Simone I Strasser

Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia

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Publications (82)339.4 Total impact

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    ABSTRACT: Background & Aims: An increased liver disease burden has been reported in Aboriginal and Torres Strait Islanders (ATSI) in Australia, however, only few proceed to liver transplantation (LT). We aimed to compare overall and graft survival after LT between ATSI and non-ATSI population, assess the factors influencing survival within ATSI and finally to examine the proportion of ATSI having LT.Methods: Retrospective review of Australia and New Zealand Liver Transplant Registry (ANZLTR) from 1985-2012 examining consecutive primary LT performed in Australia. Overall and graft survival was compared between ATSI and non-ATSI groups. Accessibility/Remoteness Index of Australia (ARIA) score was used to calculate the remoteness of individuals.Results: 3493 primary LT were performed and 45 (14 children and 31 adults) were ATSI (1.3%). The median (range) ages of ATSI children and adults at the time of LT were 9.6 (0.2-15.3) and 44.5 (19.5-65.5) years, respectively. There were 10 deaths in the ATSI cohort. Median overall (range) survival was similar between ATSI and non-ATSI children [6.5 (0.1-23.5) vs. 9.0 (0-28.2) years, p=0.9] and adults [7.1 (0.1-15.7) v 6.3 (0-26.7) years, p=0.8]. Cumulative graft survival was similar between ATSI and non-ATSI children (p=0.8) and adults (p=0.8). High ARIA score [HR (95% CI) = 1.2 (1.01-1.53), p=0.03] in children and blood group O [HR (95% CI) = 3.8 (1.1-12.7), p=0.03] in adults predicted a worse outcome in ATSI. Although ATSI account for 4.7% and 1.8% of the Australian paediatric and adult populations respectively, they represent only 2.2% of paediatric (χ2 =8.2, p=0.004) and 1.1% of adult (χ2=7.9, p=0.005) LT recipients.Conclusion: Overall and graft survival post-LT in ATSI is comparable to non-ATSI. There was a trend towards increased death/re-transplantation in ATSI from remote areas. ATSI children and adults appear under-represented in the Australian LT population. Liver Transpl , 2014. © 2014 AASLD.
    Liver Transplantation 04/2014; · 3.94 Impact Factor
  • Simone I Strasser
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    ABSTRACT: Chronic hepatitis B (CHB) infection is a major cause of human mortality worldwide. The majority of people with CHB are infected early in life, and 20-40% of men and 15% of women with chronic infection will develop hepatocellular carcinoma (HCC). Antiviral therapy is recommended for patients with CHB who have cirrhosis or active disease with the aims of reducing disease progression to cirrhosis, liver failure and liver cancer, thereby preventing death. Evidence that treatment with interferon or with early nucleos(t)ide analogue therapy reduces HCC has been somewhat conflicting, however evidence is emerging to support a significant role in HCC prevention of the more effective antivirals, entecavir and tenofovir. Older patients, those with cirrhosis, and those undergoing curative treatments for HCC derive the greatest medium-term benefit in terms of HCC reduction, but HCC can still occur and long-term surveillance is recommended.
    Expert review of gastroenterology & hepatology 03/2014;
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    ABSTRACT: Tenofovir disoproxil fumarate (TDF) is increasingly used in patients with chronic hepatitis B (CHB) infection. Although associated with renal toxicity in HIV-infected patients, renal dysfunction has been reported rarely in the monoinfected CHB population. To date, TDF-associated Fanconi Syndrome has not been reported. Here we present two cases of TDF-associated Fanconi Syndrome with rapid resolution after its cessation. We then discuss risk factors for TDF nephrotoxicity and its implications for screening for renal disease in those patients with CHB monoinfection on TDF, and the use of TDF in at risk populations.
    Antiviral therapy 07/2013; · 3.07 Impact Factor
  • Internal Medicine Journal 05/2013; 43(5):607. · 1.82 Impact Factor
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    Mauricio F Silva, Simone I Strasser, Flair J Carrilho
    Clinics (São Paulo, Brazil) 04/2013; 68(4). · 1.59 Impact Factor
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    ABSTRACT: Without effective prophylaxis, liver transplantation for hepatitis B virus (HBV)–related liver disease is frequently complicated by severe and rapidly progressive HBV recurrence. Combination prophylaxis with hepatitis B immune globulin (HBIG) and lamivudine (LAM) reduces long-term recurrence rates below 10%; however, HBIG is costly and inconvenient to administer. We, therefore, conducted a multicenter, prospective study of outcomes with an HBIG-sparing regimen of LAM plus adefovir dipivoxil (ADV) initiated at the time of listing for liver transplantation and continued after transplantation. Twenty-six patients were recruited into this study at the time of listing for transplantation, and 20 subsequently underwent transplantation. Twelve of the 26 patients had LAM exposure before the study baseline, but none had LAM resistance. The median HBV viral load before the institution of antiviral therapy was approximately 4.0 log10 IU/mL (range=2.3–7.5 log10 IU/mL). To the 20 patients who underwent transplantation, 800 IU of intramuscular HBIG was given immediately after transplantation and daily for 7 days only (total HBIG dose=6400 IU). All transplant patients remained alive without HBV recurrence (they were negative for hepatitis B surface antigen, and HBV DNA was undetectable) after a median follow-up of 57 months after transplantation (range=27–83 months). The median serum creatinine level in these patients rose from 81 to 119 μmol/L over the course of the study. No patient required dose reduction or cessation. After the completion of this prospective study, the regimen was modified so that no perioperative HBIG was administered if the pretransplant serum HBV DNA level was suppressed below 3 log10 IU/mL. Another 28 patients with HBV-related liver disease underwent transplantation (18 without HBIG). All remained alive and well without HBV recurrence after a median follow-up of 22 months after transplantation (range=10–58 months). In conclusion, a combination of LAM and ADV initiated at the time of wait listing provides safe and effective protection against recurrent HBV infection without the high costs and inconvenience associated with long-term HBIG therapy. Liver Transpl 19:268–274, 2013. © 2013 AASLD.
    Liver Transplantation 03/2013; 19(3). · 3.94 Impact Factor
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    ABSTRACT: BACKGROUND AND AIM: The current guideline of the American Association for the Study of Liver Diseases recommends liver resection for Child-Pugh-Turcotte A patients with a single hepatocellular carcinoma, total serum bilirubin ≤1 mg/dL and absence of significant portal hypertension. This subset of patients would have a long-term survival comparable to transplantation. The main aim of this study is to evaluate the survival rates in patients with a single nodule ≤5 cm following resection. METHODS: Medical records of 105 Child-Pugh-Turcotte A patients who underwent liver resection between 1997 and 2009 were analyzed in 3 countries. RESULTS: One, 3-, and 5-year survival rate was 97%, 83%, and 66%, respectively, and no variable that can be assessed prior to liver resection predicted survival probabilities. CONCLUSIONS: Liver resection offers 5-year survival similar to transplantation for Child-Pugh-Turcotte A patients with hepatocellular carcinoma and a single nodule up to 5 cm, independently of any patient baseline characteristics.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 01/2013; · 2.56 Impact Factor
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    ABSTRACT: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction characterised by rash, eosinophilia and systemic involvement. We report a case of DRESS induced by pentoxifylline used for the treatment of severe alcoholic hepatitis, in a patient with longstanding caffeine intolerance. A history of intolerance to caffeine and other methylxanthines is listed as a contraindication to the use of pentoxifylline, yet this precaution is not mentioned in alcoholic hepatitis treatment guidelines. Prescribers should always seek a history of intolerance to caffeine and related compounds prior to use of pentoxifylline, as severe life threatening reactions can occur.
    Journal of Dermatological Case Reports 01/2013; 7(3):77-81.
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    ABSTRACT: BACKGROUND: Hyponatremia in liver failure is associated with increased morbidity and mortality. Improving serum sodium in liver failure has been observed in patients receiving terlipressin. METHODS: We assessed the response of hyponatremia in patients with liver failure to terlipressin using comparative retrospective analysis. RESULTS: Twenty-three patients received terlipressin for hyponatremia after failed conservative management (median age 52 years (27-67), MELD score 28 (16-38)). The median therapy was 7 days (1-27), with an average total dose of 25 mg (4-90) and a mean follow-up of 51 days (5-1248). These patients were compared to eleven hyponatremic patients managed conservatively during the same period with comparable age, baseline serum sodium and follow-up. After 1 week of terlipressin therapy, serum sodium increased from a median of 120 (115-128) to 129 mmol/L (121-144) (p<0.001) and at the end of terlipressin therapy, the serum sodium had increased significantly to 131 mmol/L (120-148) (p<0.001). In comparison, in the conservatively managed group the serum sodium did not increase significantly from the baseline of 123 (117-127) mmol/L. Adverse events occurred in 26% of patients receiving terlipressin, which predominantly pulmonary edema. Importantly, more hyponatremic patients treated with terlipressin (48%) were alive compared to the conservative group (18%), despite the latter having a significantly lower baseline median MELD score of 21 (16-30)(p=0.008). Moreover, the transplant-free survival was higher in the terlipressin (30%) compared to the conservative group (0%). CONCLUSIONS: Terlipressin is effective in treating hyponatremia in liver failure. Importantly, terlipressin use results in better transplant-free survival but also more adverse events.
    Internal Medicine Journal 11/2012; · 1.82 Impact Factor
  • Simone I Strasser
    The Medical journal of Australia 10/2012; 197(8):429-30. · 2.85 Impact Factor
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    ABSTRACT: A CD antibody microarray has been previously developed allowing semi-quantitative identification of greater than 80 CD antigens on circulating leucocytes from peripheral blood samples. This assay, which uses a live cell-capture technique, enables an extensive leucocyte immunophenotype determination in a single analysis and to date this has been used successfully to characterise diseases including human leukaemias and HIV infection. To determine CD antigen expression profiles for patients with various liver diseases and to look for preserved disease-specific signatures. Three liver disease groups including hepatitis C (HCV) (n = 35), non-alcoholic steatohepatitis (NASH) (n = 21) and alcohol-related liver disease (n = 14) were compared with a normal group (n = 23). Hierarchal Clustering (HCL) and Principal Component Analysis (PCA) of the data revealed distinct binding patterns for patients with and without cirrhosis. Patients with cirrhosis and portal hypertension compared with those without cirrhosis had significantly reduced expression of several markers of T-cell function including CD45, CD8, CD28 and TCR α/β. Disease prediction algorithms based on the expression data were able to discriminate cirrhotics from non-cirrhotics with 71% overall success, which improved to 77% when only patients with HCV were considered. These results demonstrate disease-specific consensus patterns of expression of CD antigens for patients with chronic liver disease, suggesting that the CD antibody array is a promising tool in the analysis of human liver disease, and with further refinement may have future research and clinical utility.
    Liver international: official journal of the International Association for the Study of the Liver 08/2012; 32(10):1527-34. · 3.87 Impact Factor
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    ABSTRACT: Background and Aim:  Donor liver steatosis can impact on liver allograft outcomes. The aim of the present study was to comprehensively report on the impact of type and grade of donor steatosis, as well as donor and recipient factors, including the reported Donor Risk Index (DRI), on liver allograft outcomes.Methods:  A review of unit data for all adult liver transplant procedures from 2001 to 2007, as well as donor offers. Donor liver biopsies were regraded for steatosis by an experienced histopathologist.Results:  Steatosis was detected in 184/255 (72%) of biopsies, of which 114 (62%) had microvesicular steatosis (MiS; 68 mild, 22 moderate, 24 severe) and 70 (38%) macrovesicular steatosis (MaS; 59 mild, 7 moderate, 4 severe). The majority (66/70, 94%) of biopsies with MaS also contained MiS. Allograft steatosis was associated with increasing donor body mass index (P = 0.000), plus donor male sex (P < 0.05). Primary non function (P = 0.002), early renal failure (P = 0.040), and requirement for retransplantation (P = 0.012) were associated only with severe MaS. Early biliary complications were associated with moderate MaS (P = 0.039). Only severe MaS was significantly associated with inferior allograft survival at 3 months (relative risk = 12.09 [8.75–19.05], P = 0.000) and 1 year (P = 0.000).Conclusions:  MiS is a common finding and frequently coexists with MaS on liver allograft biopsy, while isolated MaS is uncommon. Only the presence of moderate to severe MaS is associated with inferior early allograft outcomes. The impact of severe MaS on allograft survival appears greater than other donor factors, including the calculated DRI.
    Journal of Gastroenterology and Hepatology 02/2012; 27(3):540 - 546. · 3.33 Impact Factor
  • Simone I Strasser, Helen Vidot
    Journal of Gastroenterology and Hepatology 09/2011; 26(9):1346-8. · 3.33 Impact Factor
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    ABSTRACT: Screening for hepatocellular carcinoma (HCC) is commonly practiced and recommended in published guidelines, but evidence for its efficacy has been controversial. We tested the feasibility of conducting a randomized controlled trial (RCT) of HCC surveillance in patients with cirrhosis and followed up those offered screening to detect clinical outcomes. Participation was offered to patients with cirrhosis attending liver clinics at three university hospitals. Following discussion, patients received a decision aid (DA) that outlined the risks and benefits of surveillance. The proposed screening program comprised ultrasonography 6-monthly and serum alpha-fetoprotein every 3 months. We envisaged five groups of patients: those who agreed to randomization, those choosing nonrandomized screening, those wanting continuation of usual care, those who were undecided, and those refusing participation. Among 205 patients, 204 (99.5%) declined randomization. Of these, 181 (88%) elected for a nonrandomized screening program, 10% chose usual care (which typically included ad hoc screening), and two were undecided. Among 176 patients fluent in English communication skills, 160 (91%) preferred nonrandomized screening compared with 22/29 (76%) patients needing an interpreter (P < 0.026). Of 173 patients in nonrandomized screening followed up for a mean 13.5 ± 6.04 months, three developed HCC, two died from nonliver-related causes, and one underwent liver transplantation for liver failure. Eighteen of 21 patients in "usual care" received ad hoc screening. A simultaneous survey on the quality of the DA showed that the majority of participants believed that the information provided was unbiased. Conclusion: Although an RCT is theoretically ideal for determining the efficacy, efficiency, and cost-effectiveness of HCC screening, informed patients prefer surveillance. A randomized study of HCC screening is not feasible when informed consent is imparted.
    Hepatology 07/2011; 54(6):1998-2004. · 12.00 Impact Factor
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    ABSTRACT: To determine uptake of treatment for hepatitis C virus (HCV) infection and predictors of deferral of treatment for HCV by using prospectively collected data from the Australian Chronic Hepatitis C Observational Study (ACHOS). Cohort study involving interview and medical record review at enrolment and routine follow-up clinic visits of patients with chronic HCV and compensated liver disease attending a national network of 24 HCV clinics between April 2008 and December 2009. Eligible patients were those who had not been previously treated, were enrolled within 6 months of their first clinic visit, were eligible for treatment and had been enrolled for at least 6 months. Predictors of patients undergoing HCV treatment within the first 6 months of assessment. 1239 patients were enrolled in ACHOS, of whom 406 met the criteria for inclusion in the subcohort for this study. Among this subcohort, 171 (42%) received treatment within 6 months of their first clinic visit. Current injecting drug use (odds ratio [OR], 0.26; 95% CI, 0.08-0.77), past and current treatment for drug dependency (OR, 0.34; 95% CI, 0.18-0.67, and OR, 0.42; 95% CI, 0.22-0.81, respectively) and alcohol use above 20 g/day (OR, 0.20; 95% CI, 0.08-0.46) were independent predictors of deferral of treatment. At least one of these factors applied to 41% of the subcohort. Clinical factors, including HCV genotype, HCV RNA level, and stage of liver disease were not associated with deferral of treatment for HCV. Factors related to drug and alcohol use, rather than clinical factors, influenced uptake of treatment for HCV. Further support for patients with drug and alcohol dependency is required to optimise treatment uptake.
    The Medical journal of Australia 04/2011; 194(8):398-402. · 2.85 Impact Factor
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    ABSTRACT: To determine the efficacy of tenofovir disoproxil fumarate (TDF) in adults with chronic hepatitis B virus (HBV) infection who had previously failed lamivudine (LAM) and had significant viral replication (HBV DNA >10⁵ copies/ml if HBeAg positive, > 10⁴ copies/ml if HBeAg negative) despite at least 24 weeks of treatment with adefovir dipivoxil (ADV). A prospective open-label study of TDF 300 mg daily. Patients receiving combination ADV/LAM prior to baseline were switched to TDF/LAM. Multiple tertiary referral centres. Sixty patients were enrolled. The median age was 48.5 years (range 21e80), 46 (77%) were male and 40 (67%) were HBeAg positive. Thirty-eight patients (63%) were switched from ADV to TDF, the remainder from ADV/LAM to TDF/LAM. At baseline, substitutions conferring resistance to LAM or ADV were present in 20 patients (33%) and 17 patients (28%), respectively. The median baseline viral load was 5.33 log₁₀ IU/ml (range 2.81-8.04). Patients initially treated with TDF monotherapy with persistent viral replication at or after 24 weeks were switched to TDF/LAM. The main outcome measures were change in HBV viral load from baseline and percentage of patients achieving an undetectable viral load (<15 IU/ml). Results are reported at 96 weeks of treatment. One patient discontinued TDF at 10 days due to rash. The time-weighted change in viral load from baseline to week 12 was -2.19 log10 IU/ml overall. The median change in HBV DNA from baseline to weeks 12, 24, 48 and 96 was -2.86, -3.23, -3.75 and -4.03 log₁₀ IU/ml, respectively. At 48 and 96 weeks, 27/59 (46%) and 38/59 (64%) patients achieved a HBV DNA <15 IU/ml. The response was independent of baseline LAM therapy or mutations conferring ADV resistance. In heavily pretreated patients with a high rate of genotypic resistance, TDF retains significant activity against HBV although this appears diminished in comparison with studies of naïve patients.
    Gut 10/2010; 60(2):247-54. · 10.73 Impact Factor
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    ABSTRACT: CF liver disease is an uncommon indication for pediatric LT. Determining optimal timing and type (isolated liver versus multi-organ) of transplantation for those with severe liver disease can be challenging and involves consideration of the extent of liver disease (PHT, synthetic dysfunction) and extrahepatic factors such as pulmonary function. We present the experience of isolated LT for CF at our center. Eight children received one allograft each (3.9% of all grafts). One- and four-yr survivals are both 75%. The two deaths occurred within the first two months after LT, and in both cases, invasive fungal infections were implicated, one following treatment for acute severe rejection. All had significant PHT, and six had synthetic dysfunction. All had roux-en Y biliary anastomoses and none developed long-term biliary complications. Seven had pulmonary colonization with Pseudomonas aeruginosa and six with fungus at time of transplantation. Mean pre-LT FEV1 was 80% (range 59-116%) predicted, and lung function post-LT was stable. Isolated LT in children with CF is successful in those with relatively preserved pulmonary function, which does not appear to deteriorate as a consequence. Roux-en Y biliary anastomosis and antifungal prophylaxis should be a part of management of these patients.
    Pediatric Transplantation 09/2010; 14(6):779-85. · 1.50 Impact Factor
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    ABSTRACT: Locoregional therapies for hepatocellular carcinoma (HCC) are considered to confer a survival advantage, however, the patient group that should be targeted is not clearly defined. This study aimed to determine the impact on survival of locoregional therapies compared with supportive care, within prognostic categories as stratified by the Cancer of the Liver Italian Program (CLIP) scoring system. A prospective database was used to identify those patients who were treated with either locoregional therapy (n = 128) or supportive care (n = 92). Survival analysis was performed for groups matched by CLIP score at presentation. Comparison of important prognostic factors was undertaken and univariate and multivariate analysis was performed to assess determinants of survival. Use of locoregional therapies was only associated with a survival benefit in patients with a CLIP score of 1 or 2. In this group, the median survival in patients who received locoregional therapies was 25.0 months (95% confidence interval 22.7-27.4) compared with 8.9 months (95% confidence interval 7.3-10.5) for supportive care (P = 0.001). For patients with CLIP scores of 3 or greater, no survival benefit of locoregional therapies was observed. Multivariate analysis revealed locoregional intervention, CLIP score, tumor symptoms, alpha-fetoprotein level, bilirubin and alkaline phosphatase level as independent prognostic indicators. Locoregional therapies should be targeted specifically to patients with non-advanced hepatocellular carcinoma as assessed by validated scoring systems. Use of these therapies in patients with advanced disease does not appear to be associated with a survival benefit and may expose patients to unnecessary harm.
    Journal of Gastroenterology and Hepatology 07/2010; 25(7):1299-305. · 3.33 Impact Factor
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    ABSTRACT: ABSTRACT Background: We aimed to describe the demand for liver transplantation (LTx) and patient outcomes on the waiting list at the Australian National Liver Transplantation Unit Sydney over the last twenty years. Methods: We performed a retrospective analysis with the data divided into 3 eras: 1985-1993, 1994-2000, and 2001-2008. Results: The number of patients accepted for LTx increased from 320 to 372 and 548 (p < 0.001) with the number of LTx being performed increasing from 262 to 312 and 452 respectively (p < 0.001). The median adult recipient age increased from 45 to 48 and 52 years (p < 0.001) while it decreased in children from 4 to 2 and 1 years respectively (p=0.001). In parallel, the deceased donor offers decreased from 1003 to 720 and 717 (p < 0.001). Methods to improve access to donor livers have been utilised with the use of split livers, extended criteria and non-heart beating donors, resulting in increased acceptance of deceased donor offers by 65% and 115% in the second and third eras when compared to the first era (p < 0.001). However, the adult median waiting time has increased from 23 to 41 and 120 days respectively (p < 0.001). This was associated with increased adult mortality on the waiting list from 23 to 40 and 122 respectively (p < 0.001). Conclusions: Despite the increasing proportion of donor offers being utilised, the waiting list mortality is increasing. A solution to this problem is an increase in organ donation to keep pace with the escalating demand for LTx.
    Internal Medicine Journal 06/2010; · 1.82 Impact Factor
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    ABSTRACT: Although 1-year survival rates following liver transplantation over the last 20 years may have improved, there is doubt about improvement in long-term survival. We examined survival with and without initial 12-month mortality in adult liver transplant recipients over a 20-year period. Patient and allograft survival for 3 different time periods was compared: 1986-1994 (group 1, n = 547), 1995-2000 (group 2, n = 735), and 2000-2005 (group 3, n = 749). After this, all deaths in the first 12 months of each group were removed. Patient and allograft survival was then once again compared across the 3 groups. There was significant improvement in both patient and allograft survival across the 20-year period (P < 0.001). Overall patient and allograft survival improved in non-hepatitis C virus (HCV) patients but not in HCV patients. A similar comparison with deaths in the first year removed, however, showed no difference in patient survival (P = 0.07) and only a marginal improvement in allograft survival (P = 0.048) between the 3 time periods. When patients were divided into HCV-positive and HCV-negative groups with deaths in the first year removed, there was, however, improved patient and allograft survival in the HCV-negative group but not in the HCV-positive group. The causes of death between 1 and 5 years were then compared. There were 48 deaths in period 1, 63 in period 2, and 43 in period 3 (P = not significant). There were more deaths due to cardio/cerebrovascular disease and hepatitis B virus recurrence in the first time period, but there were more deaths due to recurrent HCV and de novo malignancy in later time periods. In conclusion, although overall survival following liver transplantation in adults seems to be improving over time, the long-term results are not, particularly in HCV patients.
    Liver Transplantation 02/2010; 16(2):130-7. · 3.94 Impact Factor

Publication Stats

1k Citations
339.40 Total Impact Points

Institutions

  • 1993–2014
    • Royal Prince Alfred Hospital
      • Department of Surgery
      Camperdown, New South Wales, Australia
  • 2011
    • Centenary Institute
      Camperdown, New South Wales, Australia
  • 2009
    • Flinders University
      Tarndarnya, South Australia, Australia
  • 1998–2009
    • Fred Hutchinson Cancer Research Center
      • • Division of Clinical Research
      • • Division of Public Health Sciences
      Seattle, WA, United States
  • 2007
    • Auckland City Hospital
      Окленд, Auckland, New Zealand
  • 1995–2001
    • St. Vincent's Hospital Melbourne
      • Department of Gastroenterology
      Melbourne, Victoria, Australia
  • 1999
    • University of Washington Seattle
      • Division of Gastroenterology
      Seattle, WA, United States
  • 1997–1998
    • St. Vincent Hospital
      Green Bay, Wisconsin, United States