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CancerSpectrum Knowledge Environment 04/2013; · 14.07 Impact Factor
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ABSTRACT: Worsening donor liver quality resulting in decreased organ utilization may be contributing to the recent decline in liver transplants nationally. We sought to examine trends in donor liver utilization and the relationship between donor characteristics and non-use. We used the United Network for Organ Sharing database to review all deceased adult organ donors in the United States who had at least one solid organ transplanted into a recipient. Trends in donor characteristics were examined. Multivariate logistic regression was used to evaluate the association between donor characteristics and liver non-use between 2004 and 2010. Population attributable risk proportions were determined for donor factors associated with non-use. 107,259 organ donors were analyzed. The number of unused livers decreased steadily from 1,958 (66% of donors) in 1988 to 841 (15%) in 2004, but then gradually increased to 1,345 (21%) in 2010. Donor age, body mass index (BMI), and the prevalence of diabetes and donation after cardiac death (DCD) all increased over time, and all four were independently associated with liver non-use. DCD had the highest adjusted odds ratio (OR) for non-use, and the odds increased nearly four-fold between 2004 (OR 5.53; 95% CI, 4.57-6.70) and 2010 (OR 21.31; 95% CI, 18.30-24.81). The proportion of non-use attributable to DCD increased from 9% in 2004 to 28% in 2010. The proportion of donor livers not used has increased since 2004. Older donor age, greater BMI, diabetes, and DCD are all independently associated with non-use and are on the rise nationally. Current trends may lead to significant declines in liver transplant availability. Liver Transpl, 2012. © 2012 AASLD.
Liver Transplantation 09/2012; · 3.39 Impact Factor
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Liver Transplantation 05/2012; 18(9):1127-8. · 3.39 Impact Factor
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ABSTRACT: Primary therapy for biliary atresia is a surgical hepatoportoenterostomy (Kasai procedure), which has been shown to reduce mortality, but is frequently complicated by ascending cholangitis and the development of biliary cirrhosis. Previously reported therapy for recurrent cholangitis caused by biliary obstruction has included surgical revision and percutaneous biliary drainage, but endoscopic retrograde cholangiopancreatography has not been previously described. Here, we report a patient with recurrent cholangitis after a Kasai procedure and an anastomotic stricture successfully treated with single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. This novel technique could be considered in patients with this common complication of the Kasai procedure and may impact long-term outcomes in this patient population.
Journal of Pediatric Surgery 05/2012; 47(5):E1-5. · 1.45 Impact Factor
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ABSTRACT: Safety concerns have been raised about nighttime and weekend patient care, but it is unknown whether these issues affect liver transplantation. We sought to identify the impact of nighttime and weekend liver transplants on graft and patient survival. We used the United Network for Organ Sharing database to review adult liver transplants from 1987 to 2010. Comparisons were made between nighttime and daytime operations and between weekday and weekend operations. Cox proportional hazard ratios (HRs) were determined 30, 90, and 365 days after transplantation after we controlled for relevant factors; 94,768 transplants were included in the analysis. The patient survival rates at 30, 90, and 365 days for nighttime operations were 96%, 93%, and 86%, respectively. The patient survival rates at 30, 90, and 365 days for weekend operations were 95%, 92%, and 86%, respectively. These rates did not significantly differ from those for daytime and weekday operations, respectively. The graft failure rate was unchanged at 30 and 90 days for weekend transplants but was modestly increased at 365 days [HR = 1.05 (95% confidence interval = 1.01-1.11)]. Graft survival was unaffected by nighttime transplantation. Nighttime and weekend operations for liver transplantation do not affect patient or graft survival, and this testifies to the patient safety measures in place.
Liver Transplantation 01/2012; 18(5):558-65. · 3.39 Impact Factor
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ABSTRACT: Fluoroquinolone-induced liver injury is rare; no prospective studies of well-characterized case series have been published. We studied patients with fluoroquinolone-induced hepatotoxicity from the Drug-Induced Liver Injury Network (DILIN) to characterize injury patterns, outcomes, and associated features.
We identified subjects with fluoroquinolone hepatotoxicity enrolled in the DILIN from September 2004 to January 2010. Demographic, clinical, and laboratory data were analyzed by descriptive statistical methods.
Of the 679 registrants in the DILIN prospective study, 12 had fluoroquinolone hepatotoxicity (6 ciprofloxacin, 4 moxifloxacin, 1 levofloxacin, and 1 gatifloxacin). Seven were women; median age was 57 years (range, 23-80 years), and median time from fluoroquinolone start to symptoms was only 4 days (range, 1-39 days). Nine patients developed symptoms on medication; 3 did so 2, 8, and 32 days after stopping the medication. Cases were equally distributed among hepatocellular injury (predominantly increased levels of alanine aminotransferase), cholestatic injury (predominantly increased levels of alkaline phosphatase), and both. Seven patients had immunoallergic features. Patients with mixed hepatocellular and cholestatic injury had mild disease without jaundice; all recovered. In contrast, 2 of 4 patients with hepatocellular injury and jaundice died, 1 of acute liver failure. One patient with cholestatic injury developed vanishing bile duct syndrome and required liver transplantation; another had a persistently increased serum level of alkaline phosphatase.
Fluoroquinolone liver injury is rapid in onset and often has immunoallergic features, indicating a hypersensitivity reaction. The pattern of injury can be hepatocellular, cholestatic, or mixed; mixed cases are the least severe. Acute and chronic liver failure can occur.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 02/2011; 9(6):517-523.e3. · 5.64 Impact Factor
