhru, Timothy M Schmitt, Carl L Berg, Mitchell H Rosner
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  ABSTRACT: The Model for End-Stage Liver Disease system has given priority on the liver transplant waiting list to candidates with renal failure. This study determined the predictors of spontaneous recovery of renal function after transplantation in 1041 liver transplant recipients on renal replacement therapy (RRT) at the time of transplant (from February 2002 to January 2007). Data from these patients were obtained from the US Organ Procurement and Transplantation Network and US Renal Data System databases. Univariate and multivariate survival models were constructed along with multivariate logistic regression models to find independent predictors of spontaneous renal recovery. Seven hundred seven recipients (67.9%) had spontaneous recovery of renal function after liver transplantation. Those recovering spontaneously had a significantly shorter course of RRT in the pretransplant time period (15.6 versus 36.6 days, P < 0.001). Recovery of renal function was observed in 70.8% and 11.5% of recipients on RRT for less than 30 days and more than 90 days, respectively. Other statistically significant pretransplant variables independently associated with recovery of renal function included recipient age, recipient pretransplant diabetes, and donor age. In conclusion, the duration of pretransplant RRT is highly predictive of spontaneous renal recovery post-transplant. Liver transplant candidates requiring less than 30 days of pretransplant RRT are likely to spontaneously recover renal function after liver transplantation, whereas those on RRT for more than 90 days are not.
  Liver Transplantation 01/2010; 16(4):440-6. · 3.39 Impact Factor