Publications by authors named "Alexandra Shingina"

Multidisciplinary clinics (MDCs) are gaining momentum throughout the medical field, having initially been pioneered in oncology clinics due to their inherent ability to streamline complex care and improve both patient outcomes and the patient care experience. Liver transplant and hepatobiliary tumor clinics are examples of established MDCs in hepatology. With the changing landscape of liver disease in regard to etiology and patient complexity and acuity, there is a clear need for efficient, highly coordinated care.

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Sarcopenic obesity increases the risk of mortality in patients with liver disease awaiting liver transplantation and in the post-transplant period. Nutrition recommendations for individuals with sarcopenia differ from recommendations for patients with obesity or sarcopenic obesity. While these nutrition guidelines have been established in non-cirrhotic patients, established guidelines for liver transplant candidates with sarcopenic obesity are lacking.

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Article Synopsis
  • * This research involved a nested case-control study with 50 cases (43 with HCC) and 151 controls from the Southern Community Cohort Study, analyzing urine samples for specific biomarkers related to liver cancer.
  • * Two biomarkers, 11dTxB and the PGI-M/11dTXB ratio, showed a significant association with increased HCC risk in African Americans, indicating they could serve as potential urinary indicators for liver cancer.
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The increasing legality and acceptance of cannabis sale and consumption across the United States has led to a measurable increase in cannabis use nationwide, including in liver transplant (LT) candidates and recipients. With over 75% of liver transplant recipients transplanted in states with legalized use of medicinal and/or recreational cannabis, liver transplant clinicians must have expertise in the assessment of cannabis use given its potential impact on clinical care. In this review, the authors provide an understanding of nomenclature and tools to assess cannabis use, highlight essential components to guide clinical policy development and implementation, and discuss the potential impacts of cannabis use on patients' transplant course.

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Article Synopsis
  • - The 2023 Congress of ILTS, ELITA, and LICAGE in Rotterdam was a pivotal event for the liver transplant community, marking a recovery after COVID-19 with 1159 participants and increased abstract submissions.
  • - The conference centered around "Liver Disorders and Transplantation: Innovations and Evolving Indications," covering various topics in Hepatology, Surgical Approaches, and more.
  • - It served as a vital platform for discussions on advancements and collaborative efforts in the liver transplant field, highlighting ongoing innovations and evolving practices.
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Objectives: Combined heart-liver transplantation (CHLT) is becoming increasingly frequent as a maturing population of patients with Fontan-palliated congenital heart disease develop advanced liver fibrosis or cirrhosis. The authors present their experience with CHLT for congenital and noncongenital indications, and identify characteristics associated with poor outcomes that may guide intervention in high-risk patients.

Design: This was a single-center retrospective cohort study.

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Patients with severe heart disease may have coexisting liver disease from various causes. The incidence of combined heart-liver transplant (CHLT) is increasing as more patients with congenital heart disease survive to adulthood and develop advanced heart failure with associated liver disease from chronic right-sided heart or Fontan failure. However, the criteria for CHLT have not been established.

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Background: During the perioperative period of living donor liver transplantation, anesthesiologists and intensivists may encounter patients in receipt of small grafts that puts them at risk of developing small for size syndrome (SFSS).

Methods: A scientific committee (106 members from 21 countries) performed an extensive literature review on aspects of SFSS with proposed recommendations. Recommendations underwent a blinded review by an independent expert panel and discussion/voting on the recommendations occurred at a consensus conference organized by the International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplantation Society of India.

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Acute liver failure (ALF) is a rare, acute, potentially reversible condition resulting in severe liver impairment and rapid clinical deterioration in patients without preexisting liver disease. Due to the rarity of this condition, published studies are limited by the use of retrospective or prospective cohorts and lack of randomized controlled trials. Current guidelines represent the suggested approach to the identification, treatment, and management of ALF and represent the official practice recommendations of the American College of Gastroenterology.

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Article Synopsis
  • The 27th Annual Congress of the International Liver Transplantation Society took place from May 4 to 7, 2022, in Istanbul, with a hybrid format allowing both in-person and online attendance.
  • The event saw participation from 1123 liver transplant professionals across 61 countries, and nearly 500 scientific abstracts were presented.
  • The Vanguard Committee intended to summarize important invited lectures and noteworthy abstracts from the congress to benefit the liver transplant community.
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Congestive hepatopathy is becoming increasingly recognized among Fontan-palliated patients. Elevated central venous pressure is thought to drive the pathologic progression, characterized by sinusoidal dilatation, congestion, and fibrosis. A clinically relevant large animal model for congestive hepatopathy would provide a valuable platform for researching novel biomarkers, treatment, and prevention.

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We conducted a web-based survey to characterize liver transplant (LT) evaluation and listing practices for patients being evaluated for combined heart-liver transplantation (CHLT), with a specific emphasis on patients with congenital heart disease (CHD), around transplant centers in North America. Very few protocols for liver evaluation and listing in patients undergoing combined heart-liver transplantation are published, and no guidelines currently exist on this topic. A subject of intense debate in the transplant community is the decision of which patients with CHD and liver disease benefit from CHLT compared with heart transplantation.

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Purpose: To evaluate whether same-day discharge increased the incidence of 30-day readmission (30dR) after conventional transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) at a single institution.

Materials And Methods: In this retrospective study, 253 patients with HCC underwent 521 transarterial chemoembolization procedures between 2013 and 2020. TACE was performed with 50-mg doxorubicin/10-mg mitomycin C/5-10-mL ethiodized oil/particles.

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Article Synopsis
  • Severe renal dysfunction is common in liver transplant candidates, leading to considerations for simultaneous liver-kidney transplantation (SLKT) based on 2017 UNOS criteria; however, many patients still receive liver transplant alone (LTA).
  • A study of 37 LTA recipients showed an 84% rate of relative renal recovery post-transplant, with 43% maintaining this recovery for over 180 days; factors such as pre-transplant eGFR levels significantly influenced recovery outcomes.
  • The findings suggest that LTA candidates meeting SLKT criteria can have substantial renal recovery, advocating for broader adoption of SLKT guidelines and policies that assist patients who don't strictly meet the criteria.
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Introduction: Alcohol-related liver disease (ALD) is now the leading indication for liver transplantation (LT) in the United States (US). It remains unclear how centers are managing the medical and psychosocial issues associated with these patients.

Methods: We conducted a web-based survey of LT centers in the United States to identify center-level details on peri-LT management of ALD and related issues.

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Consistent with previous cross-sectional studies, in the Southern Community Cohort Study, the largest cohort for Black Americans conducted in a predominantly low-income population with 81,694 participants, we found that moderate alcohol drinking was associated with a significantly increased risk of mortality due to liver disease in Black Americans (hazard ratio = 2.06; 95% confidence interval: 1.08-3.

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Background: Living Donor Liver Transplantation(LDLT) in acute liver failure(ALF) patients has been limited by concerns regarding donor safety, consent process and recipient outcomes. Our objective was to conduct a systematic review(SR) and meta-analysis to address the concerns about subpar LDLT outcomes in patients with ALF.

Methods: We retrieved a total of 5965 literature references in our SR.

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Background: Liver transplantation (LT) has been employed for hepatic adenoma (HA) on a case-oriented basis. We aimed to describe the characteristics, waitlist, and post-LT outcomes of patients requiring LT for HA.

Methods: All patients listed or transplanted for HA in the United States were identified in the United Network for Organ Sharing (UNOS) database (1987-2020).

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Background: Donation after circulatory death (DCD) is an increasingly utilized alternative to donation after brain death (DBD) to expand the liver donor pool. We compared the outcomes of liver transplant (LT) after DCD versus DBD.

Methods: A PRISMA-compliant systematic literature review was performed using the PubMed, Cochrane Library, and Embase databases (end-of-search-date: July 2, 2020).

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Acute graft-versus-host disease (GVHD) is a rare complication after orthotopic liver transplantation (OLT) that carries high mortality. We hypothesized that machine-learning algorithms to predict rare events would identify patients at high risk for developing GVHD. To develop a predictive model, we retrospectively evaluated the clinical features of 1938 donor-recipient pairs at the time they underwent OLT at our center; 19 (1.

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