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Impact of utilization of hepatitis C positive organs in liver transplant:Analysis of united network for organ sharing database

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World Journal of Hepatology 2022年第5期14卷 984-991页

作者： amaninder dhaliwal Banreet Dhindsa Daryl Ramai Harlan Sayles Saurabh Chandan Rajani Rangray Department of Gastroenterology and Hepatology Moffitt Cancer CenterTampaFL 33612United States Department of Gastroenterology and Hepatology University of Nebraska Medical CenterOmahaNE 68198United States Department of Internal Medicine The Brooklyn Hospital CenterBrooklynNY 11201United States Department of Biostatistics University of Nebraska Medical CenterOmahaNE 68198United States Department of Gastroenterology and Hepatology Creighton University Medical CenterOmahaNE 68124United States

BACKGROUND The utility of hepatitis C virus(HCV)organs has increased after the Food and Drug Administration approval of direct acting anti-viral(DAA)medications for the HCV treatment.The efficacy of DAA in treating HCV is nearly 100%.AIM To analyze the United Network for Organ Sharing(UNOS)database to compare the survival rates between the hepatitis C positive donors and negative recipients and hepatitis C negative donors and recipients.METHODS We analyzed the adult patients in UNOS database who underwent deceased donor liver transplant from January 2014 to December 2017.The primary endpoint was to compare the survival rates among the four groups with different hepatitis C donor and recipient status:(Group 1)Both donor and recipient negative for HCV(Group 2)Negative donor and positive recipient for HCV(Group 3)Positive donor and negative recipient for HCV(Group 4)Both positive donor and recipient for HCV.SAS 9.4 software was used for the data analysis.Kaplan Meier log rank test was used to analyze the estimated survival rates among the four groups.RESULTS A total of 24512 patients were included:Group 1:16436,Group 2:6174,Group 3:253 and Group 4:1649.The 1-year(Group 1:91.8%,Group 2:92.12%,Group 3:87%,Group 4:92.8%),2-year(Group 1:88.4%,Group 2:88.1%,Group 3:84.3%,Group 4:87.5%),3-year(Group 1:84.9%,Group 2:84.3%,Group 3:75.9%,Group 4:83.2%)survival rates showed no statistical significance among the four groups.Kaplan Meier log rank test did not show any statistical significance difference in the estimated survival rates between Group 3 vs all the other groups.CONCLUSION The survival rates in hepatitis C positive donors and negative recipients are similar as compared to both hepatitis C negative donors and recipients.This could be due to the use of DAA therapy with cure rates of nearly 100%.This study supports the use of hepatitis C positive organs in the selected group of recipients with and without HCV infection.Further long-term studies are needed to further validate these findings.

关键词： Hepatitis C Liver transplant Survival United Network for Organ Sharing Direct acting antiviral

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Impact of psychosocial comorbidities on clinical outcomes after liver transplantation: Stratification of a high-risk population

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World Journal of Hepatology 2019年第8期11卷 638-645页

作者： Neil Bhogal amaninder dhaliwal Elizabeth Lyden Fedja Rochling Marco Olivera-Martinez Department of Internal Medicine Division of Gastroenterology and Hepatology University of Nebraska Medical Center Omaha NE 68198 United States Department of Biostatistics Division of Public Health University of Nebraska Medical Center Omaha NE 68198 United States

BACKGROUND Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy. There are currently over 13000 candidates on the liver transplant waiting list emphasizing the importance of rigorous patient selection. There are few studies regarding the impact of additional psychosocial barriers to liver transplant including financial hardship, lack of caregiver support, polysubstance abuse, and issues with medical noncompliance. We hypothesized that patients with certain psychosocial comorbidities experienced worse outcomes after liver transplantation. AIM To assess the impact of certain pre-transplant psychosocial comorbidities on outcomes after liver transplantation. METHODS A retrospective analysis was performed on all adult patients from 2012-2016. Psychosocial comorbidities including documented medical non-compliance, polysubstance abuse, financial issues, and lack of caregiver support were collected. The primary outcome assessed post-transplantation was survival. Secondary outcomes measured included graft failure, episodes of acute rejection, psychiatric decompensation, number of readmissions, presence of infection, recidivism for alcohol and other substances, and documented caregiver support failure.RESULTS For the primary outcome, there were no differences in survival. Patients with a history of psychiatric disease had a higher incidence of psychiatric decompensation after liver transplantation (19% vs 10%, P = 0.013). Treatment of psychiatric disorders resulted in a reduction of the incidence of psychiatric decompensation (21% vs 11%, P = 0.022). Patients with a history of polysubstance abuse in the transplant evaluation had a higher incidence of substance abuse after transplantation (5.8% vs 1.2%, P = 0.05). In this cohort, 15 patients (3.8%) were found to have medical compliance issues in the transplant evaluation. Of these specific patients, 13.3% were found to hav

关键词： Liver transplantation Recidivism Psychosocial decompensation Noncompliance Transplant psychiatry

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Endoscopic cryotherapy:Indications,techniques,and outcomes involving the gastrointestinal tract

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World Journal of Gastrointestinal Endoscopy 2022年第1期14卷 17-28页

作者： amaninder dhaliwal Syed M Saghir Harmeet S Mashiana Annie Braseth Banreet S Dhindsa Daryl Ramai Pushpak Taunk Rene Gomez-Esquivel Aamir Dam Jason Klapman Douglas G Adler Division of Gastroenterology and Advanced Endoscopy McLeod Regional Medical CenterFlorenceSC 29501United States Division of Gastroenterology Creighton University School of MedicineOmahaNE 68124United States Division of Gastroenterology and Hepatology University of Nebraska Medical CenterOmahaNE 68198-2000United States Division of Gastroenterology University of IowaIowa CityIA 52242-1009United States Division of Gastroenterology and Hepatology University of Utah School of MedicineSalt Lake CityUT 84132United States Division of Gastroenterology USF HealthTampaFL 33612United States Division of Gastroenterology and Hepatology Moffitt Cancer CenterTampaFL 33612United States Gastrointestinal Tumor Program Moffitt Cancer CenterTampaFL 33612United States Center for Advanced Therapeutic Endoscopy Porter Adventist HospitalCenter HealthDenverCO 80210United States

Endoscopic cryotherapy is a technique utilized for the ablation of target tissue within the gastrointestinal tract.A cryotherapy system utilizes the endoscopic application of cryogen such as liquid nitrogen,carbon dioxide or liquid nitrous oxide.This leads to disruption of cell membranes,apoptosis,and thrombosis of local blood vessels within the target tissue.Several trials utilizing cryotherapy for Barrett’s esophagus(BE)with variable dysplasia,gastric antral vascular ectasia(GAVE),esophageal carcinoma,radiation proctitis,and metastatic esophageal carcinomas have shown safety and efficacy.More recently,liquid nitrogen cryotherapy(cryodilation)was shown to be safe and effective for the treatment of a benign esophageal stricture which was refractory to dilations,steroid injections,and stenting.Moreover,liquid nitrogen cryotherapy is associated with less post procedure pain as compared to radiofrequency ablation in BE with comparable ablation rates.In patients with GAVE,cryotherapy was found to be less tedious as compared to argon plasma coagulation.Adverse events from cryotherapy most commonly include chest pain,esophageal strictures,and bleeding.Gastric perforations did occur as well,but less often.In summary,endoscopic cryotherapy is a promising and growing field,which was first demonstrated in BE,but the use now spans for several other disease processes.Larger randomized controlled trials are needed before its role can be established for these different diseases.

关键词： Cryotherapy Gastric antral vascular ectasia Barrett’s esophagus Esophageal cancer Palliative therapy

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Efficacy of pancreatoscopy for pancreatic duct stones:A systematic review and meta-analysis

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World Journal of Gastroenterology 2020年第34期26卷 5207-5219页

作者： Syed M Saghir Harmeet S Mashiana Babu P Mohan Banreet S Dhindsa amaninder dhaliwal Saurabh Chandan Neil Bhogal Ishfaq Bhat Shailender Singh Douglas G Adler Department of Internal Medicine University of Nevada Las Vegas School of MedicineLas VegasNV 89102United States Division of Gastroenterology and Hepatology University of Nebraska School of MedicineOmahaNE 68198-2000United States Division of Gastroenterology and Hepatology University of Utah HealthSalt Lake CityUT 84132United States

BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients.Per oral pancreatoscopy(POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi(PDC)in chronic pancreatitis.POP uses two techniques:Electrohydraulic lithotripsy(EHL)and laser lithotripsy(LL).Data on the safety and efficacy are limited for this procedure.We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP.The secondary aim was to assess pooled rates of technical success,clinical success for the two individual techniques,and adverse event rates.AIM To perform a systematic review and meta-analysis of POP,EHL and LL for management of PDC in chronic pancreatitis.METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed,EMBASE,Cochrane,Google Scholar and Web of Science databases(from 1999 to October 2019)to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP,EHL and LL.The primary outcome assessed involved the pooled technical success and clinical success rate of POP.The secondary outcome included the pooled technical success and clinical success rate for EHL and LL.We also assessed the pooled rate of adverse events for POP,EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP:Hemorrhage,post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP),perforation,abdominal pain,fever and infections.Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain.Randomeffects model was used for analysis.Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I2 statistics.Publication bias was ascertained,qualitatively by visual inspection of funnel plot and quantitatively by the Egger test.RESULTS A total of 16 studies including 383 patients

关键词： Electrohydraulic shockwave lithotripsy Laser lithotripsy Chronic pancreatitis Calculi Extracorporeal shockwave lithotripsy Endoscopic retrograde cholangiopancreatography Systematic review Meta-analysis Outcome

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Impact of sarcopenia on mortality in patients undergoing liver retransplantation

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World Journal of Hepatology 2020年第10期12卷 807-815页

作者： amaninder dhaliwal Diana Larson Molly Hiat Lyudmila M Muinov William L Harrison Harlan Sayles Tomoki Sempokuya Marco A Olivera Fedja A Rochling Timothy M McCashland Department of Gastroenterology and Hepatology University of South Florida and Moffitt Cancer CenterTampaFL 33612United States Division of Gastroenterology and Hepatology Department of Internal MedicineUniversity of Nebraska Medical CenterOmahaNE 68198United States Department of Internal Medicine University of Nebraska Medical CenterOmahaNE 68198United States Department of Radiology University of Nebraska Medical CenterOmahaNE 68198United States Division of Abdominal Imaging Department of RadiologyUniversity of Nebraska Medical CenterOmahaNE 68198United States Department of Biostatistics College of Public HealthUniversity of Nebraska Medical CenterOmahaNE 68198United States

BACKGROUND Sarcopenia,which is a loss of skeletal muscle mass,has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant.Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures.However,there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation(re-OLT).AIM To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT.METHODS This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1,2007 to January 1,2017.We divided patients into sarcopenia and no sarcopenia groups.“TeraRecon AquariusNet 4.***.12.194”software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT,to calculate the Psoas muscle area at L3-L4 intervertebral disc.We defined cutoffs for sarcopenia as<1561 mm2 for males and<1464 mm2 for females.The primary outcome was to compare 90 d,one,and 5-year survival rates.We also compared complications after re-OLT,length of stay,and readmission within 30 d.Survival analysis was performed with Kaplan-Meier survival analysis.Continuous variables were evaluated with Wilcoxon rank-sum tests.Categorical variables were evaluated with Fisher’s exact tests.RESULTS Fifty-seven patients were included,32 males:25 females,median age 50 years.Two patients were excluded due to incomplete information.Overall,47%(26)of patients who underwent re-OLT had sarcopenia.Females were found to have significantly more sarcopenia than males(73%vs 17%,P<0.001).Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups.Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant(36.5 mo vs 16.7 mo).Biological markers,outcome parameters,and survival at 90 d,1 and 5 years,were

关键词： Sarcopenia Liver transplantation Mortality Re-transplantation Psoas muscle index

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Fecal DNA testing for colorectal cancer screening:molecular targets and perspectives

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World Journal of Gastrointestinal Oncology 2015年第10期7卷 178-183页

作者： amaninder dhaliwal Panagiotis J Vlachostergios Katerina G Oikonomou Yitzchak Moshenyat Department of Medicine NYU Lutheran Medical Center Division of Gastroenterology NYU Lutheran Medical Center

The early detection of colorectal cancer with effective screening is essential for reduction of cancer-specific mortality. The addition of fecal DNA testing in the armamentarium of screening methods already in clinical use launches a new era in the noninvasive part of colorectal cancer screening and emanates from a large number of previous and ongoing clinical investigations and technological advancements. In this review, we discuss the molecular rational and most important genetic alterations hallmarking the early colorectal carcinogenesis process. Also, representative DNA targets-markers and key aspects of their testing at the clinical level in comparison or/and association with other screening methods are described. Finally, a critical view of the strengths and limitations of fecal DNA tests is provided, along with anticipated barriers and suggestions for further exploitation of their use.

关键词： Colorectal cancer Screening Fecal DNA Cologuard^(■) Adenoma

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Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications: What does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging?

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World Journal of Gastrointestinal Endoscopy 2018年第2期10卷 56-68页

作者： Mohit Girotra Kaartik Soota amaninder S dhaliwal Rtika R Abraham Mauricio Garcia-Saenz-de-Sicilia Benjamin Tharian Division of Gastroenterology University of Miami Miller School of Medicine Division of Gastroenterology and Hepatology University of Iowa School of Medicine Division of Gastroenterology and Hepatology University of Nebraska School of Medicine Department of Medicine University of Miami Miller School of Medicine Division of Gastroenterology and Hepatology University of Arkansas for Medical Sciences Division of Gastroenterology University of Arkansas for Medical Sciences

Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.

关键词： Hepatocellular carcinoma Liver Cancer Fine needle aspiration Endoscopy Endoscopic ultrasound Endoscopic ultrasonography Staging Management Treatment

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Endoscopic retrograde cholangiopancreatography in cirrhosis-a systematic review and meta-analysis focused on adverse events

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World Journal of Gastrointestinal Endoscopy 2018年第11期10卷 354-366页

作者： Shailender Singh Mashiana amaninder Singh dhaliwal Harlan Sayles Banreet Dhindsa Ji Won Yoo Qing Wu shailender singh Ali A Siddiqui Gordon Ohning Mohit Girotra Douglas G Adler Department of Internal Medicine University of Nevada Las Vegas School of MedicineLas VegasNV 89102United States Division of Gastroenterology and Hepatology University of Nebraska Medical Center982000 Nebraska Medical CenterOmahaNE 68198-2000United States Department of Biostatistics University of Nebraska Medical Center982000 Nebraska Medical CenterOmahaNE 68198-2000United States Nevada Institute of Personalized Medicine Department of Environmental and Occupational HealthSchool of Community Health SciencesUniversity of NevadaLas VegasNV 89154-4009United States Division of Gastroenterology Jefferson Medical CollegePhiladelphiaPA 19107United States Division of Gastroenterology University of Nevada Las Vegas School of MedicineLas VegasNV 89102United States Division of Gastroenterology University of Miami Miller School of MedicineMiamiFL 33136United States Division of Gastroenterology and Hepatology University of Utah School of MedicineHuntsman Cancer CenterSalt Lake CityUT 84132United States

AIM To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography(ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events.METHODS We performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017.RESULTS A total of 6,505 patients from 15 studies were analyzed(male ratio 59%, mean age 59 years), 11% with alcoholic and 89% with non-alcoholic cirrhosis, with 56.2% Child-Pugh class A, and 43.8% class B or C. Indications for ERCP included choledocholithiasis 60.9%, biliary strictures 26.2%, gallstone pancreatitis 21.1% and cholangitis 15.5%. Types of interventions included endoscopic sphincterotomy 52.7%, biliary stenting 16.7% and biliary dilation 4.6%. Individual adverse events included hemorrhage in 4.58%(95%CI: 2.77-6.75%, I^2 = 85.9%), post-ERCP pancreatitis(PEP) in 3.68%(95%CI: 1.83-6.00%, I^2 = 89.5%), cholangitis in 1.93%(95%CI: 0.63-3.71%, I^2 = 87.1%) and perforation in 0.00%(95%CI: 0.00-0.23%, I^2 = 37.8%). Six studies were used for comparison of ERCPrelated complications in cirrhosis vs non-cirrhosis, which showed higher overall rates of complications in cirrhosis patients with pooled OR of 1.63(95%CI: 1.27-2.09, I2 = 65%): higher rates of hemorrhage with OR of 2.05(95%CI: 1.62-2.58, I^2 = 2.1%) and PEP with OR of 1.33(95%CI: 1.04-1.70, I2=65%), but similar cholangitis rates with OR of 1.23(95%CI: 0.67-2.26, I^2 = 44.3%).CONCLUSION There is an overall higher rate of adverse events related to ERCP in patients with cirrhosis, especially hemorrhage and PEP. A thorough risk/benefit assessment should be performed prior to undertaking ERCP in patients with cirrhosis.

关键词： Meta-analysis endoscopic retrograde cholangiopancreatography Systematic review Adverse events Cirrhosis

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