Publications by authors named "Ahmet Gurakar"
Simultaneous liver-kidney transplantation (SLK) is a feasible option for patients with end-stage liver disease and concomitant renal dysfunction or end-stage renal disease. SLK has gained significant attention primarily due to multiple alterations in the allocation criteria over the past two decades. This review aims to summarize the most recent updates and outcomes of the SLK allocation policy, comparing SLK outcomes with those of liver transplantation alone and exploring the implications of donation after cardiac death in SLK procedures.
View Article and Find Full Text PDFIntroduction: Living liver donation improves survival of end-stage liver disease (ESLD) patients. Yet, it continues to represent a small proportion of United States (U.S.
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- The study focused on improving chronic hepatitis B (CHB) testing in primary and community care settings to aid in elimination efforts, aiming to assess various implementation strategies from existing literature.
- A systematic review and meta-analysis were conducted, analyzing 25 studies with over 130,000 participants, but found that no studies were conducted in low-and-middle-income countries.
- Key findings showed that community strategies, like education from lay health workers, and primary care strategies, such as electronic alerts and healthcare provider education, were effective, with a significant relationship observed between the number of strategy components and effectiveness.
Objective: Liver transplant (LT) evaluation is a complex process for patients involving multi-step and parallel medical, surgical, and psychosocial assessments of a patient's appropriateness for transplant. Patients may experience difficulties in navigating the evaluation process, potentially leading to disengagement and resulting in further health decline or death prior to completing evaluation. We aimed to identify and characterize patients' perceptions of undergoing LT evaluation.
View Article and Find Full Text PDF(1) Background: Hepatocellular carcinoma (HCC) contributes to the significant burden of cancer mortality in the United States (US). Despite highly efficacious antivirals, chronic viral hepatitis (CVH) remains an important cause of HCC. With advancements in therapeutic modalities, along with the aging of the population, we aimed to assess the contribution of CVH in HCC-related mortality in the US between 1999-2020.
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- Solid organ transplant recipients have a higher risk of HPV-related diseases, including anal squamous cell cancer (ASCC), but current screening guidelines are lacking.
- A survey of 113 liver transplant centers across the U.S. revealed that only 46% of centers screen for ASCC, and only 12.5% have formal guidelines for screening.
- The study highlights the need for better data, training, and resources to enhance ASCC prevention among liver transplant recipients, as many centers do not regularly assess HPV vaccination status.
Liver transplantation (LT) remains the only curative treatment for end-stage liver disease as well as acute liver failure. With the exponential increase in organ demand due to the increasing incidence and prevalence of liver diseases, the need to overcome the supply and demand mismatch has arisen. In this review, we discuss the current universal status of LT, emphasizing various LT practices worldwide.
View Article and Find Full Text PDFPurpose Of Review: Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in the current era after implementing the simultaneous liver kidney (SLK) allocation policy and safety net.
Recent Findings: The implementation of the SLK policy inverted the steady rise in SLK transplants and improved the utilization of high-quality kidneys.
Acute kidney injury (AKI) is common in hospitalized patients with cirrhosis. Hepatorenal syndrome (HRS) is a type of AKI known as HRS-AKI. It is a severe complication of cirrhosis with high morbidity and mortality.
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- The study evaluated the effects of metastasis-directed therapy to all disease sites (MDT-All) in patients with recurrent hepatocellular carcinoma (HCC) who had limited disease after liver transplantation, defined as having 3 or fewer lesions (oligoM1).
- Among 43 patients analyzed, 63% had oligoM1 disease, and those receiving MDT-All showed a significantly better overall survival rate compared to those who did not, with median survival of 38.4 months versus lower survival for non-MDT-All patients.
- Key predictors of worse outcomes included microvascular invasion and high alpha-fetoprotein levels, while having oligoM1 was linked to more favorable survival
Article Synopsis
- Acute liver failure (ALF) is a serious condition that occurs suddenly in people without pre-existing liver issues, featuring symptoms like bleeding problems and brain dysfunction.
- It has a high risk of severe health complications and requires careful monitoring of the patient’s blood circulation, metabolism, and infection status.
- Prompt evaluation and management in a specialized liver transplant unit are essential to determine which patients may need a liver transplant to improve their condition.
Article Synopsis
- The study examined livers from 45 patients with severe alcoholic hepatitis (SAH) and found high levels of IgG and IgA antibodies linked to liver cell damage.
- Antibodies extracted from SAH livers showed the ability to kill liver cells and recognized specific human proteins not found in healthy livers or livers affected by other diseases.
- The research identified cross-reacting autoantibodies in SAH that target common cellular components, which is unique compared to antibodies from livers with other conditions.
Importance: Racial disparities in liver transplant (LT) for hepatocellular carcinoma (HCC) may be associated with unequal access to life-saving treatment.
Objective: To quantify racial disparities in LT for HCC and mortality after LT, adjusting for demographic, clinical, and socioeconomic factors.
Design, Setting, And Participants: This cohort study was a retrospective analysis of United Network Organ Sharing/Organ Procurement Transplant Network (OPTN) data from 2003 to 2021.
Article Synopsis
- Increased alcohol consumption during the COVID-19 pandemic is expected to worsen cases of alcohol-related liver disease (ALD) and raise mortality rates.
- An analysis of referral requests to a hepatology unit from January 2020 to December 2022 showed the majority were for ALD cases.
- There was a notable rise in requests from intermediate care units, indicating patients were facing more severe health issues related to ALD.
Living Donor Liver Transplantation (LDLT) is a valuable solution to the shortage of donor organs for patients with end-stage liver disease. However, the eligibility of obese donors for LDLT remains a subject of debate. This literature review explores global practices and perceptions of LDLT, identifies donor eligibility criteria, and discusses special considerations and ethical caveats.
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- The study explored how healthcare providers view the use of AI-based clinical decision support (AI-CDS) for liver transplantation, focusing on the need for fairness and health equity in decision-making.
- Researchers conducted interviews with 53 liver transplant providers, identifying six key themes that emphasize the importance of transparency, data interpretability, and the integration of AI as a supportive team member rather than a replacement.
- Overall, findings show that providers are cautiously optimistic about AI-CDS improving clinical outcomes, highlighting the need for careful design that prioritizes equitable treatment for patients.
Article Synopsis
- The study investigates the presence and role of antibodies in the livers of patients with severe alcoholic hepatitis (SAH), finding substantial deposition of IgG and IgA antibodies in affected liver tissues.
- Antibodies extracted from SAH livers demonstrated the ability to kill liver cells in specific tests, indicating their pathogenic potential, unlike antibodies found in the patients' serum.
- Unique autoantigens were identified in SAH livers, suggesting that cross-reactive anti-bacterial antibodies may play a part in the progression of severe alcoholic hepatitis, distinct from other liver diseases.
Article Synopsis
- The study examines how neighborhood socioeconomic deprivation impacts liver transplant evaluation disparities among patients, using a detailed Area Deprivation Index for analysis.
- Researchers analyzed data from 1,377 adults referred for liver transplant evaluation and found that those in low socioeconomic neighborhoods faced higher risks of not being listed for transplantation, not starting evaluation, and dying before evaluation compared to those from high socioeconomic neighborhoods.
- The findings suggest that specific interventions targeting neighborhood deprivation could help improve outcomes for low-income patients and reduce racial and ethnic disparities in liver transplant listings.
Unlabelled: Liver transplantation (LT) candidates frequently have multiple cardiovascular risk factors, and cardiovascular disease is a major cause of morbidity and mortality after LT. Coronary artery calcium (CAC) scores are a noninvasive assessment of coronary artery disease using computed tomography. This study examines CAC scores and cardiac risk factors and their association with outcomes after LT.
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- The study examined how donor body mass index (BMI) affects outcomes for both living liver donors and their recipients, focusing on data from 66 cases between 2013 and 2020.
- No significant differences were found in donor or recipient characteristics based on BMI, except for a higher rate of wound complications in donors with BMI ≥30 kg/m.
- Overall, donors with a BMI of 30 or higher can still successfully donate their liver, but they face increased risks for perioperative complications.
Solid organ transplants are associated with a modestly increased risk of colorectal cancers (CRC). However, the molecular profile of these cancers has not been described. We hypothesized that transplant-related immunosuppression may promote development of more immunogenic tumors as suggested by a high tumor mutation burden or mismatch repair deficiency.
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- A quality improvement initiative was implemented at a single academic center to standardize immediate postoperative extubation (IPE) practices for liver transplant recipients, aiming to increase IPE rates while including high-risk patients.
- A retrospective study of 591 liver transplant patients from 2013 to 2018 showed significant increases in IPE rates over time, especially among high-risk groups, with minimal reintubation rates and no effect on mortality.
- IPE was found to be linked with shorter intensive care unit and overall hospital lengths of stay, demonstrating the benefits of standardized care practices in liver transplant procedures.