Category Archives: Liver

Arizona 10-month-old home, happy and healthy after successful liver transplant – KPNX 12 News TV

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KPNX 12 News TV

KPNX 12 News TV
TEMPE, Ariz. – After a whirlwind and life-saving few months in San Francisco, 10-month-old Elijah Vazquez, is happy, healthy and home in Arizona. Elijah had a successful liver transplant back in the middle of February and just got back to Tempe with  

Everolimus Reduces Weight Gain in Liver Transplant Recipients – Drug Discovery & Development

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Drug Discovery & Development

Drug Discovery & Development
Researchers from the Intermountain Medical Center Transplant Program found that liver transplant patients taking everolimus (Afinitor) gained less weight – and kept it off at one and two years after starting the drug—than patients taking tacrolimus, … 

John Oliver takes on dialysis, a procedure that’s exhausting, deadly, and very profitable – Vox

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Vox

Vox
It would be far better for DaVita and Fresenius’s patients to get kidney transplants, which extends your lifespan by about 10 years on average, relative to remaining on dialysis, while avoiding exhausting, time-consuming treatment that makes holding

New pill spares women trauma of liver transplant – Daily Mail

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Daily Mail

Daily Mail
‘The 30 to 40 per cent of PBC patients who need Ocaliva are mostly those who have had an early presentation of the disease, and by default from suffering longer they are more likely to need a liver transplant. ‘This drug will make a difference to these  

Liver Transplant Outcomes Improve Over Time – MedPage Today

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Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Note that this retrospective study suggests that liver transplant outcomes have improved since the advent of the direct-acting agent era, particularly among those with HCV infection.
  • Be aware that patient-level data on who received DAAs was not available for this analysis.

CHICAGO — The advent of direct-acting anti-hepatitis C agents (DAAs) appears to have improved both patient and graft survival after liver transplant, a researcher said here.

In almost all cases, patients with chronic hepatitis C (HCV) who undergo liver transplant see the virus quickly recur, with rapid progression to fibrosis and cirrhosis, according to Nyan Latt, MD, of the Mayo Clinic in Jacksonville, Fla.

But the new DAAs can cure HCV in most patients and halt that process, with the possibility of a beneficial impact on both survival of the transplanted organ and patients themselves, Latt said at Digestive Disease Week, co-sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

Treatment with DAAs is indicated for all transplant patients with recurrence, Latt said, and the therapy seems likely to change survival rates.

To examine the issue, he and colleagues looked back over some 3,575 liver transplant patients at two centers over three time periods — before 2006, from 2006 through 2010, and after 2010.

The time periods were chosen to allow comparison of HCV and non-HCV transplant recipients with enough follow-up in the DAA era — post 2010 — to allow calculation of five-year survival rates, Latt said.

They also allowed the sample sizes in each era to be roughly the same, he said.

All told, 1,437, or 40%, of the patients, had HCV.

The researchers expected to see a gradual improvement in outcomes over time, reflecting better medical and surgical care, with a differential between those with and without an HCV diagnosis, he added.

And indeed, for graft survival, that’s pretty much what they saw.

For instance, five-year graft survival among non-HCV patients rose from 71.9% to 82% from the earliest era to the most recent time, increases that were paralleled but somewhat higher for one- and three-year survival.

Among HCV patients the pattern was similar: 66.6% rising to 81.8%, with slightly higher numbers associated with shorter follow-up.

In both groups, the trend was significant at P=0.001.

For patient survival, the picture was different:

  • There were no significant improvements among the non-HCV group, with five-year rates rising slightly from 77.9% to 83.2%
  • But among those with HCV, the five-year rates did not change markedly in the first two eras — 75.8% and 76.2%, respectively — but then jumped significantly in the DAA era to 83.7%

In other words, Latt said, patient survival in the DAA era was comparable for patients with and without HCV.

However, the study had two important flaws, commented Richard Sterling, MD, of Virginia Commonwealth University in Richmond, Va., who was not part of the study but who moderated the session at which it was presented.

The first is the way the time periods were set up. In order to get five-year data, Latt and colleagues started their DAA era after 2010, when the earliest of such agents came on the market.

But those agents, Sterling told MedPage Today, were protease inhibitors that still needed to be given with pegylated interferon and ribavirin. Interferon- and ribavirin-free drugs did not appear until 2014 and later and it is possible that outcomes using them would have been different from those seen with the first DAAs.

He said it would have been better to hold off on the analysis until there was enough data to yield five-year graft and patient survival rates for interferon- and ribavirin-free regimens.

“We need to wait another two or three years in order to have the five-year DAA-only data,” he said.

The other important flaw, he said, is that Latt and colleagues don’t yet have data on how patients in their latest era were actually treated. “Did 20 get treated [with DAAs] or 300?” he asked.

The assumption is that most got DAA therapy and therefore did better, Sterling said, “but he can’t show that.”

The study had no external support. Latt said the authors had no disclosures.

Sterling disclosed relationships with Salix, Bayer, ViiV, Baxter, Pfizer, AbbVie, Gilead, Merck, BMS, and Roche/Genentech.

  • Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
2017-05-09T13:00:00-0400
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Calgary girl given life saving transplant at Cincinnati Children’s hospital – CTV News

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A three-year-old Calgary girl with a rare form of liver cancer is recovering in a Cincinnati hospital after undergoing a liver transplant on the weekend.

Greta Marofke was diagnosed with hepatoblastoma just before her second birthday and had 70 percent of her liver taken out and several months of chemotherapy treatments.

It appeared that the little girl had beaten the disease but a routine follow up showed the cancer had returned and the family learned she would need a liver transplant.

The Marofke’s worked with physicians in Canada and the States and found a doctor at the Cincinnati Children’s Hospital who had extensive experience with treating hepatoblastoma in children.

Greta was placed on a waiting list at the facility for a liver transplant and the family was contacted early Sunday and told the operation could happen as soon as they arrived.

The family posted an update on Greta’s Guardians Facebook page saying that they are sad for the family who lost their baby but are thankful for giving Greta a shot at the life she deserves.

On Monday, Greta’s mother, Lindsey, said her daughter was feeling a bit rough but that her pain in now under control and she is sleeping.

Doctor’s at the Cincinnati hospital say they are happy with her progress so far.

The procedure has put a strain on the family’s finances and a GoFundMe page has been set up to help them out. Click HERE for more information.

UPDATE: Jarrius Robertson getting ‘spunk’ back after transplant – FOX 8 News WVUE-TV

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J.J. Robertson gives a thumbs up before his liver transplant on April 29. (Source: Facebook)J.J. Robertson gives a thumbs up before his liver transplant on April 29. (Source: Facebook)
NEW ORLEANS (WVUE) –
Saints super fan Jarrius “J.J.” Robertson is not ready to dance on the sidelines yet, but it sounds like he is well on his way.

His father, Jordy, said he is still in ICU at Ochsner resting and recovering from the liver transplant. Because it is his second transplant, it makes recovery slower and puts J.J. at risk for infection.

Jordy believes his son’s spunk is back. He said even lying in bed it seems tough for J.J. to remain still. When someone comes into the room, he opens his eyes to see who is visiting.

His parents said J.J. is stronger than they thought he would be.

Nancy Parker – A day with J.J.: Teen puts on brave face while waiting for a transplant 

People are communicating with them on their Twitter page and Facebook.

Jordy said they are promoting It Takes Lives To Save Lives, a foundation that shines light on organ donation. He hopes to visit lawmakers in Baton Rouge with J.J. raise more awareness and push for new laws to help kids who need transplants.

Copyright 2017 WVUE. All rights reserved.

Genomic Signature for Predicting Acute Rejection in Liver Transplant Patients to be Presented at the American … – Markets Insider

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CHICAGO, May 1, 2017 /PRNewswire/ — Dr. Josh Levitsky, Professor of Medicine (Gastroenterology, Hepatology) and Surgery (Organ Transplantation) at Northwestern University Feinberg School of Medicine, will be providing an oral presentation at the American Transplant Congress (ATC) describing discovery of predictive signatures of acute rejection in liver transplant recipients. Titled “Blood and Biopsy Genomic Signatures of Acute Rejection in Liver Transplant Recipients”, Dr. Levitsky’s talk will be presented on Tuesday, May 2, 2017, at 5:42 pm (Concurrent Session: Late Breaking E353C).  He will report on a single-center discovery and internal validation study of gene expression profiles in the peripheral blood and biopsy tissue of liver transplant recipients (LTRs).

One hundred and eighty-one patients were studied, including 45 with normal function (TX), 45 with elevation in liver function tests (LFTs) with a biopsy showing acute rejection (AR), and another 45 patients with abnormal LFTs with no clinical or histological evidence of AR. Using Affymetrix gene expression arrays, the authors were able to show a significant number of differentially expressed genes in the peripheral blood between the 3 clinical phenotypes with high predictive accuracy (sensitivity, specificity, PPV, NPV), even when adjusted for prevalent incidence of each phenotype. Internal validation was performed using both standard bootstrapping and leave-one-out-cross-validation. These encouraging results suggest a robust predictive model for AR in LTRs.  A prospective, multi-center serial validation study (CTOT-14) is now underway, fully enrolled, with all samples collected from an external cohort of 200 LTRs.

Commenting on this work, Dr. Levitsky said, “We have discovered a significant number of genes in the peripheral blood that are differentially expressed between three clinical phenotypes; normal function (TX), elevated liver function tests with a biopsy showing acute rejection (AR), and elevated liver function tests with no clinical symptoms or histological evidence of AR.  These encouraging results suggest a predictive model for AR in peripheral blood samples, which if further validated, may form the basis for a test that can be used to improve health management of liver transplant recipients and make possible personalized immunosuppression.  Such validation studies are already in process.” 

In addition to his role at Northwestern University, Dr. Levitsky is a clinical advisor to Transplant Genomics Inc. (TGI).  TGI has an exclusive license to commercialize transplant diagnostic tests based on the groundbreaking work performed through the collaboration of scientists at Northwestern and The Scripps Research Institute (TSRI).

Dr. Stan Rose, CEO of Transplant Genomics commented, “Dr. Levitsky’s discovery may lead to a new predictive tool that, in the future, can enable improved management of liver transplant patients.  TGI is excited about the opportunity to expand our product portfolio from kidney to liver as we strive to bring innovative molecular tests to market that benefit the lives of organ transplant recipients.”

Dr. Levitsky’s work was partially supported through sponsored research funding provided to Northwestern by TGI.

MEDIA CONTACTS:
Darren Lee, Transplant Genomics Inc., at 781-454-6523 rel=”nofollow”>dlee@transplantgenomics.com, or Marla Paul, Northwestern University – Feinberg School of Medicine at 312-503-8928 rel=”nofollow”>marla-paul@northwestern.edu.

About Transplant Genomics Inc.
Transplant Genomics Inc. (TGI) is a molecular diagnostics company committed to improving organ transplant outcomes, with an initial focus on kidney transplant recipients. Working with the transplant community, TGI is commercializing a suite of tests enabling diagnosis and prediction of transplant recipient immune status. Test results will support clinicians with information to optimize immunosuppressive therapy, enhance patient care and improve graft survival. Test services are offered through TGI’s CLIA lab in Pleasanton, CA.www.transplantgenomics.com

About Northwestern University Feinberg School of Medicine

Northwestern University Feinberg School of Medicine, founded in 1859, attracts talented individuals to its faculty, staff, and student body through its cutting-edge research initiatives, superb clinical affiliates, global outlook and innovative curriculum. Located in the heart of Chicago’s Magnificent Mile, Feinberg has built a national reputation for excellence through a strong history of collaborative, interdisciplinary medical education and research, and along with Northwestern Memorial Hospital and Northwestern Medical Group is part of the premier academic medical center known as Northwestern Medicine. 
http://www.feinberg.northwestern.edu/

To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/genomic-signature-for-predicting-acute-rejection-in-liver-transplant-patients-to-be-presented-at-the-american-transplant-congress-300448502.html

SOURCE Transplant Genomics Inc.

New anti-rejection drug reduces weight gain, enhances outcomes for liver transplant recipients – Science Daily

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Researchers have discovered that a new anti-rejection drug that is gentler on the kidneys after liver transplant also reduces weight gain, which is common after surgery and can lead to serious complications for transplant patients.

Researchers from the Intermountain Medical Center Transplant Program in Salt Lake City, led a randomized, international multi-center study of more than 700 patients, which also included researchers from Northwestern University, Novartis Pharmaceuticals Corp., and Mayo Clinic.

For the study, researchers compared a new drug, Everolimus, to Tacrolimus, a routinely prescribed anti-rejection drug. Researchers found that transplant patients taking Everolimus gained less weight — and kept it off at one and two years after starting the drug.

Weight gain after liver transplantation can lead to serious complications and increase the risk of post-transplant metabolic syndrome, cardiovascular events, and kidney failure. Components of post-transplant metabolic syndrome include diabetes, obesity, high blood pressure, and abnormal fat and cholesterol blood levels, which can cause heart disease and related adverse events such as heart attack and stroke.

Researcher will present results of the study at the American Transplant Congress in Chicago on May 2. The study is also published in the American Journal of Transplantation.

After transplant, patients must take anti-rejection drugs so their immune systems don’t attack and destroy the transplanted organ. The research was originally undertaken to see if Everolimus is gentler on the kidneys than Tacrolimus, the most commonly prescribed immunosuppressant drug.

“Everolimus did have less impact on kidney function, and the Food and Drug Administration approved the drug based on that finding for use in liver transplant patients,” said Michael M. Charlton, MD, researcher and clinician from the Intermountain Medical Center Center Transplant Program, and the study’s lead author.

Early-stage research had shown Everolimus prevented weight gain in fruit flies and other animals, so the researchers wondered if that finding would hold in human subjects, as well.

To find out, they randomized a total of 719 patients between 25 and 35 days after liver transplant into three study arms. The first group of 245 patients received Everolimus and reduced dose of Tacrolimus; the second group of 243 received the usual dose of Tacrolimus and served as the control group; and the final group of 231 patients were prescribed only Everolimus to suppress their immune systems.

“We found that the two Everolimus groups in this study gained around 10 pounds less than patients in the tacrolimus arm,” said Dr. Charlton. “It used to be that rejection was a big deal and that was the most common cause of liver rejection or death. Now, the most common cause of death following liver transplantation is related to cardiovascular events and cancers, with kidney function increasingly important as well. Cardiovascular disease, cancers, and renal disease are driven in part by weight.”

The reduced weight gain was seen both one and two years after transplant.

Dr. Charlton said the second most-common reason people need liver transplant today is weight-related liver failure. “Since nearly everyone who receives a liver transplant gains weight after the surgery, this could be an easy way to avoid or limit the need for a transplant,” he said.

Story Source:

Materials provided by Intermountain Medical Center. Note: Content may be edited for style and length.

Facing inevitable liver transplant, young girl didn’t need to look far for a living donor – The Denver Post

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Peri Erickson, all 25 pounds of her, turns to her mother in the hospital exam room, curls her right arm in the air and demands: “Feel my muscle.”

Claire Erickson gently pinches the flesh of her daughter’s slender biceps and smiles. “Dang, girl, you must be working out,” she says.

At 3, Peri hasn’t been hitting the gym, but she’s definitely feeling stronger. On March 21, she underwent a liver transplant at Children’s Hospital Colorado that has helped solve medical problems that began at birth with her diagnosis of biliary atresia, a rare and life-threatening disease of the liver and bile ducts.

And though her condition wouldn’t have placed her high on the list of patients seeking potential deceased liver donors, Peri took a different route. She found a living donor — and she didn’t have to look far.

“I was the first one tested and, lo and behold, I was a match, so we didn’t have to continually look for someone,” says Claire, whose family over the past three years has shuttled Peri to doctor visits from their home in Red Lodge, Mont. “It doesn’t always work out like that for everybody.”

Peri and her mother participated in only the second pediatric live-donor transplant this year performed through a partnership between Children’s Hospital Colorado and the University of Colorado Hospital.

But Dr. Michael Wachs, the surgical director of abdominal transplantation at Children’s who performed Peri’s surgery, says several other families have expressed interest and he hopes eventually live donors will figure in 30 to 40 percent of the hospital’s pediatric transplants.

“Babies are harder to transplant with the current (deceased) donor pool,” says Wachs, who has been part of the live-donor cooperative between Children’s and University hospitals since its 1995 inception. “To compete for a portion of an adult liver, she would have to have been much sicker to be higher up on the list. Live donation allows you to bypass the list.”

Live donation also offers the advantage of familiarity with the donor that gives doctors a clearer view of the liver’s quality ahead of time. There’s also an ability to control the timeline of the surgery so it can be done at the optimal point for both donor and recipient.

By dodging the uncertainty of the waiting list, recipients sidestep a donor pool that has changed dramatically over the past 30 years, Wachs notes. Young donors are fewer. Most tend to be in their 50s or 60s and often overweight, with potentially less healthy organs.

They may still be viable donors for other adults, but in a pediatric scenario where the size of the adult liver would have to be reduced, that could place added stress on the organ.

In Peri’s case, Claire and husband, Justin, have long known that a transplant loomed somewhere in the future.

“We didn’t know at what point it would become a reality,” Claire says. “But probably within the last year we started to talk more seriously about it. Every visit, we felt half a step closer to doing a transplant.”

On a January visit to Colorado, doctors broached the idea of the live-donor route. Justin, a supervisor for a road construction company in Montana, arranged to stay in Colorado for the surgeries and only recently returned to their home in Red Lodge with Peri’s older brother Shay, 5.

But there was little doubt that Claire would be the donor.

“I knew it would be me,” she says. “I wanted to do it ever since live-donor was an option. I know I’m resilient, my body is healthy, and I wanted to do this for her. My husband is the breadwinner, and having him missing out on work would have been a scary process. But we definitely had friends and family members lining up.”

Potential donors undergo rigorous evaluation in both medical and psycho-social areas, says Dr. Elizabeth Pomfret, the chief of transplant surgery at University of Colorado Hospital who performed Claire’s surgery.

“What’s critical is a compatible blood type — not necessarily identical, but a compatible blood type,” she says, adding that anatomical considerations rank second. “Depending on how big the recipient is dictates how much liver volume we’d need from the donor. In this case, Peri’s a little girl, so thankfully she doesn’t require very much liver volume.”

Data from two types of body imaging were merged and sent to a company in Germany whose software created three-dimensional models that advised where to divide Claire’s liver, how large a portion to transplant and how to approach blood supply.

“It gives us a very detailed road map,” Pomfret says.

She stresses that anyone 18 or older can be a living donor — it’s not necessary to be related or even genetically similar to potential recipients.

“The number of people waiting has outstripped supply, basically,” Pomfret says. “This is a critical option to have available for recipients who would not otherwise make it.”

Fear or uncertainty over the transplant process never figured into the equation, by Claire’s calculations.

“I was so ready to move on and get our daughter healthy, and give her the best opportunity for a normal life,” she says. “Once you let fear and doubt and worry creep in, it can consume you.”

The night before the surgery, Peri was admitted to Children’s, where her parents stayed overnight in their daughter’s room.The next morning, around 5:30, Justin walked Claire across the medical campus parking lots to University of Colorado Hospital, where she would undergo her surgery.

“It smelled like spring out, calm and clear, a beautiful morning,” Claire recalls of the March day. “I felt refreshed and hopeful. I was just ready to do it, anxious and excited about it, knowing she was in the best hands possible and I was, too.”
Peri Erickson, 3, underwent a liver transplant in which her mother was the living donor. RJ Sangosti, The Denver Post
Peri Erickson, 3, underwent a liver transplant in which her mother was the living donor. Peri and her mother, Claire Erickson, were at Children’s Hospital for a follow-up exam April 24, 2017 in Aurora.
While Peri was prepped at Children’s, Claire underwent surgery at University of Colorado Hospital — just a short distance away on the Anschutz Medical Campus in Aurora. Pomfret removed a portion of the left lobe of her liver while circulating nurses at both hospitals kept in touch via cellphone to coordinate the transfer.

When the timing was right, that portion of Claire’s liver was put on ice and shuttled over to Children’s to replace Peri’s diseased organ. The transplanted portion will grow right along with Peri, while Claire’s liver will heal and regenerate in a month or two.

Both surgeries went well, although about a week into her recovery Peri underwent a second surgery to correct a blood flow issue before it could damage the liver graft.

At her most recent checkup, she proudly lifts her purple shirt to reveal the wavy scar that extends across her abdomen. Dr. Shikha Sundaram, medical director of the hospital’s pediatric transplant program, is impressed.

“Oh, it’s looking good!” she says, and nods as Claire details the growing appetite — French fries, chicken strips — that has added a pound to the girl’s tiny frame.

Claire notes that her daughter has recently shown an inclination to run, and Sundaram encourages the increased activity.

“Kids listen to their bodies,” she says. “If she’s wanting to run and play, it’s because her body is ready.”

Peri remains on about 10 medications, but slowly those will be reduced based on her blood work. Sundaram cleared mother and daughter to move from their Denver-area quarters to Carbondale, where Claire grew up, so they can visit family and return to Children’s for gradually less frequent checkups.

Before long, they will return to Montana, where Peri can continue her recovery. Wachs estimates her risk of a severe rejection episode that can’t be reversed at “close to zero.”

Claire can see the upside of live-donor transplant reflected in her daughter’s playful eyes.

“I think people don’t know a lot about it,” she says, “but it wasn’t hard to do — especially to save your own child.”
Peri Erickson, 3, underwent a liver transplant in which her mother was the living donor. RJ Sangosti, The Denver Post
Peri Erickson, 3, underwent a liver transplant in which her mother was the living donor. Peri with her mother, Claire Erickson, and grandmother, Ramona Griffith, left, leave after their appointment at Children’s Hospital for a follow-up exam on April 24, 2017 in Aurora.