Lewis W Teperman, M.D.

Results of a Survey of Transplant Center HCC Imaging Practices
Heimbach, J. K.; Harper, A. M.; Marvin, M. R.; Brown, K. A.; Edwards, E. B.; McCashland, T. M.; Sudan, D. L.; Trotter, J. F.; Washburn, W. K.; Teperman, L. W.
2011 APR ;11(7):468-468, American journal of transplantation
— id: 131948, year: 2011, vol: 11, page: 468, stat: Journal Article,

A randomized, multicenter study comparing steroid-free immunosuppression and standard immunosuppression for liver transplant recipients with chronic hepatitis C
Klintmalm, Goran B; Davis, Gary L; Teperman, Lewis; Netto, George J; Washburn, Kenneth; Rudich, Stephen M; Pomfret, Elizabeth A; Vargas, Hugo E; Brown, Robert; Eckhoff, Devin; Pruett, Timothy L; Roberts, John; Mulligan, David C; Charlton, Michael R; Heffron, Thomas G; Ham, John M; Douglas, David D; Sher, Linda; Baliga, Prabhakar K; Kinkhabwala, Milan; Koneru, Baburao; Abecassis, Michael; Millis, Michael; Jennings, Linda W; Fasola, Carlos G
2011 Dec;17(12):1394-1403, Liver transplantation
This randomized, prospective, multicenter trial compared the safety and efficacy of steroid-free immunosuppression (IS) to the safety and efficacy of 2 standard IS regimens in patients undergoing transplantation for hepatitis C virus (HCV) infection. The outcome measures were acute cellular rejection (ACR), severe HCV recurrence, and survival. The patients were randomized (1:1:2) to tacrolimus (TAC) and corticosteroids (arm 1; n = 77), mycophenolate mofetil (MMF), TAC, and corticosteroids (arm 2; n = 72), or MMF, TAC, and daclizumab induction with no corticosteroids (arm 3; n = 146). In all, 295 HCV RNA-positive subjects were enrolled. At 2 years, there were no differences in ACR, HCV recurrence (biochemical evidence), patient survival, or graft survival rates. The side effects of IS did not differ, although there was a trend toward less diabetes in the steroid-free group. Liver biopsy samples revealed no significant differences in the proportions of patients in arms 1, 2, and 3 with advanced HCV recurrence (ie, an inflammation grade >/= 3 and/or a fibrosis stage >/= 2) in years 1 (48.2%, 50.4%, and 43.0%, respectively) and 2 (69.5%, 75.9%, and 68.1%, respectively). Although we have found that steroid-free IS is safe and effective for liver transplant recipients with chronic HCV, steroid sparing has no clear advantage in comparison with traditional IS
— id: 149840, year: 2011, vol: 17, page: 1394, stat: Journal Article,

Donor-Transmitted Malignancies in Organ Transplantation: Assessment of Clinical Risk
Nalesnik, M. A.; Woodle, E. S.; DiMaio, J. M.; Vasudev, B.; Teperman, L. W.; Covington, S.; Taranto, S.; Gockerman, J. P.; Shapiro, R.; Sharma, V.; Swinnen, L. J.; Yoshida, A.; Ison, M. G.
2011 JUN ;11(6):1140-1147, American journal of transplantation
The continuing organ shortage requires evaluation of all potential donors, including those with malignant disease. In the United States, no organized approach to assessment of risk of donor tumor transmission exists, and organs from such donors are often discarded. The ad hoc Disease Transmission Advisory Committee (DTAC) of the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) formed an ad hoc Malignancy Subcommittee to advise on this subject. The Subcommittee reviewed the largely anecdotal literature and held discussions to generate a framework to approach risk evaluation in this circumstance. Six levels of risk developed by consensus. Suggested approach to donor utilization is given for each category, recognizing the primacy of individual clinical judgment and often emergent clinical circumstances. Categories are populated with specific tumors based on available data, including active or historical cancer. Benign tumors are considered in relation to risk of malignant transformation. Specific attention is paid to potential use of kidneys harboring small solitary renal cell carcinomas, and to patients with central nervous system tumors. This resource document is tailored to clinical practice in the United States and should aid clinical decision making in the difficult circumstance of an organ donor with potential or proven neoplasia
— id: 134379, year: 2011, vol: 11, page: 1140, stat: Journal Article,

Randomized Trial of Emtricitabine/Tenofovir DF Plus/Minus HBIG Withdrawal in Prevention of Chronic Hepatitis B Recurrence Post-Liver Transplantation: 48 Week Results
Teperman, L.; Spivey, J.; Poordad, F.; Schiano, T.; Bzowej, N.; Martin, P.; Coombs, D.; Hirsch, K. R.; Anderson, J.
2011 APR ;11(7):48-48, American journal of transplantation
— id: 131946, year: 2011, vol: 11, page: 48, stat: Journal Article,

Randomized Trial of Emtricitabine/Tenofovir DF +/- HBIG Withdrawal Post-Orthotopic Liver Transplantation for Chronic Hepatitis B: 48 Week Results
Teperman, Lewis; Spivey, James; Poordad, Fred; Schiano, Thomas; Bzowej, Natalie; Martin, Paul; Hirsch, Kenneth R.; Coombs, Derek; Anderson, Jane
2011 JUN ;17(6):S94-S94, Liver transplantation
— id: 134481, year: 2011, vol: 17, page: S94, stat: Journal Article,

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,

Kidney function: glomerular filtration rate measurement with MR renography in patients with cirrhosis
Vivier, Pierre-Hugues; Storey, Pippa; Rusinek, Henry; Zhang, Jeff L; Yamamoto, Akira; Tantillo, Kristopher; Khan, Umer; Lim, Ruth P; Babb, James S; John, Devon; Teperman, Lewis W; Chandarana, Hersh; Friedman, Kent; Benstein, Judith A; Skolnik, Edward Y; Lee, Vivian S
2011 May;259(2):462-470, Radiology
PURPOSE: To assess the accuracy of glomerular filtration rate (GFR) measurements obtained with low-contrast agent dose dynamic contrast material-enhanced magnetic resonance (MR) renography in patients with liver cirrhosis who underwent routine liver MR imaging, with urinary clearance of technetium 99m ((99m)Tc) pentetic acid (DTPA) as the reference standard. MATERIALS AND METHODS: This HIPAA-compliant study was institutional review board approved. Written informed patient consent was obtained. Twenty patients with cirrhosis (14 men, six women; age range, 41-70 years; mean age, 54.6 years) who were scheduled for routine 1.5-T liver MR examinations to screen for hepatocellular carcinoma during a 6-month period were prospectively included. Five-minute MR renography with a 3-mL dose of gadoteridol was performed instead of a routine test-dose timing examination. The GFR was estimated at MR imaging with use of two kinetic models. In one model, only the signal intensities in the aorta and kidney parenchyma were considered, and in the other, renal cortical and medullary signal intensities were treated separately. The GFR was also calculated by using serum creatinine levels according to the Cockcroft-Gault and modification of diet in renal disease (MDRD) formulas. All patients underwent a (99m)Tc-DTPA urinary clearance examination on the same day to obtain a reference GFR measurement. The accuracies of all MR- and creatinine-based GFR estimations were compared by using Wilcoxon signed rank tests. RESULTS: The mean reference GFR, based on (99m)Tc-DTPA clearance, was 74.9 mL/min/1.73 m(2) +/- 27.7 (standard deviation) (range, 10.3-120.7 mL/min/1.73 m(2)). With both kinetic models, 95% of MR-based GFRs were within 30% of the reference values, whereas only 40% and 60% of Cockcroft-Gault- and MDRD-based GFRs, respectively, were within this range. MR-based GFR estimates were significantly more accurate than creatinine level-based estimates (P < .001). CONCLUSION: GFR assessment with MR imaging, which outperformed the Cockcroft-Gault and MDRD formulas, adds less than 10 minutes of table time to a clinically indicated liver MR examination without ionizing radiation. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101338/-/DC1
— id: 134249, year: 2011, vol: 259, page: 462, stat: Journal Article,

Derivation of the uncontrolled donation after circulatory determination of death protocol for New York city
Wall, S P; Kaufman, B J; Gilbert, A J; Yushkov, Y; Goldstein, M; Rivera, J E; O'Hara, D; Lerner, H; Sabeta, M; Torres, M; Smith, C L; Hedrington, Z; Selck, F; Munjal, K G; Machado, M; Montella, S; Pressman, M; Teperman, L W; Dubler, N N; Goldfrank, L R
2011 Jul;11(7):1417-1426, American journal of transplantation
Evidence from Europe suggests establishing out-of-hospital, uncontrolled donation after circulatory determination of death (UDCDD) protocols has potential to substantially increase organ availability. The study objective was to derive an out-of-hospital UDCDD protocol that would be acceptable to New York City (NYC) residents. Participatory action research and the SEED-SCALE process for social change guided protocol development in NYC from July 2007 to September 2010. A coalition of government officials, subject experts and communities necessary to achieve support was formed. Authorized NY State and NYC government officials and their legal representatives collaboratively investigated how the program could be implemented under current law and regulations. Community stakeholders (secular and religious organizations) were engaged in town hall style meetings. Ethnographic data (meeting minutes, field notes, quantitative surveys) were collected and posted in a collaborative internet environment. Data were analyzed using an iterative coding scheme to discern themes, theoretical constructs and a summary narrative to guide protocol development. A clinically appropriate, ethically sound UDCDD protocol for out-of-hospital settings has been derived. This program is likely to be accepted by NYC residents since the protocol was derived through partnership with government officials, subject experts and community participants
— id: 136512, year: 2011, vol: 11, page: 1417, 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,

Rifaximin Treatment in Hepatic Encephalopathy
Bass, NM; Mullen, KD; Sanyal, A; Poordad, F; Neff, G; Leevy, CB; Sigal, S; Sheikh, MY; Beavers, K; Frederick, T; Teperman, L; Hillebrand, D; Huang, S; Merchant, K; Shaw, A; Bortey, E; Forbes, WP
2010 MAR 25 ;362(12):1071-1081, New England journal of medicine
BACKGROUND Hepatic encephalopathy is a chronically debilitating complication of hepatic cirrhosis. The efficacy of rifaximin, a minimally absorbed antibiotic, is well documented in the treatment of acute hepatic encephalopathy, but its efficacy for prevention of the disease has not been established. METHODS In this randomized, double-blind, placebo-controlled trial, we randomly assigned 299 patients who were in remission from recurrent hepatic encephalopathy resulting from chronic liver disease to receive either rifaximin, at a dose of 550 mg twice daily ( 140 patients), or placebo ( 159 patients) for 6 months. The primary efficacy end point was the time to the first breakthrough episode of hepatic encephalopathy. The key secondary end point was the time to the first hospitalization involving hepatic encephalopathy. RESULTS Rifaximin significantly reduced the risk of an episode of hepatic encephalopathy, as compared with placebo, over a 6-month period ( hazard ratio with rifaximin, 0.42; 95% confidence interval [CI], 0.28 to 0.64; P<0.001). A breakthrough episode of hepatic encephalopathy occurred in 22.1% of patients in the rifaximin group, as compared with 45.9% of patients in the placebo group. A total of 13.6% of the patients in the rifaximin group had a hospitalization involving hepatic encephalopathy, as compared with 22.6% of patients in the placebo group, for a hazard ratio of 0.50 (95% CI, 0.29 to 0.87; P = 0.01). More than 90% of patients received concomitant lactulose therapy. The incidence of adverse events reported during the study was similar in the two groups, as was the incidence of serious adverse events. CONCLUSIONS Over a 6-month period, treatment with rifaximin maintained remission from hepatic encephalopathy more effectively than did placebo. Rifaximin treatment also significantly reduced the risk of hospitalization involving hepatic encephalopathy. (ClinicalTrials.gov number, NCT00298038.)
— id: 108817, year: 2010, vol: 362, page: 1071, stat: Journal Article,

A peer-based intervention to educate liver transplant candidates about living donor liver transplantation
Delair, Samantha; Feeley, Thomas Hugh; Kim, Hyunjung; Del Rio Martin, Juan; Kim-Schluger, Leona; Lapointe Rudow, Dianne; Orloff, Mark; Sheiner, Patricia A; Teperman, Lewis
2010 Jan;16(1):42-48, Liver transplantation
The number of liver donors has not measurably increased since 2004 and has begun to decrease. Although many waitlisted patients may be suitable candidates to receive a living donor graft, they are often reticent to discuss living donation with close friends and family, partly because of a lack of knowledge about donor health and quality of life outcomes after donation. The objective of this study was to test the effectiveness of an educational intervention that uses testimonials and self-report data from living donors in New York State. The study had an independent sample pretest (n = 437) and posttest (n = 338) design with posttest, between-subjects comparison for intervention exposure. All waitlisted patients at 5 liver transplant centers in New York were provided a peer-based educational brochure and DVD either by mail or at the clinic. The outcome measures were liver candidates' knowledge and self-efficacy to discuss living donation with family and friends. The number and proportion of individuals who presented to centers for living liver donation evaluation were also measured. Liver transplant candidates' self-efficacy to discuss living donation and their knowledge increased from the pretest period to the posttest period. Those exposed to the peer-based intervention reported significantly greater knowledge, a greater likelihood of discussing donation, and increased self-efficacy in comparison with those not exposed to the intervention. The results did not differ by age, length of time on the waiting list, education, or ethnicity. In comparison with the preintervention period, living donation increased 42%, and the number of individuals who presented for donation evaluation increased by 74%
— id: 134975, year: 2010, vol: 16, page: 42, stat: Journal Article,

Derivation of the NYC UDCD Protocol for New York City
Gilbert, AJ; Wall, SP; Kaufman, BJ; Teperman, LW; Dubler, NN; Goldfrank, LR
2010 APR ;10(Suppl 4):367-367, American journal of transplantation
— id: 111531, year: 2010, vol: 10, page: 367, stat: Journal Article,

A Randomized Trial of HBIG Withdrawal Using Emtricitabine/Tenofovir DF in Post-Liver Transplant Recipients
Teperman, L; Spivey, J; Poordad, F; Schiano, T; Bzowej, N; Pungpapong, S; Martin, P; Coombs, D; Hirsch, KR; Anderson, J; Rousseau, F
2010 APR ;10(4):77-78, American journal of transplantation
— id: 111529, year: 2010, vol: 10, page: 77, stat: Journal Article,

EMTRICITABINE TENOFOVIR DF COMBINATION plus /- HBIG POST-ORTHOTOPIC LIVER TRANSPLANTATION TO PREVENT HEPATITIS B RECURRENCE IN PATIENTS WITH NORMAL TO MODERATE RENAL IMPAIRME
Teperman, L; Spivey, J; Poordad, F; Schiano, T; Bzowej, N; Pungpapong, S; Martin, P; Coombs, D; Hirsch, KR; Anderson, J; Rousseau, F
2010 MAR ;52(2):S12-S13, Journal of hepatology
— id: 109709, year: 2010, vol: 52, page: S12, stat: Journal Article,

Donor-Transmitted Diseases
Teperman, Lewis
2010 OCT ;16(11):S40-S44, Liver transplantation
— id: 114068, year: 2010, vol: 16, page: S40, stat: Journal Article,

Considerations on the impact of hepatic encephalopathy treatments in the pretransplant setting
Teperman, Lewis W; Peyregne, Vincent P
2010 Apr 15;89(7):771-778, Transplantation
Hepatic encephalopathy (HE) is a common complication of acute and chronic liver disease associated with exposure of brain tissue to excessive levels of ammonia produced by intestinal bacteria. Clinical manifestations range from subtle neurologic abnormalities to coma. Because development of HE can reduce survival probability, guidelines for evaluating patients for liver transplantation suggest that patients who develop HE should be considered for transplantation. Various patient factors before transplantation, including the presence of HE and reduced nutritional status, may increase the risk of poor outcomes after transplantation. Therefore, effective management of HE before transplantation, while minimizing the potential impact of negative predictive factors, may improve transplantation outcomes. The most common HE treatments are directed toward reducing systemic ammonia levels, thereby reducing brain exposure to this neurotoxin. The administration of nonabsorbable disaccharides is considered as a first-line therapy for HE, and the antibiotics neomycin and metronidazole are frequently administered, despite a lack of clinical data supporting their efficacy. These agents are associated with adverse events that may reduce nutritional status in patients awaiting transplantation and could contribute to poor posttransplantation outcomes. The nonsystemic antibiotic rifaximin has demonstrated efficacy for the treatment of HE and has a favorable safety profile. Given these data, nonsystemic antibiotics may also provide a safe and effective option for treating HE in the pretransplant setting. This article reviews treatments for HE and the potential impact these treatments may have on pretransplantation status of patients awaiting liver transplantation and on posttransplantation outcomes
— id: 109038, year: 2010, vol: 89, page: 771, stat: Journal Article,

GLOMERULAR FILTRATION RATE IN CIRRHOTIC PATIENTS BY MR RENOGRAPHY
Vivier, Pierre-Hugues; Storey, Pippa; Rusinek, Henry; Zhang, Jeff L.; Yamamoto, Akira; Tantillo, Kristopher; Lim, Ruth P.; Khan, Umer A.; Babb, James; John, Devon G.; Teperman, Lewis W.; Friedman, Kent P.; Benstein, Judith; Skolnik, Edward; Lee, Vivian S.
2010 OCT ;52(4):963A-964A, Hepatology
— id: 130850, year: 2010, vol: 52, page: 963A, stat: Journal Article,

Derivation of the NYC Uncontrolled Donation after Cardiac Death Protocol for New York City
Wall, SP; Gilbert, AJ; Kaufman, BJ; Teperman, LW; Dubler, NN; Goldfrank, LR
2010 ;10(Suppl 1):44-45, American journal of transplantation
— id: 122679, year: 2010, vol: 10, page: 44, 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,

A PHASE 2b, OPEN-LABEL, MULTI-CENTER, PROSPECTIVE, RANDOMIZED STUDY TO COMPARE THE PHARMACOKINETICS AND SAFETY OF LCP-Tacro (TM) TABLETS ONCE-A-DAY TO PROGRAF (R) CAPSULES TWICE-A-DAY IN DE NOVO LIVER TRANSPLANT PATIENTS
Dubay, DA; Alloway, RR; Alsina, AE; Chapman, WC; Feng, S; Tzakis, AG; Teperman, LW; Katz, E; Griffin, HE; Gordon, RD; Hamberg, KJ; Chodoff, L
2009 AUG ;22:116-116, Transplant international
— id: 102286, year: 2009, vol: 22, page: 116, 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,

U.S. surgeon and medical student attitudes toward organ donation
Hobeika, Mark J; Simon, Ronald; Malik, Rajesh; Pachter, H Leon; Frangos, Spiros; Bholat, Omar; Teperman, Sheldon; Teperman, Lewis
2009 Aug;67(2):372-375, Journal of trauma
BACKGROUND: Nearly 100,000 people await an organ transplant in the U.S. Improved utilization of potential organ donors may reduce the organ shortage. Physician attitudes toward organ donation may influence donation rates; however, the attitudes of U.S. physicians have not been formally evaluated. METHODS: Anonymous questionnaires were distributed to surgical attendings, surgical residents, and medical students at two academic medical centers. Willingness to donate one's own organs and family member's organs was examined, as well as experience with transplant procedures and religious views regarding organ donation. RESULTS: A total of 106 surveys were returned. Sixty-four percent of responders were willing to donate their own organs, and 49% had signed an organ donor card. Willingness to donate inversely correlated with professional experience. Eighty-four percent of those surveyed would agree to donate the organs of a family member, including 55% of those who refused to donate their own organs. Experience on the transplant service influenced 16% of those refusing donation, with the procurement procedure cited by 83% of this group. Sixteen percent refused organ donation on the basis of religious beliefs. CONCLUSIONS: The surveyed U.S. physicians are less willing to donate their organs compared with the general public. Despite understanding the critical need for organs, less than half of physicians surveyed had signed organ donor cards. Previous experiences with the procurement procedure influenced several responders to refuse organ donation. As the lay public traditionally looks to physicians for guidance, efforts must be made to improve physician attitudes toward organ donation with the hope of increasing donation rates
— id: 101453, year: 2009, vol: 67, page: 372, stat: Journal Article,

Donor-derived disease transmission events in the United States: data reviewed by the OPTN/UNOS Disease Transmission Advisory Committee
Ison, M G; Hager, J; Blumberg, E; Burdick, J; Carney, K; Cutler, J; Dimaio, J M; Hasz, R; Kuehnert, M J; Ortiz-Rios, E; Teperman, L; Nalesnik, M
2009 Aug;9(8):1929-1935, American journal of transplantation
Donor-derived disease transmission is increasingly recognized as a source of morbidity and mortality among transplant recipients. Policy 4.7 of the Organ Procurement and Transplantation Network (OPTN) currently requires reporting of donor-derived events. All potential donor-derived transmission events (PDDTE) reported to OPTN/UNOS were reviewed by the Disease Transmission Advisory Committee (DTAC). Summary data from January 1, 2005-December 31, 2007, were prepared for presentation. Reports of PDDTE have increased from 7 in 2005, the first full year data were collected, to 60 in 2006 and to 97 in 2007. More detailed information is available for 2007; a classification system for determining likelihood of donor-derived transmission was utilized. In 2007, there were four proven and one possible donor-derived malignancy transmissions and four proven, two probable and six possible donor-derived infectious diseases transmissions. There were nine reported recipient deaths attributable to proven donor transmissions events arising from eight donors during 2007. Although recognized transmission events resulted in significant morbidity and mortality, transmission was reported in only 0.96% of deceased donor donations overall. Improved reporting, through enhanced recognition and communication, will be critical to better estimate the transmission risk of infection and malignancy through organ transplantation
— id: 133698, year: 2009, vol: 9, page: 1929, 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,

Tolerability of Mycophenolate Mofetil/Sirolimus Maintenance Therapy after Calcineurin Inhibitor Withdrawal in Liver Transplant Recipients: 1-Year Outcomes of the Spare-the-Nephron (STN) Trial
Roberts, J; Sher, L; Marotta, P; Teperman, L; Sebastian, A; Moonka, D; Patel, D; Koneru, B; Klintmalm, G
2009 MAY ;9(5):529-530, American journal of transplantation
— id: 98853, year: 2009, vol: 9, page: 529, stat: Journal Article,

MRI FEATURES OF HCC DO NOT PREDICT MICROVASCULAR INVASION IN LIVER TRANSPLANT FOR HEPATOCELLULAR CARCINOMA
Robinson, E; Chandarana, H; Droxhinin, L; Hajdu, C; Xu, RL; Teperman, L; Taouli, B
2009 JUL ;15(7):S111-S111, Liver transplantation
— id: 101245, year: 2009, vol: 15, page: S111, stat: Journal Article,

CHRONIC ADMINISTRATION OF RIFAXIMIN FOR THE MAINTENANCE OF REMISSION OF HEPATIC ENCEPHALOPAT
Sanyal, A; Bass, N; Teperman, L; Sigal, S; Hillebrand, D; Merchant, K; Huang, S; Shaw, A; Bortey, E; Forbes, W
2009 JUL ;50(3):S90-S90, Journal of hepatology
— id: 100447, year: 2009, vol: 50, page: S90, stat: Journal Article,

Transplant Tourism and Unregulated Black-Market Trafficking of Organs
Starzl, T; Teperman, L; Sutherland, D; Sollinger, H; Roberts, J; Miller, C; Merion, R; Matas, A; Marsh, JW; Langnas, A; Kam, I; Hippen, B; Gaston, R; Freeman, R; Fung, J; Eason, J; Fine, R; Crippen, J; Abecassis, M
2009 JUN ;9(6):1484-1484, American journal of transplantation
— id: 100451, year: 2009, vol: 9, page: 1484, stat: Journal Article,

Efficacy of Mycophenolate Mofetil/Sirolimus Maintenance Therapy after CNI Withdrawal in Liver Transplant Recipients: 1-Year Outcomes of the Spare-the-Nephron (STN) Trial
Teperman, L; Sher, L; Marotta, P; Sebastian, A; Moonka, D; Patel, D; Koneru, B; Klintmalm, G; Roberts, J
2009 MAY ;9(5):229-230, American journal of transplantation
— id: 98850, year: 2009, vol: 9, page: 229, stat: Journal Article,

EMTRICITABINE/TENOFOVIR DF (FTC/TDF) FIXED DOSE COMBINATION IN PATIENTS WITH NORMAL AND IMPAIRED RENAL FUNCTION POST ORTHOTOPIC LIVER TRANSPLANT (OLT) FOR PREVENTION OF CHRONIC HEPATITIS B (CHB) RECURRENCE IN THE PRESENCE OR ABSENCE OF HB
Teperman, L; Spivey, J; Poordad, F; Schiano, T; Coombs, D; Anderson, J; Oldach, D; Rousseau, F
2009 JUL ;15(7):S118-S118, Liver transplantation
— id: 101246, year: 2009, vol: 15, page: S118, stat: Journal Article,

Emtricitabine/Tenofovir Disoproxil Fumarate (FTC/TDF) Fixed Dose Combination in Patients with Normal and Impaired Renal Function Post-Orthotopic Liver Transplant for Prevention of Hepatitis B Recurrence in the Presence or Absence of Hepatitis B Immune Globulin (HBIG): Preliminary Safety Analysis
Teperman, L; Spivey, J; Poordad, F; Schiano, T; Coombs, D; Anderson, J; Oldach, D; Rousseau, F
2009 MAY ;9(5):527-527, American journal of transplantation
— id: 98852, year: 2009, vol: 9, page: 527, 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,

Transmission of anaplastic large cell lymphoma via organ donation after cardiac death
Harbell, J W; Dunn, T B; Fauda, M; John, D G; Goldenberg, A S; Teperman, L W
2008 Jan;8(1):238-244, American journal of transplantation
Recently, donation after cardiac death (DCD) has been encouraged in order to expand the donor pool. We present a case of anaplastic T-cell lymphoma transmitted to four recipients of solid organ transplants from a DCD donor suspected of having bacterial meningitis. On brain biopsy, the donor was found to have anaplastic central nervous system T-cell lymphoma, and the recipient of the donor's pancreas, liver and kidneys were found to have involvement of T-cell lymphoma. The transplanted kidneys and pancreas were excised from the respective recipients, and the kidney and pancreas recipients responded well to chemotherapy. The liver recipient underwent three cycles of chemotherapy, but later died due to complications of severe tumor burden. We recommend transplanting organs from donors with suspected bacterial meningitis only after identification of the infectious organism. In cases of lymphoma transmission, excision of the graft may be the only chance at long-term survival
— id: 76327, year: 2008, vol: 8, page: 238, 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,

Response to: Transmission of lymphoma via organ transplantation
Teperman, LW; Harbell, JW
2008 JUN ;8(6):1351-1351, American journal of transplantation
— id: 86962, year: 2008, vol: 8, page: 1351, stat: Journal Article,

Intrahepatic portal cavernoma as an indication for liver transplantation
Hajdu, Cristina H; Murakami, Takahiro; Diflo, Thomas; Taouli, Bachir; Laser, Jordan; Teperman, Lewis; Petrovic, Lydia M
2007 Sep;13(9):1312-1316, Liver transplantation
Cavernous transformation of the portal vein (portal cavernoma) consists of a periportal or/and intrahepatic venous collateral network, developed as a result of acute or long-standing portal vein thrombosis. Better control of hemorrhagic and thrombotic complications in the patients with portal cavernoma substantially improves their life span and the clinical outcome. However, biliary complications that occur in the late stages of this disease have been recently recognized as challenging management issues because they recur and are difficult to treat. Because of the relatively small number of the patients with cholangiopathy due to portal cavernoma, there is no current standardized treatment approach. We report the case of a predominantly intrahepatic portal cavernoma occurring in a patient with chronic idiopathic portal vein thrombosis, which led to severe cholangiopathy that mimicked primary sclerosing cholangitis and cholangiocarcinoma, was unresponsive to endoscopic stent placement, and finally required liver transplantation
— id: 74459, year: 2007, vol: 13, page: 1312, stat: Journal Article,

Corticosteroid-free immunosuppression with daclizumab in HCV(+) liver transplant recipients: 1-year interim results of the HCV-3 study
Klintmalm, Goran B G; Washburn, W Kenneth; Rudich, Steven M; Heffron, Thomas G; Teperman, Lewis W; Fasola, Carlos; Eckhoff, Devin E; Netto, George J; Katz, Eliezer
2007 Nov;13(11):1521-1531, Liver transplantation
This work is a 1-yr interim analysis of a prospective, randomized, multicenter trial evaluating the effect of corticosteroid-free immunosuppression on hepatitis C virus-positive (HCV(+)) liver transplant recipients following liver transplantation (LT). Patients received tacrolimus and corticosteroids (Arm 1; n = 80); tacrolimus, corticosteroids, and mycophenolate mofetil (MMF) (Arm 2; n = 79); or daclizumab induction, tacrolimus, and MMF (Arm 3; n = 153). At 1 yr, 64.1%, 63.4%, and 69.4% of patients achieved the composite primary endpoint of freedom from rejection, freedom from HCV recurrence, and freedom from treatment failure, respectively. Excellent patient and graft survival did not differ significantly among treatment arms. Freedom from HCV recurrence at 1 yr was 61.8 +/- 6.2%, 60.1 +/- 6.1%, and 67.0 +/- 4.3% in Arms 1, 2, and 3, respectively (P = not significant). Freedom from rejection was significantly higher in Arm 3 compared to Arm 1 (93.0 +/- 2.2% vs. 81.9 +/- 4.4%; P = 0.011). Multivariate analysis identified acute rejection (hazard ratio = 2.692; P = 0.001) and donor age (hazard ratio = 1.015; P = 0.001) as significant risk factors for HCV recurrence. HCV recurrence was not influenced by recipient demographics, HCV genotype, or immunosuppression. In conclusion, these results suggest that a corticosteroid-free regimen of tacrolimus and MMF following daclizumab induction is safe and effective in HCV(+) liver transplant recipients
— id: 94995, year: 2007, vol: 13, page: 1521, stat: Journal Article,

Preserving renal function in liver transplantation. Efficacy and safety of a mycophenolate mofetil (MMF)/sirolimus maintenance regimen following calcineurin inhibitor (CNI) withdrawal: Interim data from the spare-the-nephron (STN) trial
Teperman, L; Sebastian, A; Arenas, J; Sher, L; Koneru, B; Marotta, P; Roberts, JP; Patel, D
2007 OCT ;46(4):269A-270A, Hepatology
— id: 75126, year: 2007, vol: 46, page: 269A, 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,

Treatment of hepatitis C related cryoglobulinemia with Rituxan
Goldenberg, A; Teperman, L; Hong, L; Kelley, P; Tobias, H
2006 ;130(4):A840-A840, Gastroenterology
— id: 92758, year: 2006, vol: 130, page: A840, 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,

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,

West Nile virus a deadly event for liver transplantation
Teperman, L; Tobias, H; Fine, A
2006 MAY ;12(5):C116-C116, Liver transplantation
— id: 64397, year: 2006, vol: 12, page: C116, 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,

A novel three-dose regimen of daclizumab in liver transplant recipients with hepatitis C: a pharmacokinetic and pharmacodynamic study
Washburn, W Kenneth; Teperman, Lewis W; Heffron, Thomas G; Douglas, David D; Gay, Steven; Katz, Eliezer; Klintmalm, Goran B G
2006 Apr;12(4):585-591, Liver transplantation
This study evaluated the pharmacokinetics and pharmacodynamics of a novel 3-dose regimen of daclizumab in de novo hepatitis C liver transplant recipients. In 30 of 156 recipients receiving daclizumab, mycophenolate mofetil, tacrolimus, and no steroids (Arm 3 of Hep C 3 Liver Study), daclizumab (2, 2, and 1 mg/kg, respectively) was given on days 1, 3, and 8 posttransplant, respectively, with trough, peak (C(max)), and CD25 saturation (CD(sat)) measured sequentially. Mean daclizumab C(max) was 50.3 microg/mL on day 1, and mean trough levels were 21.8, 25.7, and 9.9 microg/mL on days 3, 8, and 30, respectively. A significant decline in CD(sat) (mean, 15.7% to 4.7%) was observed on day 1 and was sustained throughout the study (2.8% on day 30). Daclizumab concentration > or = 5 microg/mL was the level where most of the effect on CD(sat) was noticed. Elevated baseline CD(sat) was observed in African Americans, patients weighing < or = 75 kg, and patients <60 years of age. After 365 days, 2 patients had experienced 3 rejections, 10 patients had recurrent hepatitis C, 4 patients died, and 2 grafts were lost. In conclusion, this novel 3-dose regimen is effective in rapidly achieving high therapeutic concentration of daclizumab and a significant decline in CD(sat) lasting over 30 days
— id: 94996, year: 2006, vol: 12, page: 585, stat: Journal Article,

Peginterferon alfa-2a for hepatitis C after liver transplantation: Two randomized, controlled trials
Chalasani, N; Manzarbeitia, C; Ferenci, P; Vogel, W; Fontana, RJ; Voigt, M; Riely, C; Martin, P; Teperman, L; Jiao, J; Lopez-Talavera, JC
2005 FEB ;41(2):289-298, Hepatology
There is currently no effective treatment for recurrent hepatitis C after orthotopic liver transplantation (OLT). We therefore performed two randomized, controlled trials-a prophylaxis trial and a treatment trial-to evaluate the safety and efficacy of peginterferon alfa-2a in patients who had undergone OLT. The prophylaxis trial enrolled 54 patients within 3 weeks after OLT, and the treatment trial enrolled 67 patients 6 to 60 months after OLT. In each trial, patients were randomized to treatment with once weekly injections of 180 jug peginterferon alfa-2a or no antiviral treatment for 48 weeks and were followed up for 24 weeks thereafter. Peginterferon alfa-2a treated patients had significantly lower hepatitis C virus RNA levels and more favorable changes in hepatic histological features compared with untreated controls. However, only 2 treated patients in the prophylaxis trial (8%) and 3 in the treatment trial (12%) achieved a sustained virological response. In the prophylaxis trial, 8 patients (31%) in the peginterferon alfa-2a group and 9 (32%) in the untreated group were withdrawn prematurely; whereas in the treatment trial, 10 patients (30%) in the peginterferon alfa-2a group and 6 (19%) in the untreated group were withdrawn prematurely. The incidence of acute rejection was similar in the treated and untreated groups in both the prophylaxis (12% vs. 21%; P = .5) and treatment (12% vs. 0%; P = .1) trials. In conclusion, peginterferon alfa-2a treatment for 48 weeks is safe and tolerable and offers some efficacy in the post-OLT setting. Randomized controlled studies are needed to establish the efficacy of pegylated interferon and ribavirin in patients who have undergone OLT
— id: 48251, year: 2005, vol: 41, page: 289, stat: Journal Article,

A multicenter evaluation of utility of chest computed tomography and bone scans in liver transplant candidates with stages I and II hepatoma
Koneru, Baburao; Teperman, Lewis W; Manzarbeitia, Cosme; Facciuto, Marcelo; Cho, Kyunghee; Reich, David; Sheiner, Patricia; Fisher, Adrian; Noto, Khristian; Goldenberg, Alec; Korogodsky, Maria; Campbell, Donna
2005 Apr;241(4):622-628, Annals of surgery
OBJECTIVE: To determine utility of practice of chest computed tomography (CCT) and bone scan (BS) in patients with early-stage hepatoma evaluated for transplantation (LT). SUMMARY BACKGROUND DATA: Consensus-based policy mandates routine CCT and BS in LT candidates with hepatoma. No data exist either to support or refute this policy. METHODS: From January 1999 to December 2002, stages I and II hepatoma patients evaluated at 4 centers were included. Scan interpretation was positive, indeterminate, or negative. Outcomes of evaluation and transplantation were compared between groups based on scans. Total charges incurred were derived from mean of charges at the centers. RESULTS: One hundred seventeen stages I and II patients were evaluated. None had positive scans, 78 had negative, 29 had at least 1 indeterminate, and 10 did not have 1 or both scans. Twelve patients were declined listing, 6 from progression of hepatoma but none from CCT or BS findings. Two listed patients were delisted for progression of the hepatoma. Proportion of patients listed, transplanted, clinical and pathologic stage of hepatoma, and recurrence after LT were similar in groups with negative and indeterminate scans. Indeterminate scans led to 6 invasive procedures, 1 patient died of complications of a mediastinal biopsy, and none of the 6 showed metastases. Charges of $2933 were generated per patient evaluated. CONCLUSIONS: Positive yield of routine CCT and BS in patients with hepatoma is very low despite substantial charges and potential complications. CCT and BS performed only when clinically indicated will be a more cost-effective and safer approach
— id: 66709, year: 2005, vol: 241, page: 622, 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,

Are routine chest computed tomography and bone scan required in patients with hepatoma and cirrhosis undergoing liver transplant evaluation? A cooperative study by the hepatoma and liver transplantation (HALT)
Koneru, B; Teperman, L; Manzarbeitia, C; Facciuto, M; Cho, K; Reich, D; Campbell, D; Scheiner, P; Fisher, A; Korogodsky, M; Noto, K
2004 JUL ;4(7):438-439, American journal of transplantation
— id: 46605, year: 2004, vol: 4, page: 438, 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,

The MELD/PELD system and heptocellular cancer (HCC)
Freeman, RB; Harper, A; Edwards, EB; Teperman, L; Merion, R; Wolfe, R; Wiesner, R
2003 JUN ;9(6):C31-C31, Liver transplantation
— id: 38545, year: 2003, vol: 9, page: C31, stat: Journal Article,

Sonographic detection of hepatocellular carcinoma and dysplastic nodules in cirrhosis: correlation of pretransplantation sonography and liver explant pathology in 200 patients
Bennett, Genevieve L; Krinsky, Glenn A; Abitbol, Roxanne J; Kim, Sue Y; Theise, Neil D; Teperman, Lewis W
2002 Jul;179(1):75-80, American journal of roentgenology
OBJECTIVE: The objective of this study was to determine the sensitivity and specificity of sonography as an aid in detecting hepatocellular carcinomas and dysplastic nodules using explantation correlation in patients with cirrhosis and no known hepatocellular carcinomas. MATERIALS AND METHODS: The sonography reports of 200 patients with cirrhosis who underwent sonography and then underwent liver transplantation within 90 days were retrospectively reviewed for focal solid liver lesions. All focal solid masses detected on sonography were considered possible hepatocellular carcinomas. The sonographic findings were compared with thin-section explanted liver pathologic results. RESULTS: Twenty-seven patients (13.5%) had hepatocellular carcinoma at explantation, including four patients with diffuse, multifocal tumors. Eight of the 39 lesions were detected on sonography for a patient sensitivity of 29.6% and a lesion sensitivity of 20.5%. Sonography revealed three (75%) of four hepatocellular carcinomas larger than 5 cm in diameter, one (50%) of two hepatocellular carcinomas with diameters of 3.1-5.0 cm, one (20%) of five hepatocellular carcinomas with diameters of 2.1-3.0 cm, three (13.6%) of 22 hepatocellular carcinomas with diameters of 1-2 cm, and no lesions with diameters smaller than 1 cm. Forty-two patients (21%) had a total of 126 dysplastic nodules including two patients with innumerable lesions. Sonography depicted only two dysplastic nodules, for a patient sensitivity of 4.8% and a lesion sensitivity of 1.6%. The overall specificity of sonography for either hepatocellular carcinomas or dysplastic nodules was 96%. CONCLUSION: Sonography has low sensitivity but high specificity in revealing hepatocellular carcinomas and dysplastic nodules in patients with a cirrhotic liver requiring liver transplantation. In these patients, sonography should not be the sole imaging modality used for lesion detection before transplantation
— id: 35148, year: 2002, vol: 179, page: 75, 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,

A pilot study of interferon alfa and ribavirin combination in liver transplant recipients with recurrent hepatitis C
Shakil, AO; McGuire, B; Crippin, J; Teperman, L; Demetris, AJ; Conjeevaram, H; Gish, R; Kwo, P; Balan, V; Wright, TL; Brass, C; Rakela, J
2002 NOV ;36(5):1253-1258, Hepatology
Although interferon alfa (IFN-alpha) and ribavirin are widely used in the treatment of hepatitis C, their role in the transplant recipient is unclear. We conducted a pilot study to determine the efficacy and safety of this therapy in transplant recipients with recurrent hepatitis C. Patients at least 6 months posttransplantation were treated with IFN-a 3 million units 3 times a week subcutaneously and ribavirin 800 mg daily by mouth for 48 weeks followed by ribavirin monotherapy for 24 weeks. The primary end point was sustained virologic response, and secondary end points included biochemical, virologic, and histologic responses at the end of combination treatment. Thirty-eight patients initiated therapy but 16 withdrew due to adverse effects, including 2 with myocardial infarction. Median age was 50 years; 74% were men, and 91% had genotype 1. The median interval between transplantation and enrollment was 23 months. On an intention-to-treat basis, 7 patients (18%) had a biochemical and 5 (13%) had a virologic response at the end of combination treatment. Inflammatory activity did not change, but fibrosis worsened in virologic nonresponders. Ribavirin maintenance caused a further decrease in serum alanine aminotransferase levels, but hepatitis C virus (HCV) RNA levels increased. Only 2 of the 38 patients (5%) had a sustained virologic response. Several patients required treatment with erythropoietin for anemia. In conclusion, IFN-alpha and ribavirin are effective in a small proportion of liver allograft recipients with recurrent hepatitis C. Adverse effects occur commonly, requiring dose reductions and treatment withdrawal
— id: 33046, year: 2002, vol: 36, page: 1253, 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,

Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation
Krinsky GA; Lee VS; Theise ND; Weinreb JC; Rofsky NM; Diflo T; Teperman LW
2001 May;219(2):445-454, Radiology
PURPOSE: To determine the sensitivity and specificity of magnetic resonance (MR) imaging for detection of hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) by using explantation correlation in patients with cirrhosis and no known HCC. MATERIALS AND METHODS: Seventy-one patients without a known history of HCC who underwent MR imaging and subsequent transplantation within 90 days were examined. Breath-hold turbo short inversion time inversion-recovery and/or T2-weighted turbo spin-echo MR images were obtained. Dynamic two- or three-dimensional gadolinium-enhanced gradient-echo MR images were obtained in the hepatic arterial, portal venous, and equilibrium phases. Prospective MR image interpretations were compared directly with explanted liver pathologic results. RESULTS: Eleven (15%) of 71 patients had hepatic malignancies; MR imaging enabled diagnosis of tumor in six (54%) of 11 patients. On a lesion-by-lesion basis, MR imaging depicted 11 of 20 hepatic neoplasms, for an overall sensitivity of 55%. MR imaging depicted four (80%) of five lesions larger than 2 cm, six (50%) of 12 lesions 1-2 cm, and one (33%) of three lesions smaller than 1 cm. MR imaging depicted only nine (15%) of 59 DNS: The specificities of MR imaging for detection of HCC and DNs on a per patient basis were 60 (86%) of 70 patients and 53 (85%) of 62 patients, respectively. CONCLUSION: MR imaging is insensitive for the diagnosis of small (<2-cm) HCCs and DNS:
— id: 20703, year: 2001, vol: 219, page: 445, 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,

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,

Transplantation in the hepatitis B patient and current therapies to prevent recurrence
Colquhoun, SD; Belle, SH; Samuel, D; Pruett, TL; Teperman, LW
2000 JUL 15 ;20(7):7-12, Seminars in liver disease
Hepatitis B is the sixth most common indication for liver transplantation in the United States, accounting for about 7% of all transplants among adults. Transplantation for hepatitis B is especially problematic be cause the virus is not eradicated and there is great potential for reinfection that can lean to graft failure or death. This risk is higher still in patients with active viral replication and chronic liver disease. Treatment with short-term hepatitis B immune globulin (HBIG) delays reinfection of the allograft, but only long-term treatment with HBIG has led to a decline in the reinfection rate. Combination therapy using HBIG with nucleoside analogues will likely become thc standard of care to maintain stable serum titers of protective anti-HBs antibody and to prevent posttransplantation reinfection
— id: 54583, year: 2000, vol: 20, page: 7, 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,

Chemoembolization for Hepatocellular Carcinoma
Goldenberg A; Teperman L; Rosen R
2000 ;16:33-38, Advances in oncology (Greenwich, CT)
— id: 92765, year: 2000, vol: 16, page: 33, 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,

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,

Case studies in orthotopic liver transplantation for hepatitis B: a panel discussion [In Process Citation]
Teperman L
2000 ;14 Suppl 2:44-50, Clinical transplantation
Five cases that were referred to the Division of Transplantation at NYU School of Medicine for consideration for liver transplantation were discussed among a panel of hepatitis B and liver transplant experts. Opinions were obtained on the management at every stage of treatment of patients with the following initial information: Case one: young Asian woman in stage IV hepatic coma; intubated; prothrombin time (PT): 30 s; serum glutamic oxaloacetic transaminase (SGOT): 8,000 IU; total bilirubin: 25 mg/dL; hepatitis B surface antigen (HBsAg) positive. Case two: 70-yr-old woman, native of Greece; decompensated cirrhosis with encephalopathy; Child-Pugh Class C; HBsAg positive; hepatitis B surface antibody (HBsAb) negative; hepatitis B e antigen (HBeAg) positive; hepatitis B e antibody (HBeAb) negative; hepatitis B virus (HBV) DNA titer: 10,000. Case three: Muscular detective working full-time; cirrhosis; Child Pugh Class B; ascites controlled with spironolactone and furosemide; PT: 19s; HBsAg positive; HBsAb negative; HBV DNA titer: 50,000; low platelet count. Case four: 45-yr-old baker; cirrhosis and resectable 4-cm hepatoma; Child-Pugh Class B; PT: 16 s; Blood type O; United Network for Organ Sharing (UNOS) 2B; HBV DNA titer: 3,000. Case five: 40-yr-old Indian man; 300 pounds with massive ascites; Child Pugh Class C; PT: 17 s; HBsAg positive; HBV DNA titer: 22,000; transplanted with intra-operative hypotension; tacrolimus; graft functioning; HBIg 10,000 IU intra-operative and around the clock during the first post-operative week; required huge doses of hepatitis B immune globulin (HBIg) to maintain adequate HBsAb level; daily loss of 5 6 L of ascites fluid; post-operative day 8: anuric, blood urea nitrogen (BUN) 127, creatinine 3, mental status changes
— id: 11523, year: 2000, vol: 14 Suppl 2, page: 44, 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,

Introduction to hepatitis B transplantation
Vierling, JM; Teperman, LW
2000 JUL 15 ;20(7):1-2, Seminars in liver disease
— id: 54582, year: 2000, vol: 20, page: 1, 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,

Transplantation
Teperman LW
1999 Feb;188(2):184-190, Journal of the American College of Surgeons
— id: 6049, year: 1999, vol: 188, page: 184, 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,

Immunohistochemical detection of hepatitis C antigen by monoclonal antibody TORDJI-22 compared with PCR viral detection
Brody RI; Eng S; Melamed J; Mizrachi H; Schneider RJ; Tobias H; Teperman LW; Theise ND
1998 Jul;110(1):32-37, American journal of clinical pathology
We sought to determine the sensitivity and specificity of immunohistochemistry using the TORDJI-22 MoAb (BioGenex, San Ramon, Calif), which is specific for the C-100 protein of the hepatitis C virus, compared with reverse transcriptase-polymerase chain reaction (RT-PCR) of tissue for viral RNA. RT-PCR had been performed on 52 fixed tissue specimens. Immunohistochemistry was performed using prediluted antibody with the alkaline phosphatase/fast red (BioGenex) technique. Predigestion with Protease XXIV (BioGenex) and other procedures followed the manufacturer's protocols. Positive immunohistochemistry was narrowly defined as tightly clumped, perinuclear red granules in hepatocytes. Of the specimens, 28 were positive by RT-PCR. With RT-PCR as the standard of comparison, immunohistochemistry yielded a sensitivity of 70% and specificity of 84%. Positive cells, when present, were usually very rare. With stringent criteria, immunohistochemistry with the TORDJI-22 monoclonal antibody is a very specific, fairly sensitive diagnostic test for hepatitis C virus in fixed liver tissues
— id: 7512, year: 1998, vol: 110, page: 32, 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,

Long duration high-dose interferon therapy for hepatitis C is associated with a high sustained response rate
Pasternak, BA; Cohen, J; Weber, SA; Teperman, L; Tobias, H
1998 APR 15 ;114(4):A1320-A1321, Gastroenterology
— id: 53474, year: 1998, vol: 114, page: A1320, stat: Journal Article,

MR-guided needle aspiration biopsies of hepatic masses using a closed bore magnet
Rofsky NM; Yang BM; Schlossberg P; Goldenberg A; Teperman LW; Weinreb JC
1998 Jul-Aug;22(4):633-637, Journal of computer assisted tomography
PURPOSE: Our purpose was to assess the efficacy of MR-guided biopsies with a conventional superconducting MR scanner and describe the techniques used to achieve successful results. METHOD: Fourteen biopsies were completed under MR guidance in 11 patients. Seven patients with previously detected lesions were referred for biopsy under MR guidance when hepatic lesions were identified by MRI but not with prebiopsy noncontrast CT or ultrasound (US). Additionally referred for MR-guided biopsy were four patients in whom previous CT- or US-guided biopsies of focal lesions were nondiagnostic. A 22 gauge MR-compatible needle was used in each case. Lesions ranged in size from 8 to 32 mm. Eleven lesions (eight patients) were suspected of being hepatomas, and three lesions (three patients) were suspected of being metastases. RESULTS: Thirteen of 14 MR-guided biopsies (93%) were diagnostic. Hepatocellular carcinoma was confirmed in 6 of 11 lesions suspected of representing hepatoma. One lesion, in a patient treated with chemoembolization, demonstrated necrotic material. One lesion yielded nondiagnostic material despite repeated visualization of the needle tip in the target lesion. Three lesions demonstrated metastatic carcinoma. Benign hepatocytes were detected in three biopsy specimens. Seven of the lesions that were successfully biopsied measured < 2.5 cm in diameter. CONCLUSION: With use of a closed bore 1.5 T system, diagnostic MR-guided needle aspiration biopsies of hepatic masses and subcomponents, including small lesions (< 2.5 cm), can be successfully obtained
— id: 7763, year: 1998, vol: 22, page: 633, stat: Journal Article,

Outcome following transplantation for autoimmune hepatitis
Valdes, MT; Zakai, MD; Cohen, J; Tobias, H; Talal, A; John, D; Teperman, L
1998 APR 15 ;114(4):A1358-A1358, Gastroenterology
— id: 53475, year: 1998, vol: 114, page: A1358, 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,

Dysplastic nodules and hepatocellular carcinoma: thin-section MR imaging of explanted cirrhotic livers with pathologic correlation [see comments]
Earls JP; Theise ND; Weinreb JC; DeCorato DR; Krinsky GA; Rofsky NM; Mizrachi H; Teperman LW
1996 Oct;201(1):207-214, Radiology
PURPOSE: To evaluate detection and characterization of hepatocellular nodules in fresh whole explanted cirrhotic livers at thin-section magnetic resonance (MR) imaging. MATERIALS AND METHODS: T1-weighted spin-echo and T2-weighted fast spin-echo MR imaging (5-mm-thick sections) were performed in a head coil at 1.5 T in the whole cirrhotic livers of 28 consecutive patients within 4 hours of explantation. MR imaging findings were correlated with findings at pathologic examination, and new international terminology was used to classify the hepatocellular nodules. RESULTS: At pathologic examination, 42 suspect (other than regenerative) nodules were identified in 11 patients. MR imaging depicted 41 of 42 (98%) of these nodules (five of five hepatocellular carcinomas [HCCs :diameter, > or = 2 cm:], 10 of 10 small HCCs [diameter, < 2 cm], two of two dysplastic nodules with subfoci of HCC, three of three high-grade dysplastic nodules, and 21 of 22 low-grade dysplastic nodules. Lesions demonstrated the following combinations of signal intensity characteristics on thin-section T1- and T2-weighted images, respectively: HCC, hyperintense, hypointense (n = 3); hyperintense, hyperintense (n = 1); hypointense, isointense (n = 1). Small HCC, hyperintense, hypointense (n = 7); hypointense, hyperintense (n = 2); hyperintense, hyperintense (n = 1). Both dysplastic nodules with subfoci of HCC, hyperintense, hypointense. All seven nonsiderotic low-grade dysplastic nodules, hyperintense, hypointense. All 14 siderotic low-grade dysplastic nodules, hypointense, hypointense. All three high-grade dysplastic nodules, hyperintense, hypointense. CONCLUSION: The variable signal intensity characteristics of HCCs made reliable diagnosis impossible, but the thinsection unenhanced in vitro MR images were sensitive for detection of HCCs and dysplastic nodules in cirrhotic livers
— id: 7067, year: 1996, vol: 201, page: 207, stat: Journal Article,

Incidence and treatment of recurrent hepatitis C after liver transplantation
Harren P; Rudow DL; Teperman LW; Dieterich D; Diflo T
1996 Mar;6(1):24-27, Journal of transplant coordination
Recurrence of hepatitis C is a significant problem after liver transplantation. This prospective study was done to assess the rate of recurrence and discuss two possible treatment modalities that have been successful in avoiding retransplantation. Twenty-one patients underwent orthotopic liver transplantation for hepatitis C at a metropolitan medical center over a 34-month period. The mean follow-up interval was 13.4 +/- 2.2 months (range 5-28 months). The patients were routinely evaluated with clinic visits and liver function tests, specifically total bilirubin, serum glutamic-oxaloacetic transaminase, and gamma-glutamyl transpeptidase. If values were elevated, the patient was admitted to the hospital for liver biopsy. Ten of the 21 patients demonstrated recurrence on biopsy. Two of 10 patients required no therapy. Interferon A was initiated in the remaining eight. Three of the eight patients had no significant response to interferon and were given intravenous ribavirin under an experimental protocol. Two of these three showed significant improvement in liver function values. The third died of chronic rejection. The incidence of recurrent hepatitis C after liver transplantation is significant. Many centers have had to resort to retransplantation. Our results show that with early detection and aggressive treatment with interferon and ribavirin, hepatitis C can be controlled and retransplantation may be avoided
— id: 12633, year: 1996, vol: 6, page: 24, 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,

Chemoembolization of hepatocellular carcinoma induces capsule formation
Theise, N. D.; Mizrachi, H.; Rosen, R.; Goldenberg, A.; Diflo, T.; Tobias, H.; Teperman, L.
1996 ;24(4 PART 2):588A-1845, Hepatology
— id: 92757, year: 1996, vol: 24, page: 588A, stat: Journal Article,

HCV REPLICATIVE INTERMEDIATES AS A PREDICTOR OF DISEASE-ACTIVITY AFTER LIVER-TRANSPLANTATION
BRODY, RI; MIZRACHI, HH; TEPERMAN, LW; SCHNEIDER, RJ
1995 JAN ;72(1):A128-A128, Laboratory investigation
— id: 87437, year: 1995, vol: 72, page: A128, stat: Journal Article,

MRI RELIABLY DETECTS MACROREGENERATIVE NODULES AND SMALL HEPATOCELLULAR-CARCINOMA IN CIRRHOTIC LIVERS
THEISE, ND; KRINSKY, G; MIZRACHI, HH; ROFSKY, N; GOLDENBERG, A; TOBIAS, H; DIFLO, T; WEINREB, J; TEPERMAN, L
1995 OCT ;22(4):313-313, Hepatology
— id: 86726, year: 1995, vol: 22, page: 313, stat: Journal Article,

USE OF RIBAVIRIN FOR RECURRENT HEPATITIS-C VIRUS (HCV) IN LIVER-TRANSPLANT PATIENTS AFTER FAILURE OF INTERFERON
DIETERICH, DT; DIFLO, T; POLES, MA; LEW, EA; TEPERMAN, L
1994 APR ;106(4):A884-A884, Gastroenterology
— id: 52457, year: 1994, vol: 106, page: A884, stat: Journal Article,

CHANGES IN PLATELET-ASSOCIATED ANTIBODIES WITH ORTHOTOPIC LIVER-TRANSPLANTATION
GOLDENBERG, A; TEPERMAN, L; DIFLO, T; TOBIAS, H
1994 OCT ;20(4):A351-A351, Hepatology
— id: 52318, year: 1994, vol: 20, page: A351, stat: Journal Article,

Primary cutaneous infection by Aspergillus ustus in a 62-year-old liver transplant recipient
Stiller MJ; Teperman L; Rosenthal SA; Riordan A; Potter J; Shupack JL; Gordon MA
1994 Aug;31(2 Pt 2):344-347, Journal of the American Academy of Dermatology
We report the first case of primary cutaneous aspergillosis caused by Aspergillus ustus, a species that seldom infects human beings. The patient, a 62-year-old liver transplant recipient with end-stage hepatitis C-induced cirrhosis, was receiving the experimental immunosuppressive drug FK-506. Trauma to the skin of the right arm from tape and from an arm board holding intravenous and intraarterial catheters in place and to the left leg from an occlusive knee brace may have contributed to this unusual mycosis. The patient's cutaneous aspergillosis responded to a combination of intravenous amphotericin B and topical terbinafine cream. Although the patient died shortly thereafter from hepatic failure, there was no evidence of systemic aspergillosis
— id: 16905, year: 1994, vol: 31, page: 344, stat: Journal Article,

ELEVATIONS OF PLATELET-ASSOCIATED ANTIBODIES DURING ORTHOTOPIC LIVER-TRANSPLANT REJECTIONS
TEPERMAN, L; GOLDENBERG, A; DIFLO, T; TOBIAS, H
1994 OCT ;20(4):A406-A406, Hepatology
— id: 52319, year: 1994, vol: 20, page: A406, stat: Journal Article,

PROLONGED ABNORMALITIES OF HEMOSTASIS FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION
LEE, M; TEPERMAN, L; GOLDENBERG, A; KARPATKIN, M
1993 NOV 15 ;82(10):A596-A596, Blood
— id: 52150, year: 1993, vol: 82, page: A596, stat: Journal Article,

RETROGRADE CAVAL FLUSH WITH PORTAL VENTING IN ORTHOTOPIC LIVER-TRANSPLANTATION
TEPERMAN, LW; DIFLO, T
1993 SEP ;18(3):755-755, Hepatology
— id: 52244, year: 1993, vol: 18, page: 755, stat: Journal Article,

Anatomic distribution of preservation solutions during canine hepatic procurement
Harris LJ; Crooke GA; Grossi EA; Teperman LW; Halff GA; Galloway AC; Spencer FC; Weil R 3d
1991 Oct;23(5):2430-2431, Transplantation proceedings
— id: 13878, year: 1991, vol: 23, page: 2430, stat: Journal Article,

Improved arterial allograft preservation with the University of Wisconsin solution
Teperman LW; Baumann FG; Harris L; Crooke G; Halff GA; Weil R 3d
1991 Feb;23(1 Pt 1):896-898, Transplantation proceedings
— id: 14143, year: 1991, vol: 23, page: 896, stat: Journal Article,

PERITONEOVENOUS SHUNTING FOR THE TREATMENT OF MASSIVE ASCITES
Teperman, LW; Halff, G; Tzakis, A
1990 Jun 14;322(24):1751-1751, New England journal of medicine
— id: 31931, year: 1990, vol: 322, page: 1751, stat: Journal Article,