Patrick S Kamath

Baylor University, Waco, Texas, United States

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Publications (277)2699.84 Total impact

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    ABSTRACT: Objective: To determine the incidence of major adverse events related to a large volume of image-guided liver biopsies performed at our institution over a 12-year period and to identify risk factors for major bleeding events. Patients and methods: A retrospective analysis of an internally maintained biopsy registry was performed. The analysis revealed that 6613 image-guided liver biopsies were performed in 5987 adult patients between December 7, 2001, and December 31, 2013. Liver biopsies were performed using real-time ultrasound guidance and a spring-loaded biopsy device, with rare exceptions. Adverse events considered major and included in this study were hematoma, infection, pneumothorax, hemothorax, and death. Using data from the biopsy registry, we evaluated statistically significant risk factors (P<.05) for hematoma related to image-guided liver biopsy, including coagulation status, biopsy technique, and medications. Results: A total of 49 acute and delayed major adverse events (0.7%) occurred after 6613 liver biopsy events. The incidence of hematoma requiring transfusion and/or angiographic intervention was 0.5% (34 of 6613). The incidence of infection was 0.1% (8 of 6613), and that of hemothorax was 0.06% (4 of 6613). No patient (0%) incurred a pneumothorax after biopsy. Three patients (0.05%) died within 30 days of liver biopsy, 1 being directly related to biopsy. Thirty-eight of 46 major adverse events (83%) presented acutely (within 24 hours). More than 2 biopsy passes, platelets 50,000/μL or less, and female sex were statistically significant risk factors for postbiopsy hemorrhage. Conclusion: Image-guided liver biopsy performed by subspecialized interventionalists at a tertiary medical center is safe when the platelet count is greater than 50,000/μL. With appreciation of specific risk factors, safety outcomes of this procedure can be optimized in both general and specialized centers.
    No preview · Article · Feb 2016 · Mayo Clinic Proceedings
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    ABSTRACT: Non-selective beta-blockers (NSBBs), given to reduce risk of variceal bleeding, have been associated with increased mortality in patients with cirrhosis and refractory ascites in some, but not all, studies. We performed a systematic review and meta-analysis to evaluate the effect of NSBBs on all-cause mortality in patients with cirrhosis and refractory ascites.
    No preview · Article · Jan 2016
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    Dataset: mmc1

    Full-text · Dataset · Jan 2016
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    Full-text · Dataset · Jan 2016
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    ABSTRACT: Partial hepatectomy and cyst fenestration (PHCF) selectively provides clinical benefit in highly symptomatic patients with Polycystic Liver Disease (PLD). This study aims to ascertain whether the reduction in liver volume achieved by PHCF is sustained long-term.
    Full-text · Article · Jan 2016 · Journal of the American College of Surgeons
  • Patrick S. Kamath · Julie Heimbach · Russell H. Wiesner

    No preview · Article · Dec 2015
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    ABSTRACT: Aim: To evaluate the determinants of 3-month readmissions in cirrhotic inpatients using the prospective 14-center NACSELD (North American Consortium for the Study of End-Stage Liver Disease) cohort. Methods: Cirrhotics hospitalized for non-elective indications were consented and followed for 3-months post-discharge. The number of 3-month readmissions and their determinants on index admission and discharge were calculated. We used multivariable logistic regression for all readmissions, and for hepatic encephalopathy (HE), renal/metabolic and infection-related readmissions. A score was developed using admission/discharge variables for the total sample, which was validated on a random half of the total population. Results: 1353 patients were enrolled, 1177 were eligible on discharge and 1013 had 3-month outcomes. Readmissions occurred in 53% (n=535;316 with one, 219 with ≥2), with consistent rates across sites. The leading causes were liver-related (n=333, HE, renal/metabolic and infections). Cirrhotics with worse MELD, diabetes, those taking prophylactic antibiotics and with prior HE, were more likely to be readmitted. The admission model included MELD and diabetes (c-statistic=0.64; after split-validation 0.65). The discharge model included MELD, proton pump inhibitor use and lower length-of-stay (c-statistic=0.65; after split-validation 0.70). 30% of readmissions could not be predicted. Patients with liver-related readmissions consistently had index-stay nosocomial infections as a predictor for HE, renal/metabolic and infection-associated readmissions (OR 1.9-3.0). Conclusions: Three-month readmissions occurred in about half of discharged cirrhotics, which were associated with cirrhosis severity, diabetes and nosocomial infections. Close monitoring of advanced cirrhotics and prevention of nosocomial infections could reduce this burden. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Hepatology
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    ABSTRACT: We reviewed records of all patients with an initial Fontan operation or revision from 1973 to 2012 at our institution (n = 1,138); 195 patients had postoperative liver data available. Cirrhosis was identified by histopathology or characteristic findings on imaging with an associated diagnosis of cirrhosis by a hepatologist. Of 195 patients with biopsy or imaging, 10-, 20-, and 30-year freedom from cirrhosis was 99%, 94%, and 57%, respectively. There were 40 of 195 patients (21%) diagnosed with cirrhosis (mean age at Fontan 10.7 ± 8 years). On multivariate analysis, hypoplastic left heart syndrome was associated with increased risk of cirrhosis (n = 2 of 16, p = 0.0133), whereas preoperative sinus rhythm was protective (p = 0.009). Survival after diagnosis of cirrhosis was 57% and 35%, at 1, and 5 years, respectively. The cause of death was known for 9 patients (5 multiorgan failure, 2 liver failure, and 2 heart failure). In conclusion, there is an incremental occurrence of cirrhosis after the Fontan, which should be considered when designing follow-up protocols for patients after Fontan operation.
    No preview · Article · Nov 2015 · The American journal of cardiology
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    ABSTRACT: Background/aims: The mechanisms by which hepatocyte exposure to alcohol activates inflammatory cells such as macrophages in alcoholic liver disease (ALD) are unclear. The role of released nano-sized membrane vesicles, termed extracellular vesicles (EV), in cell-to-cell communication has become increasingly recognized. We tested the hypothesis that hepatocytes exposed to alcohol may increase EV release to elicit macrophage activation. Methods: Primary hepatocytes or HepG2 hepatocyte cell lines overexpressing ethanol-metabolizing enzymes Alcohol dehydrogenase (HepG2(ADH)) or cytochrome P450 2E1 (HepG2(Cyp2E1)) were treated with ethanol and EV release was quantified with nanoparticle tracking analysis (NTA). EV mediated macrophage activation was monitored by analyzing inflammatory cytokines and macrophage associated mRNA expression, immunohistochemistry, biochemical serum ALT and triglycerides analysis in our in vitro macrophage activation and in vivo murine ethanol feeding studies. Results: Ethanol significantly increased EV release by 3.3 fold from HepG2(Cyp2E1) cells and was associated with activation of caspase-3. Blockade of caspase activation with pharmacological or genetic approaches abrogated alcohol induced EV release. EV stimulated macrophage activation and inflammatory cytokine induction. An unbiased microarray-based approach and antibody neutralization experiments demonstrated a critical role of CD40 ligand (CD40L) in EV mediated macrophage activation. In vivo, wild-type (WT) mice receiving a pan-caspase, Rho kinase inhibitor or with genetic deletion of CD40 (CD40(-/-)) or the caspase-activating TRAIL receptor (TR(-/-)), were protected from alcohol-induced injury and associated macrophage infiltration. Moreover, serum from patients with alcoholic hepatitis (AH) showed increased levels of CD40L enriched EV. Conclusion: In conclusion, hepatocytes release CD40L containing EV in a caspase dependent manner in response to alcohol exposure which promotes macrophage activation, contributing to inflammation in ALD.
    Full-text · Article · Nov 2015 · Journal of Hepatology
  • Sakkarin Chirapongsathorn · Patrick S. Kamath

    No preview · Article · Oct 2015 · Mayo Clinic Proceedings
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    ABSTRACT: Objectives: The purpose of this study was to determine the rate of major bleeding complications for ultrasound-guided paracentesis performed in thrombocytopenic patients. Methods: We retrospectively reviewed the electronic medical records of patients with platelet counts of less than 50,000/μL who had ultrasound-guided paracenteses performed in the Department of Radiology without correcting preprocedural platelet transfusions between 2005 and 2011. Medical records were evaluated for evidence of major bleeding complications (grade 3 or higher as defined by the National Institutes of Health's Common Terminology Criteria for Adverse Events, version 4.03) and their clinical sequelae. Platelet count and bleeding complications were evaluated for an association, and a sensitivity analysis was performed to determine whether analysis of a control group of patients without thrombocytopenia would yield added confidence in this assessment. Results: Among 304 procedures in 205 thrombocytopenic patients (69% male; mean age ± SD, 56.6 ± 11.9 years), the mean platelet count was 38,400 ± 9300/μL (range, 9000-49,000/μL). Three major bleeding complications requiring red blood cell transfusion were observed in patients with platelet counts of 41,000 to 46,000/μL, for a complication rate of 0.99% (95% confidence interval, 0.3%-2.9%). No patient required an additional procedure or died because of the bleeding complication. There was no association of platelet count with bleeding complications. The sensitivity analysis showed that further evaluation of patients with normal platelet counts would not add to the conclusion. Conclusions: The risk of major bleeding after ultrasound-guided paracentesis in thrombocytopenic patients is very low. In most patients, routine assessment of the preprocedural serum platelet concentration is not necessary, and correction of such an abnormal laboratory value is not indicated.
    No preview · Article · Sep 2015 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • Patrick S Kamath · John J Poterucha · Jurgen Ludwig

    No preview · Article · Aug 2015 · Journal of Hepatology
  • William Sanchez · Patrick S Kamath

    No preview · Article · Aug 2015 · Hepatology
  • Sumeet K Asrani · Douglas A Simonetto · Patrick S Kamath
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    ABSTRACT: Over the last two decades, the concept of acute-on-chronic liver failure (ACLF) has been proposed as an alternate path in the natural history of decompensated cirrhosis. ACLF is thus characterized by the presence of a precipitating event (identified or unidentified) in subjects with underlying chronic liver disease leading to rapid progression of liver injury and ending in multi-organ dysfunction characterized by high short term mortality. Multiple organ failure and increased risk for mortality are key to diagnosis of ACLF. The prevalence of ACLF ranges from 24-40% in hospitalized patients. The pathophysiological basis of ACLF can be explained using a 4 part model of predisposing event, injury due to precipitating event, response to injury and organ failure. Though several mathematical scores have been proposed for identifying outcomes with ACLF, it is yet unclear whether these organ failure scores are truly prognostic or are only reflective of the dying process. Treatment paradigms continue to evolve but consist of early recognition, supportive intensive care, and consideration of liver transplantation prior to onset of irreversible multiple organ failure. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association
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    ABSTRACT: To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis. A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I (2) test. Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%). TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis.
    No preview · Article · Jul 2015 · World Journal of Hepatology
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    Patrick S Kamath · Raj Mookerjee

    Preview · Article · Jul 2015 · Journal of Hepatology
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    ABSTRACT: Endoscopic band ligation and glue injection are established techniques for variceal bleeding. As EUS may enhance variceal detection and improve therapeutic targeting, we aim to report our experience on EUS-guided coil embolization, with and without concomitant glue injection, of varices. A prospectively maintained EUS database was retrospectively reviewed to identify consecutive patients who underwent EUS-guided variceal angiotherapy. All patients had failed or were poor candidates for standard endoscopic, surgical, or interventional radiologic therapies. The main outcome measurements were rates of rebleeding and adverse events. Fourteen patients [mean age 58 (SD 12) years, 50 % male] underwent EUS-guided coil injection with (n = 4) or without (n = 10) concomitant glue injection to treat esophagogastric (n = 1), gastric (n = 5), duodenal (n = 3), or choledochal (n = 5) varices. Prior endoscopic and cross-sectional imaging detected only 57 and 64 % of the varices seen. A mean of 5.1 (SD 1.9) coils and a median of 3.25 (range 2-3.5) mL of cyanoacrylate were injected during the initial procedure. During median follow-up of 12 (range 1-104) months, three patients died from unrelated causes and eight patients did not have further bleeding episodes. In the remaining three patients who had choledochal varices, the frequency and intensity of rebleeding decreased significantly. Only one asymptomatic adverse event occurred with coil migration to the liver. EUS-guided angiotherapy of varices is safe and feasible in selected patients who failed conventional therapy, and should be considered in the clinical management of these patients.
    No preview · Article · Jul 2015 · Surgical Endoscopy
  • Patrick S Kamath · Terry Therneau · Vijay H Shah

    No preview · Article · Jun 2015 · Gastroenterology
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    ABSTRACT: To evaluate the utility of magnetic resonance elastography (MRE) in screening patients for hepatic fibrosis, cirrhosis, and hepatocellular carcinoma after the Fontan operation. Hepatic MRE was performed in conjunction with cardiac magnetic resonance imaging in patients who had undergone a Fontan operation between 2010 and 2014. Liver stiffness was calculated using previously reported techniques. Comparisons to available clinical, laboratory, imaging, and histopathologic data were made. Overall, 50 patients at a median age of 25 years (range, 21-33 years) who had undergone a Fontan operation were evaluated. The median interval between Fontan operation and MRE was 22 years (range, 16-26 years). The mean liver stiffness values were increased: 5.5±1.4 kPa relative to normal participants. Liver stiffness directly correlated with liver biopsy-derived total fibrosis score, time since operation, mean Fontan pressure, γ-glutamyltransferase level, Model for End-Stage Liver Disease score, creatinine level, and pulmonary vascular resistance index. Liver stiffness was inversely correlated with cardiac index. All 3 participants with hepatic nodules exhibiting decreased contrast uptake on delayed postcontrast imaging and increased nodule stiffness had biopsy-proven hepatocellular carcinoma. The association between hepatic stiffness and fibrosis scores, Model for End-Stage Liver Disease scores, and γ-glutamyltransferase level suggests that MRE may be useful in detecting (and possibly quantifying) hepatic cirrhosis in patients after the Fontan operation. The correlation between stiffness and post-Fontan time interval, mean Fontan pressure, pulmonary vascular resistance index, and reduced cardiac index suggests a role for long-term hepatic congestion in creating these hepatic abnormalities. Magnetic resonance elastography was useful in detecting abnormal nodules ultimately diagnosed as hepatocellular carcinoma. The relationship between stiffness with advanced fibrosis and hepatocellular carcinoma provides a strong argument for additional study and broader application of MRE in these patients. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · Mayo Clinic Proceedings
  • Sakkarin Chirapongsathorn · Patrick S Kamath
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    ABSTRACT: The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print., *2007 Journal Citation Report (Thomson Reuters, 2008)
    No preview · Article · Jun 2015 · The American Journal of Gastroenterology

Publication Stats

11k Citations
2,699.84 Total Impact Points


  • 2015
    • Baylor University
      Waco, Texas, United States
  • 1994-2015
    • Mayo Clinic - Rochester
      • • Department of Gastroenterology and Hepatology
      • • Department of Hematology
      Рочестер, Minnesota, United States
  • 2009
    • Rochester College
      Rochester, New York, United States
  • 2006
    • Mayo Foundation for Medical Education and Research
      • Division of Gastroenterology and Hepatology
      Rochester, Michigan, United States
    • University of California, San Francisco
      San Francisco, California, United States
  • 2004
    • University of Helsinki
      Helsinki, Uusimaa, Finland
    • Hennepin County Medical Center
      Minneapolis, Minnesota, United States
  • 2001
    • University of Barcelona
      Barcino, Catalonia, Spain
    • University of Washington Seattle
      Seattle, Washington, United States
  • 1992
    • St. Joseph's College of Bangalore
      Bengalūru, Karnataka, India
    • Church of South India Hospital, Bangalore
      Bengalūru, Karnataka, India