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Article ; Online: Management of Patients with Chronic Liver Disease in the Perioperative Period.

Oliver, Joseph B / Merchant, Aziz M / Koneru, Baburao

Journal of investigative surgery : the official journal of the Academy of Surgical Research

2022 Volume 36, Issue 1, Page(s) 2156346

MeSH term(s)	Humans ; Perioperative Period ; Liver Diseases/surgery ; Perioperative Care
Language	English
Publishing date	2022-12-14
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	639444-9
ISSN	1521-0553 ; 0894-1939
ISSN (online)	1521-0553
ISSN	0894-1939
DOI	10.1080/08941939.2022.2156346
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Article ; Online: The Impact of Chronic Liver Disease on Postoperative Outcomes and Resource Utilization.

Oliver, Joseph B / Merchant, Aziz M / Koneru, Baburao

Journal of investigative surgery : the official journal of the Academy of Surgical Research

2019 Volume 34, Issue 6, Page(s) 617–626

Abstract: Background: Multiple studies have shown high rates of postoperative morbidity and mortality in individuals with chronic liver disease (CLD). However, analyses from comparisons with individuals without CLD are not available. Such analyses might provide ... ...

Abstract	Background: Multiple studies have shown high rates of postoperative morbidity and mortality in individuals with chronic liver disease (CLD). However, analyses from comparisons with individuals without CLD are not available. Such analyses might provide opportunities to improve outcomes. Methods: Data from The National Surgical Quality Improvement Program (NSQIP) from 2008 to 2011 were analyzed comparing CLD patients undergoing non-liver surgery propensity matched to those without CLD. Patients with CLD were stratified by Model of End Stage Liver Disease (MELD) scores <15 and ≥15. Primary outcome was all cause mortality, and secondary outcomes were composite and individual morbidity, hospital length of stay, readmission, reoperation, and discharge destination. Odds ratios (OR) were calculated, and length of hospital stay was estimated using Poisson regression. Results: There were 6,209 patients with CLD (4,013 with low MELD, 2,196 with high MELD) matched to 18,627 patients without. Patients with CLD had 1.8- and 3.3-times higher odds of mortality (95% CI 1.6-2.1 for Low MELD (10.6%), 2.9-3.8 for high MELD (35.2%), and 1.8- and 2.2-times higher odds of any morbidity (1.6-1.9 and 1.9-2.4). Complications specific to CLD were increased based on MELD specifically coma (OR 1.6, 0.9-2.9 for Low MELD, 2.2, 1.5-3.2 for High MELD), renal failure (OR 1.4, 1.1-1.8 and 2.4, 2.0-2.9), and bleeding (OR 1.7, 1.5-1.9 and 2.0, 1.8-2.3). They also had a 20% and 80% longer length of stay, 2.2- and 3.4-times higher odds of being discharged somewhere other than home, 1.7- and 1.6-times higher odds of readmission, and 1.5- and 1.6-times higher odds of reoperation. Conclusion: Patients with CLD have significantly higher odds of mortality and morbidity, which is increased with a higher MELD. Interventions that decrease those morbidities are needed and have the potential to decrease mortality and resource utilization.
MeSH term(s)	End Stage Liver Disease/surgery ; Humans ; Length of Stay ; Liver Diseases/epidemiology ; Liver Diseases/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Reoperation ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2019-10-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	639444-9
ISSN	1521-0553 ; 0894-1939
ISSN (online)	1521-0553
ISSN	0894-1939
DOI	10.1080/08941939.2019.1676846
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Article: Improved Outcomes Following Hepatocellular Carcinoma (HCC) Diagnosis in Patients Screened for HCC in a Large Academic Liver Center versus Patients Identified in the Community.

Okoronkwo, Nneoma / Wang, Yucai / Pitchumoni, Capecomorin / Koneru, Baburao / Pyrsopoulos, Nikolaos

Journal of clinical and translational hepatology

2017 Volume 5, Issue 1, Page(s) 31–34

Abstract: Background and Aims: ...

Abstract	Background and Aims:
Language	English
Publishing date	2017-02-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	3019822-7
ISSN	2310-8819 ; 2225-0719
ISSN (online)	2310-8819
ISSN	2225-0719
DOI	10.14218/JCTH.2016.00051
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Article ; Online: Resolving issues of consent and oversight: one step closer to terra firma in deceased organ donor research.

Mora-Esteves, Cesar / Koneru, Baburao

Critical care medicine

2011 Volume 39, Issue 2, Page(s) 400–401

MeSH term(s)	Critical Illness/mortality ; Female ; Humans ; Informed Consent/ethics ; Informed Consent/legislation & jurisprudence ; Intensive Care Units ; Male ; Needs Assessment ; Organ Transplantation/standards ; Organ Transplantation/trends ; Presumed Consent/ethics ; Presumed Consent/legislation & jurisprudence ; Tissue Donors/ethics ; Tissue Donors/legislation & jurisprudence ; Tissue and Organ Procurement/ethics ; Tissue and Organ Procurement/legislation & jurisprudence ; Tissue and Organ Procurement/organization & administration ; United States
Language	English
Publishing date	2011-02
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0b013e318206b0eb
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Article ; Online: Ministering to the dead in critical care medicine: has its time come?

Desai, Kunj K / Koneru, Baburao

Critical care medicine

2009 Volume 37, Issue 8, Page(s) 2480–2481

MeSH term(s)	Biomarkers/blood ; Hemodynamics ; Humans ; Hypovolemia/blood ; Hypovolemia/diagnosis ; Interleukin-6/blood ; Systemic Inflammatory Response Syndrome/blood ; Systemic Inflammatory Response Syndrome/prevention & control ; Tissue and Organ Harvesting
Chemical Substances	Biomarkers ; Interleukin-6
Language	English
Publishing date	2009-08
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0b013e3181abf8ba
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Article ; Online: Review of randomized clinical trials of donor management and organ preservation in deceased donors: opportunities and issues.

Dikdan, George S / Mora-Esteves, Cesar / Koneru, Baburao

Transplantation

2012 Volume 94, Issue 5, Page(s) 425–441

Abstract: Given the static number of deceased donors, improvements in donor management and organ preservation to increase the number and quality of organs transplanted per donor are more pressing. Because controlled trials provide the best evidence, we conducted a ...

Abstract	Given the static number of deceased donors, improvements in donor management and organ preservation to increase the number and quality of organs transplanted per donor are more pressing. Because controlled trials provide the best evidence, we conducted a review of English-language literature of trials in donor management and organ preservation to provide a compendium and to promote additional discussion and studies. Eighty-seven reports were retrieved: 13 on hemodynamic and fluid management, 7 on immunosuppressants, 12 on preconditioning, 34 on preservation fluids, and 21 on pulsatile perfusion. Sixteen studies are ongoing. Although hormonal therapy is used widely, additional studies are needed to determine the benefit of thyroid hormone and insulin replacement and to optimize steroid regimens. Dopamine's success in reducing kidney delayed graft function highlights the opportunity for additional preconditioning trials of remote ischemia, gases, opioids, and others. More rapid progress requires addressing unique barriers in consent and research approval, legal constraints precluding research in cardiac death donors, and streamlining collaboration of multiple stakeholders. With little interest from industry, federal funding needs to be increased. While the University of Wisconsin solution still reigns supreme, several promising preservative solutions and additives with not only biophysical but also pharmacological effects are on the cusp of phase 1 to 2 trials. After nearly three decades of uncertainty, the recent success of a European trial has reenergized the topic not only of machine preservation of the kidney but also of other organs evident by trials in progress. However, the costs of such technical innovations merit the burden of rigorous proof from controlled trials.
MeSH term(s)	Cytoprotection ; Donor Selection/methods ; Humans ; Organ Preservation/methods ; Organ Preservation Solutions/therapeutic use ; Organ Transplantation ; Perfusion ; Protective Agents/therapeutic use ; Pulsatile Flow ; Randomized Controlled Trials as Topic ; Tissue Donors/supply & distribution ; Tissue and Organ Procurement
Chemical Substances	Organ Preservation Solutions ; Protective Agents
Language	English
Publishing date	2012-09-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0b013e3182547537
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Article ; Online: Dr. Jekyll and Mr. Hyde saga of a cytokine: the devil in the details.

Mora-Esteves, Cesar / Dikdan, George / Koneru, Baburao

Critical care medicine

2010 Volume 38, Issue 3, Page(s) 997–998

MeSH term(s)	Animals ; Capillary Permeability/immunology ; Lung/blood supply ; Lung Transplantation/physiology ; Postoperative Complications/immunology ; Primary Graft Dysfunction/physiopathology ; Pulmonary Edema/immunology ; Rats ; Reactive Oxygen Species/metabolism ; Reperfusion Injury/immunology ; Tumor Necrosis Factor-alpha/physiology
Chemical Substances	Reactive Oxygen Species ; Tumor Necrosis Factor-alpha
Language	English
Publishing date	2010-03
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0b013e3181ce2070
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Article ; Online: Organ Procurement Organization Survey of Practices and Beliefs Regarding Prerecovery Percutaneous Liver Biopsy in Donation After Neurologic Determination of Death.

Oliver, Joseph Benton / Marcus, Andrea Fleisch / Paster, Mark / Nespral, Joseph / Bongu, Advaith / Dikdan, George / Brown, Lloyd / Neidlinger, Nikole / Koneru, Baburao

Transplantation

2017 Volume 101, Issue 4, Page(s) 821–825

Abstract: Background: Prerecovery liver biopsy (PLB) allows histological evaluation of the organ before procurement. The opinions and what factors might influence PLB use within Organ Procurement Organizations (OPOs) are unknown.: Methods: A survey instrument ... ...

Abstract	Background: Prerecovery liver biopsy (PLB) allows histological evaluation of the organ before procurement. The opinions and what factors might influence PLB use within Organ Procurement Organizations (OPOs) are unknown. Methods: A survey instrument was distributed by the Association of OPOs to the clinical directors of all 58 OPOs. Descriptive statistics were calculated. Results were also stratified based on OPO characteristics. Results: Forty-nine (84.5%) of 58 OPOs responded to the survey; 40 (81.6%) of 49 currently perform PLB. This did not vary based on land mass, population, livers discarded, transplanted, donor age, or recipient MELD scores. Donor age, obesity, alcohol abuse, hepatitis serology, liver only donor, imaging results, and transplant center request were the most common indications for PLB in over 80% of OPOs. The median rate of performance is 5% to 10% of donors. Most use interventional radiologists to perform and the donor hospital pathologist/s to interpret PLB. Most OPOs believe PLBs are safe, reliable, useful, and performed often enough. Most say they did not believe they are easy to obtain. Beliefs were mixed regarding accuracy. The topics likely to influence PLB use were utility and accuracy of PLB, and availability of staff to perform PLB. OPOs that perform PLB more often were more likely to have favorable opinions of safety and pathologist availability, and more influenced by safety, reliability, availability, and a national consensus on the use of PLB. Conclusions: Considerable variability exists in the use of PLB. Additional information on the utility, accuracy, and safety of PLB are needed to optimize its use.
MeSH term(s)	Attitude of Health Personnel ; Biopsy/trends ; Cause of Death ; Donor Selection/trends ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Liver/pathology ; Liver Transplantation/trends ; Practice Patterns, Physicians'/trends ; Predictive Value of Tests ; Reproducibility of Results ; Risk Factors ; Tissue Donors ; United States
Language	English
Publishing date	2017-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000001632
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Article: Hepatic steatosis and liver transplantation current clinical and experimental perspectives.

Koneru, Baburao / Dikdan, George

Transplantation

2002 Volume 73, Issue 3, Page(s) 325–330

MeSH term(s)	Animals ; Disease Models, Animal ; Fatty Liver/complications ; Fatty Liver/epidemiology ; Fatty Liver/therapy ; Graft Survival ; Humans ; Liver Regeneration ; Liver Transplantation/adverse effects ; Prevalence ; Reperfusion Injury/etiology ; Tissue Donors
Language	English
Publishing date	2002-02-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/00007890-200202150-00001
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Article ; Online: Self-reported non-adherence to immune-suppressant therapy in liver transplant recipients: demographic, interpersonal, and intrapersonal factors.

Lamba, Sangeeta / Nagurka, Roxanne / Desai, Kunj K / Chun, Shaun J / Holland, Bart / Koneru, Baburao

Clinical transplantation

2012 Volume 26, Issue 2, Page(s) 328–335

Abstract: Adherence to immune suppressants and follow-up care regimen is important in achieving optimal long-term outcomes after organ transplantation. To identify patients most at risk for non-adherence, this cross-sectional, descriptive study explores the ... ...

Abstract	Adherence to immune suppressants and follow-up care regimen is important in achieving optimal long-term outcomes after organ transplantation. To identify patients most at risk for non-adherence, this cross-sectional, descriptive study explores the prevalence and correlates of non-adherence to immune-suppressant therapy among liver recipients. Anonymous questionnaires mailed consisted of the domains: (i) adherence barriers to immune suppressants, (ii) immune suppressants knowledge, (iii) demographics, (iv) social support, (v) medical co-morbidities, and (vi) healthcare locus of control and other beliefs. Overall response was 49% (281/572). Data analyzed for those transplanted within 10 yr of study reveal 50% (119/237) recipients or 9.2/100 person years reporting non-adherence. Non-adherence was reported highest in the 2-5 yr post-transplant phase (69/123, 56%). The highest immune-suppressant non-adherence rates were in recipients who are: divorced (26/34, 76%, p=0.0093), have a history of substance or alcohol use (42/69, 61%, p=0.0354), have mental health needs (50/84, 60%, p=0.0336), those who missed clinic appointments (25/30, 83%, p<0.0001), and did not maintain medication logs (71/122, 58%, p=0.0168). Respondents who were non-adherent with physician appointments were more than four and a half times as likely (OR 4.7, 95% CI 1.5-14.7, p=0.008) to be non-adherent with immune suppressants. In conclusion, half of our respondents report non-adherence to immune suppressants. Factors identified may assist clinicians to gauge patients' non-adherence risk and target resources.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Internal-External Control ; Liver Transplantation ; Male ; Medication Adherence ; Middle Aged ; Social Support ; Socioeconomic Factors ; Substance-Related Disorders ; Surveys and Questionnaires ; Young Adult
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2012-03
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/j.1399-0012.2011.01489.x
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