A5050357012- Liver Disease and Transplantation
- Liver Disease Diagnosis and Treatment
- Organ Transplantation Techniques and Outcomes
- Liver Diseases and Immunity
- Nutrition and Health in Aging
- Renal Transplantation Outcomes and Treatments
- Clinical Nutrition and Gastroenterology
- Alcohol Consumption and Health Effects
- Gallbladder and Bile Duct Disorders
- Pediatric Hepatobiliary Diseases and Treatments
- Transplantation: Methods and Outcomes
- Pancreatic function and diabetes
- Hepatitis C virus research
- Diabetes Treatment and Management
- Drug-Induced Hepatotoxicity and Protection
- Artificial Intelligence in Healthcare
- Cardiovascular Function and Risk Factors
- Hematopoietic Stem Cell Transplantation
- Diet and metabolism studies
- Organ Donation and Transplantation
- Diet, Metabolism, and Disease
- Cardiovascular and exercise physiology
- Metabolism and Genetic Disorders
- Body Composition Measurement Techniques
- Muscle metabolism and nutrition
University of Toronto
2012-2025
University Health Network
2015-2025
Toronto General Hospital
2012-2024
Royal College of Physicians and Surgeons of Canada
2024
Health Net
2024
3M (United States)
2024
Princess Margaret Hospital
2024
Toronto Liver Centre
2023
Canada Research Chairs
2023
University of New Brunswick
2023
Significance Loss of skeletal muscle mass, or sarcopenia, is nearly universal in cirrhosis and adversely affects the outcome these patients. There are no established therapies to prevent reverse sarcopenia because mechanisms not known. We show that expression myostatin, a negative regulator increased cirrhotic mediated by ammonia concentration. Skeletal concentrations significantly cirrhosis, resulting activation transcription factor NF-κB, which turn increases myostatin. Given high...
Hepatorenal syndrome in cirrhosis with ascites is a well-defined entity significant morbidity and mortality. It unclear whether milder degrees of acute kidney injury (AKI), defined as serum creatinine increase over 26.4 μmol/l (0.3 mg/dl) or by 50% from baseline, also has negative impact on patient outcomes.To determine the prevalence AKI outcomes.Patients baseline less than 110 μmol/l, no evidence structural renal disease, prospectively underwent 4-6-weekly blood work-up for full count,...
Loss of muscle mass and function, or sarcopenia, is a common feature cirrhosis contributes significantly to morbidity mortality in this population. Sarcopenia main indicator adverse outcomes population, including poor quality life, hepatic decompensation, patients with evaluated for liver transplantation (LT), longer hospital intensive care unit stay, higher incidence infection following LT, overall health cost. Although it clear that an important predictor LT outcomes, many questions...
Skeletal muscle loss (sarcopenia) is a major clinical complication in alcoholic cirrhosis with no effective therapy. autophagic proteolysis and myostatin expression (inhibitor of protein synthesis) are increased believed to contribute anabolic resistance. A prospective study was performed determine the mechanisms sarcopenia potential reversal by leucine. In six well‐compensated, stable, patients eight controls, serial vastus lateralis biopsies were obtained before 7 hours after single oral...
The European trial investigating normothermic ex vivo liver perfusion (NEVLP) as a preservation technique for transplantation (LT) uses gelofusine, non–US Food and Drug Administration–approved, bovine‐derived, gelatin‐based solution. We report safety feasibility clinical NEVLP with human albumin–based Steen Transplant outcomes of 10 grafts that were perfused on the Metra device at 37 °C solution, plus 3 units erythrocytes compared matched historical control group 30 using cold storage (CS)...
Hyperammonemia and sarcopenia (loss of skeletal muscle) are consistent abnormalities in cirrhosis portosystemic shunting. We have shown that muscle ubiquitin-proteasome components not increased with hyperammonemia despite sarcopenia. This suggests an alternative mechanism proteolysis contributes to cirrhosis. hypothesized autophagy could be this pathway since we observed increases classic markers, LC3 lipidation, beclin-1 expression, p62 degradation immunoblots protein cirrhotic patients....
Background Sarcopenia is the most frequent complication of cirrhosis. A transjugular intrahepatic portosystemic stent (TIPS) lowers portal pressure in cirrhosis and alters body composition. Changes skeletal muscle area adipose tissue volume were quantified by computed tomography (CT) before after TIPS. Materials methods Fifty-seven consecutive cirrhotics who had a CT scan TIPS studied. Simultaneous age-matched, sex-matched, Child's score-matched, Model for End-Stage Liver Disease...
Pre-transplant sarcopenia (reduced skeletal muscle mass) predicts poor outcome in cirrhosis. In contrast, whether mass increases post-orthotopic liver transplantation (OLT) is not known and was studied prospectively.Consecutive patients who underwent a comprehensive nutritional evaluation transplant nutrition clinic were included. Core abdominal area measured on computed tomography obtained pre- post-OLT. Age- gender-based controls used to define sarcopenia. Measures of body composition...
Myosteatosis (pathological fat accumulation in muscle) is defined by lower mean skeletal muscle radiodensity CT. We aimed to determine the optimal cut-offs for myosteatosis a cohort of 855 patients with cirrhosis. CT images were used expressed as Hounsfield Unit (HU). Patients values below lowest tertile considered have myosteatosis. Competing-risk analysis was performed associations between and pre-transplant mortality. Muscle less than 33 28 HU males females, respectively, identify In...
Patients with cirrhosis have increased gluconeogenesis and fatty acid oxidation that may contribute to a low respiratory quotient (RQ), this be linked sarcopenia metabolic decompensation when these patients are hospitalized. Therefore, we conducted prospective study measure RQ its impact on skeletal muscle mass, survival, related complications in hospitalized cirrhotic patients. Fasting resting energy expenditure (REE) were determined by indirect calorimetry ( n = 25), age, sex,...
Background. Liver transplantation is essential for many people with primary sclerosing cholangitis (PSC). People PSC are less likely to receive a deceased donor liver transplant compared other causes of chronic disease. This disparity may stem from the inaccuracy model end-stage disease (MELD) in predicting waitlist mortality or dropout PSC. The broad applicability MELD across comes at expense accuracy prediction certain that involve unique comorbidities. We aimed develop could more...
Patients with primary biliary cholangitis (PBC) incomplete response to ursodeoxycholic acid are at risk of disease progression and need additional therapy. Obeticholic (OCA) was approved in Canada May 2017, but its effectiveness a real‐world setting has not been described. We sought describe our experience OCA Canadian cohort. OCA‐naive patients treated two centers were included. Clinical biochemical data collected initiation during follow‐up. Primary outcomes changes serum alkaline...
BACKGROUND Extracorporeal photopheresis (ECP) culls pathogenic T lymphocytes, be these the clones of cutaneous T‐cell lymphoma, or mediators chronic graft‐versus‐host disease (GVHD) after allogeneic bone marrow transplantation (BMT‐GVHD). Whether not ECP may have an effect in rarer instances solid organ transplantation–associated GVHD (SOT‐GVHD) is unclear. Mortality rates SOT‐GVHD rival those transfusion‐associated GVHD, with fatalities preceded by pancytopenia and peripheral blood...
Living donor liver transplantation (LDLT) offers the opportunity to decrease waitlist time and mortality for patients with autoimmune disease (AILD), hepatitis, primary biliary cholangitis, sclerosing cholangitis. We compared survival of a potential living (pLDLT) on versus no (pDDLT) an intention-to-treat basis. Our retrospective cohort study investigated adults AILD listed transplant in our program between 2000 2021. The pLDLT group comprised recipients donor. Otherwise, they were included...
Abstract Aim To investigate the efficacy and safety of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) sodium‐glucose cotransporter‐2 (SGLT2) inhibitors in liver transplant (LT) recipients with diabetes. Methods A single‐centre, retrospective analysis prospectively collected data from an LT recipient database (1990–2023) was conducted. We included adults pre‐existing diabetes post‐transplant diabetes, newly started on GLP‐1RAs and/or SGLT2 after LT. Metabolic biochemical parameters...
Increasing rates of liver transplantation and improved outcomes have led to greater numbers transplant recipients followed up in non-transplant centres. Our aim was document long-term clinical managed this 'hub-and-spoke' healthcare model.
The prognostic impact of the first ever episode spontaneous bacterial peritonitis (SBP) on patient outcomes is not well described. Our aim was to compare clinical cirrhotic patients with ascites, and or without a SBP.Consecutive cirrhosis ascites were prospectively enrolled. Demographics, liver renal function, hemodynamics documented at baseline, resolution SBP, thereafter 4 monthly intervals for 12 months. Complications survival noted.Twenty-nine SBP (group A) 123 control slightly younger...