Browsing by Author "Singhal, Ashish"

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Orthotopic Liver Transplant Using Allografts From Geriatric Population in the United States: Is There Any Age Limit?
(Başkent Üniversitesi, 2010-09) Singhal, Ashish; Jabbour, Nicolas; Cho, Yong W.; Hutchinson, Lan V.; Ghuloom, Adel E.; Sezginsoy, Banu
Objectives: Observations of minimal pathophysiological changes in the liver with healthy aging represent the rationale for expanding the donor pool with older donors. However, a debate exists for their upper age limit. The aim of this study is to examine the outcomes of orthotopic liver transplants from older patients (≥ 60 years). Materials and Methods: Using the Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) data, we retrospectively analyzed graft and patient survivals of orthotopic liver transplants done with octogenarian grafts (n=197) and compared them with orthotopic liver transplants done with donors aged between 60 and 79 years (n=4003) and < 60 years (n=21 290) during 2003 to 2007. Results: One- and 3-year graft and patient survival rates among recipients of hepatic allografts from donors < 60 years of age were significantly superior to recipients of octogenarian grafts (graft: 84% vs 75.5% at 1 year; 74.2% vs 61.2% at 3 years; P < .001; patient: 87.8% vs 81.0% at 1-year; 79.3% vs 69.1% at 3 years; P < .001). However, there was no survival difference between recipients of allografts from donors aged > 80 years and 60-79 years (graft: 75.5% vs 77.4% at 1 year; 61.2% vs 64.2% at 3 years; P = .564; patient: 81.0% vs 83.8% at 1 year; 69.1% vs 71.8% at 3 years; P = .494). It correlates well with hepatitis C virus-seronegativity and relatively lower model for end-stage liver disease score among recipients of octogenarian grafts (P < .001). Conclusions: Careful donor evaluation, avoidance of additional donor risk factors, and their pairing with appropriate recipients offer acceptable functional recovery, even with donors > 80 years.
Peroneal Neuropathy Following Liver Transplantation: Possible Predisposing Factors and Outcome
(Başkent Üniversitesi, 2009-12) Singhal, Ashish; Gupta, Subash; Wadhawan, Manav; Vij, Vivek; Goyal, Neerav; Varma, Mukul
Introduction: Perioperative peroneal neuropathy is an uncommon complication following operations remote from the leg or in supine position including liver transplant. Materials and Methods: We retrospectively reviewed the medical records of 132 living-donor liver transplant recipients done at our center between September 2006 and December 2008. Various potential preoperative, intraoperative, and postoperative factors were studied in the cases that developed perioperative peroneal neuropathy. Results: Peroneal neuropathy was reported in 7 recipients (5.3%) following liver transplant. Apart from intraoperative positioning, other identifiable predisposing factors appear to be poor nutritional status, tall and slender body shape, alcoholic liver disease, and higher pretransplant model for end-stage liver disease score. All patients were treated conservatively, including nutritionally balanced diet and vitamin supplements combined with physical rehabilitation therapy. The motor power returned to normal within 6 months in all 7 patients. Conclusions: Perioperative peroneal neuropathy may be contributed by various preoperative factors apart from intraoperative nerve compression. It can be effectively prevented by being aware of the predisposing factors and implicating adequate precautions perioperatively.
Portal Biliopathy Treated With Living-donor Liver Transplant: Index Case
(Başkent Üniversitesi, 2011-04) Gupta, Subash; Wadhawan, Manav; Vij, Vivek; Goyal, Neerav; Singhal, Ashish
Portal biliopathy refers to abnormalities of the entire biliary tract in patients with extrahepatic portal vein obstruction. Most of the patients are asymptomatic. However, more than 80% of patients show characteristic morphologic features on endoscopic retrograde cholangiopancreatography. Symptomatic cases usually require therapy. The proposed therapies include endoscopic dilatation and stenting of the common bile duct, portosystemic shunt with splenectomy, meso Rex bypass, and occasionally, bilioenteric bypass. In patients with failed stenting and nonshuntable anatomy, liver transplant may be the only option, provided an adequate inflow can be achieved to the graft. To the best of our knowledge, only 2 cases have been reported, and these have undergone deceased-donor liver transplant for portal biliopathy. We report an index case treated successfully with living-donor liver transplant.