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Item Liver Transplantation in Recipients With Class III Obesity: Posttransplant Outcomes and Weight Gain(Wolters Kluwer, 2022-01-05) Soma, Daiki; Park, Yujin; Mihaylov, Plamen; Ekser, Burcin; Ghabril, Marwan; Lacerda, Marco; Chalasani, Naga; Mangus, Richard S.; Kubal, Chandrashekhar A.; Surgery, School of MedicineBackground: There has been a dramatic increase in obesity in the United States. Several studies have reported conflicting results for the impact of obesity on outcomes of liver transplantation (LT). This study aims to assess the impact of obesity on LT and changes in body mass index (BMI) after transplantation. Methods: All adult LTs performed at Indiana University between 2001 and 2018 were reviewed. BMIs of recipients were subdivided into 6 categories. Survival outcomes were compared across the subgroup. BMI was followed up in a cohort of patients from 2008 to 2018. Results: Among 2024 patients, 25% were in class I obesity, 9.3% were in class II obesity, and 1.1% were in class III obesity. There was no significant difference in patient and graft survival at 10-y follow-up with respect to BMI. Among 1004 patients in the subgroup, BMI of all groups except the underweight group declined in the first 3 mo postoperatively; however, the BMI of all groups except the class III obesity group returned to the pre-LT level by 2 y and reached a plateau by 5 y. In the class III obesity group, there was a significant increase in body weight at 5 y. Conclusions: Class III obesity was not associated with higher mortality in our cohort. Because our cohort is small, it may be underpowered to detect a smaller difference in outcome. From our observation, obesity should not be considered a contraindication for LT. Post-LT interventions are required to prevent significant weight gain for the class III obesity group.Item A National Survey of Hepatocellular Carcinoma Surveillance Practices Following Liver Transplantation(Wolters Kluwer, 2020-12-08) Aggarwal, Avin; Te, Helen S.; Verna, Elizabeth C.; Desai, Archita P.; Medicine, School of MedicineRecurrence of hepatocellular carcinoma (HCC) is an important predictor of survival after liver transplantation (LT). Recent studies show that early diagnosis, aggressive treatment, and surveillance may improve outcomes after HCC recurrence. We sought to determine the current practices and policies regarding surveillance for HCC recurrence after LT. Methods: We conducted a web-based national survey of adult liver transplant centers in the United States to capture center-specific details of HCC surveillance post-LT. Responses were analyzed to generate numerical and graphical summaries. Results: Of 101 eligible adult liver transplant centers, 48 (48%) centers across the United States responded to the survey. Among the participating centers, 79% stratified transplant recipients for HCC recurrence risk, while 19% did not have any risk stratification protocol. Explant microvascular invasion (mVI) was the most common factor used in risk stratification. Use of pretransplant serum biomarkers such as alpha-fetoprotein (AFP) was variable, with only 48% of the participating centers reporting specific "cutoff" values. While a majority of centers (88%) reported having a routine imaging protocol for HCC recurrence surveillance, there was considerable heterogeneity in terms of frequency and duration of such surveillance. Of the centers that did risk stratify patients to identify those at higher risk of HCC recurrence, about 50% did not change their surveillance protocol. Conclusions: Our study affirms significant variability in center practices, and our results reflect the need for high-quality studies to guide risk stratification and surveillance for HCC recurrence.Item Resumption of valued occupations in the first year post-liver transplant(Office of the Vice Chancellor for Research, 2010-04-09) Scott, Patricia J.Liver transplantation (LT) is popularly understood through the media as recovery of the organs and life saving surgery. In reality it is much more. Recovery from prolonged illness then major surgery is difficult, and long-term survival requires adaptation to lifelong medications, constant monitoring and life while immunosuppressed. Current involvement of occupational therapists is generally limited to post-surgical resumption of basic ADL’s. The assumption being that ADL’s, IADL’s leisure and productivity will gradually return. Quality of life studies clearly show many recipients re-engage in valued occupations, others do not. No evidence is available to show specific recovery of pre-transplant skills. This pilot study of 20 persons Recovering (n=9), Stabilized (n=5), and Reintegrating (n=6) during 12 months post-LT, suggests ADL’s are stable by the third month, and despite some progress in IADL’s, leisure and productivity, problems persist. SF-36 findings of low Physical Component Scores (PF, p=0.049, BP, p=0.019, and VT p=.019) in the group performing ‘worse than expected’, are consistent with other published studies. There is a need for longitudinal study of the occupational performance reintegration patterns to provide recipients with clear expectations of recovery, and the treatment team, particularly the occupational therapist with alerts to problems and need for intervention.