Mark S Cattral

University Health Network, Toronto, Ontario, Canada

Are you Mark S Cattral?

Claim your profile

Publications (164)636.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Donor-specific antibodies (DSA) have been associated with increased rejection and lower kidney transplant survival. The impact of DSA on pancreas transplant outcomes in patients with negative T-cell cytotoxicity cross-matches remains unclear. We performed a retrospective analysis of DSA in 171 (69 PAK and 102 SPK) consecutive pancreas transplants from a single center since January 2009, when routine DSA examination using luminex single antigen assays began. Pre-transplant DSA (Pre-DSA) was detected in 36 (21%) recipients, and was more prevalent in PAK than SPK recipients (32% vs. 16%, p=0.02). All patients with pre-DSA had a negative CDC or flow cross-match and were treated routinely with IVIG during surgery. De novo DSA developed in 44 (33%) recipients during follow-up (33% in PAK vs. 32% in SPK, p=0.89). Kidney and/or pancreas rejection occurred in 25% (42), and most 64% (22) of these occurred in the presence of DSA (p=0.012). The presence of DSA also increased the risk of having > 1 rejection episode (p=0.004). DSA became undetectable in 21 (26%) patients: in 5 patients, the same DSA reappeared in 3 and new DSA developed in 2 (reappearance of DSA was associated with an acute rejection episode in 4 of 5 recipients); in 16 patients in whom DSA remained undetectable, 5 had a subsequent rejection episode with no evidence of new DSA. Pancreas graft survival among those with and without pre-transplant DSA was 92% and 88% at 1-year and 80% and 88% at 3-years (p=0.26). Similarly, pancreas graft survival among those with and without de novo DSA was 86% and 91% at 1-year and 81% and 89% at 3-years (p=0.14). 24 graft failures occurred during follow-up time (9 in the DSA- and 15 in the DSA+), only 6 were due to rejection (3 in the DSA- and 3 in the DSA+; p=0.64). Pre-transplant DSA also did not increase the risk graft loss from rejection (13% in Pre-DSA- and 28% of Pre-DSA+; p=0.57). Conclusion: Pre-transplant DSA with a negative cross-match and post-transplant de novo DSA are risk factors for rejection, but have little impact on early pancreas transplant survival.
    American Transplant Congress 2015; 05/2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Due to a persistent discrepancy between the demand for liver transplantation and the supply of deceased donor organs, there is an interest in increasing live donation rates at centres trained in this method of transplantation. We examined a large socioeconomically heterogeneous cohort of patients listed for liver transplantation to identify recipient factors associated with live donation. We retrospectively reviewed 491 consecutive patients who were listed for liver transplantation at our centre over a 24 month period. Demographic, medical, and socioeconomic data were extracted from electronic records and compared between those who had a potential live donor volunteer for assessment, and those who did not. 245 patients (50%) had at least one potential live donor volunteer for assessment. Multivariate logistic regression analysis identified that patients with a live donor were more likely to have Child-Pugh C disease (OR 2.44, p=0.019), and less likely to be older (OR 0.96, p=0.002), single (OR 0.34, p=0.006), divorced (OR 0.53, p=0.03), immigrants (OR 0.38, p=0.049) or from the lowest income quintile (OR 0.44, p=0.016). Conclusion: This analysis has identified several factors associated with access to live donation. More research is warranted to define and overcome barriers to live donor liver transplant through targeted interventions in underrepresented populations. This article is protected by copyright. All rights reserved.
    Liver Transplantation 04/2015; DOI:10.1002/lt.24148 · 3.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Long-term biliary complications after living donor liver transplantation (LDLT) are not well described in the literature. This study was undertaken to determine the long-term impact of biliary complications after adult right-lobe LDLT. This retrospective review analyzed an 11-year experience of 344 consecutive right-lobe LDLT with at least 2 years of follow-up. Biliary leaks occurred in 50 patients (14.5%), and strictures occurred in 67 patients (19.5%). Cumulative biliary complication rates at 1, 2, 5, and 10 years were 29%, 32%, 36%, and 37%, respectively. Most early biliary leaks were treated with surgical drainage (N = 29, 62%). Most biliary strictures were treated first with endoscopic retrograde cholangiography (42%). There was no association between biliary strictures and the number of ducts (hazard ratio [HR] 1.017 [0.65-1.592]), p = 0.94), but freedom from biliary stricture was associated with a more recent era (2006-2010) (HR 0.457 [0.247-0.845], p = 0.01). Long-term graft survival did not differ between those who had or did not have biliary complications (66% versus 67% at 10 years). Biliary strictures are common after LDLT but may decline with a center's experience. With careful follow-up, they can be successfully treated, with excellent long-term graft survival rates. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 03/2015; DOI:10.1111/ctr.12538 · 1.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We report the outcome of live donor liver transplantation (LDLT) for patients suffering from acute liver failure (ALF). From 2006 to 2013, all patients with ALF who received a LDLT (n = 7) at our institution were compared to all ALF patients receiving a deceased donor liver transplantation (DDLT = 26). Groups were comparable regarding pretransplant ICU stay (DDLT: 1 [0-7] vs. LDLT: 1 days [0-10]; p = 0.38), mechanical ventilation support (DDLT: 69% vs. LDLT: 57%; p = 0.66), inotropic drug requirement (DDLT: 27% vs. LDLT: 43%; p = 0.64) and dialysis (DDLT: 2 vs. LDLT: 0 patients; p = 1). Median evaluation time for live donors was 24 h (18-72 h). LDLT versus DDLT had similar incidence of overall postoperative complications (31% vs. 43%; p = 0.66). No difference was detected between LDLT and DDLT patients regarding 1- (DDLT: 92% vs. LDLT: 86%), 3- (DDLT: 92% vs. LDLT: 86%), and 5- (DDLT: 92% vs. LDLT: 86%) year graft and patient survival (p = 0.63). No severe donor complication (Dindo-Clavien ≥3 b) occurred after live liver donation. ALF is a severe disease with high mortality on liver transplant waiting lists worldwide. Therefore, LDLT is an attractive option since live donor work-up can be expedited and liver transplantation can be performed within 24 h with excellent short- and long-term outcomes. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
    American Journal of Transplantation 03/2015; DOI:10.1111/ajt.13203 · 6.19 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Pancreas-kidney transplantation with enteric drainage has become a standard treatment in diabetic patients with renal failure. Leaks of the graft duodenum (DL) remain a significant complication after transplantation. We studied incidence and predisposing factors of DLs in both simultaneous pancreas-kidney (SPK) and pancreas after kidney (PAK) transplantation.Method Between January 2002 and April 2013 284 pancreas transplantations were performed including 191 SPK (67.3%) and 93 PAK (32.7%). Patient data were analyzed for occurrence of DLs, risk factors, leak etiology, and graft survival.ResultsOf 18 DLs (incidence 6.3%), 12 (67%) occurred within the first 100 days after transplantation. Six grafts (33%) were rescued by duodenal segment resection. Risk factors for a DL were: PAK transplantation sequence (odds ratio 3.526, p=0.008) and preoperative immunosuppression (odds ratio 3.328, p=0.012). In the SPK subgroup, postoperative peak amylase as marker of preservation/reperfusion injury and recipient pre-transplantation cardiovascular interventions as marker of atherosclerosis severity were associated with an increased incidence of DLs. CMV mismatch constellations showed an increased incidence in the SPK subgroup, however without significance probability.Conclusion Long-term immunosuppression in PAK transplantation is a major risk factor for DLs. Early surgical revision offers the chance of graft rescue.This article is protected by copyright. All rights reserved.
    Transplant International 02/2015; DOI:10.1111/tri.12535 · 3.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Data regarding transplantation outcomes in ventilated intensive care unit (ICU)-dependent patients with end-stage liver disease (ESLD) are conflicting. This single-center cohort study investigated the outcomes of patients with ESLD who were intubated with mechanical support before liver transplantation (LT). The ICU plus intubation group consisted of 42 patients with decompensated cirrhosis and mechanical ventilation before transplantation. LT was considered for intubated ICU patients if the fraction of inspired oxygen was ≤40% with a positive end-expiratory pressure ≤ 10, low pressor requirements, and the absence of an active infection. Intubated ICU patients were compared to 80 patients requiring ICU admission before transplantation without intubation and to 126 matched non-ICU-bound patients. Patients requiring ICU care with intubation and ICU care alone had more severe postoperative complications than non-ICU-bound patients. Intubation before transplantation was associated with more postoperative pneumonias (15% in intubated ICU transplant candidates, 5% in ICU-bound but not intubated patients, and 3% in control group patients; P = 0.02). Parameters of reperfusion injury and renal function on postoperative day (POD) 2 and POD 7 were similar in all groups. Bilirubin levels were higher in the ICU plus intubation group at POD 2 and POD 7 after transplantation but were normalized in all groups within 3 months. The ICU plus intubation group versus the ICU-only group and the non-ICU group had decreased 1-, 3-, and 5-year graft survival (81% versus 84% versus 92%, 76% versus 78% versus 87%, and 71% versus 77% versus 84%, respectively; P = 0.19), but statistical significance was not reached. A Glasgow coma scale score of <7 versus >7 before transplantation was associated with high postoperative mortality in ICU-bound patients requiring intubation (38% versus 23%; P = 0.01). In conclusion, ICU admission and mechanical ventilation should not be considered contraindications for LT. With careful patient selection, acceptable long-term outcomes can be achieved despite increased postoperative complications. This article is protected by copyright. All rights reserved. © 2015 American Association for the Study of Liver Diseases.
    Liver Transplantation 01/2015; DOI:10.1002/lt.24115 · 3.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pancreas transplant recipient obesity has been associated with increased risk of perioperative complications, graft failure, and death. The imperative to maximize organ utility must be balanced against the need to maintain equity of access, including for the increasing number of obese diabetic patients. We compared the outcomes of pancreas transplant recipients with body mass index (BMI) greater than 30 kg/m (n=60, mean±SD BMI 32.1±1.7 kg/m) to those with BMI less than 30 kg/m (n=308, mean±SD BMI 24.5±2.7 kg/m) between 1996 and 2013. There were no differences in the pretransplant recipient or donor characteristics apart from BMI. The BMI greater than 30 group were more likely to suffer a rejection episode (43% vs. 29%; P=0.03). The median time to first rejection was shorter (1 vs. 6 months; P=0.04), and wound infection was more common in the BMI greater than 30 group (P=0.03). There was no difference in the rate of patient, pancreas, or kidney graft survival or difference in graft function between the two groups. The obese recipients in this study were in the lower range of the obese category. Although there was an increased risk of rejection and wound infection in the obese group, there was no difference in patient or graft survival. This finding, when compared with previous reports, may be related to stringent recipient selection and posttransplant care particularly with respect to cardiovascular disease.
    Transplantation 12/2014; DOI:10.1097/TP.0000000000000495 · 3.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To identify prognostic factors after hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). We retrospectively reviewed the combined experience at Toronto General Hospital and Hospital Vall d'Hebron managing HCC recurrence after LT (n = 121) between 2000 and 2012. We analyzed prognostic factors by uni- and multi-variate analysis. Median follow-up from LT was 29.5 (range 2-129.4) months. Median follow-up from HCC recurrence was 12.2 (range 0.1-112.5) months. At recurrence, 31.4 % were treated with curative-intent treatments (surgery or ablation), 42.1 % received palliative treatment, and 26.4 % received best supportive care. The 1-, 3-, and 5-year survivals, respectively, after HCC recurrence were 75, 60, and 31 %, vs. 60, 19, and 12 %, vs. 52, 4, and 5 % (p < 0.001). By multivariate analysis, not being amenable to a curative-intent treatment [hazard ratio (HR) 4.7, 95 % confidence interval (CI) 2.7-8.3, p < 0.001], α-fetoprotein of ≥100 ng/mL at the time of HCC recurrence (HR 2.1, 95 % CI 1.3-2.3, p = 0.002) and early recurrence (<12 months) after LT (HR 1.6, 95 % CI 1.1-2.5, p = 0.03) were found to be poor prognosis factors. A prognostic score was devised on the basis of these three independent variables. Patients were divided into three groups, as follows: good prognosis, 0 points (n = 22); moderate prognosis, 1 or 2 points (n = 84); and poor prognosis, 3 points (n = 15). The 1-, 3-, and 5-year actuarial survival for each group was 91, 50, and 50 %, vs. 52, 7, and 2 %, vs. 13, 0, and 0 %, respectively (p < 0.001). Patients with HCC recurrence after transplant amenable to curative-intent treatments can experience significant long-term survival (~50 % at 5 years), so aggressive management should be offered. Poor prognosis factors after recurrence are not being amenable to a curative-intent treatment, α-fetoprotein of ≥100 ng/mL, and early (<1 year) recurrence after LT.
    Annals of Surgical Oncology 12/2014; DOI:10.1245/s10434-014-4273-6 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Liver transplantation from donation-after-circulatory death (DCD) donors has been associated with a high rate of ischemic-type biliary strictures (ITBS) and inferior graft survival. To investigate the impact of intraoperative tissue plasminogen activator (tPA) on outcomes following DCD liver transplantation (DCD-LT), we conducted a retrospective analysis of DCD liver transplants at the Toronto General Hospital (TGH) and Ochsner Medical Center (OMC). Between 2009 and 2013, 85 DCD liver transplants were performed with intraoperative tPA injection (N=30 TGH, 55 OMC) and compared to 33 DCD liver transplants without tPA. Donor and recipient characteristics were similar between both groups. There was no significant difference in intra-operative packed red blood cell transfusion requirement (3.2 ± 3.4 vs 3.1 ± 2.3, P=0.74). Overall, biliary strictures occurred less commonly in the tPA treated group (16.5% vs 33.3%, P=0.07) with a much lower rate of diffuse intra-hepatic strictures (3.5% vs 21.2%, P=0.005). After 1- and 3-years the tPA vs non tPA group had superior patient survival (97.6% vs 87.0% and 92.7% vs 79.7%; P=0.016) and graft survival (96.4% vs 69.7% and 90.2% vs 63.6%; p<0.001). In conclusion, tPA injection into the hepatic artery during DCD liver transplantation reduces ITBS and improves graft and patient survival without increasing the risk for bleeding. This article is protected by copyright. All rights reserved.
    Liver Transplantation 12/2014; 21(3). DOI:10.1002/lt.24071 · 3.79 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Helicobacter pylori infects the human gastric mucosa causing a chronic infection that is the primary risk factor for gastric cancer development. Recent studies demonstrate that H. pylori promotes tolerogenic dendritic cell (DC) development indicating that this bacterium evades the host immune response. However, the signaling pathways involved in modulating DC activation during infection remain unclear. Here, we report that H. pylori infection activated the signal transducer and activator of transcription 3 (STAT3) pathway in murine bone marrow-derived DCs (BMDCs) and splenic DCs isolated ex vivo. Isogenic cagA-, cagE-, vacA- and urease-mutants exhibited levels of phosphoSTAT3 that were comparable to in the wild-type (WT) parent strain. H. pylori-infected BMDCs produced increased immunosuppressive IL-10, which activated STAT3 in an autocrine/paracrine fashion. Neutralization of IL-10 prevented H. pylori-mediated STAT3 activation in both BMDCs and splenic DCs. In addition, anti-IL-10 treatment of infected H. pylori-BMDCs was associated with increased CD86 and MHC II expression and enhanced proinflammatory IL-1β cytokine secretion. Finally, increased CD86 and MHC II expression was detected in H. pylori-infected STAT3 knockout DCs when compared to WT controls. Together, these results demonstrate that H. pylori infection induces IL-10 secretion in DCs, which activates STAT3, thereby modulating DC maturation and reducing IL-1β secretion. These findings identify a host molecular mechanism by which H. pylori can manipulate the innate immune response to potentially favor chronic infection and promote carcinogenesis. © 2014 S. Karger AG, Basel.
    Journal of Innate Immunity 11/2014; DOI:10.1159/000368232 · 4.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Outcomes of living versus deceased donor liver transplantation in patients with chronic liver disease and hepatorenal syndrome (HRS) was compared using a matched pair study design. Thirty patients with HRS receiving a live donor liver transplantation (LDLT) and 90 HRS patients receiving a full graft deceased donor liver transplantation (DDLT) were compared. LDLT versus DDLT of patients with HRS was associated with decreased peak aspartate aminotransferase levels (339 ± 214 vs. 935 ± 1253 U/L; p = 0.0001), and similar 7-day bilirubin (8.42 ± 7.89 vs. 6.95 ± 7.13 mg/dL; p = 0.35), and international normalized ratio levels (1.93 ± 0.62 vs. 1.78 ± 0.78; p = 0.314). LDLT vs. DDLT had a decreased intensive care unit (2 [1–39] vs. 4 [0–93] days; p = 0.004), and hospital stay (17 [4–313] vs. 26 [0–126] days; p = 0.016) and a similar incidence of overall postoperative complications (20% vs. 27%; p = 0.62). No difference was detected between LDLT and DDLT patients regarding graft survival at 1 (80% vs. 82%), at 3 (69% vs. 76%) and 5 years (65% vs. 76%) (p = 0.63), as well as patient survival at 1 (83% vs. 82%), 3 (72% vs. 77%) and 5 years (72% vs. 77%) (p = 0.93). The incidence of chronic kidney disease post-LT (10% vs. 6%; p = 0.4) was similar between both groups. LDLT results in identical long-term outcome when compared with DDLT in patients with HRS.
    American Journal of Transplantation 10/2014; DOI:10.1111/ajt.12975 · 6.19 Impact Factor
  • Transplantation 09/2014; 99(2). DOI:10.1097/TP.0000000000000554 · 3.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Pancreas transplant recipient obesity has been associated with increased risk of peri-operative complications, graft failure and death. Cardiovascular co-morbidity is the key risk for the obese candidate. Methods We compared the outcomes of pancreas transplant recipients with body mass index (BMI) >30kg/m 2(n=60) to those with BMI <30kg/m 2 (n=308) between 1996 and 2013. All patients were assessed by a cardiologist prior to, and annually after transplantation. There was a low threshold for cardiovascular intervention both pre- and post-operatively. Results There were no differences in the pre-transplant recipient or donor characteristics apart from BMI. There was an increased incidence of surgical site infections in the BMI>30 group compared to the BMI<30 group (12% vs 3.2% respectively; p=0.03). Despite this, the median length of hospital stay was shorter in the BMI>30 group (9 days vs. 10 days in the BMI<30 group; p=0.02). There were no other significant differences in the complications in the first three post-operative months. The BMI>30 group were more likely to suffer a rejection episode (43% vs 29%; p=0.03) compared to the BMI<30 group, and the median time to first rejection was also shorter (1 vs. 6 months; p=0.04) in the BMI>30 group. There was no difference in the rate of patient survival, pancreas or kidney graft survival or difference in graft function between the two groups. Conclusion Although there was an increased risk of rejection and wound infection in the obese group, there was no difference in the rate of patient or graft survival. This finding, when compared with previous reports, may be related to stringent recipient selection and post-transplant care particularly with respect to cardiovascular disease.
    The World Transplant Congress, San Francisco; 06/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Although commonly applied in many centers, there are limited data to validate age alone as a selection criterion for pancreas transplantation. We analyzed the impact of recipient age ( ≥55yrs) on outcome of pancreas transplantation. Methods Retrospective analysis of a prospectively collected database was undertaken, including 382 consecutive pancreas transplants performed between 1995 and 2013. Outcomes including postoperative complications, rejection, as well as graft and patient survival were compared between recipients ≥55years (n=30) and <55 yrs (n=352). Results The recipients ≥55years had a significantly higher rate of pre-operative cardiac intervention (46% vs. 13%, p=<0.001) than those <55years. However, there were no differences in the incidence of infectious and non-infectious post-operative complications between the groups. The rate of rejection in the first three months after transplant of recipients ≥55yrs was significantly lower (13% vs. 33%, p=0.02) than recipients <55years. There were no differences in kidney or pancreas graft function. There were no statistically significant differences between the groups with respect to patient (p=0.25), kidney (p=0.71), or pancreas (p=0.14) graft survival. Conclusion Pancreas transplantation in carefully selected recipients ≥55yrs of age can yield equivalent outcomes to transplantation of recipients of a younger age. Advanced recipient age by itself should not be considered a contraindication for pancreas transplantation.
    The World Transplant Congress, San Francisco, California; 06/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background:Steroids are known to be associated with several adverse metabolic and cardiovascular (CV) side effects. Given the increase in risk of CV disease in patients with diabetes, pancreas transplant recipients may benefit from steroid withdrawal after transplant. However, the impact of steroid withdrawal on acute rejection and graft survival is controversial. Methods:A retrospective cohort study was conducted at our institution. Simultaneous pancreas-kidney (SPK) and pancreas after kidney (PAK) transplant recipients between Feb 1997 and May 2005 were included in the study and followed until April 2010. Exposure to steroids was modeled as a time-varying exposure. Cox proportional hazards models were used to examine the relation between steroid withdrawal and acute rejection as well as graft survival. Traditional CV risk factors were evaluated using parametric and non-parametric methods as appropriate. Results:141 SPK and PAK transplant recipients were included in the cohort, of which 42 underwent steroid withdrawal. 41 patients experienced acute rejection, with 17 episodes occurring in the steroid withdrawal group (36%) compared to 24 occurring in the non-steroid withdrawal group (25%). Withdrawal of steroids was associated with an increased risk of acute rejection (HR 4.74, [95% CI 1.9, 11.8], p value 0.001) but was not associated with an increased risk of graft failure (HR 1.42, [95% CI 0.64, 3.16], p value 0.4). There were no clinically significant differences in lipid profile, blood pressure and glucose tolerance at 1 year after steroid withdrawal. Conclusion:In a cohort of SPK and PAK transplant recipients at our institution, steroid withdrawal was associated with a significantly increased risk of acute rejection but no clinically meaningful changes in traditional CV risk factors. Further study is needed to determine whether steroid withdrawal may be beneficial in a subgroup of carefully selected patients.
    The World Transplant Congress, San Francisco, California; 06/2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Evaluation for pancreas transplantation in this centre requires routine cardiovascular consultation with a low threshold for intervention. We hypothesized that the requirement for pre-operative cardiovascular intervention (PCVI) may be associated with an adverse impact on outcome after pancreas transplantation. Methods Retrospective analysis of a prospectively collected database was undertaken, including 366 consecutive primary pancreas transplants performed between 1995 and 2013. Outcomes including postoperative complications, rejection, as well as graft and patient survival were compared between recipients who had undergone PCVI (n=48) and those who had not (n=318). Results The recipients undergoing PCVI were older than those not undergoing PCVI (47.6yrs (+/- 7.9) vs. 41.9yrs (+/- 7.6) respectively, p<0.0001) and the cohort included more males (73% vs. 62% respectively, p=0.02). There was a higher rate of post-operative cardiovascular events or interventions in the PCVI group (11.9% vs. 2.2% respectively, p=0.02). In the long term, there were no difference in the rate of death with graft function (p=0.77) or rejection (p=0.17). There were no statistically significant differences between the groups with respect to patient (p=0.54), kidney (p=0.76), or pancreas (p=0.63) graft survival. Conclusion PCVI is a risk factor for short term peri-operative cardiovascular events. However, the long-term transplant outcomes are equivalent to patients not requiring PCVI. The requirement for PCVI by itself should not be considered a contraindication for pancreas transplantation, but should raise awareness of increased peri-operative risk.
    The World Transplant Congress, San Francisco, California; 06/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: There is a paucity of contemporary data describing the results of pancreas retransplantation (PRT). As a measure of utility, we wished to determine whether PRT could produce equivalent short-term and long-term recipient outcomes to primary pancreas after kidney (PAK) transplantation. Methods: Retrospective analysis of 96 consecutive pancreas only transplants performed from 2003 to May 2012. Primary PAK transplants (n=78) were compared to PRT (n=18). Results: Donor and recipient demographics were similar. Pancreas graft survival was similar for PAK and PRT at 1 year (88.2% vs. 100%) and 3 years (85.1% vs. 85.1%). Pancreas graft failure occurred in 14 PAK and two PRT patients with a mean follow-up of 61.6+/-38.7 and 37.8+/-26.1 months, respectively. There were no differences in postoperative length of stay (9.9 days vs. 8.7 days; P=0.9) or postoperative complications in the first 3 months (47.4% vs. 38.9%, P=0.6). At 3-year follow-up, both groups had comparable HBA1c (0.06 vs. 0.05; P=0.8), serum creatinine (116.6 [mu]mol/L v 131.7 [mu]mol/L; P=0.09), and oral glucose tolerance tests. Conclusion: Pancreas retransplantation is a safe and effective therapy for select recipients after graft loss. Pancreas retransplantation is associated with the same risk of postoperative complications and has similar intermediate-term graft survival compared to primary PAK transplantation. Copyright
    Transplantation 06/2014; DOI:10.1097/TP.0000000000000383 · 3.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Bacterial infections are major cause of early morbidity and mortality after liver transplantation (LT). Selective digestive decontamination (SDD) can be used pre-operatively for living donor LT (LD-LT), but its role in this setting remains controversial. To evaluate this strategy, we retrospectively analyzed a cohort of consecutive LD-LTs performed in our center from March 2007 to February 2011 and compared the incidence and nature of early infectious complications, length of intensive care unit stay and hospitalization, antibiotic use, and emergence of resistant bacteria in patients with or without SDD prophylaxis. Of 148 LD-LTs in the study period, 111 received SDD prophylaxis while 37 did not. In a multivariate model, the independent factors associated with an increased risk of early post-transplant infections were length of post-operative mechanical ventilation (for every additional day OR=2.37, 95% CI 1.4-; p=0.002), and choledochojejunostomy (OR=4.14.5, 95% CI 1.95-; p=<0.0001). Use of SDD did not affect the rate or distribution of infectious complications, duration of hospitalization, antibiotic use or acquisition of resistant bacteria (OR=33.52, 95% CI; p=0.68376). In conclusion, the use of SDD prophylaxis in LD-LT was not beneficial and should be avoided, as it offers no advantage and could potentiate the emergence of multidrug resistant organisms.
    Transplant Infectious Disease 05/2014; DOI:10.1111/tid.12235 · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Cytomegalovirus (CMV) is a major pathogen affecting solid organ transplant (SOT) recipients. Prophylactic strategies have decreased the rate of CMV infection/disease among SOT. However, data on the effect of current prophylactic strategies for simultaneous pancreas-kidney (SPK) or pancreas after kidney (PAK) transplant remain limited. We report our experience of CMV prophylaxis in SPK/PAK recipients. METHODS: A total of 130 post-SPK/PAK patients were analyzed retrospectively for the rate of CMV and the risk factors associated with the acquisition of CMV. All patients received antiviral prophylaxis. The follow-up period was one yr post-transplant or until death. RESULTS: The rate of CMV post-SPK/PAK transplant was 24%, 44%, and 8.2% among the whole cohort, the D+/R- and the R+ groups, respectively. Median time of prophylaxis was 49 (0-254) d. In the whole cohort, risk factors for CMV infection/diseases were D+/R- CMV status (odds ratio [OR] = 16.075), preceding non-CMV (infection caused by bacteria or fungi and other viruses) infection (OR = 6.362) and the duration of prophylaxis (OR = 0.984). Among the CMV D+/R- group, non-CMV infection was the only risk factor for CMV disease (OR = 10.7). CONCLUSIONS: Forty-four per cent (25/57) of the D+/R- recipients developed CMV infection/disease despite CMV prophylaxis. Current CMV prophylaxis failed to prevent CMV infection/disease in this group of patients.
    Clinical Transplantation 06/2013; 27(4). DOI:10.1111/ctr.12138 · 1.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Evidence indicates that pre-transplant donor specific antibody (DSA) in kidney transplantation recipients worsens graft survival significantly. The impact of pre-transplant DSA on pancreas transplant outcome in patients with negative T-cell cytotoxicity cross-matches remains unclear. Methods: We performed a retrospective analysis of 69 consecutive pancreas transplants (40 kidney-pancreas, 29 pancreas after kidney) performed at a single institution from Jan 2010 to May 2012. The presence of DSA before transplantation was detected by Luminex single-antigen assays. All recipients received prednisone/tacrolimus/mycophenlate mofetil–based immunosuppression. Recipients with DSA also received IVIG (1g/Kg preoperatively). Results: Pre-transplant DSA was detected in 20 (29%) recipients. Demographics of the No-DSA and DSA groups were similar with respect to male sex (70% vs. 90%), recipient age (43+9 vs. 42+9 yrs., p=0.7), donor age (26+10 vs. 25+10 yrs., p=0.6), donor weight (74.5+21.2 vs. 75.7+29.9 kg, p=0.86), pancreas cold ischemic Time (CIT) (9h17m+2h10m vs. 10h6m+2h6m, p=0.2), kidney CIT (7h32m+2h vs. 9h33m+4h6m, p=0.07), pancreas warm ischemic time (WIT) (30.5+7 vs. 34.4+12 m, p=0.12), kidney WIT (31.5+7 vs. 32.3+6.5 m, p=0.9). Rejection occurred in 8 (16%) and 5 (25%) patients in the No-DSA and DSA groups (p=0.5). The median (range) time of first rejection was similar in both groups (No-DSA, 27 days (11-224); DSA, 33 days (25-124) p=0.9). Severe rejection (Banff 2a,b) occurred in 2 patients in the No-DSA group and 1 in the DSA group (p=0.68). Two pancreas grafts were lost from acute rejection in the NO-DSA group, both from non-compliance. The other causes of graft loss in the No-DSA group were duodenal leak (3), pancreatitis (3), thrombosis (1) and death (1); causes in the DSA group were leak, pancreatitis, thrombosis, and death (1 of each). Pancreas graft survival was comparable in the No-DSA and DSA groups at 3, 6, and 12 mo (92% vs. 100%, 85% vs. 94%, and 83% vs. 94% respectively). Kidney graft survival at 12 mo in the No-DSA and DSA groups was also similar at 96% vs. 92%. Conclusion: The presence of pre-transplant DSA is not associated with reduced survival of pancreas allografts during short-term follow-up. Further studies are needed to clarify the effect of IVIG therapy and impact of DSA on long-term graft survival.
    American Transplant Congress; 05/2013

Publication Stats

3k Citations
636.82 Total Impact Points

Institutions

  • 2006–2015
    • University Health Network
      • Department of Surgery
      Toronto, Ontario, Canada
  • 1994–2014
    • University of Toronto
      • • Department of Surgery
      • • Division of General Surgery
      • • Department of Medical Imaging
      Toronto, Ontario, Canada
  • 2001–2009
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 2003
    • The University of Western Ontario
      • Department of Surgery
      London, Ontario, Canada
  • 1999
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1996
    • SickKids
      Toronto, Ontario, Canada
  • 1994–1995
    • University of Nebraska Medical Center
      • • Department of Pathology and Microbiology
      • • Department of Surgery
      Omaha, Nebraska, United States