Elizabeth A Pomfret

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

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Publications (56)242.11 Total impact

  • Elizabeth A Pomfret ·

    Liver Transplantation 09/2015; DOI:10.1002/lt.24314 · 4.24 Impact Factor
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    ABSTRACT: To compare long-term survival of living donor liver transplant (LDLT) at experienced transplant centers with outcomes of deceased donor liver transplant and identify key variables impacting patient and graft survival. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study is a prospective multicenter National Institutes of Health study comparing outcomes of LDLT and deceased donor liver transplant and associated risks. Mortality and graft failure for 1427 liver recipients (963 LDLT) enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study who received transplant between January 1, 1998, and January 31, 2014, at 12 North American centers with median follow-up 6.7 years were analyzed using Kaplan-Meier and multivariable Cox models. Survival probability at 10 years was 70% for LDLT and 64% for deceased donor liver transplant. Unadjusted survival was higher with LDLT (hazard ratio = 0.76, P = 0.02) but attenuated after adjustment (hazard ratio = 0.98, P = 0.90) as LDLT recipients had lower mean model for end-stage liver disease (15.5 vs 20.4) and fewer received transplant from intensive care unit, were inpatient, on dialysis, were ventilated, or with ascites. Posttransplant intensive care unit days were less for LDLT recipients. For all recipients, female sex and primary sclerosing cholangitis were associated with improved survival, whereas dialysis and older recipient/donor age were associated with worse survival. Higher model for end-stage liver disease score was associated with increased graft failure. Era of transplantation and type of donated lobe did not impact survival in LDLT. LDLT provides significant long-term transplant benefit, resulting in transplantation at a lower model for end-stage liver disease score, decreased death on waitlist, and excellent posttransplant outcomes. Recipient diagnosis, disease severity, renal failure, and ages of recipient and donor should be considered in decision making regarding timing of transplant and donor options.Clinical Trials ID: NCT00096733.
    Annals of surgery 09/2015; 262(3):465-475. DOI:10.1097/SLA.0000000000001383 · 8.33 Impact Factor
  • Mohamed E. Akoad · Elizabeth A. Pomfret ·

  • 15th Annual State of the Art Winter Symposium of the; 01/2015
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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. Trial Registration ClinicalTrials.gov NCT00548405
    PLoS ONE 08/2014; 9(8):e104408. DOI:10.1371/journal.pone.0104408 · 3.23 Impact Factor

  • Radiology 11/2013; 269(2):619. DOI:10.1148/radiol.13131051 · 6.87 Impact Factor
  • Article: Response.

    Radiology 11/2013; 269(2):619-20. · 6.87 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). DOI:10.1002/lt.23608 · 4.24 Impact Factor
  • Yee Lee Cheah · Mary Ann Simpson · James J Pomposelli · Elizabeth A Pomfret ·
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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 05/2013; 19(5). DOI:10.1002/lt.23575 · 4.24 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 04/2013; 19(4). DOI:10.1002/lt.23610 · 4.24 Impact Factor
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    ABSTRACT: A new liver allocation policy featuring improved imaging criteria for HCC exceptions has been developed and approved by OPTN/UNOS in late 2011. Included are minimum technical and protocol requirements for CT and MR imaging, diagnostic and classification criteria for HCC, and standardized reporting requirements. The intent is to improve the accuracy of radiologic diagnosis and staging of HCC, qualifying patients for automatic MELD exception points on the LT waiting list and in the absence of liver biopsy. Radiologists in accredited transplantation centers in the United States are now challenged to implement the policy.
    Radiology 02/2013; 266(2):376-82. DOI:10.1148/radiol.12121698 · 6.87 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 11/2012; 18(S2). DOI:10.1002/lt.23525 · 4.24 Impact Factor
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    James J Pomposelli · Assanee Tongyoo · Christoph Wald · Elizabeth A Pomfret ·
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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 09/2012; 18(9):1083-92. DOI:10.1002/lt.23461 · 4.24 Impact Factor
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    ABSTRACT: Sher L, Jennings L, Rudich S, Alexopoulos SP, Netto G, Teperman L, Kinkhabwala M, Brown RS Jr, Pomfret E, Klintmalm G; HCV-3 Study Group. Results of live donor liver transplantation in patients with hepatitic C virus infection: the HCV 3 trial experience. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01561.x. © 2011 John Wiley & Sons A/S. 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. DOI:10.1111/j.1399-0012.2011.01561.x · 1.52 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 12/2011; 17(12):1394-403. DOI:10.1002/lt.22417 · 4.24 Impact Factor
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    ABSTRACT: Pomposelli JJ, Akoad M, Khwaja K, Lewis WD, Cheah YL, Verbesey J, Jenkins RL, Pomfret EA. Evolution of anterior segment reconstruction after live donor adult liver transplantation: a single-center experience. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01529.x. © 2011 John Wiley & Sons A/S. 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. DOI:10.1111/j.1399-0012.2011.01529.x · 1.52 Impact Factor
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    Elizabeth A Pomfret · J Peter A Lodge · Federico G Villamil · Mark Siegler ·

    Liver Transplantation 10/2011; 17 Suppl 2(S2):S128-32. DOI:10.1002/lt.22356 · 4.24 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 10/2011; 17(10):1226-33. DOI:10.1002/lt.22342 · 4.24 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 Transpl 17: 1005-1012, 2011. (C) 2011 AASLD.
    Liver Transplantation 09/2011; 17(9):1005-12. DOI:10.1002/lt.22349 · 4.24 Impact Factor
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    ABSTRACT: Pulmonary arterial hypertension (PAH) associated with portal hypertension [portopulmonary hypertension (PPHTN)] occurs in 2% to 10% of patients with advanced liver disease and carries a very poor prognosis without treatment. Most hepatic transplantation centers consider moderate to severe PPHTN to be a contraindication to liver transplantation because of the high rate of perioperative complications. We present 3 patients with PPHTN who were managed with intravenous prostacyclin therapy followed by living donor liver transplantation (LDLT). These individuals demonstrated subsequent resolution of their pulmonary hypertension and were weaned off all PAH-specific medical therapy. We present their demographics, clinical courses, and hemodynamics. We discuss the potential indications for LDLT and risks with respect to this patient population. Limitations of the Model for End-Stage Liver Disease scoring system and outcome data for this patient population are reviewed. Future studies should be directed toward better defining indications for LDLT in patients with PPHTN, improving medicosurgical management, and assessing long-term outcomes.
    Liver Transplantation 08/2010; 16(8):983-9. DOI:10.1002/lt.22107 · 4.24 Impact Factor

Publication Stats

2k Citations
242.11 Total Impact Points


  • 2001-2015
    • Lahey Hospital and Medical Center
      • • Department of Transplantation
      • • Department of Radiology
      Берлингтон, Massachusetts, United States
  • 2013
    • St Vincent's University Hospital
      Dublin, Leinster, Ireland
  • 2003-2013
    • Tufts University
      • Clinical Research Division
      Бостон, Georgia, United States
  • 2010
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 1998
    • Beth Israel Deaconess Medical Center
      • Department of Surgery
      Boston, MA, United States