Clinical Focus

  • Pediatric Hepatology
  • Pediatric Transplant Hepatology
  • Pediatric Gastroenterology

Academic Appointments

Professional Education

  • Medical Education: New York Medical College Registrar (2012) NY
  • Fellowship: Children's Hospital Los Angeles Pediatric Transplant Hepatology (2019) CA
  • Fellowship: Children's Hospital Los Angeles Pediatric Gastroenterology (2018) CA
  • Board Certification: American Board of Pediatrics, Pediatrics (2015)
  • Residency: Baylor College of Medicine Pediatric Residency (2015) TX



All Publications

  • Severe Late-Onset Acute Cellular Rejection in a Pediatric Patient With Isolated Small Intestinal Transplant Rescued With Aggressive Immunosuppressive Approach: A Case Report. Transplantation proceedings Narang, A., Xi, D., Mitsinikos, T., Genyk, Y., Thomas, D., Kohli, R., Lin, C. H., Soufi, N., Warren, M., Merritt, R., Yanni, G. 2019; 51 (9): 3181?85


    Small intestinal transplantation is performed for patients with intestinal failure who failed other surgical and medical treatment. It carries notable risks, including, but not limited to, acute and chronic cellular rejection and graft malfunction. Late severe acute intestinal allograft rejection is associated with increased risk of morbidity and mortality and, in the majority of cases, ends with total enterectomy. It usually results from subtherapeutic immunosuppression or nonadherence to medical treatment. We present the case of a 20-year-old patient who underwent isolated small bowel transplant for total intestinal Hirschsprung disease at age 7. Due to medication nonadherence, she developed severe late-onset acute cellular rejection manifested by high, bloody ostomy output and weight loss. Ileoscopy showed complete loss of normal intestinal anatomic landmarks and ulcerated mucosa. Graft biopsies showed ulceration and granulation tissue with severe architectural distortion consistent with severe intestinal graft rejection. She initially received intravenous corticosteroids and increased tacrolimus dose without significant improvement. Her immunosuppression was escalated to include infliximab and finally antithymocyte globulin. Graft enterectomy was considered repeatedly; however, clinical improvement was noted eventually with evidence of histologic improvement and salvage of the graft. The aggressive antirejection treatment was complicated by development of post-transplant lymphoproliferative disorder that resolved with reducing immunosuppression. Her graft function is currently maintained on tacrolimus, oral prednisone, and a periodic infliximab infusion. We conclude that a prompt and aggressive immunosuppressive approach significantly increases the chance of rescuing small bowel transplant rejection.

    View details for DOI 10.1016/j.transproceed.2019.08.012

    View details for PubMedID 31711586

  • A 10-Year united network for organ sharing review of mortality and risk factors in young children awaiting liver transplantation. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Leung, D. H., Narang, A., Minard, C. G., Hiremath, G., Goss, J. A., Shepherd, R. 2016; 22 (11): 1584?92


    Young children??21 (hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.6-6.5), lack of exception (HR, 5.8; 95% CI, 2.8-11.8), listing height??10?kg (HR, 3.8; 95% CI, 1.5-9.2), and initial creatinine?>?0.5 (HR, 6.8; 95% CI, 3.4-13.5) were independent risk factors for YC2 wait-list mortality (P?

    View details for DOI 10.1002/lt.24605

    View details for PubMedID 27541809

    View details for PubMedCentralID PMC5083224

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