Scholars@Duke
Daniel Firl

Daniel Firl

House Staff
Surgery

Selected Publications

Development and validation of a machine-learning model to reduce futile procurements in donations after circulatory death in liver transplantation in the USA: a multicentre study.

Journal Article The Lancet. Digital health · October 2025 BackgroundThe number of liver transplants from donors after the circulatory determination of death continues to increase, helping to alleviate the existing organ shortage. However, the rate of attempted but subsequently terminated procurements, kn ... Full text Cite

Reappraisal of tacrolimus levels after liver transplant for HCC: A multicenter study toward personalized immunosuppression regimen.

Journal Article Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · March 2025 Post-liver transplant (LT) immunosuppression is necessary to prevent rejection; however, a major consequence of this is tumor recurrence. Although recurrence is a concern after LT for patients with HCC, the oncologically optimal tacrolimus (FK) regimen is ... Full text Cite

Continuous Risk Score Predicts Waitlist and Post-transplant Outcomes in Hepatocellular Carcinoma Despite Exception Changes.

Journal Article Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · October 2024 Background & aimsContinuous risk-stratification of candidates and urgency-based prioritization have been utilized for liver transplantation (LT) in patients with non-hepatocellular carcinoma (HCC) in the United States. Instead, for patients with H ... Full text Cite

Design and testing of a humanized porcine donor for xenotransplantation.

Journal Article Nature · October 2023 Recent human decedent model studies1,2 and compassionate xenograft use3 have explored the promise of porcine organs for human transplantation. To proceed to human studies, a clinically ready porcine donor must be engineered and its xenograft successfully t ... Full text Link to item Cite

Clinical and molecular correlation defines activity of physiological pathways in life-sustaining kidney xenotransplantation.

Journal Article Nature communications · June 2023 Porcine kidney xenotransplantation is accelerating towards clinical translation. However, despite the demonstrated ability of porcine kidneys to remove metabolic waste products, questions remain about their ability to faithfully recapitulate renal endocrin ... Full text Cite

Reply to "Letter to the editor in response to: Measuring success in pig to non-human-primate renal xenotransplantation: Systematic review and comparative outcomes analysis of 1051 life-sustaining NHP renal allo- and xeno-transplants".

Journal Article American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · September 2022 Full text Cite

Measuring success in pig to non-human-primate renal xenotransplantation: Systematic review and comparative outcomes analysis of 1051 life-sustaining NHP renal allo- and xeno-transplants.

Journal Article American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · June 2022 Facile gene editing has accelerated progress in pig to non-human-primate (NHP) renal xenotransplantation, however, outcomes are considered inferior to NHP-allotransplantation. This systematic review and outcomes analysis of life-sustaining NHP-renal transp ... Full text Cite

Should We Be Utilizing More Liver Grafts From Pediatric Donation After Circulatory Death Donors? A National Analysis of the SRTR from 2002 to 2017.

Journal Article Transplantation · September 2021 BackgroundRates of withdrawal of life-sustaining treatment are higher among critically ill pediatric patients compared to adults. Therefore, livers from pediatric donation after circulatory death (pDCD) could improve graft organ shortage and waiti ... Full text Cite

Conditional probability of graft survival in liver transplantation using donation after circulatory death grafts - a retrospective study.

Journal Article Transplant international : official journal of the European Society for Organ Transplantation · August 2021 The use of livers from donation after circulatory death (DCD) is historically characterized by increased rates of biliary complications and inferior short-term graft survival (GS) compared to donation after brain death (DBD) allografts. This study aimed to ... Full text Cite

Risk assessment criteria in liver transplantation for hepatocellular carcinoma: proposal to improve transplant oncology.

Journal Article Hepatic oncology · July 2020 Liver transplantation for hepatocellular carcinoma has proved to be a highly effective cure if the right patient can be selected. Milan criteria has traditionally guided physicians toward appropriate liver allocation but changes in clinical practice, patie ... Full text Cite

Charting the Path Forward for Risk Prediction in Liver Transplant for Hepatocellular Carcinoma: International Validation of HALTHCC Among 4,089 Patients.

Journal Article Hepatology (Baltimore, Md.) · February 2020 Prognosticating outcomes in liver transplant (LT) for hepatocellular carcinoma (HCC) continues to challenge the field. Although Milan Criteria (MC) generalized the practice of LT for HCC and improved outcomes, its predictive character has degraded with inc ... Full text Cite

Prognostication of inflammatory cells in liver transplantation: Is the waitlist neutrophil-to-lymphocyte ratio really predictive of tumor biology?

Journal Article Clinical transplantation · December 2019 ObjectiveThe objective of this retrospective study was to characterize the neutrophil to lymphocyte ratio (NLR) on the waitlist and determine its prognostic utility in liver transplantation (LT) for hepatocellular carcinoma (HCC) with special focu ... Full text Cite

Sufficient hepatic artery flow compensates for poor portal vein flow after liver transplantation in patients with portal vein thrombosis.

Journal Article Clinical transplantation · November 2019 ObjectivePortal vein thrombosis (PVT) does not preclude liver transplantation (LT), but poor portal vein (PV) flow after LT remains a predictor of poor outcomes. Given the physiologic tendency of the hepatic artery (HA) to compensate for low PV fl ... Full text Cite

Improved Survival Following Living Donor Liver Transplantation for Pediatric Acute Liver Failure: Analysis of 20 Years of US National Registry Data.

Journal Article Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · August 2019 This study estimated the utility of technical variant grafts (TVGs), such as split/reduced liver transplantation (SRLT) and living donor liver transplantation (LDLT), in pediatric acute liver failure (PALF). PALF is a devastating condition portending a poo ... Full text Cite

The impact of resection margin on overall survival for patients with colon cancer liver metastasis varied according to the primary cancer location.

Journal Article HPB : the official journal of the International Hepato Pancreato Biliary Association · June 2019 IntroductionInvestigation into right and left-sided primary colon liver metastasis (CLM) has revealed differences in the tumor biology and prognosis. This indicates that preoperative and operative factors may affect outcomes of right-sided primary ... Full text Cite

Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast?

Journal Article Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · May 2019 A recent study using US national registry data reported, using Cox proportional hazards (PH) models, that split-liver transplantation (SLT) has improved over time and is no more hazardous than whole-liver transplantation (WLT). However, the study methods v ... Full text Cite

Reframing the approach to patients with hepatocellular carcinoma: Longitudinal assessment with hazard associated with liver transplantation for HCC (HALTHCC) improves ablate and wait strategy.

Journal Article Hepatology (Baltimore, Md.) · October 2018 Patients with hepatocellular carcinoma (HCC) are screened at presentation for appropriateness of liver transplantation (LT) using morphometric criteria, which poorly specifies risk. Morphology is the crux of measuring tumor response to locoregional therapy ... Full text Cite

Techniques for placement of stereotactic electroencephalographic depth electrodes: Comparison of implantation and tracking accuracies in a cadaveric human study.

Journal Article Epilepsia · September 2018 ObjectiveStereotactic electroencephalography (SEEG) is used for the evaluation and identification of the epileptogenic zone (EZ) in patients suffering from medically refractory seizures and relies upon the accurate implantation of depth electrodes ... Full text Cite

Capturing change in clonal composition amongst single mouse germinal centers.

Journal Article eLife · August 2018 Understanding cellular processes occurring in vivo on time scales of days to weeks requires repeatedly interrogating the same tissue without perturbing homeostasis. We describe a novel setup for longitudinal intravital imaging of murine peripheral lymph no ... Full text Cite

Clonal Evolution of Autoreactive Germinal Centers.

Journal Article Cell · August 2017 Germinal centers (GCs) are the primary sites of clonal B cell expansion and affinity maturation, directing the production of high-affinity antibodies. This response is a central driver of pathogenesis in autoimmune diseases, such as systemic lupus erythema ... Full text Cite

Development and validation of the HALT-HCC score to predict mortality in liver transplant recipients with hepatocellular carcinoma: a retrospective cohort analysis.

Journal Article The lancet. Gastroenterology & hepatology · August 2017 BackgroundTumour morphological criteria for determining the appropriateness of liver transplantation in patients with hepatocellular carcinoma poorly estimate post-transplantation mortality. The aim of this study was to develop and assess the util ... Full text Cite

Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma: a single-center experience.

Journal Article Hepatobiliary & pancreatic diseases international : HBPD INT · June 2017 BackgroundReports of liver transplantation (LT) in patients with mixed hepatocellular carcinoma/cholangiocarcinoma (HCC/CC) and intrahepatic cholangiocarcinoma (ICC) are modest and have been mostly retrospective after pathological categorization i ... Full text Cite

A Paradigm Shift on the Question of B Cells in Transplantation? Recent Insights on Regulating the Alloresponse.

Journal Article Frontiers in immunology · January 2017 B lymphocytes contribute to acute and chronic allograft rejection through their production of donor-specific antibodies (DSAs). In addition, B cells present allopeptides bound to self-MHC class II molecules and provide costimulation signals to T cells, whi ... Full text Cite

Role of donor hemodynamic trajectory in determining graft survival in liver transplantation from donation after circulatory death donors.

Journal Article Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · November 2016 Donation after circulatory death (DCD) donors show heterogeneous hemodynamic trajectories following withdrawal of life support. Impact of hemodynamics in DCD liver transplant is unclear, and objective measures of graft viability would ease transplant surge ... Full text Cite

Impact of donor age in liver transplantation from donation after circulatory death donors: A decade of experience at Cleveland Clinic.

Journal Article Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · December 2015 The use of liver grafts from donation after circulatory death (DCD) donors remains controversial, particularly with donors of advanced age. This retrospective study investigated the impact of donor age in DCD liver transplantation. We examined 92 recipient ... Full text Cite

Postnatal Erythropoietin Mitigates Impaired Cerebral Cortical Development Following Subplate Loss from Prenatal Hypoxia-Ischemia.

Journal Article Cerebral cortex (New York, N.Y. : 1991) · September 2015 Preterm birth impacts brain development and leads to chronic deficits including cognitive delay, behavioral problems, and epilepsy. Premature loss of the subplate, a transient subcortical layer that guides development of the cerebral cortex and axonal refi ... Full text Cite

Prenatal Hypoxia-Ischemia Induces Abnormalities in CA3 Microstructure, Potassium Chloride Co-Transporter 2 Expression and Inhibitory Tone.

Journal Article Frontiers in cellular neuroscience · January 2015 Infants who suffer perinatal brain injury, including those with encephalopathy of prematurity, are prone to chronic neurological deficits, including epilepsy, cognitive impairment, and behavioral problems, such as anxiety, inattention, and poor social inte ... Full text Cite

Complex pattern of interaction between in utero hypoxia-ischemia and intra-amniotic inflammation disrupts brain development and motor function.

Journal Article Journal of neuroinflammation · August 2014 BackgroundInfants born preterm commonly suffer from a combination of hypoxia-ischemia (HI) and infectious perinatal inflammatory insults that lead to cerebral palsy, cognitive delay, behavioral issues and epilepsy. Using a novel rat model of combi ... Full text Cite

Erythropoietin attenuates loss of potassium chloride co-transporters following prenatal brain injury.

Journal Article Molecular and cellular neurosciences · July 2014 Therapeutic agents that restore the inhibitory actions of γ-amino butyric acid (GABA) by modulating intracellular chloride concentrations will provide novel avenues to treat stroke, chronic pain, epilepsy, autism, and neurodegenerative and cognitive disord ... Full text Cite