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William D Payne - One of the best experts on this subject based on the ideXlab platform.
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delayed splenic artery occlusion for treatment of established small for size syndrome after partial liver Transplantation
Liver Transplantation, 2009Co-Authors: Abltinav Humar, Joy Beissel, Shaina Crotteau, Melissa Cohen, John R Lake, William D PayneAbstract:We looked at the impact of delayed splenic artery occlusion (SAO) on recipients with established small-for-size syndrome (SFSS) after partial graft liver Transplantation [either from a living donor (LD) or split from a deceased donor (DD)]. Between 1999 and 2007 we performed a total of 100 partial liver Transplantations in adult recipients: 66 LD Transplantations and 34 DD split Transplantations. Of these, 7 (7%) developed SFSS, diagnosed by the clinical features of cholestasis, coagulopathy, and ascites. Mean graft weight/recipient weight (GW/RW) ratio in these 7 recipients was 0.94%. Five of these 7 recipients underwent relaparotomy at a mean of 10 days post-Transplantation to rule out a technical complication, and then intraoperative splenic artery ligation was performed. The other 2 recipients were treated radiologically by splenic artery coiling-at 9 and 13 days post-Transplantation. Median serum bilirubin at the time of the splenic artery procedure was 20 mg/dL; by 3 weeks postprocedure this had decreased to 2.5 mg/dL. Of the 7 recipients with SFSS, 6 improved and eventually obtained normal graft function; 1 recipient did not improve and ultimately underwent reTransplantation because of persistent cholestasis and failure to thrive. Delayed SAO represents a potential option for the treatment of recipients with established SFSS after partial liver Transplantation.
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delayed splenic artery occlusion for treatment of established small for size syndrome after partial liver Transplantation
Liver Transplantation, 2009Co-Authors: Abltinav Humar, Joy Beissel, Shaina Crotteau, Melissa Cohen, John R Lake, William D PayneAbstract:We looked at the impact of delayed splenic artery occlusion (SAO) on recipients with established small-for-size syndrome (SFSS) after partial graft liver Transplantation [either from a living donor (LD) or split from a deceased donor (DD)]. Between 1999 and 2007 we performed a total of 100 partial liver Transplantations in adult recipients: 66 LD Transplantations and 34 DD split Transplantations. Of these, 7 (7%) developed SFSS, diagnosed by the clinical features of cholestasis, coagulopathy, and ascites. Mean graft weight/recipient weight (GW/RW) ratio in these 7 recipients was 0.94%. Five of these 7 recipients underwent relaparotomy at a mean of 10 days post-Transplantation to rule out a technical complication, and then intraoperative splenic artery ligation was performed. The other 2 recipients were treated radiologically by splenic artery coiling—at 9 and 13 days post-Transplantation. Median serum bilirubin at the time of the splenic artery procedure was 20 mg/dL; by 3 weeks postprocedure this had decreased to 2.5 mg/dL. Of the 7 recipients with SFSS, 6 improved and eventually obtained normal graft function; 1 recipient did not improve and ultimately underwent reTransplantation because of persistent cholestasis and failure to thrive. Delayed SAO represents a potential option for the treatment of recipients with established SFSS after partial liver Transplantation. Liver Transpl 15:163–168, 2009. © 2009 AASLD.
Abltinav Humar - One of the best experts on this subject based on the ideXlab platform.
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delayed splenic artery occlusion for treatment of established small for size syndrome after partial liver Transplantation
Liver Transplantation, 2009Co-Authors: Abltinav Humar, Joy Beissel, Shaina Crotteau, Melissa Cohen, John R Lake, William D PayneAbstract:We looked at the impact of delayed splenic artery occlusion (SAO) on recipients with established small-for-size syndrome (SFSS) after partial graft liver Transplantation [either from a living donor (LD) or split from a deceased donor (DD)]. Between 1999 and 2007 we performed a total of 100 partial liver Transplantations in adult recipients: 66 LD Transplantations and 34 DD split Transplantations. Of these, 7 (7%) developed SFSS, diagnosed by the clinical features of cholestasis, coagulopathy, and ascites. Mean graft weight/recipient weight (GW/RW) ratio in these 7 recipients was 0.94%. Five of these 7 recipients underwent relaparotomy at a mean of 10 days post-Transplantation to rule out a technical complication, and then intraoperative splenic artery ligation was performed. The other 2 recipients were treated radiologically by splenic artery coiling-at 9 and 13 days post-Transplantation. Median serum bilirubin at the time of the splenic artery procedure was 20 mg/dL; by 3 weeks postprocedure this had decreased to 2.5 mg/dL. Of the 7 recipients with SFSS, 6 improved and eventually obtained normal graft function; 1 recipient did not improve and ultimately underwent reTransplantation because of persistent cholestasis and failure to thrive. Delayed SAO represents a potential option for the treatment of recipients with established SFSS after partial liver Transplantation.
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delayed splenic artery occlusion for treatment of established small for size syndrome after partial liver Transplantation
Liver Transplantation, 2009Co-Authors: Abltinav Humar, Joy Beissel, Shaina Crotteau, Melissa Cohen, John R Lake, William D PayneAbstract:We looked at the impact of delayed splenic artery occlusion (SAO) on recipients with established small-for-size syndrome (SFSS) after partial graft liver Transplantation [either from a living donor (LD) or split from a deceased donor (DD)]. Between 1999 and 2007 we performed a total of 100 partial liver Transplantations in adult recipients: 66 LD Transplantations and 34 DD split Transplantations. Of these, 7 (7%) developed SFSS, diagnosed by the clinical features of cholestasis, coagulopathy, and ascites. Mean graft weight/recipient weight (GW/RW) ratio in these 7 recipients was 0.94%. Five of these 7 recipients underwent relaparotomy at a mean of 10 days post-Transplantation to rule out a technical complication, and then intraoperative splenic artery ligation was performed. The other 2 recipients were treated radiologically by splenic artery coiling—at 9 and 13 days post-Transplantation. Median serum bilirubin at the time of the splenic artery procedure was 20 mg/dL; by 3 weeks postprocedure this had decreased to 2.5 mg/dL. Of the 7 recipients with SFSS, 6 improved and eventually obtained normal graft function; 1 recipient did not improve and ultimately underwent reTransplantation because of persistent cholestasis and failure to thrive. Delayed SAO represents a potential option for the treatment of recipients with established SFSS after partial liver Transplantation. Liver Transpl 15:163–168, 2009. © 2009 AASLD.
Hiroshi Date - One of the best experts on this subject based on the ideXlab platform.
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Significance of single lung Transplantation in the current situation of severe donor shortage in Japan
General Thoracic and Cardiovascular Surgery, 2016Co-Authors: Ryo Miyoshi, Toyofumi F. Chen-yoshikawa, Kyoko Hijiya, Hideki Motoyama, Akihiro Aoyama, Toshi Menju, Toshihiko Sato, Makoto Sonobe, Hiroshi DateAbstract:Objective Although bilateral lung Transplantation is the procedure of choice internationally, single lung Transplantation is preferred in Japan because of the severe donor shortage except in cases of contraindications to single lung Transplantation. This study aimed to evaluate the clinical characteristics of single lung transplant recipients and outcomes of this procedure at one of the largest lung transplant centers in Japan. Methods Between April 2002 and May 2015, 57 cadaveric lung Transplantations (33 single and 24 bilateral) were performed in Kyoto University Hospital. The clinical characteristics of the lung transplant recipients and outcomes of these procedures, including overall survival and postoperative complications, were investigated. Results Overall, the 1-, 3-, and 5-year survival rates were 86, 77, and 72 %, respectively, with a median follow-up period of 1.9 years. There was no significant difference in survival between patients who underwent single lung Transplantations and those who underwent bilateral lung Transplantations ( p = 0.92). The median waiting time was significantly shorter for single lung transplant patients than for bilateral lung transplant patients ( p = 0.02). Native lung complications were seen in 14 out of 33 patients (42 %) who underwent single lung Transplantation. There was no significant difference in survival between patients with and without postoperative native lung complications. Conclusions Single lung Transplantation has been performed with acceptable outcomes in our institution. In the current situation of severe donor shortage in Japan, single lung Transplantation can remain the first choice of treatment except in cases of contraindications to single lung Transplantation.
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Registry of the Japanese Society of Lung and Heart-Lung Transplantation: official Japanese lung Transplantation report, 2014.
General thoracic and cardiovascular surgery, 2014Co-Authors: Masaaki Sato, Yoshinori Okada, Takahiro Oto, Takeshi Shiraishi, Masayuki Chida, Masato Minami, Takeshi Nagayasu, Meinoshin Okumura, Ichiro Yoshino, Hiroshi DateAbstract:The number of organ donations after brain death has significantly increased since the revised Japanese Organ Transplant Law took effect in July 2010. Sixty-one lung Transplantations were conducted throughout Japan in 2013, including 20 living-donor lung Transplantations and 41 brain-dead-donor lung Transplantations (23 bilateral lungs, 17 single lungs, and 1 heart-lung Transplantation). The number of lung transplant candidates newly registered at the Japan Organ Transplantation Network also increased to 126 in 2013, suggesting a severe donor shortage in Japan. More than 60 % of offered brain-dead-donor, lungs were used for Transplantation, indicating the effort of Japanese lung transplant centers to overcome the challenge of donor shortage. After lung Transplantation, patients generally enjoyed a good quality of life with excellent survival of 86.2 % at 1 year, 79.6 % at 3 years, and 73.7 % at 5 years post-Transplantation. There was no significant difference in patient survival between living-donor and brain-dead-donor lung Transplantation. Early mortality of lung transplant recipients within 90 days was attributable to graft failure followed by infection, while long-term mortality was mostly explained by chronic lung allograft dysfunction (chronic rejection), infection, and malignancy. Eight lung transplant centers are currently approved to conduct lung Transplantation in Japan (Tohoku, Dokkyo, Chiba, Kyoto, Osaka, Okayama, Fukuoka, and Nagasaki Universities). These centers are expected to continue to make a special effort to save critically ill patients waiting for lung Transplantation.
Mary Eapen - One of the best experts on this subject based on the ideXlab platform.
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Allele-level HLA matching for umbilical cord blood Transplantation for non-malignant diseases in children: a retrospective analysis
The Lancet Haematology, 2017Co-Authors: Mary Eapen, Stephen R. Spellman, Tao Wang, Paul Veys, Jaap Jan Boelens, Andrew St. Martin, Carmem Sales Bonfim, Colleen Brady, Andrew J. Cant, Jean Hugues DalleAbstract:Summary Background The standard for selecting unrelated umbilical cord blood units for Transplantation for non-malignant diseases relies on antigen-level (lower resolution) HLA typing for HLA-A and HLA-B, and allele-level for HLA-DRB1. We aimed to study the effects of allele-level matching at a higher resolution—HLA-A, HLA-B, HLA-C, and HLA-DRB1, which is the standard used for adult unrelated volunteer donor Transplantation for non-malignant diseases—for umbilical cord blood Transplantation. Methods We retrospectively studied 1199 paediatric donor-recipient pairs with allele-level HLA matching who received a single unit umbilical cord blood Transplantation for non-malignant diseases reported to the Center for International Blood and Marrow Transplant Research or Eurocord and European Group for Blood and Marrow Transplant. Transplantations occurred between Jan 1, 2000, and Dec 31, 2012. The primary outcome was overall survival. The effect of HLA matching on survival was studied using a Cox regression model. Findings Compared with HLA-matched Transplantations, mortality was higher with Transplantations mismatched at two (hazard ratio [HR] 1·55, 95% CI 1·08–2·21, p=0·018), three (2·04, 1·44–2·89, p=0·0001), and four or more alleles (3·15, 2·16–4·58, p 7 cells per kg compared with 21 × 10 7 cells per kg or less (HR 1·47, 1·11–1·95, p=0·0076), and Transplantations done in 2000–05 compared with those done in 2006–12 (HR 1·64, 1·31–2·04, p Interpretation These data support a change from current practice in that selection of unrelated umbilical cord blood units for Transplantation for non-malignant diseases should consider allele-level HLA matching at HLA-A, HLA-B, HLA-C, and HLA-DRB1. Funding National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute for Allergy and Infectious Diseases; US Department of Health and Human Services—Health Resources and Services Administration; and US Department of Navy.
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bone marrow or peripheral blood for reduced intensity conditioning unrelated donor Transplantation
Journal of Clinical Oncology, 2015Co-Authors: Mary Eapen, Miguelangel Perales, Brent R Logan, Mary M Horowitz, Xiaobo Zhong, Stephanie J Lee, Vanderson Rocha, Robert J Soiffer, Richard E ChamplinAbstract:Purpose There have been no randomized trials that have compared peripheral blood (PB) with bone marrow (BM) grafts in the setting of reduced-intensity conditioning (RIC) Transplantations for hematologic malignancy. Because immune modulation plays a significant role in sustaining clinical remission after RIC, we hypothesize that higher graft-versus-host disease (GVHD) associated with PB Transplantation may offer a survival advantage. Patients and Methods The primary outcome evaluated was overall survival. Cox regression models were built to study outcomes after Transplantation of PB (n = 887) relative to BM (n = 219) for patients with acute myeloid leukemia, myelodysplastic syndrome, or non-Hodgkin lymphoma, the three most common indications for unrelated RIC Transplantation. Transplantations were performed in the United States between 2000 and 2008. Conditioning regimens consisted of an alkylating agent and fludarabine, and GVHD prophylaxis involved a calcineurin inhibitor (CNI) with either methotrexate (...
Jean Hugues Dalle - One of the best experts on this subject based on the ideXlab platform.
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Allele-level HLA matching for umbilical cord blood Transplantation for non-malignant diseases in children: a retrospective analysis
The Lancet Haematology, 2017Co-Authors: Mary Eapen, Stephen R. Spellman, Tao Wang, Paul Veys, Jaap Jan Boelens, Andrew St. Martin, Carmem Sales Bonfim, Colleen Brady, Andrew J. Cant, Jean Hugues DalleAbstract:Summary Background The standard for selecting unrelated umbilical cord blood units for Transplantation for non-malignant diseases relies on antigen-level (lower resolution) HLA typing for HLA-A and HLA-B, and allele-level for HLA-DRB1. We aimed to study the effects of allele-level matching at a higher resolution—HLA-A, HLA-B, HLA-C, and HLA-DRB1, which is the standard used for adult unrelated volunteer donor Transplantation for non-malignant diseases—for umbilical cord blood Transplantation. Methods We retrospectively studied 1199 paediatric donor-recipient pairs with allele-level HLA matching who received a single unit umbilical cord blood Transplantation for non-malignant diseases reported to the Center for International Blood and Marrow Transplant Research or Eurocord and European Group for Blood and Marrow Transplant. Transplantations occurred between Jan 1, 2000, and Dec 31, 2012. The primary outcome was overall survival. The effect of HLA matching on survival was studied using a Cox regression model. Findings Compared with HLA-matched Transplantations, mortality was higher with Transplantations mismatched at two (hazard ratio [HR] 1·55, 95% CI 1·08–2·21, p=0·018), three (2·04, 1·44–2·89, p=0·0001), and four or more alleles (3·15, 2·16–4·58, p 7 cells per kg compared with 21 × 10 7 cells per kg or less (HR 1·47, 1·11–1·95, p=0·0076), and Transplantations done in 2000–05 compared with those done in 2006–12 (HR 1·64, 1·31–2·04, p Interpretation These data support a change from current practice in that selection of unrelated umbilical cord blood units for Transplantation for non-malignant diseases should consider allele-level HLA matching at HLA-A, HLA-B, HLA-C, and HLA-DRB1. Funding National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute for Allergy and Infectious Diseases; US Department of Health and Human Services—Health Resources and Services Administration; and US Department of Navy.
