Glyn R Morgan, M.D.

Liver Transplant for Mixed Capillary-cavernous Hemangioma Masquerading as Hepatocellular Carcinoma in a Patient With Hepatocellular Carcinoma
Unal, Ethem; Francis, Franto; Aquino, Alger; Xu, Ruliang; Morgan, Glyn; Teperman, Lewis
2011 Oct;9(5):344-348, Experimental & Clinical Transplantation
Hemangioma is the most common benign tumor of the liver. Unlike cavernous hemangioma, hepatic capillary or mixed capillary-cavernous hemangioma is a rare type of tumor in adults. Clinical presentation of hemangioma may mimic that of hepatocellular carcinoma. Furthermore, radiologic features on computed tomography and magnetic resonance imaging may not be typical for hemangioma and can be confused with hepatocellular carcinoma. Symptomatic hemangiomas require some form of treatment, such as corticosteroids, interferon, radiation, arterial embolization, surgical resection, or liver transplant. In the present case study, we present a patient treated with liver transplant for hemangioma mimicking hepatocellular carcinoma. This case report illustrates the atypical imaging appearance of hemangioma and possible confusion it can cause in diagnosing hepatocellular carcinoma, especially in a hepatitis C carrier
— id: 138115, year: 2011, vol: 9, page: 344, stat: Journal Article,

Impact of H1N1 Vaccination in Liver Transplantation
Winnick, A.; Mitsiev, I.; Diflo, T.; Fahmy, A.; Morgan, G.; Teperman, L.
2011 APR ;11(7):198-199, American journal of transplantation
— id: 131947, year: 2011, vol: 11, page: 198, stat: Journal Article,

The Effects of H1N1 Vaccination in Liver Transplantation
Winnick, Aaron; Mitsiev, Ivaylo; Diflo, Thomas; Fahmy, Ahmed; Morgan, Glyn; Teperman, Lewis
2011 JUN ;17(6):S94-S95, Liver transplantation
— id: 134482, year: 2011, vol: 17, page: S94, stat: Journal Article,

Long Term Sequela in the Donor after Adult Living Donor Liver Transplantation
Winnick, A; Mitsiev, I; Karabicak, I; Diflo, T; Fahmy, A; John, D; Morgan, G; Teperman, L
2010 APR ;10(4):211-212, American journal of transplantation
— id: 111530, year: 2010, vol: 10, page: 211, stat: Journal Article,

PRE-TRANSPLANT IMAGING CORRELATE POORLY WITH EXPLANT PATHOLOGY IN LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA
Fahmy, A; Mitsiev, I; Peyregne, V; Diflo, T; John, D; Morgan, G; Teperman, L
2009 JUL ;15(7):S79-S79, Liver transplantation
— id: 101243, year: 2009, vol: 15, page: S79, stat: Journal Article,

PREDICTORS OF TUMOR RECURRENCE IN LIVER TRANSPLANTATION FOR HCC
Mitsiev, I; Fahmy, A; Peyregne, V; John, D; Diflo, T; Morgan, G; Teperman, L
2009 JUL ;15(7):S142-S143, Liver transplantation
— id: 101248, year: 2009, vol: 15, page: S142, stat: Journal Article,

EFFICACY OF PRE-TRANSPLANT TRANS-ARTERIAL CHEMO-EMBOLIZATION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA
Peyregne, V; Fahmy, A; John, D; Diflo, T; Morgan, G; Teperman, L
2009 JUL ;15(7):S142-S142, Liver transplantation
— id: 101247, year: 2009, vol: 15, page: S142, stat: Journal Article,

Increased Morbidity Following Donation after Cardiac Death in Liver Transplantation
Peyregne, V; Mitsiev, I; Fahmy, A; John, D; Diflo, T; Morgan, G; Teperman, L
2009 MAY ;9(5):522-522, American journal of transplantation
— id: 98851, year: 2009, vol: 9, page: 522, stat: Journal Article,

MACROSTEATOSIS AND INFLUENCE OF THE CRITICAL CARE MANAGEMENT BEFORE RECOVERY OF ORGANS IN DECEASED DONORS
Peyregne, V; Rabilloud, M; Fahmy, A; John, D; Diflo, T; Morgan, G; Teperman, L
2009 JUL ;15(7):S86-S86, Liver transplantation
— id: 101244, year: 2009, vol: 15, page: S86, stat: Journal Article,

Volumetric analysis of hepatocellular cancers in liver transplantation
Aquino, A; Teperman, L; Morgan, G; John, D; Fahmy, A; Diflo, T
2008 MAY ;8(2):471-471, American journal of transplantation
— id: 79109, year: 2008, vol: 8, page: 471, stat: Journal Article,

HCC recurrence following liver transplantation is associated with older donors
Morgan, GR; Diflo, T; John, D; Fahmy, A; Goldenberg, A; Tobias, H; Teperman, L
2008 MAY ;8(2):383-384, American journal of transplantation
— id: 79108, year: 2008, vol: 8, page: 383, stat: Journal Article,

MACROSTEATOSIS AND INFLUENCE OF THE CRITICAL CARE MANAGEMENT BEFORE ORGAN DONATION
Peyregne, V; Aquino, A; Fahmy, A; John, D; Diflo, T; Morgan, G; Teperman, L
2008 JUL ;14(7):S200-S200, Liver transplantation
— id: 97667, year: 2008, vol: 14, page: S200, stat: Journal Article,

Learning curve in right lobe living donation liver transplantation: Determination of the threshold
Peyregne, V; Fahmy, A; John, D; Diflo, T; Morgan, G; Teperman, L
2008 MAY ;8(2):613-614, American journal of transplantation
— id: 79110, year: 2008, vol: 8, page: 613, stat: Journal Article,

Identification of hepatocytic and bile ductular cell lineages and candidate stem cells in bipolar ductular reactions in cirrhotic human liver
Zhou, HC; Rogler, LE; Teperman, L; Morgan, G; Rogler, CE
2007 MAR ;45(3):716-724, Hepatology
Hepatocyte function and regeneration are severely compromised in severe liver disease, and a common sequela is cirrhosis. Structural changes caused by cirrhosis create a cellular environment conducive to the formation of ductular reactions (DRs). Ductular reactions are primarily composed of oval cells also known as 'intermediate hepatobiliary cells'. We have conducted single, double, and triple staining to study lineages of oval cells present in DRs. Staining with NCAM, CK19, and HepPar1 has revealed a distinctly bipolar structure to DRs that are embedded in cirrhotic tissue. Spatial analysis of cells that are singly HepPar1-positive, or CK19-positive, has revealed hepatocytic and biliary poles, respectively, in the DRs. Also, the location of singly NCAM-positive cells in DRs suggests that they may be bipotent liver stem/progenitor cells. The locations of other intermediate hepatobiliary cells, which have combinations of markers, suggest that CK19+/NCAM+ cells are transitional cells in the biliary lineage and that rare cells that are negative for all three markers are transitional cells in the hepatocytic lineage. A working cell lineage model for DRs is presented
— id: 71379, year: 2007, vol: 45, page: 716, stat: Journal Article,

Clinical application of pentoxifylline in liver transplantation, an useful tool in extended criteria donors
Martin, JVD; Rubio, LRV; Shim, I; Murakami, T; Diflo, T; Morgan, G; John, D; Fahmy, A; Teperman, L
2006 MAY ;12(5):C53-C53, Liver transplantation
— id: 64394, year: 2006, vol: 12, page: C53, stat: Journal Article,

Experience with plasmapheresis and liver transplantation for fulminant hepatic failure
Murakami, T; Fahmy, A; John, DG; Morgan, GR; Diflo, T; Tobias, H; Eperman, LW
2006 MAY ;12(5):C93-C93, Liver transplantation
— id: 64396, year: 2006, vol: 12, page: C93, stat: Journal Article,

Impact of extended criteria donor on hepatitis C recurrence following liver transplantation
Murakami, T; Fahmy, A; John, DG; Morgan, GR; Diflo, T; Tobias, H; Petrovic, L; Teperman, LW
2006 OCT ;44(4):479A-479A, Hepatology
— id: 70932, year: 2006, vol: 44, page: 479A, stat: Journal Article,

Risk factor for bile duct stricture in living donor liver transplantation
Shim, I; Morgan, G; Diflo, T; John, D; Fahmy, A
2006 MAY ;12(5):C86-C86, Liver transplantation
— id: 64395, year: 2006, vol: 12, page: C86, stat: Journal Article,

Successful post transplant treatment of HCV may induce liver allograft rejection
Teperman, LW; Weber, S; Martin, JD; Morgan, G; Tobias, H
2006 MAY ;12(5):C126-C126, Liver transplantation
— id: 64398, year: 2006, vol: 12, page: C126, stat: Journal Article,

Comprehensive evaluation of potential right lobe liver donors: Comparison of MRI with 3D MRCP and CT with CT cholangiography
Morgan, GR; Taouli, B; Israel, GM; Macari, M; Moses, DA; Heche, E; Lee, VS; Teperman, LW
2005 MAY ;5(5):209-209, American journal of transplantation
— id: 57861, year: 2005, vol: 5, page: 209, stat: Journal Article,

West Nile virus infections in organ transplant recipients--New York and Pennsylvania, August-September, 2005
Teperman LW; Diflo T; Fahmy A; Morgan GR; Wetherbee RE; Ratner L; Cohen D; Ackelsberg J; Campbell M; DeBernardo E; Fine A;
2005 Oct 14;54(40):1021-1023, MMWR
In September 2005, West Nile virus (WNV) infection was confirmed in three of four recipients of organs transplanted from a common donor. Two recipients subsequently had neuroinvasive disease, one recipient had asymptomatic WNV infection, and a fourth recipient apparently was not infected. This report summarizes the ongoing investigation. Clinicians should be aware of the potential for transplant-associated transmission of infectious disease
— id: 61342, year: 2005, vol: 54, page: 1021, stat: Journal Article,

Does the current MELD system disadvantage hepatoma patients?
Teperman, L; Campbell, D; Morgan, G; Harper, A; Fahmy, A; John, D; Diflo, T; Tobias, H; West, B; Goldenberg, A
2005 JUL ;11(7):C62-C62, Liver transplantation
— id: 58643, year: 2005, vol: 11, page: C62, stat: Journal Article,

Living donor liver transplantation (LDLT) is safe and effective for hepatitis C recipients
Fahmy, A; O'Mahony, CA; Kaul, H; Morgan, GR; John, D; Diflo, T; Teperman, L
2004 JUL ;4(7):355-355, American journal of transplantation
— id: 46604, year: 2004, vol: 4, page: 355, stat: Journal Article,

Double duct anastomoses in living donor liver transplant (LDUT)
Fahmy, AE; Kaul, H; O'Mahony, CA; Diflo, T; John, D; Morgan, GR; Teperman, L
2004 JUN ;10(6):C23-C23, Liver transplantation
— id: 46477, year: 2004, vol: 10, page: C23, stat: Journal Article,

Thalidomide (Thal) tolerance in patients treated with transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC)
Goldenberg, A; Volm, M; Hochster, H; Muggia, F; Rosen, R; Teperman, L; Morgan, G; Schwartz, J; Sung, M; Wadler, S
2004 JUL 15 ;22(14):376S-376S, Journal of clinical oncology
— id: 48682, year: 2004, vol: 22, page: 376S, stat: Journal Article,

Dose-dependent oval cell reaction in acetaminophen-induced murine liver injury
Kofman, A; Morgan, G; Kirschenbaum, A; Osbeck, J; Hussain, M; Theise, ND
2004 OCT ;40(4):623A-623A, Hepatology
— id: 47391, year: 2004, vol: 40, page: 623A, stat: Journal Article,

Defining intrahepatic biliary anatomy in living liver transplant donor candidates at mangafodipir trisodium-enhanced MR cholangiography versus conventional T2-weighted MR cholangiography
Lee, Vivian S; Krinsky, Glenn A; Nazzaro, Carol A; Chang, Jerry S; Babb, James S; Lin, Jennifer C; Morgan, Glyn R; Teperman, Lewis W
2004 Dec;233(3):659-666, Radiology
PURPOSE: To compare three-dimensional (3D) mangafodipir trisodium-enhanced T1-weighted magnetic resonance (MR) cholangiography with conventional T2-weighted MR cholangiography for depiction and definition of intrahepatic biliary anatomy in liver transplant donor candidates. MATERIALS AND METHODS: One hundred eight healthy liver transplant donor candidates were examined with two MR cholangiographic methods. All candidates gave written informed consent, and the study was approved by the institutional review board. First, breath-hold transverse and coronal half-Fourier single-shot turbo spin-echo and breath-hold oblique coronal heavily T2-weighted turbo spin-echo sequences were performed. Second, mangafodipir trisodium-enhanced breath-hold fat-suppressed 3D gradient-echo sequences were performed through the ducts (oblique coronal plane) and through the entire liver (transverse plane). Interpretation of biliary anatomy findings, particularly variants affecting right liver lobe biliary drainage, and degree of interpretation confidence at both 3D mangafodipir trisodium-enhanced MR cholangiography and T2-weighted MR cholangiography were recorded and compared by using the Wilcoxon signed rank test. Then, consensus interpretations of both MR image sets together were performed. Intraoperative cholangiography was the reference-standard examination for 51 subjects who underwent right lobe hepatectomy. The McNemar test was used to compare the accuracies of the individual MR techniques with that of the consensus interpretation of both image sets together and to compare each technique with intraoperative cholangiography. RESULTS: Biliary anatomy was visualized with mangafodipir trisodium enhancement in all patients. Mangafodipir trisodium-enhanced image findings agreed with findings seen at combined interpretations significantly more often than did T2-weighted image findings (in 107 [99%] vs 88 [82%] of 108 donor candidates, P < .001). Confidence was significantly higher with the mangafodipir trisodium-enhanced images than with the T2-weighted images (mean confidence score, 4.5 vs 3.4; P < .001). In the 51 candidates who underwent intraoperative cholangiography, mangafodipir trisodium-enhanced imaging correctly depicted the biliary anatomy more often than did T2-weighted imaging (in 47 [92%] vs 43 [84%] donor candidates, P = .14), whereas the two MR imaging techniques combined correctly depicted the anatomy in 48 (94%) candidates. CONCLUSION: Mangafodipir trisodium-enhanced 3D MR cholangiography depicts intrahepatic biliary anatomy, especially right duct variants, more accurately than does conventional T2-weighted MR cholangiography
— id: 47766, year: 2004, vol: 233, page: 659, stat: Journal Article,

Liver transplant donor candidates: associations between vascular and biliary anatomic variants
Lee, Vivian S; Morgan, Glyn R; Lin, Jennifer C; Nazzaro, Carol A; Chang, Jerry S; Teperman, Lewis W; Krinsky, Glenn A
2004 Aug;10(8):1049-1054, Liver transplantation
Our objective was to investigate the coexistence of vascular and biliary anatomic variants, the latter of which are known to increase the risk of biliary complications in living liver donor transplantation. A total of 108 consecutive liver donor candidates were examined by magnetic resonance (MR) imaging that included 2 MR cholangiography methods, T2-weighted MR cholangiography and mangofodipir-enhanced T1-weighted three-dimensional (3D) MR cholangiography, as well as gadolinium-enhanced MR angiography and venography of the liver. Images were interpreted by at least 2 investigators in consensus for definition of hepatic arterial, portal venous, and biliary anatomy. A subset of 51 subjects underwent laparotomy for right hepatectomy. Of the 108 subjects examined, 50 (46%) demonstrated normal hepatic artery, portal vein, and biliary anatomy. Variants of the hepatic artery were found in 27 of 108 (25%) subjects, of the portal vein in 12 of 108 (11%) subjects, and of the bile ducts in 30 of 108 (28%) subjects. Of the 27 subjects with hepatic arterial variants, 8 (30%) also had variant biliary anatomy. The association between hepatic arterial variants and biliary variants was not statistically significant (P >.5). However, of the 12 subjects with portal vein variants, 7 (58%) had biliary variants, and in 6 of 7 cases, the right posterior hepatic duct was anomalous. By chi-square analysis, the association between portal venous and biliary variants was significant (P =.012). In conclusion, over half of subjects with portal vein variants were found to have anomalous biliary anatomy, which always involved the hepatic ducts of the right lobe. The association between portal venous and biliary variants is statistically significant, while there is no significant association between hepatic arterial and biliary variants
— id: 47846, year: 2004, vol: 10, page: 1049, stat: Journal Article,

Scirrhous changes in dysplastic nodules do not indicate high-grade status
An, Hee J; Illei, Peter; Diflo, Thomas; John, Devon; Morgan, Glyn; Teperman, Lewis; Theise, Neil
2003 Jun;18(6):660-665, Journal of gastroenterology & hepatology
BACKGROUND AND AIMS: Dysplastic nodules (DN) may be divided into high-grade and low-grade, and the former has been known as a precancerous or borderline lesion. Recently many morphological characteristics concerning these types of DN have been reported. In the present study we attempted to evaluate the scirrhous change in DN as an indicative feature of high-grade DN, based on the morphological and cell-kinetic analyses using immunohistochemical stains for Ki-67. METHODS: We reviewed 35 livers with DN and selected 15 DN with scirrhous change. We stained DN-bearing sections of each case with hematoxylin and eosin, trichrome, reticulin and Perls' stain. We tried to subclassify and characterize the scirrhous change according to the fibrosis pattern. We also stained with Ki-67 immunohistochemically to assess the proliferative activity of DN with scirrhous change. RESULTS: We found two types of scirrhous change, that is, pericellular and stellate. The pericellular type was related to the Mallory body-forming cholestatic degeneration, whereas the stellate type was associated with extensive portal fibrosis probably induced by ischemic damage. Among DN with scirrhous change, high-grade DN comprised five nodules (33%) and there were 10 (67%) low-grade nodules. There was no significant relationship between the presence or the types of scirrhous change and the grade of DN. The significant differences of Ki-67 labeling indices between types of scirrhous change were not shown in this study. We also could not find the differences between Ki-67 labeling indices of scirrhous DN (high and low grades) and those of surrounding regenerative nodules. CONCLUSIONS: This evidence indicated that the scirrhous change in DN was not a specific feature of high-grade DN. We also found that scirrhous DN have two morphological varieties that may represent biologically different processes, that is, pericellular scirrhous type and stellate scirrhous type
— id: 43149, year: 2003, vol: 18, page: 660, stat: Journal Article,

Right lobe liver donors: Association between hepatic arterial, portal venous, and biliary anatomic variants
Cha, JP; Lee, VS; Krinsky, GA; John, D; Diflo, T; Teperman, L; Morgan, GR
2003 OCT ;38(4):653A-653A, Hepatology
— id: 55388, year: 2003, vol: 38, page: 653A, stat: Journal Article,

Hepatic artery thrombosis in adult right lobe living donor liver transplantation
John, D; Diflo, T; Karp, N; Morgan, G; Wehbe, M; Kaul, H; Fahmy, A; Teperman, L
2002 OCT abstract #2045;36(4):675A-675A, Hepatology
— id: 36613, year: 2002, vol: 36, page: 675A, stat: Journal Article,

Transplantation for hepatocellular carcinoma and cirrhosis: sensitivity of magnetic resonance imaging
Krinsky, Glenn A; Lee, Vivian S; Theise, Neil D; Weinreb, Jeffrey C; Morgan, Glyn R; Diflo, Thomas; John, Devon; Teperman, Lewis W; Goldenberg, A S
2002 Dec;8(12):1156-1164, Liver transplantation
The sensitivity of magnetic resonance imaging (MRI) in patients who undergo transplantation for hepatocellular carcinoma (HCC) and cirrhosis is not known. We prospectively evaluated 24 patients with known HCC who underwent MRI and subsequent transplantation within 60 days (mean, 20 days). Using a phased-array coil at 1.5T, breath-hold turbo STIR and T2-weighted MR images were performed. Dynamic gadolinium-enhanced MRI was performed using a two- or three-dimensional gradient echo pulse sequence with images obtained in the hepatic arterial, portal venous, and equilibrium phases. The prospective interpretation of the MR study was directly compared with thin-section pathology evaluation of the explanted livers. All 24 patients had at least one HCC, and MR diagnosed tumor in 21 (88%) of these patients. On a lesion-by-lesion basis, MRI depicted 39 of 118 HCC for an overall sensitivity of 33%. MRI detected five (100%) of five lesions >5 cm, 20 (100%) of 20 lesions >2 cm but not exceeding 5 cm, 11 (52%) of 21 lesions between 1 and 2 cm, and three (4%) of 72 lesions <1 cm. Of the nine patients with carcinomatosis (innumerable lesions less than 1 cm), MR detected three lesions in one patient. Of the 15 dysplastic nodules found at pathology, MRI depicted a single 1.8-cm high-grade lesion, for a sensitivity of 7%. In conclusion, MRI is sensitive for the detection of HCC measuring at least 2 cm in diameter but is insensitive for the diagnosis of small HCC (<2 cm) and carcinomatosis
— id: 92764, year: 2002, vol: 8, page: 1156, stat: Journal Article,

Recipients are rarely denied right lobe living donor liver transplantation solely because of donor billary anomalies
Morgan, G; Lavelle, M; Krinsky, G; Lee, V; Diflo, T; John, D; Wehbe, M; Tobias, H; Teperman, L
2002 OCT abstract #2047;36(4):675A-675A, Hepatology
— id: 36612, year: 2002, vol: 36, page: 675A, stat: Journal Article,

Variations in risk factors for HCV recurrence after living donor and cadaveric liver transplantation
Teperman, L; Meininger, M; Wehbe, M; Diflo, T; Morgan, G; John, D; Theise, N; Tobias, H
2002 OCT abstract #1965;36(4):654A-654A, Hepatology
— id: 36610, year: 2002, vol: 36, page: 654A, stat: Journal Article,

Recipients of right lobe grafts from live donors experience lower acute rejection rates than recipients of cadaveric whole livers
Wehbe, M; John, D; Diflo, T; Morgan, G; Tobias, H; Teperman, L
2002 OCT abstract #1989;36(4):660A-660A, Hepatology
— id: 36611, year: 2002, vol: 36, page: 660A, stat: Journal Article,

Siderotic nodules in the cirrhotic liver at MR imaging with explant correlation: no increased frequency of dysplastic nodules and hepatocellular carcinoma
Krinsky GA; Lee VS; Nguyen MT; Rofsky NM; Theise ND; Morgan GR; Teperman LW; Weinreb JC
2001 Jan;218(1):47-53, Radiology
PURPOSE: To determine the sensitivity of magnetic resonance (MR) imaging for detection of siderotic nodules in patients with cirrhosis and whether the frequency of hepatocellular carcinoma (HCC) and dysplastic nodules is greater if siderotic nodules are present. MATERIALS AND METHODS: MR imaging (1.5 T) was performed within 0-117 days (mean, 30 days) before liver transplantation in 77 patients. Two readers retrospectively evaluated gradient-echo (GRE) (echo time [TE], > or = 9 and 4-5 msec) and turbo short inversion time inversion-recovery or T2-weighted images for low-signal-intensity nodules. Whole-explant pathologic correlation was available in every case. RESULTS: At explantation, 28 (36%) of 77 patients had HCC, 25 (32%) had dysplastic nodules, and nine (12%) had both; 35 (45%) patients had siderotic nodules. The sensitivity of GRE imaging with 9-msec or longer TE for the detection of siderotic nodules was 80% (28 of 35) but decreased to 31% (11 of 35) with 4-5-msec TE. Frequency of HCC was not significantly higher (P =.27) in patients with (43% [15 of 35]) than in patients without (31% [13 of 42]) siderotic nodules. Frequency of dysplastic nodules also was not significantly higher (P =.42) in patients with (37% [13 of 35]) than in patients without (29% [12 of 42]) siderotic nodules. CONCLUSION: Sensitivity of MR imaging for the detection of siderotic nodules was improved with use of GRE pulse sequences with longer TEs of 9 msec or greater (80%) versus 4-5 msec (31%); however, there was no significant increased frequency of HCC or dysplastic nodules in patients with pathologically proved siderotic nodules
— id: 21258, year: 2001, vol: 218, page: 47, stat: Journal Article,

Mr imaging as the sole preoperative imaging modality for right hepatectomy: a prospective study of living adult-to-adult liver donor candidates
Lee VS; Morgan GR; Teperman LW; John D; Diflo T; Pandharipande PV; Berman PM; Lavelle MT; Krinsky GA; Rofsky NM; Schlossberg P; Weinreb JC
2001 Jun;176(6):1475-1482, American journal of roentgenology
OBJECTIVE. Our aim was to investigate the feasibility of MR imaging as a comprehensive preoperative imaging test for examination of liver donor candidates for adult-to-adult right lobe transplantation. SUBJECTS AND METHODS. Twenty-five consecutive donor candidates were examined at 1.5 T using a torso phased array coil with breath-hold T1- and T2-weighted imaging of the abdomen, MR cholangiography using T2-weighted turbo spin-echo imaging, and MR angiography and venography of the liver using two interpolated three-dimensional spoiled gradient-echo sequences (average dose of gadolinium contrast material, 0.17 mmol/kg). Images were interpreted for liver parenchymal and extrahepatic abnormalities; measurements of right and left lobe liver volumes; definition of hepatic arterial, portal venous, and hepatic venous anatomy; and definition of the biliary branching pattern. Findings were compared with those of conventional angiography in 13 patients, 11 of whom also had surgical findings for comparison. RESULTS. Nine patients were excluded as candidates for donation on the basis of MR imaging findings that included parenchymal or extrahepatic abnormalities in five patients, vascular anomalies in two, and biliary anomalies in three. Two patients who did not undergo surgery underwent conventional angiography that confirmed MR angiographic findings except for a small (<2 mm) accessory left hepatic artery missed on MR imaging. Of the nine patients who underwent successful right hepatectomy, all MR imaging findings were corroborated intraoperatively. In two patients, right hepatectomy was aborted at laparotomy because of intraoperative cholangiography findings; in one of them, the biliary finding was unsuspected on MR imaging. CONCLUSION. A comprehensive MR imaging examination has the potential to serve as the sole preoperative imaging modality for living adult-to-adult liver donor candidates provided improvements in definition of intrahepatic biliary anatomy can be achieved
— id: 20646, year: 2001, vol: 176, page: 1475, stat: Journal Article,

Volumetric mangafodipir trisodium-enhanced cholangiography to define intrahepatic biliary anatomy
Lee VS; Rofsky NM; Morgan GR; Teperman LW; Krinsky GA; Berman P; Weinreb JC
2001 Apr;176(4):906-908, American journal of roentgenology
— id: 26763, year: 2001, vol: 176, page: 906, stat: Journal Article,

Adult living donor liver transplantation section
Morgan G
2001 ;6(4):349-349, Current opinion in organ transplantation
— id: 26869, year: 2001, vol: 6, page: 349, stat: Journal Article,

Selection and imaging of the living liver donor
Morgan GR; Diflo T; John D; Teperman L
2001 ;6(4):350-354, Current opinion in organ transplantation
Primum non nocere-First, do no harm: this is one of the basic tenets of medical practice. The very act of living donation violates this age-old edict. The rapidly increasing number of adult recipients and the critical shortage of cadaveric organs have forced transplant surgeons and physicians to search for suitable grafts elsewhere. The use of living liver donors for children has already had a significant impact on the pediatric waiting list. There has been considerable concern, however, regarding the rapidity with which adult-to-adult living donor transplantation has been embraced by transplant centers throughout the country compared with the very cautious and calculated start-up witnessed when living liver donation was first introduced for pediatric recipients. Children needing livers have greatly benefited from living donation and, to a lesser degree, from split-liver transplantation. The splitting of cadaveric livers has become more common, but unfortunately relatively few cadaveric organs are suitable for splitting and the procedure generally benefits an adult and a pediatric recipient and so does nothing extra to reduce the numbers of adults on the waiting list. The number of adults on the waiting list is, however, increasing at a tremendous rate, and thus the demand for solutions is great. Most living donor grafts given to adult recipients are right lobes. Left lobe grafts are not discussed in this review. The risks are considerable. Right hepatic lobectomy is a formidable procedure even in the most skilled hands. Proper donor selection is critical. The donor selection practices of four leading transplant centers are reviewed in the first segment of this review. In the second section, the imaging of potential donors is examined in more detail. (C) 2001 Lippincott Williams & Wilkins, Inc. [References: 13] <75>
— id: 26868, year: 2001, vol: 6, page: 350, stat: Journal Article,

Vascular and extravascular complications of liver transplantation: comprehensive evaluation with three-dimensional contrast-enhanced volumetric MR imaging and MR cholangiopancreatography
Pandharipande PV; Lee VS; Morgan GR; Teperman LW; Krinsky GA; Rofsky NM; Roy MC; Weinreb JC
2001 Nov;177(5):1101-1107, American journal of roentgenology
OBJECTIVE: Our purpose was to evaluate a comprehensive MR imaging strategy for recipients of liver transplants that relies on dynamic interpolated three-dimensional (3D) MR imaging for simultaneous vascular, parenchymal, and extrahepatic imaging. MATERIALS AND METHODS: Twenty-three consecutive adult patients underwent 30 MR imaging examinations between 2 days and 99 months (mean, 15 months) after transplantation using a breath-hold 3D gradient-echo sequence (TR range/TE range, 3.7-4.7/1.8-1.9; flip angle, 12-30 degrees ) with an intermittent fat-saturation pulse and interpolation in the section-select direction to enable pixel size 3 mm or less in all dimensions. Unenhanced and triphasic contrast-enhanced 3D imaging (average dose, 0.13 mmol/kg of gadopentetate dimeglumine) was performed. A subset of patients (n = 13) also underwent MR cholangiopancreatography using half-Fourier single-shot turbo spin-echo imaging. MR imaging examinations were correlated with digital subtraction angiography (n = 8), contrast-enhanced cholangiography (n = 9), sonography (n = 13), and histopathology (n = 14). RESULTS: MR imaging revealed abnormal findings in 27 (90%) of 30 examinations, including vascular disease in nine, biliary complications in four, and evidence of intra- or extra-hepatic hepatocellular carcinoma recurrence in six. Digital subtraction angiography confirmed seven MR angiography examinations but suggested disease overestimation in one. Contrast-enhanced cholangiography confirmed findings of MR cholangiopancreatography in seven cases but suggested disease underestimation in two. CONCLUSION: Dynamic interpolated 3D MR imaging combined with dedicated MR cholangiopancreatography can provide a comprehensive assessment of vascular, biliary, parenchymal, and extrahepatic complications in most recipients of liver transplants
— id: 26595, year: 2001, vol: 177, page: 1101, stat: Journal Article,

TIPS is not a contraindication for adult living donor liver transplantation
Wehbe, M; John, D; Morgan, G; Diflo, T; Dagher, F; Tobias, H; Teperman, L
2001 OCT ;34(4):654A-654A, Hepatology
— id: 54870, year: 2001, vol: 34, page: 654A, stat: Journal Article,

Adult living donor liver transplantation: Selection process and exclusion criteria
Dagher, FY; Lee, V; Rofsky, N; Morgan, G; Diflo, T; John, D; Tobias, H; Teperman, L
2000 OCT ;32(4):252A-252A, Hepatology
— id: 55259, year: 2000, vol: 32, page: 252A, stat: Journal Article,

Siderotic nodules at MR imaging: regenerative or dysplastic?
Krinsky GA; Lee VS; Nguyen MT; Rofsky NM; Theise ND; Morgan GR; Teperman LW; Weinreb JC
2000 Sep-Oct;24(5):773-776, Journal of computer assisted tomography
OBJECTIVE: To determine if iron containing 'siderotic' nodules detected at magnetic resonance (MR) imaging are regenerative (RN) or dysplastic (DN) and to attempt to identify features that may distinguish them. MATERIAL AND METHODS: MR imaging (1.5 T) was performed on 77 cirrhotic patients who underwent orthotopic liver transplantation within 0-117 days (mean 30 days) of MR imaging. Two readers retrospectively evaluated breath-hold gradient-echo pulse sequences (echo time > or =9.0 ms, flip angle < or =45 degrees) for the presence of hypointense nodules, which were classified as micronodular (< or =3 mm), macronodular (>3 mm), or mixed. Nodule distribution was classified as focal (<5), scattered (5-20), or diffuse (>20) per slice. Thin section pathologic correlation was available in all cases, and Prussian blue iron stains were performed. RESULTS: Of 35 patients with pathologically proven siderotic nodules, 10 (29%) had at least 2 siderotic DN. MR detected siderotic nodules in 10 of 10 (100%) patients with siderotic DN and RN, and in 18 of 25 patients (72%) with siderotic RN only. CONCLUSION: Siderotic RN cannot be reliably distinguished from siderotic DN with MR imaging, and therefore the widely used term 'siderotic regenerative nodule' should be avoided and replaced by 'siderotic nodule.'
— id: 32279, year: 2000, vol: 24, page: 773, stat: Journal Article,

Dysplastic nodules and hepatocellular carcinoma: sensitivity of digital subtraction hepatic arteriography with whole liver explant correlation
Krinsky GA; Nguyen MT; Lee VS; Rosen RJ; Goldenberg A; Theise ND; Morgan G; Rofsky NM
2000 Jul-Aug;24(4):628-634, Journal of computer assisted tomography
PURPOSE: The purpose of this work was to determine the sensitivity of hepatic digital subtraction arteriography (DSA) for the detection of hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) when compared with pathological findings from whole liver explants. METHOD: Twenty-one patients 30-72 years old (mean 54 years) with cirrhosis and known or clinically suspected HCC (20 prior to chemoembolization) underwent hepatic DSA with subsequent transplantation within 80 days (mean 32 days). The prospective DSA report was compared with pathologic findings from explanted livers. RESULTS: Overall, DSA detected 31 of 95 HCC lesions for a sensitivity of 33%. Of these 31 lesions, 28 were hypervascular and 3 were hypovascular. DSA detected all six HCCs measuring >5 cm, all six HCCs measuring 3-5 cm, and all five HCCs 2-3 cm, resulting in a sensitivity of 100% (17/17) for HCC >2 cm. DSA detected 7 of 18 HCCs measuring 1-2 cm (sensitivity 39%) and 7 of 60 HCCs < or =1 cm (sensitivity 12%). Overall sensitivity for DSA in detection of HCC < or =2 cm was 18% (14/78 lesions). None of 17 DNs (0.2-1.5 cm in size) was identified on DSA. CONCLUSION: DSA is insensitive to small HCC (< or =2 cm), carcinomatosis arising within nodules, and DN
— id: 11521, year: 2000, vol: 24, page: 628, stat: Journal Article,

Duct to duct biliary anastomosis with T-tube drainage in adult right lobe living donor liver transplantation (LDLT) without bile leaks
Morgan, G; Lee, V; Krinsky, G; Rofsky, N; John, D; Diflo, T; Teperman, L
2000 OCT ;32(4):214A-214A, Hepatology
— id: 55258, year: 2000, vol: 32, page: 214A, stat: Journal Article,

MRI as the sole pre-operative imaging modality for living related liver transplant donor evaluation
Morgan, GR; Lee, V; Rofsky, N; John, D; Diflo, T; Krinsky, G; Rosen, R; Schlossberg, P; Teperman, L
2000 APR 27 ;69(8):S176-S176, Transplantation
— id: 54569, year: 2000, vol: 69, page: S176, stat: Journal Article,

Liver from bone marrow in humans
Theise ND; Nimmakayalu M; Gardner R; Illei PB; Morgan G; Teperman L; Henegariu O; Krause DS
2000 Jul;32(1):11-16, Hepatology
It has been shown in animal models that hepatocytes and cholangiocytes can derive from bone marrow cells. We have investigated whether such a process occurs in humans. Archival autopsy and biopsy liver specimens were obtained from 2 female recipients of therapeutic bone marrow transplantations with male donors and from 4 male recipients of orthotopic liver transplantations from female donors. Immunohistochemical staining with monoclonal antibody CAM5.2, specific for cytokeratins 8, 18, and 19, gave typical strong staining of hepatocytes, cholangiocytes, and ductular reactions in all tissues, to the exclusion of all nonepithelial cells. Slides were systematically photographed and then restained by fluorescence in situ hybridization (FISH) for X and Y chromosomes. Using morphologic criteria, field-by-field comparison of the fluorescent images with the prior photomicrographs, and persistence of the diaminiobenzidene (DAB) stain through the FISH protease digestion, Y-positive hepatocytes and cholangiocytes could be identified in male control liver tissue and in all study specimens. Cell counts were adjusted based on the number of Y-positive cells in the male control liver to correct for partial sampling of nuclei in the 3-micron thin tissue sections. Adjusted Y-positive hepatocyte and cholangiocyte engraftment ranged from 4% to 43% and from 4% to 38%, respectively, in study specimens, with the peak values being found in a case of fibrosing cholestatic recurrent hepatitis C in one of the liver transplant recipients. We therefore show that in humans, hepatocytes and cholangiocytes can be derived from extrahepatic circulating stem cells, probably of bone marrow origin, and such 'transdifferentiation can replenish large numbers of hepatic parenchymal cells
— id: 11634, year: 2000, vol: 32, page: 11, stat: Journal Article,

Predictors of disease recurrence following chemoembolization, liver transplantation (OLT), and adjuvant chemotherapy for hepatoma (HCC)
Morgan, GR; Goldenberg, A; Rosen, R; Diflo, T; John, D; Teperman, L
1999 ;67(9):147-1164, Transplantation
— id: 92755, year: 1999, vol: 67, page: 147, stat: Journal Article,

Chemoembolization-induced tumor necrosis: Correlation of HRI. Pathology and clinical outcome in cirrhotics with hepatocellular carcinoma
Morgan, GR; Goldenberg, A; Rosen, R; Rofsky, N; Mizrahi, H; Thiese, N; Diflo, T; Devon, J; Teperman, L
1999 ;67(9):345-634, Transplantation
— id: 92754, year: 1999, vol: 67, page: 345, stat: Journal Article,

Accelerated triple dose Hepatitis B vaccination is successful in cirrhotic patients
Teperman, L; Morgan, G; Diflo, T; John, D; Gopalan, V; McCahill, J; Sayed, L; Tobias, H
1999 APR 15 ;67(7):S17-S17, Transplantation
— id: 54029, year: 1999, vol: 67, page: S17, stat: Journal Article,

Recurrent hepatitis B: Predictions and prophylaxis following liver transplantation
Morgan, G; Diflo, T; John, D; Tobias, H; Teperman, L
1998 OCT ;28(4):733A-733A, Hepatology
— id: 53703, year: 1998, vol: 28, page: 733A, stat: Journal Article,

Plasma exchange (PEx) as a bridge to successful liver transplantation (OLT) in the critically ill patient
Morgan, GR; Chen, D; Goldenberg, A; Tobias, H; Diflo, T; Teperman, L
1997 ;26(4):1748-1748, Hepatology
— id: 92756, year: 1997, vol: 26, page: 1748, stat: Journal Article,

Introduction immunotherapy in liver transplantation with mycophenolate mofetil and steroids
John, D; Morgan, G; Diflo, T; Simons, C; Tobias, H; Teperman, L
1996 OCT ;24(4):1609-1609, Hepatology
— id: 52762, year: 1996, vol: 24, page: 1609, stat: Journal Article,

Waiting time for liver transplantation increases the risk of incidental hepatocellular carcinomas found in explants
Teperman, L; Mizrachi, H; John, D; Diflo, T; Morgan, G; Goldenberg, A; Tobias, H; Theise, N
1996 OCT ;24(4):1843-1843, Hepatology
— id: 52763, year: 1996, vol: 24, page: 1843, stat: Journal Article,

The use of plasma exchange in primary non-function of liver allografts
Teperman, L; Morgan, G; Chen, C; Chen, D; Negron, C; Diflo, T; Goldenberg, A
1996 OCT ;24(4):215-215, Hepatology
— id: 52760, year: 1996, vol: 24, page: 215, stat: Journal Article,

Diltiazem is a safe drug in transplant patients on Prograf and does not affect Prograf levels
Teperman, L; Turgut, S; Negron, C; John, D; Diflo, T; Morgan, G; Tobias, H
1996 OCT ;24(4):214-214, Hepatology
— id: 52761, year: 1996, vol: 24, page: 214, stat: Journal Article,