Publications by authors named "Mariya Samoylova"
Key Points: Incidence of ESKD in the first year after primary organ transplant ranges from 2.4% to 3.6% and from 1.
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- The International Intestinal Failure Registry (IIFR) studied outcomes of intestinal failure in a large pediatric group, focusing on identifying factors that affect achieving enteral autonomy within the first year.
- The study involved 189 patients, primarily with short bowel syndrome, and found that 51.6% achieved early enteral autonomy, while 6.5% died; key findings showed that having an ostomy increased the time needed for enteral autonomy.
- The results suggest that reducing bowel resection and performing ostomy reversal can help children with intestinal failure achieve enteral autonomy more quickly.
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- This study assessed the impact of the Affordable Care Act's Medicaid expansion on kidney and liver transplant patients from 2007 to 2018, focusing on payer mix and transplant outcomes.
- The analysis showed a slight increase in the percentage of Medicaid beneficiaries on transplant waiting lists, especially in states that expanded Medicaid coverage.
- While the association of Medicaid insurance with successful transplants decreased over time for kidney patients, it improved for liver patients; however, Medicaid recipients faced higher risks of graft failure regardless of time.
The impact of HLA matching on graft survival has been well characterized in renal transplantation, with a higher degree of matching associated with superior graft survival. Additionally, living donor grafts are known to confer superior survival compared to those from deceased donors. The purpose of this study is to report our multi-decade institutional experience and outcomes for patients who received HLA-identical living donor grafts, which represent the most favorable scenario in kidney transplantation.
View Article and Find Full Text PDFBackground: Livers from "nonideal" but acceptable donors are underutilized; however, organ procurement organization (OPO) metrics do not assess how OPO-specific practices contribute to these trends. In this analysis, we evaluated nonideal liver donor avoidance or risk aversion among OPOs and within US donation service areas (DSAs).
Methods: Adult donors in the United Network for Organ Sharing registry who donated ≥1 organ for transplantation between 2007 and 2019 were included.
Background: Selection of the optimal treatment modality for primary liver cancers remains complex, balancing patient condition, liver function, and extent of disease. In individuals with preserved liver function, liver resection remains the primary approach for treatment with curative intent but may be associated with significant mortality. The purpose of this study was to establish a simple scoring system based on Model for End-stage Liver Disease (MELD) and extent of resection to guide risk assessment for liver resections.
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- Liver transplantation is a key treatment for severe liver disease in kids, with living donor liver transplantation (LDLT) being a common option involving the left lateral segment (LLS) of the liver.
- The study examined 50 patients to find a reliable formula for estimating LLS volume (LLSV) using CT scans, but ultimately found that traditional demographic factors did not effectively predict LLSV.
- The conclusion suggests that donor candidates should be evaluated on an individual basis without excluding them due to their size, as LLSV was difficult to accurately predict.
Historically in the United States, kidneys for simultaneous liver-kidney transplantation (SLKT) candidates were allocated with livers, prioritizing SLKT recipients over much of the kidney waiting list. A 2017 change in policy delineated renal function criteria for SLKT and implemented a safety net for kidney-after-liver transplantation. We compared the use and outcomes of SLKT and kidney-after-liver transplant with the 2017 policy.
View Article and Find Full Text PDFObjective: Ex vivo lung perfusion has emerged as a novel technique to safely preserve lungs before transplantation. Recent studies have demonstrated an accumulation of inflammatory molecules in the perfusate during ex vivo lung perfusion. These proinflammatory molecules, including damage-associated molecular patterns and inflammatory cytokines, may contribute to acute and chronic allograft dysfunction.
View Article and Find Full Text PDFBackground: The first wave of the Covid-19 pandemic resulted in a drastic reduction in kidney transplantation and a profound change in transplant care in France. It is critical for kidney transplant centers to understand the behaviors, concerns and wishes of transplant recipients and waiting list candidates.
Methods: French kidney patients were contacted to answer an online electronic survey at the end of the lockdown.
Background: "Textbook outcome" (TO) is a novel composite quality measure that encompasses multiple postoperative endpoints, representing the ideal "textbook" hospitalization for complex surgical procedures. We defined TO for kidney transplantation using a cohort from a high-volume institution.
Methods: Adult patients who underwent isolated kidney transplantation at our institution between 2016 and 2019 were included.
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- The incidence of simultaneous heart-kidney transplants (SHK) has risen significantly over the past 15 years, growing from 1.6% to 6.6% of total heart transplants, although the number of dialysis-dependent patients receiving SHK has not changed.
- Survival analysis revealed that SHK offers substantial benefits for dialysis-dependent patients, with a median survival of 12.6 years, compared to 7.1 years for heart-only transplants, while survival rates for non-dialysis-dependent patients were similar between SHK and heart-alone transplants.
- While 26% of SHK recipients experienced delayed graft function, rates of chronic dialysis post-transplant were comparable between
Liver grafts from pediatric donors represent a small fraction of grafts transplanted into adult recipients, and their use in adults requires special consideration of donor size to prevent perioperative complications. In the past, graft weight or volume ratios have been adopted from the living donor liver transplant literature to guide clinicians; however, these metrics are not regularly available to surgeons accepting deceased donor organs. In this study, we evaluated all pediatric-to-adult liver transplants in the United Network for Organ Sharing Standard Transplant Analysis and Research database from 1987 to 2019, stratified by donor age and donor-recipient height mismatch ratio (HMR; defined as donor height/recipient height).
View Article and Find Full Text PDFBackground: The Kidney Allocation System (KAS) was developed to improve equity and utility in organ allocation. We examine the effect of this change on kidney graft distribution and survival.
Methods: UNOS data was used to identify first-time adult recipients of a deceased donor kidney-alone transplant pre-KAS (Jan 2012-Dec 2014, n = 26,612) and post-KAS (Jan 2015-Dec 2017, n = 30,701), as well as grafts recovered Jan 2012-Jun 2019.
Objective: We sought to compare kidney transplantation outcomes between Veterans Affairs (VA) and non-VA transplant centers.
Summary Background Data: Transplant care at the VA has previously been scrutinized due to geographic and systematic barriers. The recently instituted MISSION Act entered effect June 6th, 2019, which enables veteran access to surgical care at civilian hospitals if certain eligibility criteria are met.
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- The study defines "textbook outcome" (TO) for liver transplantation as a composite quality benchmark based on several postoperative factors, aiming to standardize ideal hospitalization conditions.
- A cohort of liver transplant patients from 2014 to 2017 was analyzed, resulting in a TO definition that includes factors like mortality, organ dysfunction, and readmissions.
- Of 231 liver transplants, 31% achieved TO, which correlated with approximately $60,000 lower total charges, although TO did not significantly impact long-term health outcomes.
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- Immunosuppressive medications, while effective for preventing organ rejection and graft-versus-host disease, can negatively impact mitochondrial function in T-cells, leading to various side effects.
- In vitro studies showed that mycophenolate mofetil (MMF) caused mitochondrial depolarization, increased reactive oxygen species (ROS) production, and higher rates of apoptosis in T-cells, unlike other medications such as cyclosporine A, rapamycin, and tacrolimus.
- The findings suggest that MMF impairs T-cell function by reducing energy production, generating harmful ROS, and promoting cell death, highlighting the need for careful consideration of its use in therapy.
Recent evidence suggests that hypothermic machine perfusion of donor kidneys reduces delayed graft function (DGF). This study addresses the effect of machine perfusion (MP) on allograft rejection in the United States. We assembled a retrospective cohort of patients undergoing kidney-alone transplants in the UNOS database from June 30, 2004 to May 31, 2017.
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- Pancreas transplantation can effectively treat insulin-dependent diabetes, enhancing patient survival and quality of life, especially when done alongside kidney transplants.
- Success relies heavily on careful selection of both donors and recipients, with various technical methods available for implantation.
- Complications after surgery are mostly technical in the first year and immunological later, while islet cell transplantation yields poorer results compared to whole-organ pancreas transplantation.
With recent changes in United Network for Organ Sharing policy, patients in the United States with hepatocellular carcinoma (HCC) are likely to spend more time on the liver transplantation (LT) waiting list. The increasing wait time will allow for an opportunity to assess tumor biology prior to LT. Modified Response Evaluation Criteria in Solid Tumors (mRECIST) paradigm provides such a framework for this assessment, and yet little is understood of its utility as it would apply for patients listed for LT in the United States.
View Article and Find Full Text PDFCurrent guidelines recommend ultrasound (US) for hepatocellular carcinoma (HCC) surveillance in cirrhosis. We assess predictors of decreased US sensitivity for detecting HCC. At a single center in the United States, all HCC patients evaluated for liver transplantation (LT) received an abdominal US.
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- The study analyzed patients with hepatocellular carcinoma (HCC) near the size limit for liver transplants, revealing potential inaccuracies in tumor size reporting.
- Using a large database, the researchers found that 3.0% of patients might have measurements recorded at the edge of eligibility criteria.
- Additionally, the observed HCC recurrence rates were lower than expected for smaller tumors, further indicating possible reporting discrepancies at the margins of transplant criteria.