Graduation Date

Summer 8-13-2021

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Shaheed Merani, MD, PhD

Second Advisor

Kurt Fisher, MD, PhD

Third Advisor

Alan Langnas, DO

MeSH Headings

Transplant Surgery, Intestinal Transplant, Liver Transplant, Venovenous Bypass, Hepatocellular Carcinoma, Locoregional Therapy

Abstract

This thesis is a collection of three independent projects related to transplantation surgery. In summary, project I involves an assessment of long-term quality of life outcomes of intestinal transplantation in pediatric patients who are now in adulthood, with comparison to other solid organ transplant patients. Health related quality of life surveys were completed in 14 adult patients who underwent intestine, liver, or kidney transplants as children. Project II evaluates pre-surgical characteristics of patients undergoing liver transplant to assess predictive factors for the need of venovenous bypass utilization intraoperatively by assessing trends at the University of Nebraska Medical Center in 95 patients from 2001 to 20019. Project III is an appraisal of hepatocellular carcinoma characteristics in patients who undergo locoregional therapy prior to liver transplant and assessment of the concordance of response as determined by both radiologic and pathologic evaluations involving 30 liver transplants from the period of 2016 to 2019 occurring at the University of Nebraska Medical Center for an indication including hepatocellular carcinoma. Detailed individual abstracts for each of the three projects are included in the following pages of this thesis.

Comments

Abstract Project I: Long-Term Quality of Life Outcomes in Intestinal Transplantation Intestinal transplantation (ITx) is indicated in patients with complications from dependency on parenteral nutrition due to intestinal failure (IF). ITx has seen improved outcomes since established, though, health related quality of life (HRQOL) remains lacking in ITx, especially in long-term survivors. Prior studies show relatively preserved HRQOL compared to healthy controls in patient reporting, however, caregivers consistently report lower HRQOL scores than healthy controls. This study aims to evaluate HRQOL of adults who underwent ITx at pediatric ages utilizing validated tools and compare such data to other solid organ transplant recipients of similar age. Of 74 ITx patients meeting criteria and matched to liver and renal transplant patients, completed HRQOL surveys were obtained in 14 patients (ITx N=3, Liver N=3, Kidney N=8). There were no significant differences of demographics in survey participants. Liver patients had higher scores than both ITx and kidney patients overall and within domains of physical functioning, physical limitations, general health, social functioning and energy-fatigue (p6) showed higher scores in those transplanted younger in all domains, though without statistical significance. Of those with high medical demand, significant differences were seen in physical health components of physical limitations and pain (P

Abstract Project II: Venovenous Bypass in Liver Transplantation Utilization of venovenous bypass (VVB) in liver transplantation (LT) varies widely among institutions and lacks defined consensus for usage criteria, however, remains an acceptable practice to assist with physiologic intraoperative challenges related to venous occlusion during LT. This study aims to assess trends of VVB use in this institution as well as evaluate for the presence of pre-operative factors predict VVB use. Utilization at this institution depicts a dramatic decrease in the number of LT cases utilizing VVB beginning in 2003 and continuing through 2019. Assessment of 95 LT recipients with VVB utilization and 95 LT recipient controls from 2001 to 2019 established pre-operative differences among model end-stage liver disease scores (23.9±1.07 vs. 19.6±0.90, P=0.002), retransplantation status (31, 32.6% vs. 8, 8.4%, P=

Abstract Project III: Locoregional Therapy and Liver Transplantation for Hepatocellular Carcinoma Transplantation is the only current curative treatment for Hepatocellular Carcinoma (HCC) and cirrhosis. Locoregional therapies (LRT) are used in non-surgical candidates or as bridge to transplantation. This single center retrospective study included 30 liver transplants for HCC from 2016 – 2019 at the University of Nebraska Medical Center (UNMC), 21 which had LRT. A total 67 tumors were identified, 35 of which had LRT prior to LT. Radiologic complete response (CR) was seen in 21 of the tumors (60.0%) versus non-CR in 13 (37.1%) and 1 tumor (

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