Mohamed Safwan

Carle Foundation Hospital

Background As the number of elderly kidney transplant recipients increases, long-term outcome differences between this population and younger kidney transplant recipients are not well documented. The purpose of the study is to evaluate the effect of rATG dosing on long-term outcomes between elderly and young kidney transplant recipients. Methods A...

This study aimed to evaluate possible discrepancies in waitlist outcomes between liver diseases, including alcohol‐related liver disease (ALD), non‐alcoholic steatohepatitis (NASH), hepatitis C virus infection (HCV), primary biliary cirrhosis (PBC), and primacy sclerosing cholangitis (PSC). Patients registered for liver transplantation from January...

Background: Fast-track anesthesia in liver transplantation (LT) has been discussed over the past few decades; however, factors associated with immediate extubation after LT surgery are not well defined. This study aimed to identify predictive factors and examine impacts of immediate extubation on post-LT outcomes. Methods: A total of 279 LT pati...

Background: Portal vein thrombosis (PVT) makes the technical aspect of liver transplantation challenging and also affects outcomes. Our aim was to study impact of PVT grade and postreperfusion portal flow on posttransplant outcomes. Methods: Patients who underwent transplantation with PVT between January 2007 and May 2017 were selected (n=126)....

Background: Intraoperative continuous renal replacement therapy (CRRT) may need to be indicated for liver transplant recipients who show renal dysfunction. We aimed to investigate effects of intraoperative CRRT on outcomes after liver transplant. Material and methods: This study included all adult patients who underwent liver transplant between...

The disease phenotype in biliary atresia (BA) is caused by a fibro-inflammatory process leading to destruction of cholangiocytes, obstruction of ductular pathways and eventual progression to liver cirrhosis. The first line of management is a Kasai portoenterostomy (KPE) followed by liver transplantation (LT) in some children. Several factors have b...

Background: The number of living donor liver transplantation (LDLT) has been consistently increasing in the United Status. According to previous reports from the A2ALL group, LDLT provides long-term transplant benefit compared to deceased donor LT (DDLT) in intention-to-treat analysis. In this study, we aimed to compare post-transplant outcomes bet...

In liver transplantation (LT) for alcohol-related liver disease (ALD), a 6-month abstinence rule has been widely used in the evaluation of patients. Despite the period of abstinence, prior studies indicate alcohol relapse (AR) rate of 20% after LT. The aim of this study is to assess effects of pre-transplant alcohol use history on post-transplant o...

A 6-month abstinence rule has been widely used in the evaluation of patients with alcoholic cirrhosis (AC) for liver transplantations (LT). However, there is growing interest in performing LT in patients with alcoholic hepatitis (AH) without an abstinence period because of high mortality and favorable LT outcomes. It is important, however, to compa...

Aims: The aim of our study was to compare the outcome of Kasai portoenterostomy (KPE) in children with biliary atresia (BA) older than 90 days to children less than 90 days and to study its safety and efficacy in children older than 90 days. Subjects and Methods: Relevant data were collected from our prospectively maintained database of all childre...

Appropriate graft regeneration after living donor liver transplantation (LDLT) is crucial to avoid small‐for‐size syndrome. We enrolled 44 recipients who underwent ABO‐identical/compatible LDLT from December 2007 to August 2016, and determined possible factors associated with low graft regeneration after LDLT. Liver regeneration was calculated by t...

Purpose: Graft-versus-host disease (GVHD) after liver transplant is a rare complication. This study aimed to analyze the UNOS registry to identify risk factors for fatal GVHD. Methods: We used the UNOS registry. All adult liver transplant and liver-kidney transplant patients between 2002 and 2018 were analyzed. An endpoint was set as mortality due...

Purpose: Patients with Alcoholic liver disease (ALD) are required to be abstinent prior to listing. This may reduce disease progression while on waitlist and therefore alter waitlist outcomes compared to other disease etiologies. We aimed to evaluate discrepancy of waitlist outcomes between those with ALD and non-alcoholic liver disease (NALD). Met...

Purpose: We recently reported that, with the introduction of MELDNa liver allocation, the score at which patients benefit from liver transplant as opposed to remaining on the waitlist, has shifted from MELD of 15 to MELD-Na of 21 (Gastroenterology2018;155). The aim of this study was to evaluate waitlist outcomes in patients with MELDNa scores < 21...

Background: Delayed graft function (DGF), defined by the need for dialysis within 7 days after transplantation, impacts graft and patient outcomes. This study aims to predict the occurrence of DGF after combined liver kidney transplantation (CLKT). Methods: We examined adult CLKT transplanted from Jan 01 2003 to Mar 31 2018 in the UNOS registry. Re...

Aims and objectives: Biliary atresia (BA) is a cholangiodestructive disease of the biliary tree. The first line of treatment is a Kasai portoenterostomy (PE) following which patients may develop cholangitis. We studied the effect of early cholangitis on the outcome of PE, namely jaundice clearance and early native liver survival (NLS). Methods:...

This study aimed to investigate risk factors for early allograft dysfunction (EAD) and outcomes after liver transplantation (LT), focusing on peri‐transplant lactate clearance. We reviewed patients who underwent deceased donor LTs between 2011 and 2014. Lactate levels were checked at reperfusion and at the time of intensive care unit admission. Ear...

Presented at a special session on Pediatrics at the 25th Annual ILTS Meeting at Toronto, Canada - May 2019

Background & aims: An increasing number of patients with non-alcoholic steatohepatitis (NASH) require liver transplantation. We compared outcomes of patients with liver diseases of different etiologies (NASH, hepatitis C virus [HCV]-associated liver disease, and alcohol-associated liver disease [ALD]). Methods: We analyzed data from the United N...

Background: Status 1A patients are prioritized over liver disease patients regardless of model for end-stage liver disease (MELD) score. We aimed to identify groups with high waitlist mortality in Status 1A and MELD≥40 patients to determine who would most benefit from transplantation. Methods: Data on patients listed as Status 1A (n=4447) and ME...

Emphysematous pyelonephritis (EPN) is a rare condition which can rapidly progress to sepsis and multiple organ failure with high mortality. We experienced a rare case of EPN in a renal allograft related to antibody‐mediated rejection (AMR). The patient received a deceased donor kidney transplant due to end‐stage renal disease secondary to diabetes...

Background/Aims: Biliary atresia (BA) is a cholangio-destructive disease of the infant liver presenting with features of obstructive cholangiopathy. The Kasai portoenterostomy (KPE) is the first line of management. The aim of our study was to identify the characteristic features of liver histology in BA that impact the outcome of KPE. Patients and...

Biliary atresia (BA) is a disorder of the hepatic system which results in fibrotic obstructing cholangiopathy. BA is of multifactorial etiology with the disease outcome predicted to be worse in cases presenting with ductal plate malformation (DPM). Previous studies carried out using microarray techniques have been able to identify potential targets...

Background & aims: The model for end-stage liver disease-sodium (MELD-Na) score was introduced for liver allocation in January 2016. We evaluated the effects of liver allocation, based on MELD-Na score, on waitlist and post-transplant outcomes. Methods: We examined 2 patient groups from the United Network for Organ Sharing registry; the MELD-per...

The new Organ Procurement and Transplant Network/United Organ Sharing Network (OPTN/UNOS) simultaneous liver‐kidney transplant (SLK) policy has been implemented. The aim of this study was to review liver transplant outcomes utilizing the new SLK policy. Liver transplant alone (LTA) and SLK patients between 2009 and 2015 were reviewed. Graft surviva...

Transient thrombocytopenia is a common phenomenon after liver transplantation. After liver transplantation (LT), platelet count decreases and reaches a nadir on postoperative days 3-5, with an average reduction in platelet counts of 60%; platelet count recovers to preoperative levels approximately two weeks after LT. The putative mechanisms include...

Background: Adenoviruses are double-stranded DNA viruses that typically cause mild self-limiting respiratory, ocular, and gastrointestinal infections. In immunocompromised patients, especially transplant recipients, the infection can be severe, with dissemination and multiorgan failure. In intestinal transplant recipients, the incidence is as high...

Single center analysis of intra- and postoperative outcomes in patients who underwent intraoperative CVVH in the setting of an orthotopic liver transplant.

While minimally invasive techniques for living donor hepatectomy have been developed, the surgical feasibility and limitations remain to be elucidated. The risks and outcomes involved need to be better understood prior to their widespread application. The aim of this study was to assess feasibility of minimally invasive donor hepatectomy by reviewi...

Background: Ketorolac is a nonsteroidal anti-inflammatory drug indicated for pain control after surgeries in many fields. The aim of this study was to evaluate the impact of ketorolac use after live-donor nephrectomy (LDN). Material/Methods: We reviewed data on 251 patients who underwent laparoscopic LDN from April 2008 to March 2016. Ketorolac was...

Identification of extrahepatic metastases (EHM) of hepatocellular carcinoma (HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a histo...

Non-alcoholic fatty liver disease is becoming the leading cause of disease resulting in liver transplantation (LT). As a result of this trend, more liver transplant candidates are presenting with prior history of bariatric surgery (BS). Over the last decade, 960 patients underwent LT at our institution; 11 (1.1%) had prior BS. Most common type of B...

Age at time of presentation does not correlate with severity of liver disease (using standard accepted histological features to assess liver disease) Age at presentation correlates with fibrosis grade( fibrosis reversible after successful PE) Higher total bilirubin results in early referral for treatment in our patient population. Hence the higher...

Biliary stricture is a common cause of morbidity after liver transplantation (LT). This study aimed to determine the risk factors for post-transplant biliary anastomotic strictures (BAS), focusing on perioperative platelet counts. We enrolled 771 consecutive recipients who underwent ABO-identical/compatible deceased donor LT with duct-to-duct bilia...

Background: Readmissions are an important metric in evaluating the cost-effectiveness and quality of health services. The pattern of readmissions after liver transplantation (LT) have been poorly described and there is little data on readmissions following live donor LT(LDLT) in particular. We analysed our experience to determine the rates, and out...

Background: Factors which predict readmissions following liver transplantation(LT) are likely to improve long term outcomes and reduce the healthcare burden. However, there is a paucity of the studies regarding the readmissions following LT, especially Live donor LT(LDLT). We analysed our experience to determine the preoperativerecipient, donor, in...

Background; Early allograft dysfunction(EAD)after liver transplantation (LT) is defined as a peak values of aminotransferase>2000 IU/mL during the first week or an international normalized ratio ≥ 1.6 and/or bilirubin ≥ 10 mg/dL at day 7.While lactate level is a well–known parameter of liver graft function, an association with EAD has not been full...

Patient: Male, 50 Final Diagnosis: Pulmonary fibrosis Symptoms: Short of breath Medication: — Clinical Procedure: — Specialty: Transplantology Objective Adverse events of drug therapy Background Mycophenolate mofetil (MMF) induced lung disease has been described in only a few isolated reports. We report a case of fatal respiratory failure associa...

Background: The positive impact of platelets has been recently implicated in liver transplantation (LT). The aim of this study was to determine the risk factors for graft loss and mortality after LT, focusing on perioperative platelet counts. Methods: We reviewed all deceased donor LT from 2000 to 2012, and enrolled 975 consecutive recipients. T...

Portal vein thrombosis is common in patients with end-stage liver disease, with an incidence as high as 26% in liver transplant candidates. It is known to be associated with a high risk of morbidity and mortality posttransplantation, and its management can be challenging. The management options range from a simple thrombendvenectomy to multiviscera...

LT has played a significant role in improving the outcome of children with BA. We review our five-yr experience of LDLT for children with BA. Records of all children who underwent LDLT in our institution over a five-yr period (August 2010-June 2015) were reviewed and those with a primary diagnosis of BA were selected for our study. Data were extrac...

HCC is the second most common malignant liver tumor of childhood. It typically affects children with a median age of 10-14 yr on background hepatitis B-related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of five yr typically constitute <10% of all children with HCC. In these children, it occurs on...

Background: Live donor liver transplantation is the predominant form of liver transplantation in India and in most Asian countries. Donor outcome reports are an important source of information to be shared with prospective donors at the time of informed consent. This is the first donor outcome series from India. Methods: Analysis of donor charac...

Biliary atresia (BA) is a progressive cholangiopathy of newborn children. In infants with BA, the complement receptor C5AR1+ signals localize to both portal CD68+ cells and to cholangiocyte profiles. Here, we aimed to determine if C5AR1 signals differentiate the clinical stages at the time of Kasai and liver transplantation (LT). Methods: Biopsy sp...

Aims: In 1955, Professor Morio Kasai first performed a hepatic portoenterostomy. Since then, the procedure has changed the lives of children with biliary atresia (BA). We report our initial experience in performing "extended" Kasai portoenterostomy (KPE), a modification of the original procedure. Materials and methods: Since 2013, we have used t...

Need and purpose of review: Biliary atresia is a progressive obstructive cholangiopathy and is fatal if left untreated within 2 years of life. Delay in referral is because of difficulties in differentiating it from physiologic jaundice and identifying an abnormal stool color. This paper presents an overview on the diagnosis and discusses the curre...

Background: Biliary atresia (BA) is characterized by progressive hepatobiliary injury. C5aR is an important modulator of mucosal injury in a neonatal mouse model of rhesus rotavirus (RRV)-induced BA. Investigating immune and epithelial cell compartments as drivers of BA, we hypothesized that, macrophages and cholangiocytes show elevated expression...

Purpose Ductal plate malformation (DPM) like arrays in the liver which resemble the characteristic persistent embryonal ductular structures have been shown to adversely affect the outcome of Kasai portoenterostomy (KPE) in biliary atresia (BA). We studied the impact of DPM on survival with native liver (SNL) in children with BA who underwent liver...

Multidrug resistance protein 3 (MDR3) is a hepatocyte canalicular membrane protein encoded by the ABCB4/MDR3 gene located on chromosome 7. Several liver diseases are known to be associated with MDR3 deficiency. The basic defect is reduced secretion of biliary phospholipid causing disturbance in the primary bile composition, leading to injury to bil...

Multidrug resistance protein 3 (MDR3) is a hepatocyte canalicular membrane protein encoded by the ABCB4/MDR3 gene located on chromosome 7. Several liver diseases are known to be associated with MDR3 deficiency. The basic defect is reduced secretion of biliary phospholipid causing disturbance in the primary bile composition, leading to injury to bil...