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Article ; Online: Successful liver transplantation from deceased donors with active COVID-19 infections with undetectable SARS-CoV-2 in donor liver and aorta.

Weeks, Sharon R / Federova, Ekateria / Lee, Kyungho / Nyberg, Lyle / Mulka, Kathleen / Rabb, Hamid / Pekosz, Andrew / Philosophe, Benjamin / Mankowski, Joseph

Clinical transplantation

2023 Volume 37, Issue 9, Page(s) e15081

Abstract: Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has had unprecedented effects on society and modern healthcare. In liver transplantation, uncertainty regarding the safety of performing transplants during the early stage of the ... ...

Abstract	Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has had unprecedented effects on society and modern healthcare. In liver transplantation, uncertainty regarding the safety of performing transplants during the early stage of the pandemic resulted in increased waitlist mortality. Additionally, concerns about disease transmission led to avoidance of deceased donors with COVID-19 infections. Several successful case reports describing incidental transplant of organs from donors with COVID-19 infections or intentional transplant of such donors into recipients with current or prior COVID-19 infections prompted the transplant community to re-evaluate that position. While excellent short-term results have been published, little is known about use of donors with active infections and the extent of COVID-19 organ involvement, which may affect long term outcomes. Methods: We report the successful transplantation of three livers from deceased donors with active COVID-19 infections. Donor liver and aortic tissues were evaluated by sensitive molecular testing for SARS-CoV-2 RNA via in situ hybridization and real-time quantitative reverse transcription PCR. Results: Postoperatively, all patients had excellent allograft function, without clinical or molecular evidence of SARS-CoV-2 transmission in donor tissues. Conclusion: This evidence supports the use of liver donors with active COVID-19 infections.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Liver Transplantation/methods ; Pandemics ; RNA, Viral/genetics ; Tissue and Organ Procurement ; Living Donors ; Tissue Donors ; Liver ; Aorta
Chemical Substances	RNA, Viral
Language	English
Publishing date	2023-07-27
Publishing country	Denmark
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.15081
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Article ; Online: Innovative approach to the difficult ventricular shunt using pleural access device for maintenance drainage: case report.

Weeks, Sharon R / Gosztyla, Carolyn E / Davidson, Laurence / Pryor, Howard I

Journal of neurosurgery. Pediatrics

2020 Volume 25, Issue 4, Page(s) 407–410

Abstract: Patients with complex medical problems and multiple failed ventricular shunts require continued innovation for hydrocephalus management. The authors report the case of a 4-year-old boy with refractory hydrocephalus and secondary reduced ability to absorb ...

Abstract	Patients with complex medical problems and multiple failed ventricular shunts require continued innovation for hydrocephalus management. The authors report the case of a 4-year-old boy with refractory hydrocephalus and secondary reduced ability to absorb CSF in both the pleural and peritoneal cavities following renal transplantation. A novel management approach was devised with split shunting to pleural and peritoneal targets as well as prophylactic pleural port placement to provide a method for minimally invasive thoracentesis should symptomatic pleural effusions develop. Fluid was successfully aspirated via the pleural port with relief of symptoms over a period of 16 months without complication. The authors demonstrate that a previously undescribed approach to distal shunting can prevent neurological sequelae of shunt failure and permit noninvasive maintenance drainage for patients in whom symptomatic pleural effusion is a recurrent complication.
Language	English
Publishing date	2020-01-03
Publishing country	United States
Document type	Case Reports
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2019.10.PEDS19122
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Article ; Online: Humanitarian Surgical Care in the US Military Treatment Facilities in Afghanistan From 2002 to 2013.

Weeks, Sharon R / Oh, John S / Elster, Eric A / Learn, Peter A

JAMA surgery

2017 Volume 153, Issue 1, Page(s) 84–86

MeSH term(s)	Adult ; Afghan Campaign 2001- ; Altruism ; Elective Surgical Procedures/statistics & numerical data ; Female ; Hospitals, Military ; Humans ; Male ; Retrospective Studies ; Surgical Procedures, Operative/statistics & numerical data ; Uncompensated Care ; United States ; Wounds and Injuries/epidemiology ; Wounds and Injuries/surgery ; Young Adult
Language	English
Publishing date	2017-09-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2017.3142
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Article ; Online: Incorporation of another person's limb into body image relieves phantom limb pain: a case study.

Weeks, Sharon R / Tsao, Jack W

Neurocase

2010 Volume 16, Issue 6, Page(s) 461–465

Abstract: Phantom limb phenomena are well characterized, but the underlying mechanisms remain unclear. Here we report a patient who relieves his phantom sensations and pain, experienced as itching and cramping, through scratching or massaging his prosthesis or the ...

Abstract	Phantom limb phenomena are well characterized, but the underlying mechanisms remain unclear. Here we report a patient who relieves his phantom sensations and pain, experienced as itching and cramping, through scratching or massaging his prosthesis or the leg of another person. This pain relief occurs only when phantom limb sensations are present. We hypothesize that symptom relief results from incorporation of the foreign limb into the patient's body image, mediated by the sensory mirror neuron system, relieving pain by restoring concordance between sensory systems.
MeSH term(s)	Adult ; Artificial Limbs ; Body Image ; Humans ; Leg ; Male ; Massage ; Muscle Cramp/psychology ; Pain/psychology ; Pain Perception ; Phantom Limb/psychology ; Phantom Limb/therapy ; Pruritus/psychology
Language	English
Publishing date	2010-12
Publishing country	England
Document type	Case Reports ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1302651-3
ISSN	1465-3656 ; 1355-4794
ISSN (online)	1465-3656
ISSN	1355-4794
DOI	10.1080/13554791003730592
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Article ; Online: Noninvasive Risk Stratification for Nonalcoholic Fatty Liver Disease Among Living Liver Donor Candidates: A Proposed Algorithm.

Danis, Nilay / Weeks, Sharon R / Kim, Ahyoung / Baghdadi, Azarakhsh / Ghadimi, Maryam / Kamel, Ihab R / Saberi, Behnam / Woreta, Tinsay / Garonzik-Wang, Jacqueline / Philosophe, Benjamin / Gurakar, Ahmet / Loomba, Rohit

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

2021 Volume 28, Issue 4, Page(s) 670–677

Abstract: To reduce waitlist mortality, living donor liver transplantation (LDLT) has increased over the past decade in the United States, but not at a rate sufficient to completely mitigate organ shortage. As a result, there are ongoing efforts to expand the ... ...

Abstract	To reduce waitlist mortality, living donor liver transplantation (LDLT) has increased over the past decade in the United States, but not at a rate sufficient to completely mitigate organ shortage. As a result, there are ongoing efforts to expand the living liver donor pool. Simultaneously, the prevalence of nonalcoholic fatty liver disease (NAFLD) in the general population has increased, which has significant implications on the pool of potential living liver donors. As such, a clinical assessment algorithm that exhaustively evaluates for NAFLD and fibrosis is critical to the safe expansion of LDLT. An ideal algorithm would employ safe and noninvasive methods, relying on liver biopsy only when necessary. While exclusion of NAFLD and fibrosis by noninvasive means is widely studied within the general population, there are no well-accepted guidelines for evaluation of living donors using these modalities. Here we review the current literature regarding noninvasive NALFD and fibrosis evaluation and propose a potential algorithm to apply these modalities for the selection of living liver donors.
MeSH term(s)	Algorithms ; Fibrosis ; Humans ; Liver/pathology ; Liver/surgery ; Liver Transplantation/adverse effects ; Liver Transplantation/methods ; Living Donors ; Non-alcoholic Fatty Liver Disease/diagnosis ; Non-alcoholic Fatty Liver Disease/epidemiology ; Non-alcoholic Fatty Liver Disease/surgery ; Risk Assessment ; United States
Language	English
Publishing date	2021-12-13
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	2006866-9
ISSN	1527-6473 ; 1527-6465
ISSN (online)	1527-6473
ISSN	1527-6465
DOI	10.1002/lt.26365
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Article ; Online: Steroid-sparing maintenance immunosuppression is safe and effective after simultaneous liver-kidney transplantation.

Weeks, Sharon R / Luo, Xun / Toman, Lindsey / Gurakar, Ahmet O / Naqvi, Fizza F / Alqahtani, Saleh A / Philosophe, Benjamin / Cameron, Andrew M / Desai, Niraj M / Ottmann, Shane E / Segev, Dorry L / Garonzik-Wang, Jacqueline

Clinical transplantation

2020 Volume 34, Issue 10, Page(s) e14036

Abstract: Optimization of maintenance immunosuppression (mIS) regimens in the transplant recipient requires a balance between sufficient potency to prevent rejection and avoidance of excessive immunosuppression to prevent toxicities and complications. The optimal ... ...

Abstract	Optimization of maintenance immunosuppression (mIS) regimens in the transplant recipient requires a balance between sufficient potency to prevent rejection and avoidance of excessive immunosuppression to prevent toxicities and complications. The optimal regimen after simultaneous liver-kidney (SLK) transplantation remains unclear, but small single-center reports have shown success with steroid-sparing regimens. We studied 4184 adult SLK recipients using the Scientific Registry of Transplant Recipients, from March 1, 2002, to February 28, 2017, on tacrolimus-based regimens at 1 year post-transplant. We determined the association between mIS regimen and mortality and graft failure using Cox proportional hazard models. The use of steroid-sparing regimens increased post-transplant, from 16.1% at discharge to 88.0% at 5 years. Using multi-level logistic regression modeling, we found center-level variation to be the major contributor to choice of mIS regimen (ICC 44.5%; 95% CI: 36.2%-53.0%). In multivariate analysis, use of a steroid-sparing regimen at 1 year was associated with a 21% decreased risk of mortality compared to steroid-containing regimens (aHR 0.79, P = .01) and 20% decreased risk of liver graft failure (aHR 0.80, P = .01), without differences in kidney graft loss risk (aHR 0.92, P = .6). Among SLK recipients, the use of a steroid-sparing regimen appears to be safe and effective without adverse effects on patient or graft survival.
MeSH term(s)	Adult ; Graft Rejection/drug therapy ; Graft Rejection/etiology ; Graft Rejection/prevention & control ; Graft Survival ; Humans ; Immunosuppression ; Immunosuppressive Agents/therapeutic use ; Kidney ; Kidney Transplantation ; Liver ; Steroids/therapeutic use
Chemical Substances	Immunosuppressive Agents ; Steroids
Language	English
Publishing date	2020-08-02
Publishing country	Denmark
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14036
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Article ; Online: Delayed Graft Function in Simultaneous Liver Kidney Transplantation.

Weeks, Sharon R / Luo, Xun / Haugen, Christine E / Ottmann, Shane E / Gurakar, Ahmet O / Naqvi, Fizza F / Alqahtani, Saleh A / Philosophe, Benjamin / Cameron, Andrew M / Desai, Niraj M / Segev, Dorry L / Garonzik Wang, Jacqueline M

Transplantation

2019 Volume 104, Issue 3, Page(s) 542–550

Abstract: Background: Delayed graft function (DGF) is associated with inferior posttransplant outcomes in kidney transplantation. Given these adverse outcomes, we sought to determine the incidence, unique risk factors, and posttransplant outcomes for simultaneous ...

Abstract	Background: Delayed graft function (DGF) is associated with inferior posttransplant outcomes in kidney transplantation. Given these adverse outcomes, we sought to determine the incidence, unique risk factors, and posttransplant outcomes for simultaneous liver kidney (SLK) transplant recipients developing DGF. Methods: We studied 6214 adult SLK recipients from March 2002 to February 2017 using the Scientific Registry of Transplant Recipients. We determined associations between risk factors and DGF using Poisson multivariate regression and between DGF and graft failure and mortality using Cox proportional hazard analysis. Results: The overall rate of DGF was 21.8%. Risk factors for DGF in the hepatitis C virus (HCV)-negative recipient population included pretransplant dialysis (adjusted incident rate ratio [aIRR] 3.26, P = 0.004), donor body mass index (aIRR 1.25 per 5 kg/m, P = 0.01), and transplantation with a donation after circulatory death (aIRR 5.38, P = 0.001) or imported donor organ (regional share aIRR 1.69, P = 0.03; national share aIRR 4.82, P < 0.001). DGF was associated with a 2.6-fold increase in kidney graft failure (adjusted hazard ratio [aHR] 2.63, P < 0.001), 1.6-fold increase in liver graft failure (aHR 1.62, P < 0.001), and 1.6-fold increase in mortality (aHR 1.62, P < 0.001). Conclusions: In HCV-negative SLK recipients, recipient pretransplant dialysis and components of kidney graft quality comprise significant risk factors for DGF. Regardless of HCV status, DGF is associated with inferior posttransplant outcomes. Understanding these risk factors during clinical decision-making may improve prevention of DGF and may represent an opportunity to improve posttransplant outcomes.
MeSH term(s)	Delayed Graft Function/epidemiology ; Delayed Graft Function/etiology ; Delayed Graft Function/physiopathology ; End Stage Liver Disease/complications ; End Stage Liver Disease/mortality ; End Stage Liver Disease/surgery ; Female ; Follow-Up Studies ; Graft Rejection/epidemiology ; Graft Rejection/etiology ; Graft Rejection/physiopathology ; Graft Survival ; Hepacivirus/isolation & purification ; Humans ; Kidney/physiopathology ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Kidney Transplantation/adverse effects ; Kidney Transplantation/methods ; Liver/physiopathology ; Liver Transplantation/adverse effects ; Liver Transplantation/methods ; Male ; Middle Aged ; Proportional Hazards Models ; Registries/statistics & numerical data ; Renal Dialysis/adverse effects ; Renal Dialysis/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Tissue Donors/statistics & numerical data ; Transplant Recipients/statistics & numerical data
Language	English
Publishing date	2019-08-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000002908
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Article ; Online: A modified Kampala trauma score (KTS) effectively predicts mortality in trauma patients.

Weeks, Sharon R / Stevens, Kent A / Haider, Adil H / Efron, David T / Haut, Elliot R / MacKenzie, Ellen J / Schneider, Eric B

Injury

2016 Volume 47, Issue 1, Page(s) 125–129

Abstract: Background: Mortality prediction in trauma patients has relied upon injury severity scoring tools focused on anatomical injury. This study sought to examine whether an injury severity scoring system which includes physiologic data performs as well as ... ...

Abstract	Background: Mortality prediction in trauma patients has relied upon injury severity scoring tools focused on anatomical injury. This study sought to examine whether an injury severity scoring system which includes physiologic data performs as well as anatomic injury scores in mortality prediction. Methods: Using data collected from 18 Level I trauma centers and 51 non-trauma center hospitals in the US, anatomy based injury severity scores (ISS), new injury severity scores (NISS) were calculated as were scores based on a modified version of the physiology-based Kampala trauma score (KTS). Because pre-hospital intubation, when required, is standard of care in the US, a modified KTS was calculated excluding respiratory rate. The predictive ability of the modified KTS for mortality was compared with the ISS and NISS using receiver operating characteristic (ROC) curves. Results: A total of 4716 individuals were eligible for study. Each of the three scores was a statistically significant predictor of mortality. In this sample, the modified KTS significantly outperformed the ISS (AUC=0.83, 95% CI 0.81-0.84 vs. 0.77, 95% CI 0.76-0.79, respectively) and demonstrated similar predictive ability compared to the NISS (AUC=0.83, 95% CI 0.81-0.84 vs. 0.82, 95% CI 0.80-0.83, respectively). Conclusions: The modified KTS may represent a useful tool for assessing trauma mortality risk in real time, as well as in administrative data where physiologic measures are available. Further research is warranted and these findings suggest that the collection of physiologic measures in large databases may improve outcome prediction.
MeSH term(s)	Adult ; Area Under Curve ; Databases, Factual ; Developing Countries ; Female ; Glasgow Coma Scale ; Humans ; Injury Severity Score ; Male ; Predictive Value of Tests ; Prospective Studies ; Quality Improvement ; Trauma Centers/statistics & numerical data ; Wounds and Injuries/classification ; Wounds and Injuries/mortality
Language	English
Publishing date	2016-01
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2015.07.004
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Article: Mild traumatic brain injury update.

Anderson-Barnes, Victoria C / Weeks, Sharon R / Tsao, Jack W

Continuum (Minneapolis, Minn.)

2010 Volume 16, Issue 6 Traumatic Brain Injury, Page(s) 17–26

Abstract: Traumatic brain injury (TBI) is a prevalent condition throughout the civilian and military populations. Although TBI can be classified as mild, moderate, or severe, most TBIs are considered mild. Understanding the pathophysiologic mechanism(s) of mild ... ...

Abstract	Traumatic brain injury (TBI) is a prevalent condition throughout the civilian and military populations. Although TBI can be classified as mild, moderate, or severe, most TBIs are considered mild. Understanding the pathophysiologic mechanism(s) of mild TBI through basic science and clinical cohort studies is an area of active research. While it is well understood that most people recover from a mild TBI with minimal treatment, some patients experience long-term consequences that require rehabilitation and specialized care. Common characteristics of brain injury include loss of consciousness (LOC), posttraumatic amnesia (PTA), and postconcussion syndrome (PCS). The development of LOC, PTA, and PCS greatly depends on the nature of the injury, and the degrees to which they develop are not necessarily consistent with symptom presentation. In recent years, sports concussions have become an area of increased research and public interest in the civilian population; similarly, blast TBI has gained attention in the military. Depending on the nature of the injury, different outcomes may result in the two populations. Consequently, treatments for mild TBI are rather diverse, and early intervention is the key to maximizing outcomes following a TBI. These topics and more will be discussed throughout this article.
Language	English
Publishing date	2010-12
Publishing country	United States
Document type	Journal Article
ISSN	1080-2371
ISSN	1080-2371
DOI	10.1212/01.CON.0000391450.48225.73
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Article ; Online: Phantom limb pain: theories and therapies.

Weeks, Sharon R / Anderson-Barnes, Victoria C / Tsao, Jack W

The neurologist

2010 Volume 16, Issue 5, Page(s) 277–286

Abstract: Background and objective: Since the beginning of the conflicts in Iraq and Afghanistan, there has been a dramatic increase in the number of military service members with single and multiple-limb amputations. Phantom limb pain (PLP) frequently develops ... ...

Abstract	Background and objective: Since the beginning of the conflicts in Iraq and Afghanistan, there has been a dramatic increase in the number of military service members with single and multiple-limb amputations. Phantom limb pain (PLP) frequently develops in these individuals. As a result, identifying the best methods to treat PLP is critical. The review highlights areas of inquiry related to phantom pain, with a focus on PLP. Review summary: This review discusses phantom sensations and phantom pain that arise after amputation of a body part, and summarizes the differences between the 2 conditions. Characteristics of PLP are also discussed, including the onset, duration, and location of PLP. Theories explaining the etiology and presence of PLP are reviewed, along with the numerous treatment options reported in the published data for such pain, including the use of mirrors for treating pain. We conclude with a description of one military hospital's experiences with PLP. Conclusions: Although more research has been done in previous years, this review identifies the need for continuing investigations. The etiology of PLP needs to be determined through more vigorous investigation, and a focus must be placed on defining treatment options in addition to mirror therapy that will improve the quality of life of those who suffer from this condition.
MeSH term(s)	Afghanistan ; Amputation/adverse effects ; Animals ; Clinical Trials as Topic ; Humans ; Iraq ; Military Personnel ; Models, Theoretical ; Neuronal Plasticity ; Pain/physiopathology ; Pain Management ; Pain Measurement ; Phantom Limb/etiology ; Phantom Limb/physiopathology ; Phantom Limb/therapy
Language	English
Publishing date	2010-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1361380-7
ISSN	2331-2637 ; 1074-7931
ISSN (online)	2331-2637
ISSN	1074-7931
DOI	10.1097/NRL.0b013e3181edf128
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