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A Sustained Viral Response Achieved with Sofosbuvir/Ledipasvir May Increase the Incidence of Acute Cellular Rejection Post Liver Transplantation [Meeting Abstract]

Bortecen, K; Layman, R; Gelb, B; Winnick, A; Morgan, G; Tobias, H; Teperman, L
ISSN: 1600-6143
CID: 2386272

What Are the Charges and Costs of Transplanting High MELD Patients? [Meeting Abstract]

Bortecen, K; Gelb, B; Winnick, A; Morgan, G; Teperman, L
ISSN: 1600-6143
CID: 2386282

What are the true costs of transplanting high MELD patients? [Meeting Abstract]

Bortecen, K; Freitas, D; Bekisz, J; Gelb, B; Winnick, A; Morgan, G; Teperman, L
Purpose: There is a significant variation in the MELD scores and subsequent morbidity among liver recipients in the US. Larger OPOs consistently serve patients with advanced disease. Previous studies have shown 2.5 times greater prevalence of transplanted patients with MELD 3 24 in these OPOs. CMS recent reimbursement adjustments may disproportionately affect certain programs given their increased prevalence of patients with more advanced disease. Methods: We analyzed the prevalence of transplants among patients with high UNET MELD scores and associated charges, costs, and reimbursements. We compared low, medium and high MELD score groups. Between 2014-2015, 43 liver transplants, all with >30 days survival, were analyzed. Results: Only 2 had MELD scores below 25 at transplant, both of which from live donors. 95% of patients had MELD scores above 25 and among these, 18% had MELD 40 or were Status 1. Compared to the national average, our MELD scores were: 25% 21-30 (National 21.5%, p >0.05), 70.5% 31-40 (National 25.9%, p < 0.001), and 4.5% Status 1 (National 5.9%, p >0.05). For MELD scores 21-30, hospital charges averaged $645,214 and reimbursements were $150,706. For MELD scores 31-39, charges were $686,720, and reimbursement were $139,776. Reviewing MELD 40/ Status 1 patients, the average hospital charges and reimbursements were $1,136,813 and $293,776 respectively. We compared their amounts to the MELD 40 patients who had hospital charges of $625,371 and reimbursements of $142,051 respectively. This demonstrated a loss of $843,037 for the first group and $483,320 for the second. Length of stay was 32 days for MELD 40/ Status 1 and 8 days for MELD 40 (p < 0.000). Conclusion: 3 40 MELD patients have a huge financial impact on institutions. The difference between 25-39 and 340 MELD points is greater than half a million dollars. These data reflect and include dialysis, intubation and ICU stay but do not include rehabilitation expenses which will be the focus of another study. We find that our institution, which likely reflects many institutions in our OPO, serves sicker patients and therefore incurs higher costs but receives lower reimbursements, as they are based on national expected care costs for healthier patients. A broader sharing in the US may equalize costs. Payers should take into account the added financial burden of performing transplant in high MELD patients
ISSN: 0041-1337
CID: 2454462

An Excellent Sustained Viral Response Is Achieved in Post Liver Transplant HCV Recipients Using Sofosbuvir/Ribavirin [Meeting Abstract]

Hamshow, M; Bortecen, K; Winnick, A; Gelb, B; Morgan, G; Teperman, L
ISSN: 1534-6080
CID: 1989332

A Simple PTC Taste Test Is a Cost-Effective Adjunct To the Current Selection Criteria for Liver Transplantation [Meeting Abstract]

Bortecen, K; Hamshow, M; Gelb, B; Winnick, A; Morgan, G; Teperman, L
ISSN: 1534-6080
CID: 1989562

Interferon-Free Sofosvir/Ribavirin Treatment Achieves Excellent Sustained Viral Response in Post Liver Transplant HCV Recipients [Meeting Abstract]

Hamshow, M; Bortecen, K; Layman, R; Winnick, A; Gelb, B; Morgan, G; Teperman, L
ISSN: 1600-6143
CID: 2049032

CO2 Angiography Provides a Safe Alternative to Iodinated Contrast Agents in the Diagnosis and Endovascular Treatment of Transplant Renal Artery Stenosis [Meeting Abstract]

Gelb, B; Cayne, N; Benstein, J; Morgan, G; Bortecen, K; Hamshow, M; Teperman, L
ISSN: 1600-6143
CID: 2049062

Cost-Effective, Simple PTC Tasting Could Be a Useful Adjunct to Selection Criteria of ARLD Patients [Meeting Abstract]

Bortecen, K; Freitas, D; Teperman, C; Hamshow, M; Gelb, B; Morgan, G; Teperman, L
ISSN: 1600-6143
CID: 2049222

Liver transplantation in the setting of extra-hepatic malignancy: two case reports [Case Report]

Fayek, S; Moore, D; Bortecen, K H; Yeh, H; Markmann, J F; Olthoff, K M; Shaked, A
Candidates for liver transplantation (OLT) may be found to have an incidental extrahepatic tumor, which is amenable to resection, and may be associated with variable long-term survival. Issues to be considered include: (1) Whether it is possible to define a tumor stage and survival expectancy, which makes the patient an acceptable transplant candidate; (2) Whether cancer surgery should be preformed prior, during, or after OLT; (3) Whether the recipient be placed on immunosuppression that is tailored to address concern related to cancer recurrence. These issues are illustrated in the context of OLT and nephrectomy for renal cell carcinoma (RCC). Two patients underwent a simultaneous OLT and curative radical nephrectomy for stage 1 RCC that was incidentally discovered during OLT evaluation, one of whom received a simultaneous kidney transplant. At 51 and 14 months postoperatively, the patients are alive and healthy, with no tumor recurrence. In selected extrahepatic malignancies, simultaneous curative resection and OLT may provide the optimal outcome. This is justifiable when curative cancer-related life expectancy exceeds OLT-expected graft and patient survival. Concomitant transplantation and cancer surgery provides an acceptable cancer-free survival, avoiding the high morbidity observed when cancer resection is done in the presence of decompensated liver disease.
PMID: 18089424
ISSN: 0041-1345
CID: 1066342

Treatment of hepatic artery-biliary fistula in the setting of liver transplantation [Case Report]

Bortecen, Kerem H; Moore, Derek; Fayek, Sameh A; Shaked, Abraham
PMID: 18365444
ISSN: 0890-9016
CID: 1064892