Jerry Ingram

PALM BEACH, FLA. — The success of adult-to-adult living donor liver transplants hinges on careful candidate selection with close attention being paid to patient age, Kim Olthoff, M.D., said at the annual meeting of the American Surgical Association.

“Older age and cold ischemic time were associated with adverse outcomes in patients undergoing adult-to-adult living donor transplant. However, graft size was not a factor. Choice of appropriate recipient is critical,” explained Dr. Olthoff, principal investigator and surgical director of the liver transplant program at Children's Hospital of Philadelphia.

Dr. Olthoff and her researchers examined data on 354 patients who received adult liver donor transplants at nine different centers. The report formed part of the Adult-to-Adult Living Donor Transplantation (ALDLT) consortium, which aims to evaluate the success of ALDLT.

They found that in the first 90 days after transplantation, 44 grafts failed (18 patients died and 26 required retransplantation). Grafts failed most commonly because of vascular thrombosis, primary nonfunction, recurrent hepatitis, or sepsis. Researchers followed patients for a median of 2.2 years and utilized Cox models to examine the relationship between 35 intraoperative and postoperative variables along with the risk of graft failure. During that time, 7.3% of patients had vascular complications and 21% required further surgery.

The most significant factor predicting higher risk of graft failure was the age of the recipient, with a risk ratio of 1.04 per year and a statistical significance of P less than 0.0001, researchers stated. In addition, they noted that at centers where more than 15 transplants had been performed, the risk of graft failure was reduced by 45%, compared with centers where fewer transplants had been done.

PALM BEACH, FLA. — The success of adult-to-adult living donor liver transplants hinges on careful candidate selection with close attention being paid to patient age, Kim Olthoff, M.D., said at the annual meeting of the American Surgical Association.

“Older age and cold ischemic time were associated with adverse outcomes in patients undergoing adult-to-adult living donor transplant. However, graft size was not a factor. Choice of appropriate recipient is critical,” explained Dr. Olthoff, principal investigator and surgical director of the liver transplant program at Children's Hospital of Philadelphia.

Dr. Olthoff and her researchers examined data on 354 patients who received adult liver donor transplants at nine different centers. The report formed part of the Adult-to-Adult Living Donor Transplantation (ALDLT) consortium, which aims to evaluate the success of ALDLT.

They found that in the first 90 days after transplantation, 44 grafts failed (18 patients died and 26 required retransplantation). Grafts failed most commonly because of vascular thrombosis, primary nonfunction, recurrent hepatitis, or sepsis. Researchers followed patients for a median of 2.2 years and utilized Cox models to examine the relationship between 35 intraoperative and postoperative variables along with the risk of graft failure. During that time, 7.3% of patients had vascular complications and 21% required further surgery.

The most significant factor predicting higher risk of graft failure was the age of the recipient, with a risk ratio of 1.04 per year and a statistical significance of P less than 0.0001, researchers stated. In addition, they noted that at centers where more than 15 transplants had been performed, the risk of graft failure was reduced by 45%, compared with centers where fewer transplants had been done.

PALM BEACH, FLA. — The success of adult-to-adult living donor liver transplants hinges on careful candidate selection with close attention being paid to patient age, Kim Olthoff, M.D., said at the annual meeting of the American Surgical Association.

“Older age and cold ischemic time were associated with adverse outcomes in patients undergoing adult-to-adult living donor transplant. However, graft size was not a factor. Choice of appropriate recipient is critical,” explained Dr. Olthoff, principal investigator and surgical director of the liver transplant program at Children's Hospital of Philadelphia.

Dr. Olthoff and her researchers examined data on 354 patients who received adult liver donor transplants at nine different centers. The report formed part of the Adult-to-Adult Living Donor Transplantation (ALDLT) consortium, which aims to evaluate the success of ALDLT.

They found that in the first 90 days after transplantation, 44 grafts failed (18 patients died and 26 required retransplantation). Grafts failed most commonly because of vascular thrombosis, primary nonfunction, recurrent hepatitis, or sepsis. Researchers followed patients for a median of 2.2 years and utilized Cox models to examine the relationship between 35 intraoperative and postoperative variables along with the risk of graft failure. During that time, 7.3% of patients had vascular complications and 21% required further surgery.

The most significant factor predicting higher risk of graft failure was the age of the recipient, with a risk ratio of 1.04 per year and a statistical significance of P less than 0.0001, researchers stated. In addition, they noted that at centers where more than 15 transplants had been performed, the risk of graft failure was reduced by 45%, compared with centers where fewer transplants had been done.

ORLANDO — Adding ultrasound to maternal serum AFP screening may help clinicians identify fetal neural tube defects, according to research that was presented during the annual meeting of the American Institute of Ultrasound in Medicine.

“From the standpoint of neural tube defect detection, the maternal serum AFP screening test remains a good test —in our series, more neural tube defects were detected if the test was used than if it was not used—but the sensitivity of the test is significantly better if gestational age is confirmed with ultrasound,” explained Jodi S. Dashe, M.D., of the University of Texas Southwestern Medical Center, Dallas.

“We were also pleased to find that in this series, the detection of neural tube defects with standard ultrasound was excellent,” Dr. Dashe added during the meeting.

Dr. Dashe and her associates conducted a retrospective study at their center to examine the role of ultrasound along with AFP screening for neural tube defects. For this investigation, they reviewed prenatal and neonatal datasets to find pregnancies that were complicated by neural tube defects.

Following their standard protocol, Dr. Dashe's team offered AFP screening between 15 and 21 weeks of gestation and performed specialized ultrasound for patients with an AFP of at least 2.50 multiples of the median (MOM).

For patients with an AFP of 2.00–2.49 MOM, standard ultrasound was performed.

Investigators identified 68 singletons with neural tube defects, 60 of which were identified prenatally.

Clinicians performed AFP screening in 33 study patients. An AFP elevation of at least 2.50 MOM occurred in 22 patients (67% sensitivity). Among patients with an AFP that was less than 2.50 MOM, the AFP calculation did not include ultrasound measurements in eight of the women.

Additionally, ultrasound was performed during the second or third trimesters in 66 women.

Using ultrasound and AFP screening, they were able to detect 98% of neural tube defects in these patients.

“Other programs may want to reevaluate their experience with the AFP screening test and how well it detects neural tube defects and ventral wall defects. Over time, having an AFP screening test might become an indication for standard ultrasound, both to improve the accuracy of the test and because these anomalies may be detected by the ultrasound,” Dr. Dashe said.

She noted that her study did not (and could not) perform a cost-benefit analysis, which would differ in different populations. She therefore is not recommending routine ultrasound for this indication.

In addition, Dr. Dashe noted a few limitations of this particular study, pointing to its retrospective nature and the fact that these results might not be generalizable in other centers.

ORLANDO — Adding ultrasound to maternal serum AFP screening may help clinicians identify fetal neural tube defects, according to research that was presented during the annual meeting of the American Institute of Ultrasound in Medicine.

“From the standpoint of neural tube defect detection, the maternal serum AFP screening test remains a good test —in our series, more neural tube defects were detected if the test was used than if it was not used—but the sensitivity of the test is significantly better if gestational age is confirmed with ultrasound,” explained Jodi S. Dashe, M.D., of the University of Texas Southwestern Medical Center, Dallas.

“We were also pleased to find that in this series, the detection of neural tube defects with standard ultrasound was excellent,” Dr. Dashe added during the meeting.

Dr. Dashe and her associates conducted a retrospective study at their center to examine the role of ultrasound along with AFP screening for neural tube defects. For this investigation, they reviewed prenatal and neonatal datasets to find pregnancies that were complicated by neural tube defects.

Following their standard protocol, Dr. Dashe's team offered AFP screening between 15 and 21 weeks of gestation and performed specialized ultrasound for patients with an AFP of at least 2.50 multiples of the median (MOM).

For patients with an AFP of 2.00–2.49 MOM, standard ultrasound was performed.

Investigators identified 68 singletons with neural tube defects, 60 of which were identified prenatally.

Clinicians performed AFP screening in 33 study patients. An AFP elevation of at least 2.50 MOM occurred in 22 patients (67% sensitivity). Among patients with an AFP that was less than 2.50 MOM, the AFP calculation did not include ultrasound measurements in eight of the women.

Additionally, ultrasound was performed during the second or third trimesters in 66 women.

Using ultrasound and AFP screening, they were able to detect 98% of neural tube defects in these patients.

“Other programs may want to reevaluate their experience with the AFP screening test and how well it detects neural tube defects and ventral wall defects. Over time, having an AFP screening test might become an indication for standard ultrasound, both to improve the accuracy of the test and because these anomalies may be detected by the ultrasound,” Dr. Dashe said.

She noted that her study did not (and could not) perform a cost-benefit analysis, which would differ in different populations. She therefore is not recommending routine ultrasound for this indication.

In addition, Dr. Dashe noted a few limitations of this particular study, pointing to its retrospective nature and the fact that these results might not be generalizable in other centers.

ORLANDO — Adding ultrasound to maternal serum AFP screening may help clinicians identify fetal neural tube defects, according to research that was presented during the annual meeting of the American Institute of Ultrasound in Medicine.

“From the standpoint of neural tube defect detection, the maternal serum AFP screening test remains a good test —in our series, more neural tube defects were detected if the test was used than if it was not used—but the sensitivity of the test is significantly better if gestational age is confirmed with ultrasound,” explained Jodi S. Dashe, M.D., of the University of Texas Southwestern Medical Center, Dallas.

“We were also pleased to find that in this series, the detection of neural tube defects with standard ultrasound was excellent,” Dr. Dashe added during the meeting.

Dr. Dashe and her associates conducted a retrospective study at their center to examine the role of ultrasound along with AFP screening for neural tube defects. For this investigation, they reviewed prenatal and neonatal datasets to find pregnancies that were complicated by neural tube defects.

Following their standard protocol, Dr. Dashe's team offered AFP screening between 15 and 21 weeks of gestation and performed specialized ultrasound for patients with an AFP of at least 2.50 multiples of the median (MOM).

For patients with an AFP of 2.00–2.49 MOM, standard ultrasound was performed.

Investigators identified 68 singletons with neural tube defects, 60 of which were identified prenatally.

Clinicians performed AFP screening in 33 study patients. An AFP elevation of at least 2.50 MOM occurred in 22 patients (67% sensitivity). Among patients with an AFP that was less than 2.50 MOM, the AFP calculation did not include ultrasound measurements in eight of the women.

Additionally, ultrasound was performed during the second or third trimesters in 66 women.

Using ultrasound and AFP screening, they were able to detect 98% of neural tube defects in these patients.

“Other programs may want to reevaluate their experience with the AFP screening test and how well it detects neural tube defects and ventral wall defects. Over time, having an AFP screening test might become an indication for standard ultrasound, both to improve the accuracy of the test and because these anomalies may be detected by the ultrasound,” Dr. Dashe said.

She noted that her study did not (and could not) perform a cost-benefit analysis, which would differ in different populations. She therefore is not recommending routine ultrasound for this indication.

In addition, Dr. Dashe noted a few limitations of this particular study, pointing to its retrospective nature and the fact that these results might not be generalizable in other centers.

ORLANDO — MRI for evaluating fetal and intracranial lesions shows promise, but challenges remain, Asad U. Sheikh, M.D., said at the annual meeting of the American Institute of Ultrasound in Medicine.

“MRI has become more useful for evaluating fetal and intracranial lesions. We're starting to see application as the technology advances for abdominal lesions as well. But still, we have considerable difficulty with interpretation,” explained Dr. Sheikh, director of the division of maternal-fetal medicine at the University of South Alabama.

Dr. Sheikh reported on two specific cases of schizencephaly, a brain lesion characterized by abnormal choronal migration.

The first case was of a 20-year-old woman at 19 weeks' gestation who presented with maternal serum alpha fetoprotein (AFP) elevated by 4.4 multiples of the median (MOM). Initial ultrasound evaluation indicated a left-sided intracranial cyst, Dr. Sheikh said. Investigators found that tests for karyotype and infection proved negative.

When they performed another sonogram, they found a large cystic structure replacing the left frontal temporal region. After the 35th week of gestation, they performed MRI, which showed bilateral schizencephaly. The patient delivered vaginally at term.

The second case was a 27-year-old woman at 21 weeks' gestation with an elevated AFP of 3.6 MOM; she was in her fourth pregnancy. Ultrasound revealed bilateral ventriculomegaly.

Amniocentesis was declined, and infection studies were negative. The physicians performed fetal MRI at 24 weeks' gestation and found left-sided schizencephaly and agenesis of the corpus callosum. The image quality was poor, due to fetal movement, however. The patient delivered vaginally at term.

Dr. Sheikh and his team performed MRIs to confirm their earlier diagnoses.

In the first case, they confirmed the findings of bilateral schizencephaly.

For the second patient, they performed cranial computed tomography, which illustrated bilateral schizencephaly with left more involved than right. Additionally, they observed agenesis of the corpus callosum.

Dr. Sheikh notes that these cases are unique in terms of the elevation in maternal serum AFP, which led to further evaluation. However, he points out that ventricular anomalies detected by ultrasound studies were more “precisely defined by prenatal MRI.”

He believes MRI should be considered to further delineate intracranial anomalies to better prepare families and care providers for postnatal expectations; however, there are limitations, he noted.

“One of the current limitations is that MRI is much more costly than ultrasound is, and there is limited availability. In addition, we don't know what the false-positive and false-negative diagnoses will be with fetal application of MRI. Nevertheless, it seems to be a promising new tool,” he concluded.

ORLANDO — MRI for evaluating fetal and intracranial lesions shows promise, but challenges remain, Asad U. Sheikh, M.D., said at the annual meeting of the American Institute of Ultrasound in Medicine.

“MRI has become more useful for evaluating fetal and intracranial lesions. We're starting to see application as the technology advances for abdominal lesions as well. But still, we have considerable difficulty with interpretation,” explained Dr. Sheikh, director of the division of maternal-fetal medicine at the University of South Alabama.

Dr. Sheikh reported on two specific cases of schizencephaly, a brain lesion characterized by abnormal choronal migration.

The first case was of a 20-year-old woman at 19 weeks' gestation who presented with maternal serum alpha fetoprotein (AFP) elevated by 4.4 multiples of the median (MOM). Initial ultrasound evaluation indicated a left-sided intracranial cyst, Dr. Sheikh said. Investigators found that tests for karyotype and infection proved negative.

When they performed another sonogram, they found a large cystic structure replacing the left frontal temporal region. After the 35th week of gestation, they performed MRI, which showed bilateral schizencephaly. The patient delivered vaginally at term.

The second case was a 27-year-old woman at 21 weeks' gestation with an elevated AFP of 3.6 MOM; she was in her fourth pregnancy. Ultrasound revealed bilateral ventriculomegaly.

Amniocentesis was declined, and infection studies were negative. The physicians performed fetal MRI at 24 weeks' gestation and found left-sided schizencephaly and agenesis of the corpus callosum. The image quality was poor, due to fetal movement, however. The patient delivered vaginally at term.

Dr. Sheikh and his team performed MRIs to confirm their earlier diagnoses.

In the first case, they confirmed the findings of bilateral schizencephaly.

For the second patient, they performed cranial computed tomography, which illustrated bilateral schizencephaly with left more involved than right. Additionally, they observed agenesis of the corpus callosum.

Dr. Sheikh notes that these cases are unique in terms of the elevation in maternal serum AFP, which led to further evaluation. However, he points out that ventricular anomalies detected by ultrasound studies were more “precisely defined by prenatal MRI.”

He believes MRI should be considered to further delineate intracranial anomalies to better prepare families and care providers for postnatal expectations; however, there are limitations, he noted.

“One of the current limitations is that MRI is much more costly than ultrasound is, and there is limited availability. In addition, we don't know what the false-positive and false-negative diagnoses will be with fetal application of MRI. Nevertheless, it seems to be a promising new tool,” he concluded.

ORLANDO — MRI for evaluating fetal and intracranial lesions shows promise, but challenges remain, Asad U. Sheikh, M.D., said at the annual meeting of the American Institute of Ultrasound in Medicine.

“MRI has become more useful for evaluating fetal and intracranial lesions. We're starting to see application as the technology advances for abdominal lesions as well. But still, we have considerable difficulty with interpretation,” explained Dr. Sheikh, director of the division of maternal-fetal medicine at the University of South Alabama.

Dr. Sheikh reported on two specific cases of schizencephaly, a brain lesion characterized by abnormal choronal migration.

The first case was of a 20-year-old woman at 19 weeks' gestation who presented with maternal serum alpha fetoprotein (AFP) elevated by 4.4 multiples of the median (MOM). Initial ultrasound evaluation indicated a left-sided intracranial cyst, Dr. Sheikh said. Investigators found that tests for karyotype and infection proved negative.

When they performed another sonogram, they found a large cystic structure replacing the left frontal temporal region. After the 35th week of gestation, they performed MRI, which showed bilateral schizencephaly. The patient delivered vaginally at term.

The second case was a 27-year-old woman at 21 weeks' gestation with an elevated AFP of 3.6 MOM; she was in her fourth pregnancy. Ultrasound revealed bilateral ventriculomegaly.

Amniocentesis was declined, and infection studies were negative. The physicians performed fetal MRI at 24 weeks' gestation and found left-sided schizencephaly and agenesis of the corpus callosum. The image quality was poor, due to fetal movement, however. The patient delivered vaginally at term.

Dr. Sheikh and his team performed MRIs to confirm their earlier diagnoses.

In the first case, they confirmed the findings of bilateral schizencephaly.

For the second patient, they performed cranial computed tomography, which illustrated bilateral schizencephaly with left more involved than right. Additionally, they observed agenesis of the corpus callosum.

Dr. Sheikh notes that these cases are unique in terms of the elevation in maternal serum AFP, which led to further evaluation. However, he points out that ventricular anomalies detected by ultrasound studies were more “precisely defined by prenatal MRI.”

He believes MRI should be considered to further delineate intracranial anomalies to better prepare families and care providers for postnatal expectations; however, there are limitations, he noted.

“One of the current limitations is that MRI is much more costly than ultrasound is, and there is limited availability. In addition, we don't know what the false-positive and false-negative diagnoses will be with fetal application of MRI. Nevertheless, it seems to be a promising new tool,” he concluded.

ST. LOUIS — Type 2 diabetic patients with kidney failure or end-stage renal disease had significant reductions in LDL cholesterol, but not cardiac death, MI, or stroke, after an average of 4 years of treatment with atorvastatin, Christoph Wanner, M.D., reported at the annual meeting of the American Society of Nephrology.

“We reached the goal of reducing LDL [cholesterol] by 41% in type 2 diabetic patients with kidney failure or end-stage renal disease. In addition, safety was excellent in this patient population,” said Dr. Wanner, professor of medicine and head of nephrology at the University Clinic, Würzburg, Germany.

For this prospective, randomized, double-blind study, Dr. Wanner and his associates enrolled 1,255 patients at 178 dialysis centers in Germany between 1998 and 2004. They randomized patients to 20 mg of atorvastatin (619 patients) or placebo (636 patients) for a median of 4 years.

The trial, known as the Deutsche Diabetes Dialyse Studie, and also referred to as the 4D Trial, is the first examination of statin therapy in patients with type 2 diabetes and kidney failure. It also is the first study of cardiovascular outcomes among dialysis patients taking statins, Dr. Wanner said. All study participants had advanced-stage type 2 diabetes and were on maintenance hemodialysis. Some patients also had complications of diabetes including retinopathy, degenerative nerve disease, blindness, and diabetic gangrene, the researchers reported. Among the study participants, between 20% and 30% had a history of prior MI, revascularization, and/or heart surgery.

The investigators noted that the 41% reduction in LDL cholesterol in their study patients taking atorvastatin was consistent with data obtained previously in the general population.

But there was one important difference between the participants in their study and those in previous studies such as the Collaborative Atorvastatin Diabetes Study. Patients in the 4D Trial did not have statistically significant reductions in risk of cardiac death, myocardial infarction, and stroke.

“Importantly, this trial suggests that statins are not as effective in dialysis patients. Randomized trials will be necessary if we really want to begin to treat these patients appropriately,” David Charytan, M.D., said in an interview with this newspaper. Dr. Charytan, who is a clinical and research fellow at Brigham and Women's Hospital, Boston, was another presenter at the meeting.

Because of this difference in response to statin drugs, patients with type 2 diabetes should be treated with statin therapy early on, before the onset of renal disease, Dr. Wanner concluded.

ST. LOUIS — Type 2 diabetic patients with kidney failure or end-stage renal disease had significant reductions in LDL cholesterol, but not cardiac death, MI, or stroke, after an average of 4 years of treatment with atorvastatin, Christoph Wanner, M.D., reported at the annual meeting of the American Society of Nephrology.

“We reached the goal of reducing LDL [cholesterol] by 41% in type 2 diabetic patients with kidney failure or end-stage renal disease. In addition, safety was excellent in this patient population,” said Dr. Wanner, professor of medicine and head of nephrology at the University Clinic, Würzburg, Germany.

For this prospective, randomized, double-blind study, Dr. Wanner and his associates enrolled 1,255 patients at 178 dialysis centers in Germany between 1998 and 2004. They randomized patients to 20 mg of atorvastatin (619 patients) or placebo (636 patients) for a median of 4 years.

The trial, known as the Deutsche Diabetes Dialyse Studie, and also referred to as the 4D Trial, is the first examination of statin therapy in patients with type 2 diabetes and kidney failure. It also is the first study of cardiovascular outcomes among dialysis patients taking statins, Dr. Wanner said. All study participants had advanced-stage type 2 diabetes and were on maintenance hemodialysis. Some patients also had complications of diabetes including retinopathy, degenerative nerve disease, blindness, and diabetic gangrene, the researchers reported. Among the study participants, between 20% and 30% had a history of prior MI, revascularization, and/or heart surgery.

The investigators noted that the 41% reduction in LDL cholesterol in their study patients taking atorvastatin was consistent with data obtained previously in the general population.

But there was one important difference between the participants in their study and those in previous studies such as the Collaborative Atorvastatin Diabetes Study. Patients in the 4D Trial did not have statistically significant reductions in risk of cardiac death, myocardial infarction, and stroke.

“Importantly, this trial suggests that statins are not as effective in dialysis patients. Randomized trials will be necessary if we really want to begin to treat these patients appropriately,” David Charytan, M.D., said in an interview with this newspaper. Dr. Charytan, who is a clinical and research fellow at Brigham and Women's Hospital, Boston, was another presenter at the meeting.

Because of this difference in response to statin drugs, patients with type 2 diabetes should be treated with statin therapy early on, before the onset of renal disease, Dr. Wanner concluded.

ST. LOUIS — Type 2 diabetic patients with kidney failure or end-stage renal disease had significant reductions in LDL cholesterol, but not cardiac death, MI, or stroke, after an average of 4 years of treatment with atorvastatin, Christoph Wanner, M.D., reported at the annual meeting of the American Society of Nephrology.

“We reached the goal of reducing LDL [cholesterol] by 41% in type 2 diabetic patients with kidney failure or end-stage renal disease. In addition, safety was excellent in this patient population,” said Dr. Wanner, professor of medicine and head of nephrology at the University Clinic, Würzburg, Germany.

For this prospective, randomized, double-blind study, Dr. Wanner and his associates enrolled 1,255 patients at 178 dialysis centers in Germany between 1998 and 2004. They randomized patients to 20 mg of atorvastatin (619 patients) or placebo (636 patients) for a median of 4 years.

The trial, known as the Deutsche Diabetes Dialyse Studie, and also referred to as the 4D Trial, is the first examination of statin therapy in patients with type 2 diabetes and kidney failure. It also is the first study of cardiovascular outcomes among dialysis patients taking statins, Dr. Wanner said. All study participants had advanced-stage type 2 diabetes and were on maintenance hemodialysis. Some patients also had complications of diabetes including retinopathy, degenerative nerve disease, blindness, and diabetic gangrene, the researchers reported. Among the study participants, between 20% and 30% had a history of prior MI, revascularization, and/or heart surgery.

The investigators noted that the 41% reduction in LDL cholesterol in their study patients taking atorvastatin was consistent with data obtained previously in the general population.

But there was one important difference between the participants in their study and those in previous studies such as the Collaborative Atorvastatin Diabetes Study. Patients in the 4D Trial did not have statistically significant reductions in risk of cardiac death, myocardial infarction, and stroke.

“Importantly, this trial suggests that statins are not as effective in dialysis patients. Randomized trials will be necessary if we really want to begin to treat these patients appropriately,” David Charytan, M.D., said in an interview with this newspaper. Dr. Charytan, who is a clinical and research fellow at Brigham and Women's Hospital, Boston, was another presenter at the meeting.

Because of this difference in response to statin drugs, patients with type 2 diabetes should be treated with statin therapy early on, before the onset of renal disease, Dr. Wanner concluded.