Fischer S.,University of Toronto |
Trivedi P.J.,University of Birmingham |
Ward S.,University of Birmingham |
Greig P.D.,University of Toronto |
And 2 more authors.
International Journal of Experimental Pathology | Year: 2014
Dense tissue infiltrates of IgG4+ plasma cells >50/high-powered field (HPF) are purportedly highly specific for IgG4-related disease. However, the frequency and significance of liver-infiltrating IgG4+ plasma cells in primary sclerosing cholangitis (PSC) applying these cut-offs has not been determined. We sought to determine the incidence of intrahepatic IgG4-positive staining in PSC patients undergoing transplantation, correlating findings with clinical parameters. Immunohistochemical staining was performed on liver explants obtained between 1991 and 2009. Of 122 explants obtained, hilar IgG4+ staining was found to be mild (10-29 IgG4+ cells/HPF) in 23.0%, moderate (30-50/HPF) in 9.0% and marked (>50/HPF) in 15.6%. Marked hilar lymphoplasmacytic infiltration was significantly associated with marked hilar IgG4+ staining (P < 0.001). No patient had marked peripheral IgG4+ staining, although mild and moderate staining was observed in 24.5% and 3.3% respectively. Marked hilar IgG4+ staining was significantly associated with the presence of dominant biliary strictures (P = 0.01) and need for biliary stenting (P = 0.001). There did not, however, exist any significant differences in the age at PSC diagnosis, presence of inflammatory bowel disease or extrahepatic autoimmune disease, frequency of cholangiocarcinoma, interval between diagnosis and transplantation, or post-transplant PSC recurrence or survival. Of 51 control liver sections (PBC = 18; HCV = 19; HBV = 8; AIH = 6), none had marked or moderate hilar IgG4+ staining, whereas mild staining was seen in only 10% (P < 0.001). Marked (>50/HPF) hilar IgG4+ lymphoplasmacytic infiltration is frequently observed in PSC and associated with the presence of dominant biliary strictures. However, unlike serum IgG4+ , this does not seemingly associate with clinical disease course. © 2014 The Authors. International Journal of Experimental Pathology © 2014 International Journal of Experimental Pathology.
Mandras S.A.,Multi Organ Transplant Institute |
Crespo J.,Foundation Medicine |
Patel H.M.,Multi Organ Transplant Institute
Ochsner Journal | Year: 2010
Background: Each year, approximately 2,200 heart transplants are performed in the United States. As our understanding of the immune system grows, new tools are being developed to find compatible organ donors and to help with immune surveillance after transplantation. The purpose of this article is to review 3 of these techniques: the virtual crossmatch, the Cylex ImmuKnow assay, and the AlloMap test. Methods: Two authors (S.A.M. and J.C.) independently performed a literature search with the PubMed database using the key words ImmuKnow, Allomap, and virtual crossmatch in conjunction with heart transplantation. Articles were selected for inclusion if they had a primary focus on the use of virtual crossmatch in heart transplantation, the Cylex ImmuKnow assay, and the AlloMap test. Articles were not excluded on the basis of sample size but were excluded if they did not include heart transplant patients. Results: The virtual crossmatch is a technique that is being used successfully in heart transplant candidates to predict compatibility of donor organs by comparing the potential recipient's HLA-specific antibodies with the HLA type of the prospective donor. The ImmuKnow assay is a noninvasive blood test that measures the strength of immune activity, allowing clinicians to predict risk of infection and possible rejection in heart transplant patients. The AlloMap test is a noninvasive test that quantifies intracellular mRNA levels in mononuclear cells in peripheral blood samples using real-time polymerase chain reaction; this test has been shown to distinguish the dynamic changes in gene expression that occur in the presence or absence of acute cellular rejection. Conclusion: As the science of transplant immunology advances, transplant cardiologists are taking advantage of the growing fund of knowledge to help their sensitized transplant candidates increase their chances of finding a compatible donor heart and are using commercially available tests to monitor the immune system and rule out rejection after transplantation. © Academic Division of Ochsner Clinic Foundation.
Rehman T.,Louisiana State University Health Sciences Center |
Moore T.A.,Ochsner Clinic Foundation |
Moore T.A.,Multi Organ Transplant Institute |
Seoane L.,Multi Organ Transplant Institute |
Seoane L.,University of New Orleans
Journal of Clinical Microbiology | Year: 2012
Serratia marcescens is an extremely rare cause of necrotizing fasciitis. We report the first case of necrotizing fasciitis of the chest wall due to infection with S. marcescens that initially manifested as bilateral breast necrosis. The patient had a fulminant course leading to death within 72 h of presentation. Literature pertinent to S. marcescens-mediated necrotizing fasciitis is also reviewed. Copyright © 2012, American Society for Microbiology. All Rights Reserved.
Joshi S.N.,Multi Organ Transplant Institute |
Joshi S.N.,Tulane University
Ochsner Journal | Year: 2014
Background: Hepatitis C screening is now recommended for all individuals born between the years 1945-1965 in addition to individuals who have high-risk factors. Although most clinicians have extensive experience with the diagnosis and treatment of the disease, they have limited experience screening for it.Methods: We report current screening guidelines and methods.Results: By identifying the disease as early as possible, screening and treatment can reduce morbidity and mortality.Conclusion: Screening for hepatitis C leads to the appropriate evaluation and treatment of individuals chronically infected with the hepatitis C virus and prevents the progression of liver disease to cirrhosis, hepatocellular carcinoma, and the associated morbidity and mortality. Screening for hepatitis C is also cost effective. © 2014, Academic Division of Ochsner Clinic Foundation.
Seal J.B.,University of Toronto |
Bohorquez H.,Multi Organ Transplant Institute |
Reichman T.,Multi Organ Transplant Institute |
Kressel A.,Multi Organ Transplant Institute |
And 10 more authors.
Liver Transplantation | Year: 2015
Liver transplantation (LT) with donation after circulatory death (DCD) donors has been associated with a high rate of ischemic-type biliary strictures (ITBSs) and inferior graft survival. To investigate the impact of an intraoperative tissue plasminogen activator (tPA) on outcomes following DCD LT, we conducted a retrospective analysis of DCD LT at the Toronto General Hospital (TGH) and the Ochsner Medical Center (OMC). Between 2009 and 2013, 85 DCD LTs were performed with an intraoperative tPA injection (n=30 at TGH, n=55 at OMC), and they were compared with 33 DCD LTs without a tPA. Donor and recipient characteristics were similar in the 2 groups. There was no significant difference in the intraoperative packed red blood cell transfusion requirement (3.2±3.4 versus 3.1±2.3 U, P=0.74). Overall, biliary strictures occurred less commonly in the tPA-treated group (16.5% versus 33.3%, P=0.07) with a much lower rate of diffuse intrahepatic strictures (3.5% versus 21.2%, P=0.005). After 1 and 3 years, the tPA group versus the non-tPA group had superior patient survival (97.6% versus 87.0% and 92.7% versus 79.7%, P=0.016) and graft survival (96.4% versus 69.7% and 90.2% versus 63.6%, P<0.001). In conclusion, a tPA injection into the hepatic artery during DCD LT reduces ITBSs and improves graft and patient survival without increasing the risk for bleeding. © 2015 AASLD.
PubMed | Multi Organ Transplant Institute, University of New Orleans and Tulane University
Type: Journal Article | Journal: The Ochsner journal | Year: 2015
The number of robotic operations performed with the da Vinci Surgical System has increased during the past decade. This system allows for greater maneuverability and control than hand-assisted laparoscopic procedures, resulting in less tissue manipulation and irritation.We retrospectively analyzed the results of 100 consecutive robotic-assisted laparoscopic donor nephrectomies and compared them to our most recent 20 hand-assisted laparoscopic donor nephrectomies.Between May 2008 and June 2012, 120 laparoscopic donor nephrectomies were performed at Ochsner Clinic Foundation. Of those, 100 live kidney donors underwent robotic-assisted laparoscopic donor nephrectomies. Surgical time and hospital length of stay improved after the first 20 patients receiving robotic-assisted laparoscopic nephrectomies, which was considered the learning curve. Sixty percent of patients who underwent robotic-assisted laparoscopic donor nephrectomies were released on postoperative day 1 compared to 45% of patients who underwent hand-assisted laparoscopic techniques.In our experience, robotic-assisted laparoscopic donor nephrectomy resulted in decreased postoperative length of stay that decreased the global cost of the procedure and allowed our institution to admit more patients.
Carmody I.C.,Multi organ Transplant Institute
Clinical transplants | Year: 2012
Liver transplantation has become the best and most durable treatment for both acute and chronic liver disease. Over 1400 liver transplants have been performed at the Ochsner Clinic since the first successful transplant in 1987. Since its inception, the program has gone through several changes and advancements and has become one of the largest liver transplant programs in the United States. We have helped evolve steroid sparing immunosuppression and the use of extended criteria, donor organs. Establishment of criteria for the selection of recipients for re-transplantation has resulted in better than expected short and long-term results. Our center has faced the challenge of Hurricane Katrina and overcome it. We have improved steadily in both outcomes and transplants performed. The Ochnser Clinic Liver Transplant program will continue to improve access and outcomes for all patients with liver disease.
Rampolla R.,Multi Organ Transplant Institute
Ochsner Journal | Year: 2014
Background: Various factors must be taken into account when considering lung transplantation, including candidacy, contraindications, and outcomes.Methods: This article presents a review of the data and literature on lung transplantation, tracking the evolution of the treatment as it applies to different conditions, as well as an examination of patient survival rates in relation to pathology and treatment.Results: Timely referral and careful selection of candidates for lung transplantation maximize the outcomes of the procedure, resulting in a longer lifespan with improved physical health for patients.Conclusion: Lung transplantation is a therapeutic option for patients with various lung diseases. Adapting treatment options and follow-up treatment to the individual patient’s lifestyle and pathology optimizes patient survival rates after transplantation. © 2014, Academic Division of Ochsner Clinic Foundation.
Bohorquez H.E.,Multi Organ Transplant Institute |
Cohen A.J.,Multi Organ Transplant Institute |
Girgrah N.,Multi Organ Transplant Institute |
Bruce D.S.,Multi Organ Transplant Institute |
And 6 more authors.
Liver Transplantation | Year: 2013
The use of livers from hepatitis B surface antigen-negative (HBsAg -)/hepatitis B core antibody-positive (HBcAb+) donors in liver transplantation (LT) for HBsAg-/HBcAb- recipients is still controversial because of a lack of standard antiviral prophylaxis and long-term follow-up. We present our 13-year experience with the use of HBcAb+ donor livers in HBcAb- recipients. Patients received prophylaxis with hepatitis B immunoglobulin at the time of LT and then lamivudine daily. De novo hepatitis B virus (HBV) was defined as positive HBV DNA detection. Between January 1999 and December 2010, 1013 adult LT procedures were performed at our center. Sixty-four HBsAg-/HBcAb- patients (6.3%) received an HBsAg-/HBcAb+ liver. All donor sera were negative for HBcAb immunoglobulin M and HBV DNA. The mean follow-up was 48.8 ± 40.1 months (range = 1.2-148.8). Both the patient survival rates and the graft survival rates were 92.2% and 69.2% at 1 and 5 years, respectively. No graft losses or deaths were related to de novo HBV. Nine of the 64 patients (14.1%) developed de novo HBV. The mean time from LT to de novo HBV was 21.4 ± 26.1 months (range = 10.8-92.8 months). De novo HBV was successfully treated with adefovir or tenofovir. In conclusion, HBcAb + allografts can be safely used in HBcAb- recipients without increased mortality or graft loss. Lifelong prophylaxis, continuous surveillance, and compliance are imperative for success. Should a de novo infection occur, our experience suggests that a variety of treatments can be employed to salvage the graft and obtain serum HBV DNA clearance. Liver Transpl 19:611-618, 2013. © 2013 AASLD. Copyright © 2013 American Association for the Study of Liver Diseases.
PubMed | Multi Organ Transplant Institute
Type: | Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society | Year: 2016
Liver transplantation (LT) offers the best chance of survival in selected patients with hepatocellular carcinoma (HCC). Wait list mortality or dropout due to tumor progression can be significant and therefore timely transplantation is critical. Liver grafts discarded by outside organ procurement organizations are a potential source of grafts for low MELD tumor patients. The primary aim of this study was to assess the disease-free and overall survival of patients with HCC transplanted with imported liver grafts (ILG).Review of all patients transplanted for HCC between June 2005 and December 2014 was performed. Data on demographics, survival and HCC recurrence were analyzed.During this time period, 59 out of 190 recipients (31%) with HCC received ILG. Of these 59 grafts, 54 were imported from within the region and 5 were from national offers (outside the region). The mean cold ischemia time for local liver grafts (LLG) was 4.11.5 hours versus 5.1 1.4 hours for ILG (p<0.001). The 1, 3, and 5 year patient survival was 90%, 85%, and 83% and 85%, 80%, and 79% for LLG and ILG (p=0.08), respectively. The observed disease recurrence rate for both LLG and ILG recipients was equivalent. The median wait list time for HCC recipients was 43 days (Range 2-1167 days).With careful graft assessment, the use of ILG result in comparable outcomes following liver transplantation and no increased risk of HCC recurrence. Use of ILG maximizes the donor pool and results in a higher rate of transplantation for HCC recipients. This article is protected by copyright. All rights reserved.