Publications by authors named "Marlon Levy"

Background: Robotic living donor hepatectomy offers potential advantages but has been limited to high-volume centers, primarily in Asia and the Middle East. We report our experience establishing a robotic living donor right hepatectomy program in a U.S.

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: Hepatic resection offers promising outcomes for patients with hepatocellular carcinoma (HCC) but can be constrained by factors like patient suitability. Continuous advancements in laparoscopic and robotic technologies have made minimally invasive hepatectomies (MIHs) a viable alternative to open hepatectomies with benefits in terms of recovery and complications. : We completed a retrospective review on 138 HCC patients who underwent OH or MIH between 2010 and 2020 at the Hume-Lee Transplant Center.

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  • Robotic surgery (RDN) for kidney donation results in less tissue manipulation and faster recovery compared to open mini-incision surgery (ODN).
  • A study comparing 141 RDN cases to 191 ODN cases found that RDN led to significantly less blood loss and a shorter hospital stay.
  • Overall complication rates were low for both methods, indicating that RDN offers advantages without increasing risks.
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  • This study aimed to evaluate the feasibility and safety of robotic liver resection (RLR) for solid liver tumors, even for surgeons without extensive experience in major laparoscopic techniques.* -
  • An analysis of 226 liver resections showed that RLR resulted in less blood loss and shorter hospital stays compared to open surgeries, while having similar operation times.* -
  • The study concluded that RLR can be safely implemented with acceptable outcomes, and a surgeon can achieve proficiency after performing approximately 60 RLR procedures.*
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The Sustained Alcohol use post-Liver Transplant (SALT) and the High-Risk Alcohol Relapse (HRAR) scores were developed to predict a return to alcohol use after a liver transplant (LT) for alcohol-associated liver disease. A retrospective analysis of deceased donor LT from October 2018 to April 2022 was performed. All patients underwent careful pre-LT psychosocial evaluation.

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  • Cholecystoduodenal fistula (CDF) is a rare condition caused by ongoing issues in the biliary tree that leads to an abnormal connection between the gallbladder and duodenum.
  • Traditional open surgery is being replaced by laparoscopic methods, but inconsistencies have been noted due to the complexities of the area.
  • In a case study, a 62-year-old woman successfully underwent robotic surgery for CDF, showing promising outcomes and suggesting that robotic techniques may be the better option for avoiding complications in certain patients.
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  • The 'Burn and Push' technique was developed to improve liver parenchymal transection during robotic liver resection, addressing challenges due to limited specialized instruments.
  • A study analyzing 20 patients showed a median operation time of 241.5 minutes and low blood loss, with only one major complication reported.
  • Results suggest that the 'Burn and Push' technique is effective for robotic liver resections, but further research is needed to confirm its benefits with larger sample sizes.
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  • Islets undergo significant stress during isolation for transplantation, which negatively affects their hormone production post-surgery.
  • The study identified stress-induced exosomes containing immunogenic proteins released from islets under inflammatory conditions, which could play a role in immune responses.
  • Analysis of exosomes from transplant recipients revealed that higher levels of specific proteins correlated with increased insulin needs and poorer blood sugar control over the year following the transplant, suggesting their influence on islet survival and function.
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Objective: Robotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.

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  • - The report discusses a rare case of Intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B) in a patient, outlining its treatment through robotic surgery, which is not commonly documented.
  • - The patient, who exhibited symptoms of acute cholangitis, underwent successful robotic hepatectomy and cholecystectomy, with the pathology confirming the presence of IPMN-B.
  • - The findings highlight the significance of early diagnosis and the advantages of robotic surgery, including better visualization and control, resulting in a complication-free recovery for the patient.
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Background: Post-COVID-19 cholangiopathy is an emerging cholestatic liver disease observed in patients recovering from severe COVID-19 infection. Its prognosis is poor, necessitating liver transplantation in some cases. This study aimed to investigate the outcomes of liver transplantation for post-COVID-19 cholangiopathy.

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  • Liver transplantation (LT) is being explored as a curative option for patients with unresectable colorectal cancer liver metastasis (CRLM), particularly in selected individuals.
  • A case study highlights the first domino LT where a liver from a 30-year-old woman with heterozygous familial hypercholesterolemia (FH) was successfully transplanted to a 44-year-old woman with advanced sigmoid cancer and liver metastases.
  • The domino recipient showed positive outcomes, maintaining normal LDL-C levels and no cancer recurrence after 31 months, indicating that domino LT from donors with heterozygous FH can be a viable treatment for specific CRLM cases.
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Exosomes are 50-200 nm-sized extracellular vesicles that are secreted by cells to transfer signals and communicate with other cells. Recent research has revealed that allograft-specific exosomes containing proteins, lipids, and genetic materials are released into circulation post-transplantation which are powerful indicators of graft failure in solid-organ and tissue transplantations. The macromolecular content of exosomes released by the allograft and the immune cells serve as potential biomarkers for assessing the function and the acceptance/rejection status of the transplanted grafts.

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  • This study evaluates the outcomes of using a single subcostal incision (SI) compared to dual incisions (DI) for simultaneous liver kidney transplantation (SLK).
  • The research analyzed data from 37 SLK procedures and found that the SI group had shorter cold ischemic times and overall surgical times, despite having a higher urgency score (MELD).
  • Although the incidence of complications was slightly higher in the DI group, there was no significant difference in post-transplant kidney function or major complications between the two approaches, indicating that SI is a viable option.
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Islet culture before clinical transplantation has been adopted by various centers, but its effect on the survival and function of islets relative to the culture conditions and media needs further assessment. Human islets were cultured or preserved under four different conditions and three media options. Parameters such as recovery, viability, function, islet damage, and gene expressions for markers of hypoxia, and inflammation were assessed after 48-h culture or preservation.

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Quiescent human hepatic stellate cells (HSCs) serve as important reservoirs of fat-soluble vitamins in the body, namely vitamin A. In an activated form, HSCs are the drivers of fibrosis following chronic liver injury. In non-alcoholic steatohepatitis (NASH) specifically, activated HSCs are drivers of induction and progression of fibrogenesis.

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Importance: Ischemic cold storage (ICS) of livers for transplant is associated with serious posttransplant complications and underuse of liver allografts.

Objective: To determine whether portable normothermic machine perfusion preservation of livers obtained from deceased donors using the Organ Care System (OCS) Liver ameliorates early allograft dysfunction (EAD) and ischemic biliary complications (IBCs).

Design, Setting, And Participants: This multicenter randomized clinical trial (International Randomized Trial to Evaluate the Effectiveness of the Portable Organ Care System Liver for Preserving and Assessing Donor Livers for Transplantation) was conducted between November 2016 and October 2019 at 20 US liver transplant programs.

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Chyle leak after living donor nephrectomy is a rare complication and is associated with a significant postoperative burden. To the best of our knowledge, only 1 case of chyle leak after robotic living donor nephrectomy has been reported in the literature. In this study, we present our experience with 2 cases of chyle leak: 1 after and 1 during robotic donor nephrectomy.

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En bloc kidney transplant is a surgical treatment option that increases available donor organs and has excellent graft survival for patients with end-stage renal disease. Herein, we report a case of dissection of the external iliac artery that occurred during en bloc kidney transplant in an adult recipient. The en bloc kidneys were removed, flushed, and then reimplanted after restoring the blood flow to the lower limb.

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Trials describing 4- to 12-week courses of direct-acting antiviral drugs (DAAs) to treat hepatitis C virus (HCV) transmission from infected donors to uninfected kidney transplant recipients (D+/R- transplants) may be limited in "real-world" application by costs and delayed access to DAAs. We previously reported HCV transmission of 13% among D+/R- transplants with 2- to 4-day pangenotypic sofosbuvir/velpatasvir (SOF/VEL) perioperative prophylaxis, where one patient with HCV transmission was a nonresponder to first-line full-course DAA. Here, we report new data with a 7-day prophylaxis protocol (N = 50), as well as cumulative treatment and outcome data on all HCV D+/R- transplants (N = 102).

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Background: Circulating donor-derived cell-free DNA (cfDNA), a minimally invasive diagnostic tool for kidney transplant rejection, was validated using traditional histology. The molecular microscope diagnostic system (MMDx) tissue gene expression platform may provide increased precision to traditional histology.

Methods: In this single-center prospective study of 208 biopsies (median = 5.

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Background: Combined heart-liver transplantation (CHLT) is the only curative option for patients with concomitant pathology affecting the heart and liver. In some cases, the native livers of familial amyloidosis (FA) patients may be suitable for domino transplantation into other recipients.

Methods: Retrospective analysis (2013 to 2019) of all CHLT at our center was performed.

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Several cytokines and chemokines are elevated after islet infusion in patients undergoing total pancreatectomy with islet autotransplantation (TPIAT), including CXCL8 (also known as interleukin-8), leading to islet loss. We investigated whether use of reparixin for blockade of the CXCL8 pathway would improve islet engraftment and insulin independence after TPIAT. Adults without diabetes scheduled for TPIAT at nine academic centers were randomized to a continuous infusion of reparixin or placebo (double-blinded) for 7 days in the peri-transplant period.

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Background: The initial response to islet transplantation and the subsequent acute inflammation is responsible for significant attrition of islets following both autologous and allogenic procedures. This multicentre study compares this inflammatory response using cytokine profiles and complement activation.

Methods: Inflammatory cytokine and complement pathway activity were examined in two cohorts of patients undergoing total pancreatectomy followed either by autologous (n=11) or allogenic (n=6) islet transplantation.

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