Elizabeth A Pomfret

Lahey Hospital and Medical Center, Burlington, Massachusetts, United States

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Publications (90)404.25 Total impact

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    ABSTRACT: Rabbit antithymocyte globulin (ATG) is commonly used as an induction therapy in renal transplant recipients, but the ideal dosage in tacrolimus-based early steroid withdrawal protocols has not been established. The purpose of this pilot study was to determine the immunophenotyping and efficacy of lower dose ATG in low immunological-risk kidney transplant recipients. In this prospective study, 45 patients were randomized (1∶1) to our standard dose ATG (total dose 3.75 mg/kg)(sATG) vs. lower dose 2.25 mg/kg (lowATG). All patients underwent early steroid withdrawal within 7 days. The primary end point was biopsy-proven acute rejection at 12 months. Prospective immunophenotyping of freshly isolated PBMCs was performed at baseline, 3, 6, 12 months post-transplant. The rate of acute rejection was 17% and 10% in the sATG and lowATG, respectively. Effector memory T cells, Tregs and recent thymic emigrants T cells had similar kinetics post-transplant in both groups. No statistically significant differences were found in graft survival, patient survival or infections between the two groups, though there was a non-significant increase in leukopenia (43%v s. 30%), CMV (8% vs. 0) and BK (4% vs. 0) infections in sATG group vs. lowATG. In sum, in low immunological risk kidney recipients undergoing steroid withdrawal, low dose ATG seems to be efficacious in preventing acute rejection and depleting T cells with potentially lower infectious complications. A larger study is warranted to confirm these findings.
    PLoS ONE 01/2014; 9(8):e104408. · 3.53 Impact Factor
  • Article: Response.
    Radiology 11/2013; 269(2):619-20. · 6.34 Impact Factor
  • Radiology 11/2013; 269(2):619. · 6.34 Impact Factor
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    ABSTRACT: Living donor liver transplantation (LDLT), originally used in children with left lateral segment grafts, has been expanded to adults who require larger grafts to support liver function. Most adult LDLT procedures have been performed with right lobe grafts, and this means a significant risk of morbidity for the donors. To minimize the donor risk for adults, there is renewed interest in smaller left lobe grafts. The smaller graft size increases the recipient risk in the form of small-for-size syndrome (SFSS) and essentially transfers the risk from the donor to the recipient. We review the donor and recipient risks of LDLT and pay particular attention to the different types of liver grafts and the use of graft inflow modification to ameliorate the risk of SFSS. Finally, a new metric is proposed for quantifying the recipient benefit in exchange for a specific donor risk. Liver Transpl 19:472–481, 2013. © 2013 AASLD.
    Liver Transplantation 05/2013; 19(5). · 3.94 Impact Factor
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    ABSTRACT: A new Organ Procurement and Transplant Network/ United Network for Organ Sharing (OPTN/UNOS) bylaw recommends all centers appoint a Director of Liver Transplant Anesthesia using a uniform set of criteria. We obtained survey data from the Liver Transplant Anesthesia Consortium to compare existing criteria for a Director in the US with the current recommendations. The dataset included responses from adult academic liver transplant programs prior to the new bylaw. Respondent rates were within statistical limits to exclude sampling bias. All centers had an anesthesia liver transplant Director. Criteria varied between institutions and the data suggested that availability of resources influenced the choice of criteria. The information suggests that criteria used in the new bylaw reflect existing practices. The bylaw plays an important role in supporting emerging leadership roles in liver transplant anesthesia and brings greater uniformity to the Directorship position. Liver Transpl, 2013. © 2013 AASLD.
    Liver Transplantation 02/2013; · 3.94 Impact Factor
  • Radiology 02/2013; 266(2):376-82. · 6.34 Impact Factor
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    ABSTRACT: Rapid allograft infection complicates liver transplantation (LT) in patients with hepatitis C virus (HCV). Pegylated interferon-α and ribavirin therapy after LT has significant toxicity and limited efficacy. The effect of a human monoclonal antibody targeting the HCV E2 glycoprotein (MBL-HCV1) on viral clearance was examined in a randomized, double-blind, placebo-controlled pilot study in patients infected with HCV genotype 1a undergoing LT. Subjects received 11 infusions of 50 mg/kg MBL-HCV1 (n = 6) or placebo (n = 5) intravenously with three infusions on day of transplant, a single infusion on days 1 through 7 and one infusion on day 14 after LT. MBL-HCV1 was well-tolerated and reduced viral load for a period ranging from 7 to 28 days. Median change in viral load (log(10) IU/mL) from baseline was significantly greater (p = 0.02) for the antibody-treated group (range -3.07 to -3.34) compared to placebo group (range -0.331 to -1.01) on days 3 through 6 posttransplant. MBL-HCV1 treatment significantly delayed median time to viral rebound compared to placebo treatment (18.7 days vs. 2.4 days, p < 0.001). As with other HCV monotherapies, antibody-treated subjects had resistance-associated variants at the time of viral rebound. A combination study of MBL-HCV1 with a direct-acting antiviral is underway.
    American Journal of Transplantation 01/2013; · 6.19 Impact Factor
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    ABSTRACT: BACKGROUND: The incidence of morbidity and mortality after live-donor liver transplantation (LDLT) is not well understood since reporting is not standardized and relies on single center reports. Aborted hepatectomy (AH) or potentially life-threatening "near-miss" events where a donor's life may have been in danger but no long-term sequelae occurred are rarely reported. We conducted a world-wide survey of programs performing LDLTs to determine the incidence of these events. METHODS: A survey instrument was sent to 148 programs performing LDLT. Programs were asked to provide donor demographics, case volume, graft type, operative morbidity and mortality, "near-miss" events and AHs. RESULTS: 71 programs (48%) that performed 11, 553 donor hepatectomy cases, representing 21 countries completed the survey. Donor morbidity was 24% with 5 donors (0.04%) requiring transplantation. Donor mortality was 0.2% (23/11,553) with the majority occurring within 60 days and all but 4 deaths were related to the donation surgery. The incidence of "near-miss" events and AH was 1.1% and 1.2% respectively. Program experience did not affect the incidence of donor morbidity or mortality but "near-miss" events and AH were more likely in low volume (<50 total LDLTs) programs. CONCLUSIONS: It appears that independent of program experience, there is a consistent donor mortality rate of 0.2% associated with LDLT donor procedures yet increased experience is associated with lower rates of AH and "near miss" events. Potentially life-threatening "near-miss" events and aborted hepatectomy are under-appreciated complications that must be discussed as part of the informed consent with any potential live liver donor. © 2012 American Association for the Study of Liver Diseases.
    Liver Transplantation 11/2012; · 3.94 Impact Factor
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    Mary Ann Simpson, Elizabeth A Pomfret
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    ABSTRACT: Key Points 1. Expertise in hepatobiliary surgery. 2. Donor selection criteria. 3. Selective liver biopsy in donors. 4. Accurate determination of hepatic volumes and anatomy. 5. Extent of donor hepatectomy. 6. Donor psychosocial evaluation. 7. Catastrophic events. 8. Long-term follow up. Liver Transpl, 2012. © 2012 AASLD.
    Liver Transplantation 08/2012; · 3.94 Impact Factor
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    ABSTRACT: Although previous consensus recommendations have helped define patients who would benefit from simultaneous liver-kidney transplantation (SLK), there is a current need to reassess published guidelines for SLK because of continuing increase in proportion of liver transplant candidates with renal dysfunction and ongoing donor organ shortage. The purpose of this consensus meeting was to critically evaluate published and registry data regarding patient and renal outcomes following liver transplantation alone or SLK in liver transplant recipients with renal dysfunction. Modifications to the current guidelines for SLK and a research agenda were proposed.
    American Journal of Transplantation 07/2012; · 6.19 Impact Factor
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    ABSTRACT: The estimation of the standard liver volume (SLV) is an important component of the evaluation of potential living liver donors and the surgical planning for resection for tumors. At least 16 different formulas for estimating SLV have been published in the worldwide literature. More recently, several proprietary software-assisted image postprocessing (SAIP) programs have been developed to provide accurate volume measurements based on the actual anatomy of a specific patient. Using SAIP, we measured SLV in 375 healthy potential liver donors and compared the results to SLV values that were estimated with the previously published formulas and each donor's demographic and anthropomorphic data. The percentage errors of the 16 SLV formulas versus SAIP varied by more than 59% (from -21.6% to +37.7%). One formula was not statistically different from SAIP with respect to the percentage error (-1.2%), and another formula was not statistically different with respect to the absolute liver volume (18 mL). More than 75% of the estimated SLV values produced by these 2 formulas had percentage errors within ±15%, and the formulas provided good predictions within acceptable agreement (±15%) on scatter plots. Because of the wide variability, care must be taken when a formula is being chosen for estimating SLV, but the 2 aforementioned formulas provided the most accurate results with our patient demographics.
    Liver Transplantation 04/2012; 18(9):1083-92. · 3.94 Impact Factor
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    A Tongyoo, E A Pomfret, J J Pomposelli
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    ABSTRACT: Lee et al. recently published a method for estimating right hemi-liver volume (RHLV) by using bedside ultrasound measurement of right (R) and left (L) portal vein (PV) diameters and Urata's standard liver volume (SLV) formula where RHLV = SLV×[R(2) /(R(2) +L(2) )]. We calculated RHLV by substituting SLV from 15 different published formulas in the worldwide literature. We also modified Lee's method using right anterior (RA) and posterior (RP) where RHLV = SLV×[(RA(2) +RP(2) )/(RA(2) +RP(2) +L(2) )] for donors with unusual PV branching. We compared the calculated RHLV with RHLV estimated with software-assisted CT (SACT) volumetry and actual graft weight after right-lobe donation in 200 right-lobe donors. This study confirmed that accurate estimates of RHLV can be achieved by SACT volumetry or by the simple method of Lee but using the SLV of only 3 of the 15 published formulas (Lin or Vauthey using body weight or body surface area) rather than Urata's. Our modification of the Lee's formula using RA and RP, PV diameters was also accurate and not different from Lee's formula. These simplified formulas may be used for donor screening for graft size adequacy before expensive evaluation proceeds.
    American Journal of Transplantation 01/2012; 12(5):1229-39. · 6.19 Impact Factor
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    M A Simpson, E A Pomfret
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    ABSTRACT: Psychosocial evaluation of living liver donors is an inexact science; the article by DiMartini et al (page 136) suggests means by which this important aspect of living donor evaluation may be standardized.
    American Journal of Transplantation 01/2012; 12(1):7-8. · 6.19 Impact Factor
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    ABSTRACT: Chronic hepatitis C virus (HCV) is the most common disease indication for liver transplantation (LT). Outcomes are compromised by near universal recurrence of HCV. A prospective multi-center randomized study to evaluate immunosuppressive strategies in HCV+ transplant recipients provided the opportunity to assess impact of live donor (LD) LT. Two hundred and ninety-five patients undergoing LT for HCV (260 deceased donor [DD] recipients/35 LD recipients), randomized to three regimens, were followed for two yr for patient and graft survival and rate and severity of recurrent HCV. Biopsies were performed at baseline, 3, 12, and 24 months. One- and two-yr patient survival for LD recipients was 88.1% and 81.1% vs. 90.5% and 84.6% for DD recipients (p = 0.5665). One- and two-yr graft survival for LD recipients was 82.9% and 76.2% vs. 87.9% and 81.7% for DD recipients (p = 0.3921). Recurrent HCV did not account for more deaths or graft losses in the LD recipients. In this prospective study, controlled for immunosuppression, use of LD organs did not increase the rate or severity of HCV recurrence. The more elective nature of LDLT affords an opportunity to manipulate donor and recipient factors that can impact upon outcomes.
    Clinical Transplantation 12/2011; 26(3):502-9. · 1.63 Impact Factor
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    ABSTRACT: Although liver transplantation is a widely accepted treatment for hepatocellular carcinoma (HCC), much controversy remains and there is no generally accepted set of guidelines. An international consensus conference was held on Dec 2-4, 2010, in Zurich, Switzerland, with the aim of reviewing current practice regarding liver transplantation in patients with HCC and to develop internationally accepted statements and guidelines. The format of the conference was based on the Danish model. 19 working groups of experts prepared evidence-based reviews according to the Oxford classification, and drafted recommendations answering 19 specific questions. An independent jury of nine members was appointed to review these submissions and make final recommendations, after debates with the experts and audience at the conference. This report presents the final 37 statements and recommendations, covering assessment of candidates for liver transplantation, criteria for listing in cirrhotic and non-cirrhotic patients, role of tumour downstaging, management of patients on the waiting list, role of living donation, and post-transplant management.
    The Lancet Oncology 10/2011; 13(1):e11-22. · 25.12 Impact Factor
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    ABSTRACT: Controversy exists regarding the best method for venous outflow reconstruction after live donor liver transplantation using right lobe grafts. Some authors advocate routine inclusion of the middle hepatic vein with the graft, whereas others favor a more selective approach. In this report, we examine the evolution of our decision making and technique of selective anterior venous segment reconstruction during live donor adult liver transplantation performed in 226 recipients. We have developed a simplified back-bench procedure using sequential-composite anastomosis using various vascular conduits with syndactylization to the right hepatic vein creating a single large-outflow anastomosis in the recipient. Conduits used include iliac artery or vein allograft, recanalized umbilical vein, cryopreserved iliac artery allograft, and 6-mm synthetic expanded polytetrafluoroethylene vascular graft. This technique can be performed quickly, safely, and under cold storage conditions and results in excellent outcome while minimizing donor risk.
    Clinical Transplantation 10/2011; 26(3):470-5. · 1.63 Impact Factor
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    ABSTRACT: This randomized, prospective, multicenter trial compared the safety and efficacy of steroid-free immunosuppression (IS) to the safety and efficacy of 2 standard IS regimens in patients undergoing transplantation for hepatitis C virus (HCV) infection. The outcome measures were acute cellular rejection (ACR), severe HCV recurrence, and survival. The patients were randomized (1:1:2) to tacrolimus (TAC) and corticosteroids (arm 1; n = 77), mycophenolate mofetil (MMF), TAC, and corticosteroids (arm 2; n = 72), or MMF, TAC, and daclizumab induction with no corticosteroids (arm 3; n = 146). In all, 295 HCV RNA-positive subjects were enrolled. At 2 years, there were no differences in ACR, HCV recurrence (biochemical evidence), patient survival, or graft survival rates. The side effects of IS did not differ, although there was a trend toward less diabetes in the steroid-free group. Liver biopsy samples revealed no significant differences in the proportions of patients in arms 1, 2, and 3 with advanced HCV recurrence (ie, an inflammation grade ≥ 3 and/or a fibrosis stage ≥ 2) in years 1 (48.2%, 50.4%, and 43.0%, respectively) and 2 (69.5%, 75.9%, and 68.1%, respectively). Although we have found that steroid-free IS is safe and effective for liver transplant recipients with chronic HCV, steroid sparing has no clear advantage in comparison with traditional IS.
    Liver Transplantation 08/2011; 17(12):1394-403. · 3.94 Impact Factor
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    Liver Transplantation 06/2011; 17 Suppl 2:S128-32. · 3.94 Impact Factor
  • Kenneth Washburn, Elizabeth Pomfret, John Roberts
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    ABSTRACT: Recent discussions about the distribution of cadaveric liver allografts for transplantation have raised many important issues. Over the past 2 years, a deliberative process including discussions, modeling, a request for information, a public forum, and a concept document has led to a greater focus on a possible path for reducing wait-list mortality. Here we describe that process, our interpretation of the feedback and responses, and possible recommendations.
    Liver Transplantation 06/2011; 17(9):1005-12. · 3.94 Impact Factor
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    ABSTRACT: All right hepatic lobe (RHL) donors in our program are asked to participate in a longitudinal quality-of-life study that begins at their evaluation and continues throughout the first postdonation year. Here we report the characteristics of donor candidates who completed the donation process despite ambivalence. In all, 183 RHL candidates consented, and 133 became donors. Ambivalent donors (ADs; n = 45) identified themselves through verbal statements or written comments, or they were identified by staff during the evaluation. ADs were predominantly male (73.3%), were older than unambivalent donors (UADs; >35 years: 76% of ADs versus 53% of UADs, P = 0.008), and were well educated (college graduate: 60% of ADs versus 17% of UADs, P = 0.01). Brother-to-brother and son-to-father combinations were most common among ADs. Alcohol (22% versus 11%, P = 0.04) and hepatitis C virus (51% versus 27%, P = 0.008) were more common as disease etiologies for recipients with ADs versus recipients with UADs. More ADs than UADs considered themselves to be religious (68.9% versus 43.2%, P = 0.007). Ambivalence about RHL donation was present in 33.8% of the candidates who completed the donation process. These results suggest that ambivalence should not be the sole reason for disqualifying a potential donor who otherwise satisfies program requirements.
    Liver Transplantation 05/2011; 17(10):1226-33. · 3.94 Impact Factor

Publication Stats

2k Citations
404.25 Total Impact Points

Institutions

  • 2000–2014
    • Lahey Hospital and Medical Center
      • • Department of Transplantation
      • • Department of Anatomic Pathology
      Burlington, Massachusetts, United States
  • 2013
    • Tufts University
      Georgia, United States
    • St Vincent's University Hospital
      Dublin, Leinster, Ireland
  • 2010
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 2009
    • Stanford University
      • Division of Abdominal Transplantation
      Palo Alto, CA, United States
    • Baystate Medical Center
      Springfield, Massachusetts, United States
  • 2004
    • New England Baptist Hospital
      Boston, Massachusetts, United States
  • 2003
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1998–2003
    • Beth Israel Deaconess Medical Center
      • • Department of Pathology
      • • Department of Radiology
      • • Department of Surgery
      Boston, MA, United States