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1.
Louise Kenny Karen Booth Kathrin Freystaetter Greta Wood Gary Reynolds Sridhar Rathinam Narain Moorjani 《The Journal of thoracic and cardiovascular surgery》2018,155(6):2526-2538.e2
Objective
The study aimed to assess targeted simulation courses, including live animal operating, as complementary training tools with regard to 2 key surgical skills in early cardiothoracic surgeon training.Methods
Twenty UK surgical trainees (equivalent to cardiothoracic surgery resident physicians in the United States) in their first year of residency training were evaluated. Assessment of skills in pulmonary wedge resection and cardiopulmonary bypass were undertaken before and after 2 boot camp-style courses, including live animal operating (boot camp 1 and boot camp 2). Resident performance was evaluated by surgical trainers using objective structured assessment of technical skills matrices. Trainers completed a survey on skill development and trainer confidence in the trainee precourse and postcourse.Results
Trainee assessment scores pre- and postcourses were analyzed using a 2-tailed Wilcoxon signed-rank test demonstrating a significant improvement in trainee performance in boot camp 1 in performing cardiopulmonary bypass (median score, 21 precourse and 28 postcourse; P = .001) and pulmonary wedge resection (median score, 25 precourse and 32 postcourse; P = .012), and in boot camp 2, in performing cardiopulmonary bypass (median score, 28 precourse and 30.5 postcourse; P = .018) and pulmonary wedge resection (median score, 31.5 precourse and 37 postcourse; P = .018). Trainers reported increased confidence and decision-making competency of residents and increased confidence of trainers to allow more participation in management. It was found that 83.3% of trainers would support trainee attendance in subsequent years.Conclusions
Live animal operating as a component of targeted cardiothoracic surgery skill training courses significantly improves technical skills, builds confidence of surgical trainers in resident physicians’ practice, and should be supported by the surgery community. 相似文献2.
A. Kesavan B.C. Tai A. B B. Goh L. Raman V. Anantharaman H.Y. Tiong 《Transplantation proceedings》2018,50(8):2342-2345
Donor kidney volume (KV) is an increasingly important parameter evaluated before living kidney donation; however, KV measurements on computed tomographic (CT) scanning requires a manually intensive process of manual or semiautomatic segmentation of kidneys with interobserver variation. Renal artery diameter (RAD) is an easier marker to measure, and this study aims to investigate the relationship between donor RAD and KV.
Methods
A retrospective review of 77 patients who underwent living donor nephrectomy was conducted. Bilateral KVs were measured based on contrast-enhanced CT scan imaging, and renal artery maximum diameter was measured by direct visualization on the arterial phase of transverse CT sections.Results
On regression analysis, there was a significant association between the right and left RADs and their ipsilateral KVs with a regression coefficient of 7.9 (95% CI, 1.3–14.5; P = .02) and 9.8 (95% CI, 3.3–16.3; P = .004), respectively. Mean total RAD correlated with total KV with a regression coefficient of 9.3 (95% CI, 3.8–14.7; P = .001) and weakly correlated with estimated glomerular filtration rate with a Pearson coefficient of .10.Conclusions
This study demonstrates that renal artery size is positively associated with KV and may be used as an easily measured surrogate marker for kidney size with its attended implications in living donor transplantation. 相似文献3.
George Tolis Philip J. Spencer Jordan P. Bloom Serguei Melnitchouk David A. D&#x;Alessandro Mauricio A. Villavicencio Thoralf M. Sundt 《The Journal of thoracic and cardiovascular surgery》2018,155(5):2058-2065
Objective
Teaching the next generation operative cardiac surgery while maintaining the highest level of patient care is an ever-increasing challenge given the growing proportion of patients with multiple comorbidities, the loss of more straightforward cases to percutaneous interventions, and the pressure of public reporting. No study to date has compared the outcomes of similar cases performed entirely (“skin-to-skin”) by the resident with those performed entirely by the staff to confirm the safety of this practice.Methods
A total of 100 consecutive cardiac cases performed skin-to-skin by the resident (group R) were matched by procedure 1:1 to nonconsecutive cases performed by a single attending surgeon (group A). Patients were excluded from the analysis if there was overlap in any portion of the procedure by the trainee or the attending.Results
Patients in group A were similar to those in group R with respect to age, gender, body mass index, American Society of Anesthesiologists classification, left ventricular ejection fraction, and diabetes mellitus. Mean operative times were longer in group R (4.6 vs 2.7 hours, P < .001), as were cardiopulmonary bypass times (96 vs 50 minutes, P < .001) and aortic crossclamp times (78 vs 39 minutes, P < .001). There were no significant differences in red blood cell transfusions, reexplorations, stroke, length of stay, or wound infections. There were no in-hospital or 30-day deaths.Conclusions
Our data indicate that trainees can be educated in operative surgery under the current paradigm, despite longer operative times, without sacrificing outcome quality. It is reasonable to expect academic programs to continue providing trainees significant experience as primary operating surgeons. 相似文献4.
A. Ríos A.I. López-Navas J. Flores-Medina A. Sánchez M.A. Ayala G. Garrido L. Martínez-Alarcón G. Ramis A.M. Hernández P. Ramírez P. Parrilla 《Transplantation proceedings》2018,50(8):2268-2271
Introduction
Awareness about organ donation among the general population is fundamental to organ donation programs. It is important to determine the factors that influence attitudes toward organ donation within the general population in order to carry out cost-effective campaigns.Objective
To analyze the attitude toward organ donation among Santiago, Cuba, citizens.Methods
The study population encompassed residents in Santiago, Cuba. A sample population of residents older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation and transplant (PCID-DTO Ríos). Available census data were used. The survey was self-administered and completed anonymously.Results
Of the 455 respondents, 70% of respondents are in favour of cadaveric donation, 16% are against, and 14% were undecided. Several variables were associated with having a more favorable attitude. And in the multivariate analysis, the following variables continue to feature as independent variables: 1. knowledge of the concept of brain death [OR = 2.386 (4.761–1.194); P = .014]; 2. being in favor of donating a family member's organs [OR = 3.067 (5.952–1.584); P = .001]; 3. a partner's favorable attitude [OR = 5.795 (1.477–22.731); P = .012]; 4. being an atheist/agnostic as the religious beliefs [OR = 1.845 (3.289–1.038); P = .037]; 5. not being concerned about the possible mutilation of the body after donation [OR = 7.437 (2.918–18.955); P < .001]; 6. not accepting other treatment options after death, such as inhumation [OR = 3.048 (5.714–1.626); P = .001].Conclusions
The attitude toward cadaveric organ donation among the Santiago, Cuba population is favorable and it is associated with several psychosocial factors. 相似文献5.
6.
A. Szczurowska M. Guziński W. Krajewski D. Kamińska K. Kościelska-Kasprzak A. Arruza Echevarria B. Małkiewicz P. Dębinski O. Mazanowska M. Klinger M. Sąsiadek 《Transplantation proceedings》2018,50(6):1597-1601
Introduction
After living kidney donation, a decrease of kidney function (described as estimated glomerular filtration rate [eGFR]) is observed in majority of donors. However, the loss is more significant in some patients without an explicable reason. The aim of this study was to identify quantitative parameters in computed tomography (CT) of the abdomen that would predict greater eGFR reduction after kidney removal.Material and Methods
One hundred and ten preoperative multiphase CT examinations of the abdomen of kidney donors were analyzed for the following renal parameters: cortex, parenchyma and pyramids volume, scarring thickness (low grade: <1 cm, high grade: >1 cm), cortical gaps, vascularisation, and cortex-to-aorta enhancement index (CAEI). The radiologic and biometric (eg, donor weight) parameters were correlated with eGFR (CKD-EPI formula) change between baseline and at discharge.Results
Donor weight was correlated with a loss of eGFR (P < .001). Kidney volumetric parameters including renal cortex and parenchyma volume, as well as renal artery cross-section area were associated with donor weight (r = 0.50 P < .001 and r = 0.39 P < .001). CAEI was correlated with a loss of eGFR (P = .003) and was related to the donor's sex in favor of men. Forty-one (37%) donors had an additional renal artery, which did not influence kidney function. No influence of cortical gaps or scarring on eGFR was observed.Conclusions
CAEI may be a helpful tool in predicting greater short-term kidney function decrease after living kidney donation.Male sex is the strongest risk factor of greater eGFR loss after kidney donation. 相似文献7.
Katy A. Marino Jennifer L. Sullivan Benny Weksler 《The Journal of thoracic and cardiovascular surgery》2018,155(5):2211-2218.e1
Objectives
Endoscopic resection has been rapidly adopted in the treatment of early-stage esophageal tumors. We compared the outcomes after esophagectomy or endoscopic resection for stage T1a adenocarcinoma.Methods
We queried the National Cancer Database for patients with T1a esophageal adenocarcinoma who underwent esophagectomy or endoscopic resection and generated a balanced cohort with 735 matched pairs using propensity-score matching. We then performed a multivariable Cox regression analysis on the matched and unmatched cohorts.Results
We identified 2173 patients; 1317 (60.6%) underwent esophagectomy, and 856 (39.4%) underwent endoscopic resection. In the unmatched cohort, patients who underwent esophagectomy were younger, more often not treated in academic settings, and more likely to have comorbidities (30.4% vs 22.5%, P = .002). They had longer hospital stays and more readmissions than patients who underwent endoscopic resection. Factors positively affecting overall survival were younger age, resection at an academic medical center, and lower Charlson–Deyo comorbidity score. In the matched cohort, patients who underwent esophagectomy had longer hospital stays and were more likely to be readmitted within 30 days (7.0% vs 0.6%, P < .001). When a time period–specific partition was applied, endoscopic resection had a lower death hazard 0 to 90 days after resection (hazard ratio, 0.15; P = .003), but this was reversed for survival greater than 90 days (hazard ratio, 1.34; P = .02).Conclusions
In patients with early-stage esophageal adenocarcinoma, survival appears equivalent after endoscopic resection or esophagectomy, but endoscopic resection is associated with shorter hospital stays, fewer readmissions, and less 90-day mortality. In patients surviving more than 90 days, esophagectomy may provide better overall survival. 相似文献8.
K. Ko Y.H. Kim M.H. Kim K.W. Jun J.K. Hwang S.D. Kim S.C. Park J.I. Kim I.S. Moon 《Transplantation proceedings》2017,49(5):982-986
Purpose
Our objective was to investigate the effects of age on patient and graft survival in expanded criteria donor (ECD) renal transplantation.Methods
Between February 2000 and December 2015, we analyzed 405 deceased donor renal transplants, including 128 grafts (31.9%) from ECDs. Based on recipient age and ECD criteria classification, the recipients were divided into four groups: Group I, non-ECD to recipient age <50 years; Group II, non-ECD to recipient age ≥50 years; Group III, ECD to recipient age <50 years; and Group IV, ECD to recipient age ≥50 years.Results
Among the four groups, there were significant differences in baseline characteristics (age, body mass index [BMI], cause of end-stage renal disease [ESRD], number of kidney transplantations, and use of induction agent). The mean modification of diet in renal disease (MDRD) glomerular filtration rate (GFR) level at 1 month, 6 months, 1 year, 3 years, and 5 years after transplantation was significantly lower in patients with ECDs but MDRD GFR level at 7, 9, and 10 years did not differ significantly (P = .183, .041, and .388, respectively). There were no significant differences in graft survival (P = .400) and patient survival (P = .147).Conclusion
Our result shows that, regardless of recipient age, kidney transplants donated by deceased ECDs have similar graft and patient survival. 相似文献9.
J.R. Naranjo-Izurieta Z. Ruiz de Azúa-López J. Lameirao L. Martín-Villén A. Roldán-Reina M. Porras-López A. Rodríguez-Rodríguez J.J. Egea-Guerrero 《Transplantation proceedings》2018,50(2):644-645
Objective
This study aims to determine if donor grafts of patients older than 65 years develop more post-transplantation complications than those of younger patients.Design
This is a retrospective, observational study of liver transplant recipients during 12 months in Virgen del Rocio University Hospital. We compare incidence rates of reperfusion syndrome, acute kidney injury, and need for intra- and postoperative red blood cell transfusions in two donor age groups in which group A is <65 years old and group B is ≥65 years old.Results
Sixty cases were included. Reperfusion syndrome, acute kidney injury, and both intra- and postoperative red blood cell transfusion were more frequent in group A than group B (11.4% vs. 4%, P = .390; 44% vs. 32%, P = .423; 68.8% vs. 48%, P = .120; and 70.6% vs. 64%, P = .779, respectively). Six recipients (17.1%) died at 12 months from group A whereas there were no deaths register in group B during that time (P = .036).Conclusion
Our results showed that including elderly donors does not aggravate incidence of complications, emphasizing that advanced age should not be an exclusion criteria for liver transplantation. 相似文献10.
L. Martínez-Alarcón A. Ríos G. Ramis J. Gómez-Laguna X. Moll V. Falceto F. San Román-Acaso F. San Román-Llorens J.J. Quereda J.M. Herrero-Medrano L. Mendonça J.L. Martin-Barrasa O.M. Fernández A.I. López-Navas A.M. Hernández A. Muñoz P. Ramírez P. Parrilla 《Transplantation proceedings》2018,50(2):362-365
Background
Veterinarians often hold decision-making positions in the public health care system and can therefore influence public opinion about organ donation and transplantation (ODT). The aim of this work was to analyze the attitude of Spanish veterinary students toward ODT, because they may influence public opinion in the future, and to determine the factors that condition it.Methods
This was a sociologic, interdisciplinary, multicenter, observational study in Spain. The study population was students studying for a veterinary degree in Spain (n = 9000), and a sample of 2815 students (confidence of 99% and precision of ±1%) was stratified by geographic area and academic year. A validated questionnaire of attitude toward ODT (PCID-DTO-Ríos) was self-administered and anonymous.Results
Of the 2815 selected students (2790 plus the 0.9% per type of sample), 2650 completed the questionnaire (response rate, 94.14%): 83% (n = 2207) of the respondents were in favor of donation and 17% against. The following main variables were related to a favorable attitude: being female (odds ratio [OR], 0.752; P = .034); knowing a donor (OR, 1.834; P = .003); having discussed the matter with one's family (OR, 1.587; P = .002); having spoken about the subject in social circles with friends (OR, 1.633; P < .001), and being in favor of donating a deceased family member's organs (OR, 2.403; P < .001).Conclusions
Seventeen percent of Spanish veterinary students were not in favor of ODT. It is important to know the factors that determine their attitude, because this will make it possible to optimize the resources invested in campaigns to promote ODT and to take more specific action. 相似文献11.
Mary A. Decoteau Louis Rivera Kristina Umali Arden D. Chan Peter Soballe Romeo C. Ignacio 《American journal of surgery》2018,215(2):315-321
Background
There are several factors that influence ABSITE scores, but the optimal approach for remediation of poor scores is unclear.Methods
A structured academic curriculum and focused remediation program (FRP) were implemented to improve academic performances. Within a 15-year period, ABSITE and American Board of Surgery qualifying exam (ABS QE) results were compared before and after the establishment of the program using a paired T-test. Subgroup analysis was performed for residents who completed the FRP.Results
After establishing the FRP, the mean scores increased from 49.3% to 60% (p = 0.001). The proportion of first-time pass rates for the ABS QE increased from 89.5% to 100% (p = 0.18). With the subgroup analysis of FRP residents, the average improvement on the next ABSITE exam score was 51 percentile points (p = 0.003), raw score increased by 80 (p = 0.01) and percent correct increased by 7 percentage points (p = 0.006).Conclusions
A structured academic curriculum and FRP improves ABSITE scores. Additional strategies utilizing the self-regulated learning method can further assist trainees who remain struggling learners. Further study is required to determine direct correlation to the ABS QE. 相似文献12.
13.
A. Ríos A.I. López-Navas A. Sánchez J. Flores-Medina M.A. Ayala G. Garrido M.J. Sebastián L. Martínez-Alarcón G. Ramis A.M. Hernández P. Ramírez P. Parrilla 《Transplantation proceedings》2018,50(8):2253-2256
Introduction
Immigrants from Ecuador represent the largest group of Latin Americans in Spain and are, therefore, a subgroup of interest to understand their attitudes and influences in respect to organ donation and transplantation.Objective
To analyze the attitude of nationals of Ecuador residing in Spain regarding deceased organ donation.Methods
The study population included the Ecuadorian population residing in Spain. A sample of population older than 15 years was obtained randomly and stratified by age and sex (n=461). Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation (PCID-DTO-Ríos). Assistance from immigration support associations in Spain was needed to advice on the location of potential respondents.Results
Attitude toward cadaveric donation was favorable in 59% (n=271) of respondents, 12% (n=57) were against cadaveric donation, and 29% (n=133) were undecided. Several variables were associated with having a more favorable attitude. In the multivariate analysis, the following variables were independently associated with a more positive attitude toward organ donation: 1. level of formal education (odds ratio [OR]=6.849 [25.641–1.818]; P = .004); 2. being in favor of donating a family member's organs (OR=8.849 [20.833–3.717]; P < .001); 3. having commented at a family level about transplant (OR=3.717 [6.578–2.109]; P < .001); 4. not being concerned about the possible mutilation of the body after donation (OR=4.608 [8.547–2.487]; P < .001) and 5. knowing the attitude of one's religion toward donation (OR=7.462 [34.482–1.623]; P = .010).Conclusions
The attitude toward cadaveric organ donation among the Ecuadorian population residing in Spain is less favorable than that of the Spanish population and is determined by many different psychosocial variables. 相似文献14.
D. Cucchiari J. Rovira D. Paredes P. Ventura-Aguiar A. Sanchez-Escuredo M. Solé R. Adalia F. Oppenheimer F. Diekmann I. Revuelta 《Transplantation proceedings》2017,49(10):2260-2264
Background
Systemic inflammation affects kidney function in a wide range of diseases. Even in kidney transplant recipients, higher levels of C-reactive protein (CRP) are invariably associated with both worse short- and long-term graft outcomes. However, little is known about systemic inflammation in kidney donors and, notably, brain death causes a strong systemic inflammatory response.Objective
To analyze the role of systemic inflammation of brain-dead donors on short-term kidney graft outcomes (ie, delayed graft function [DGF], defined as the need of dialysis during the first week after transplantation).Materials and methods
Retrospective analysis of clinical and biochemical characteristics of all brain-dead kidney donors generated in the Hospital Clínic of Barcelona in the 2006 to 2015 period (n = 194). Donors who were tested for CRP in the 24 hours before BD declaration were included (n = 97, 50% of initial population). Clinical and biochemical features of their respective recipients (n = 165) were analyzed, comparing recipients who developed DGF (n = 30) with recipients who did not (n = 135).Results
Donors whose recipients later developed DGF had much higher CRP values (10.58 [5.1-18.21] vs 4.81 [1.42-12.2] mg/dL, P = .025). Other characteristics associated with the development of DGF were renal biopsy score and recipient dialysis vintage (P = .025 and P = .002, respectively). In logistic regression analysis, PCR maintained significance in the non–expanded criteria donor (ECD) group (odds ratio [OR], 1.102; P = .027), but it lost significance in the ECD group (P = .67).Conclusions
Terminal donor CRP was associated with DGF in kidney transplant recipients and proved to be mostly significant in younger donors. 相似文献15.
K. Yamanaka K. Oka T. Abe S. Nakazawa T. Kato R. Imamura H. Kishikawa N. Ichimaru K. Nishimura M. Kyakuno S. Takahara N. Nonomura 《Transplantation proceedings》2018,50(8):2545-2547
Purpose
Renal transplant patients with vascular rejection type acute T cell-mediated rejection (ATCMR) grade II have a poor prognosis. Vascular lesions in those cases are thought to randomly occur, thus we searched for a novel pathological marker related to vascular rejection in kidney transplantation.Methods
We determined pathological characteristics in 14 ATCMR grade II patients treated during an acute phase from 2004 to 2013. We then examined whether those findings appeared in transplant kidney biopsy specimens, except for cases of vascular rejection, in patients examined from 2010 to 2014.Results
In 9 of the 14 ATCMR grade II patients, phlebitis was accompanied by inflammatory cells that formed polypoid projections in the venous lumen and partial disappearance of vascular endothelium. Further investigation showed those inflammatory cells to be T cells and macrophages. Histological findings revealed coexisting phlebitis in 2 of 13 patients with ATCMR grade I, 3 of 24 with borderline changes, and none with normal findings. Phlebitis occurred at a significantly greater rate than the other findings in cases of vascular rejection (P < .05). However, there was no significant difference in regard to graft survival between patients with and without phlebitis (P = .1829).Conclusion
Our results suggest severe phlebitis as a novel finding associated with the pathology of vascular rejection in patients with a renal allograft. 相似文献16.
Results of Transplantation of Kidneys Procured From Donors After Brain Death Aged 60 Years and Older
S. Franczyk D. Skrabaka E. Jędrusik J. Ziaja A. Kolonko R. Świder S. Sekta J. Czerwiński A.J. Owczarek M. Durlik A. Więcek L. Cierpka R. Król 《Transplantation proceedings》2018,50(6):1674-1679
Objective
To analyze results of transplantation of kidneys procured from donors after brain death aged 60 years and older (hereafter denoted by “≥60”) compared to kidneys procured from donors after brain death aged 40–59 years (hereafter denoted by “40–59”) in medium-term follow-up period, and to assess factors that affect recipient and kidney graft survival.Material and methods
92 transplant recipients of kidneys procured from donors after brain death ≥60 were enrolled into the study. The control group were 363 recipients of kidneys procured from donors after brain death 40–59.Results
Mean values of serum creatinine were higher in recipients of kidneys procured from donors after brain death ≥60 compared to control after 3 years: 168.2 ± 57.5 (n = 59) vs 147.9 ± 65.7 (n = 294), P < .05; and after 5 years: 196.2 ± 95.3 (n = 38) vs 157.3 ± 80.0 μmol/L (n = 211), P < .01. Restricted mean recipient survival time was 56.4 (95% confidence interval: 55.0–57.8) and 52.0 (48.0–56.1) months, P < .05; and kidney graft survival time was 51.6 (49.6–53.5) and 43.9 (39.0–48.9) months, P < .01 in recipients who received kidneys from donors after brain death 40–59 and from donors after brain death ≥60 respectively. In Cox regression, donor death due to cardiovascular disease proved to be the factor increasing risk of kidney graft loss (hazard ratio 1.553, P < .001).Conclusions
The survival and function of kidneys procured from donors after brain death ≥60 at medium-term follow-up remain worse compared to kidneys procured from donors after brain death 40–59, and the donor dependent risk factor of kidney graft loss is cardiovascular disease, which caused donor death. 相似文献17.
L. Martínez-Alarcón A. Ríos G. Ramis J. Gómez-Laguna X. Moll V. Falceto F. San Román-Acaso F. San Román-Llorens J.J. Quereda J.M. Herrero-Medrano L. Mendonça J.L. Martin-Barrasa O.M. Fernández A.M. Hernández A. Muñoz P. Ramírez P. Parrilla 《Transplantation proceedings》2018,50(8):2280-2283
Living kidney related donations (LKRD) should be promoted because of the current deficit of organs for transplantation. The objective of the study was to analyze the attitude of Spanish veterinary students toward LKRD, because they may influence public opinion in the future, and to determine the factors that condition it.
Methods
A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in the university academic year 2010–2011. A sample of 2815 students was stratified by geographical area and academic year. The students' attitude toward LKRD was assessed using a psychosocial validated questionnaire (PCID-DVR Rios), was self-administered, and was completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis was preformed using t test, χ2 test, and logistic regression analysis.Results
The completion rate was 95% (n = 2683); 93% (n = 2504) were in favor of LKRD and 36% (n = 945) supported unrelated living kidney donation. The following variables were associated with having a more favorable attitude: (1) sex (P < .001), (2) being a student of southern universities (P = .03), (3) attitude toward deceased donation (P < .001), (4) having a father (P < .001) or a mother (P < .001) in favor of organ donation, and (5) having discussed the subject with friends (P = .03) or family (P = .02). However, only 60% would accept a kidney from a relative.Conclusion
Spanish veterinary students have a favorable attitude toward LKRD. However, only 60% would accept a kidney from a relative. 相似文献18.
H.M. Kwon Y.J. Moon K.W. Jung B.H. Sang G.S. Hwang 《Transplantation proceedings》2018,50(4):1123-1128
Background
Many studies have reported the negative influence of diabetes and hypertension on morbidity and mortality in the general population. In liver transplantation (LT) recipients, prevalence of nonalcoholic fatty liver disease and metabolic syndrome is increasing. Hence, concerns over the negative influence of metabolic syndrome, including diabetes and hypertension, are growing. However, there have been few studies about the outcomes of LT recipients with diabetes with/without hypertension. We aimed to evaluate the impact of diabetes with/without hypertension on the outcomes of LT.Methods
Between May 2010 and October 2015, 814 LT recipients (median age, 51 [46–55] years; median MELD score, 13 [9–18]), without overt cardiovascular disease were retrospectively evaluated. To rigorously adjust for clinically confounding factors, a 1:2 propensity score matching analysis was performed. Kaplan-Meier survival curves and Cox proportional hazard regression analysis were performed to examine the association between diabetes with/without hypertension and all-cause mortality or graft survival rate.Results
There were 77 (9.5%) graft failures and 71 (8.7%) deaths during a median follow-up of 2.4 years. After 1:2 matching of 173 (21.3%) diabetic patients, no significant differences were evident in graft survival rate (log-rank test, P = .46; and hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.55–2.06; P = .865) and all-cause mortality (log-rank test, P = .59; and HR, 1.06; 95% CI, 0.55–2.06; P = .727). Separate 1:2 matching was applied to a subgroup of 43 (5.3%) patients with diabetes and hypertension. This matching also showed no difference in graft survival rate (log-rank test, P = .45; and HR, 1.35; 95% CI, 0.43–4.27; P = .613) and all-cause mortality (log-rank test, P = .25; and HR, 1.87; 95% CI, 0.54–6.50; P = .325).Conclusion
Diabetes with/without hypertension does not have an impact on graft survival rate or all-cause mortality in LT recipients. 相似文献19.
20.
Eva Vallés-Carrascosa Tomás Gallego-Izquierdo José Jesús Jiménez-Rejano Gustavo Plaza-Manzano Daniel Pecos-Martín Fidel Hita-Contreras Alexander Achalandabaso Ochoa 《Journal of hand therapy》2018,31(2):227-237