Browsing by Author "Shaik, Sameer"

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    Early living donor liver transplantation for alcohol-associated hepatitis
    (2023) Kulkarni, Anand V.; Reddy, Raghuram; Arab, Juan Pablo; Sharma, Mithun; Shaik, Sameer; Iyengar, Sowmya; Kumar, Naveen; Gupta, Rajesh; Premkumar, Giri Vishwanathan; Menon, Balachandran Palat; Reddy, Duvvur Nageshwar; Rao, Padaki Nagaraja; Reddy, K. Rajender
    Introduction and Objectives: Lately, there has been a steady increase in early liver transplantation for alcohol -associated hepatitis (AAH). Although several studies have reported favorable outcomes with cadaveric early liver transplantation, the experiences with early living donor liver transplantation (eLDLT) are limited. The primary objective was to assess one-year survival in patients with AAH who underwent eLDLT. The second-ary objectives were to describe the donor characteristics, assess the complications following eLDLT, and the rate of alcohol relapse.Materials and Methods: This single-center retrospective study was conducted at AIG Hospitals, Hyderabad, India, between April 1, 2020, and December 31, 2021.Results: Twenty-five patients underwent eLDLT. The mean time from abstinence to eLDLT was 92.4 +/- 42.94 days. The mean model for end-stage liver disease and discriminant function score at eLDLT were 28.16 +/- 2.89 and 104 +/- 34.56, respectively. The mean graft-to-recipient weight ratio was 0.85 +/- 0.12. Survival was 72% (95%CI, 50.61-88) after a median follow-up of 551 (23-932) days post-LT. Of the 18 women donors,11 were the wives of the recipient. Six of the nine infected recipients died: three of fungal sepsis, two of bacterial sepsis, and one of COVID-19. One patient developed hepatic artery thrombosis and died of early graft dysfunction. Twenty percent had alcohol relapse.Conclusions: eLDLT is a reasonable treatment option for patients with AAH, with a survival of 72% in our expe-rience. Infections early on post-LT accounted for mortality, and thus a high index of suspicion of infections and vigorous surveillance, in a condition prone to infections, are needed to improve outcomes.(c) 2023 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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    Impact of Karnofsky performance status on outcomes of patients with severe alcohol-associated hepatitis: a propensity-matched analysis
    (2024) Kulkarni, Anand V.; Venishetty, Shantan; Kumar, Karan; Gurav, Nitish; Albhaisi, Somaya; Chhabbra, Prateek; Shaik, Sameer; Alla, Manasa; Iyengar, Sowmya; Sharma, Mithun; Rao, Padaki N.; Arab, Juan P.; Reddy, Duvvur N.
    Background and Aims: Severity scores, including the model for end-stage liver disease (MELD) and discriminant function score, guide the treatment of patients with severe alcohol-associated hepatitis (AH). We aimed to investigate the impact of functional status on outcomes of patients with AH. Methods: Medically managed patients (n = 133) with AH from 1 January 2019 to 31 December 2022 were included in this prospective study. The objectives were to compare the long-term survival, recompensation rates, corticosteroid response, incidence of infections, hepatic encephalopathy (HE) and acute kidney injury (AKI) among propensity score-matched patients with good Karnofsky performance status (KPS) (score >= 50) and poor KPS (score <50) using Kaplan-Meier analysis. Results: Twenty-five patients with good KPS were matched with 25 patients with poor KPS and followed up for a median duration of 10 (0.5-33) months. Survival was 76% (19/25; 95% confidence interval (CI), 54.9-90.6) in patients with good KPS compared to 42.3% (11/25; 95% CI, 23.4-63.1) patients with poor KPS (P = 0.001) at 10 months. The recompensation rate was higher in the good KPS group than in the poor KPS group (68% vs 44%; P = 0.04). A higher proportion of patients in the good KPS group (78.9%) than in the poor KPS group (42.8%; P = 0.03) responded to corticosteroids. Survival was lower among non-responders in the poor KPS group (0% vs 75%; P = 0.01). The proportion of patients who developed infection (36% vs 28%; P = 0.051), HE (36% vs 12%; P = 0.01) and AKI (60% vs 16%; P < 0.001) was higher in patients with poor KPS than in good KPS. Conclusions: KPS is an important determinant of outcomes in patients with AH, including survival, recompensation, response to corticosteroids and complications.