Amanda Jensen

All Publications

• Outcomes of choledochoduodenostomy in pediatric liver transplantation. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Jensen, A. R., Tajima, T., Pedroza, A., Esquivel, C. O. 2025

  Abstract

  The most common types of biliary reconstruction in pediatric liver transplantation are end-to-end choledochocholedocostomy (CC) and choledochojejunostomy (CJ). Choledochoduodenostomy (CD) is seldom used, and consequently, there are very few reports in the literature about the outcomes of CD reconstruction in pediatric liver transplant. We hypothesized that CD is a safe alternative for pediatric liver transplantation.Between 1/2017-2/2024, 186 consecutive primary liver transplants in children (<21 y) were performed at Stanford Medicine Children's Health. Seventy-three patients underwent CC, 55 underwent CJ, and 41 underwent CD.The type of bile duct reconstruction did not influence the 5-year patient and graft survival rates (p=0.14). Intraductal stents were used in 6%, 100%, and 95% of the CC, CJ, and CD groups, respectively. Biliary strictures were observed more frequently in the CC than in the CJ and CD groups (21% vs. 5% vs. 2%, respectively; p<0.001). Four percent (P=0.06) in the CC group experienced bile leaks, and no bile leaks were observed among patients with CJ or CD reconstructions. The incidence of cholangitis in the CC, CJ, and CD groups was 1%, 10%, and 5%, respectively (p=0.10). Overall, patients with CD had the fewest biliary complications (p=0.01). In the CC group, 2 (2.4%) patients required conversion to CD and 6 (7.3%) required conversion to CJ for bile duct obstruction (9.7%). One patient (2%) in the CD cohort and no patients in the CC cohort required stent removal post-transplantation.Choledochoduodenostomy is considered a safe alternative. Biliary complications were not associated with graft loss or mortality. Post-operative biliary complications are infrequent, suggesting that CD is a suitable and possibly superior type of biliary reconstruction compared to conventional CC or CJ anastomosis.

  View details for DOI 10.1097/LVT.0000000000000651

  View details for PubMedID 40513037

• Choledochoduodenostomy Is an Adequate Biliary Reconstruction in Pediatric Liver Transplantation Tajima, T., Pedroza, A., Jensen, A., Esquivel, C. LIPPINCOTT WILLIAMS & WILKINS. 2024: S487-S488

  View details for Web of Science ID 001348680703183

• Unlocking the promise of mesenchymal stem cells and extracorporeal photopheresis to address rejection and graft failure in intestinal transplant recipients. Human immunology Levitte, S., Nilkant, R., Jensen, A. R., Zhang, K. Y. 2024; 85 (6): 111160

  Abstract

  In patients with irreversible intestinal failure, intestinal transplant has become a standard treatment option. Graft failure secondary to acute or chronic cellular rejection continues to be a significant challenge following transplant. Even with optimal immune suppression, some patients continue to struggle with refractory rejection. Both extracorporeal photopheresis (ECP) and extracellular vesicles derived from mesenchymal stem cells (EVs) have been used to treat refractory rejection following intestinal transplantation, although their use remains limited and consistent treatment protocols are lacking.Intestinal transplant recipients who received ECP only or ECP and EVs as rescue therapy for acute cellular rejection or chronic inflammation between 2016 and 2022 were included in this single-center retrospective analysis. Baseline demographics, pre- and post-treatment histopathology, endoscopic and biochemical findings, and long-term transplant outcomes were analyzed.Three patients (two pediatric and one adult) with acute steroid- and biologic-refractory rejection were treated with ECP and/or EVs, as was one patient (pediatric) with chronic graft rejection and inflammation. Patients received twice weekly ECP for 4 weeks and once weekly thereafter. EVs were administered in three doses each separated by 72 h. Immunosuppression at the time of treatment initiation included high-dose tacrolimus and sirolimus. Histologic resolution of rejection was achieved in all patients over 12-16 weeks. Steroids were weaned to low-dose or withdrawn in every patient within 4 weeks of ECP/EV treatment. C-reactive protein decreased from an average of 14.75 to 1.6 mg/dL post-treatment and fecal calprotectin decreased from average 800 mg/g to 31 mg/g. Donor-induced cytotoxic T cell populations were quantified for two of the patients with acute rejection, and in both cases decreased dramatically following treatment. There were no complications associated with either treatment.Both ECP and EVs present novel opportunities to address graft rejection and inflammation in bowel transplant recipients. More work will be needed to define the optimal therapeutic parameters for each treatment modality.

  View details for DOI 10.1016/j.humimm.2024.111160

  View details for PubMedID 39471538