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1.
F. Nogueras López A. López Garrido E.J. Ortega Suazo F. Vadillo Calles F. Valverde López M.D. Espinosa Aguilar 《Transplantation proceedings》2018,50(2):631-633
Background
Recurrent infection with the hepatitis C virus (HCV) after liver transplantation (LT) is associated with decreased graft and patient survival. Direct-acting antiviral (DAA) therapies have changed the landscape of HCV due to their excellent safety profile and cure rates. Our aim was to evaluate the efficacy and tolerability of antiviral therapy in recurrent HCV after LT with DAA therapy.Methods
Our retrospective analysis included 46 LT recipients with HCV recurrence. Patients received therapy with DAA therapy between November 2014 and May 2016. Stage of fibrosis was documented by transient elastography (FibroScan).Results
Thirty-three of the patients were men (71.7%), with a mean age of 59.6 years. Most patients were infected with HCV genotype 1 (71.7%) (1a = 7, 1b = 26) or genotype 3 (19.6%). Cirrhosis was present in 10 (21.7%). The most frequent immunosuppression regimen was tacrolimus + mycophenolate mofetil (MMF) (41.3%). Most patients received sofosbuvir + simeprevir (SOF+SMV) (n = 13, 28.3%) and sofosbuvir + daclatasvir (SOF+DCV) (n = 15, 32.6%). A virologic response at posttreatment week 12 was detected in 93.8% of the patients. Two patients failed treatment (1 had resistance-associated variants [RAVs] Y93H in NS5A). Three patients died due to chronic rejection, acute arterial thrombosis, and spontaneous bacterial peritonitis. Adverse events were observed in 23 patients (50%). The most common events were asthenia in 17 (37%) and headache in 6 (13%) patients. One patient discontinued treatment due to serious adverse events attributable to the drug's interaction with tacrolimus.Conclusions
DAAs are safe and effective for use in treating HCV recurrence after LT, with results similar to those seen in the general population, including patients with cirrhosis. 相似文献2.
Matthew D. Free David H. Owen Paul A. Agius Edward M. Pascoe Paul Harvie 《The Journal of arthroplasty》2018,33(11):3490-3495
Background
The aim of this study was to investigate whether the direct anterior approach (DAA) to total hip arthroplasty (THA) resulted in a shorter length of stay (LOS) in surgeons new to the approach when compared to their previously used approach. Perioperative complications were also assessed.Methods
We examined 93 DAA THA performed by 3 hip arthroplasty surgeons at a single institution comparing these to their previous 166 operations performed using the lateral or posterior approach.Results
Fixed-effects generalized linear modeling demonstrated that patients who underwent THA by the DAA had 26% shorter LOS than those who were operated on using lateral or posterior approaches (adjusted risk ratio = 0.74; 95% confidence interval = 0.65-0.84; P < .001). A greater proportion of DAA patients were discharged directly home (98% vs 87%, F (1,233) = 8.12, P = .005) and complication rates were comparable between groups.Conclusion
The DAA can reduce patient LOS and may be a valuable addition to enhanced recovery pathways. Our findings also suggest that surgeons transitioning to the DAA do not have an increased complication rate when compared to their previous approach. 相似文献3.
Hai-Yan Zhao Peng-De Kang Ya-Yi Xia Xiao-Jun Shi Yong Nie Fu-Xing Pei 《The Journal of arthroplasty》2017,32(11):3421-3428
Background
Controversy exists as to whether early functional outcomes differ after total hip arthroplasty performed using the direct anterior approach (DAA) or the posterolateral approach (PLA).Methods
One hundred twenty patients were enrolled in this study and were divided into 2 groups based on surgical approach. Group A included patients who had a total hip arthroplasty with a DAA, whereas group B included those with a PLA. Patients were randomized into the DAA or PLA groups (n = 60), and perioperative and postoperative outcomes were recorded.Results
When compared with the PLA, the DAA had a shorter incision length (9.1 vs 13.1 cm; P < .01), shorter hospital stay (2.8 vs 3.3 days, P = .04), and lower self-reported pain. Both serum inflammatory and muscle damage markers were lower in the DAA group. However, the PLA had shorter operative times (65.5 vs 83.3 min, P = .03) and less intraoperative blood loss (123.8 vs 165.9 mL, P = .04). The DAA had significantly lower variance in cup inclination and anteversion. Similar rates of intraoperative complications were identified in the 2 groups. The DAA was associated with better functional recovery at 3 months based on the Harris hip score, University of California Los Angeles activity score, and gait analysis; however, functional recovery at 6 months was similar between the 2 groups.Conclusion
We found functional advantages in early recovery after the DAA compared with the PLA. The DAA can offer rapid functional recovery with less muscle damage, greater pain relief, and lower variance in cup inclination and anteversion. However, no functional difference was found at 6 months follow-up. 相似文献4.
A. Weigert S. Querido L. Carvalho L. Lebre C. Chagas P. Matias R. Birne C. Nascimento C. Jorge T. Adragão M. Bruges D. Machado 《Transplantation proceedings》2018,50(3):743-745
Introduction
Hepatitis C (HCV) is a major cause of liver impairment post–kidney transplantation (KT). Anti-HCV direct-acting antivirals (DAA) made viral eradication possible.Methods
We performed a retrospective review of KT patients (n = 23) who received DAA at our hospital. Sustained viral response (SVR) was defined as absence of viral detection 12 weeks after cessation of therapy.Results
From 1985 to September 2017, 1440 patients underwent transplantation at Hospital Santa Cruz. From a total of 32 HCV RNA+ KT recipients on follow-up, we describe the first 23 patients treated with DAA. They were 56.7 ± 9.1 years old; 22 were white, 52.2% were males, they underwent transplantation 18.8 ± 9.0 years ago, and 13 had genotype 1B, 21 were naïve, and 9 had stages F3/F4. All but 2 patients, treated with grazoprevir/elbasvir, received sofosbuvir (18 with ledispasvir, 2 with daclastavir, and 4 with simultaneous ribavirin). Pretreatment, intra-treatment, and post-treatment creatinine clearances were 61.4, 60.6, and 60.7 mL/min/1.73 m2, respectively (not significant [NS]). Cyclosporine A was the basis of immunosuppression in the majority [(n = 14); pretreatment and intra-treatment levels were 79.5 ± 23.0 and 91.8 ± 26.0 ng/mL, respectively (P = .08)]; tacrolimus (n = 8) and mammalian target of rapamycin (mTOR) levels (n = 5) were also similar. One patient interrupted ribavirin after 7 weeks due to anemia; all other patients completed the treatment course without major side effects. Only 3 patients presented positive viral RNA at the fourth week of treatment and SVR was achieved in 100% of the patients 12 weeks after treatment.Conclusions
DAA therapy was well tolerated and effective in 100% of our treated patients, without significant impact on the renal function or on the immunosuppression. 相似文献5.
Objective
Besides severe organ shortage, hepatitis C virus (HCV) infection is an important obstacle for kidney transplantation because of long waiting times on deceased kidney donor waiting lists. We aimed to evaluate calling number of candidates according to HCV serology.Method
A total of 404 adults on the deceased donor waiting list invited for cadaveric transplantation was evaluated. Demographic data, waiting time, calling number for transplantation, and viral serology were obtained during the 6-year period.Results
Mean waiting duration and calling number of all patients were 42.7 ± 34 months and 1.56 ± 4.37 times, respectively. Twenty-six candidates had chronic HCV infection and 12 of 26 were HCV RNA–positive. Mean waiting duration and calling number in anti-HCV–positive candidates were significantly higher compared with anti-HCV–negative candidates (85.3 ± 38.8 vs 39.8 ± 31.6 months, and 10.8 ± 10.3 vs 0.92 ± 2.6 times, respectively; P < .001). Mean waiting duration and total calling number in HCV-RNA–positive candidates were significantly higher than in HCV-RNA–negative ones (107.5 ± 7.5 vs 66.2 ± 44.8 months; P = .018; 15 ± 9.7 vs 7.3 ± 9.8 times, respectively; P = .026).Conclusions
Chronic HCV infection is an important issue leading to longer waiting time on the list. Our observation showed that waiting durations of anti-HCV–positive candidates were longer than that of negative patients, although they had more frequent opportunity for transplantation. 相似文献6.
M. Mucenic A. Bandeira de Mello Brandao C.A. Marroni A. Medeiros Fleck M.L. Zanotelli G. Kiss M.H. Meine I. Leipnitz E. Soares Schlindwein J. Martini A.M. Costabeber F.K.F. Sacco G.P. Cracco Cantisani 《Transplantation proceedings》2018,50(3):769-771
Background
Treatment with direct-acting antiviral drugs in interferon-free regimens is currently recommended for viral hepatitis C recurrence after liver transplantation. There are limited data regarding its results in this population, and no optimal treatment scheme has yet been singled out.Methods
We report our real-world results in liver transplant (LT) recipients. All patients were hepatitis C virus (HCV) monoinfected and completed a 12-week treatment course, followed 12 weeks later by HCV polymerase chain reaction testing with 12 IU/mL sensibility. Liver fibrosis was graded with the use of biopsies taken <12 months before treatment and stratified as early (0–1) or moderate to advanced (2–4) according to the Metavir score.Results
Median postoperative time was 5.2 years. Genotype 3 was found in 66.7% of the sample. The following regimens were prescribed: daclatasvir-sofosbuvir with (n = 11) or without (n = 28) ribavirin. Genotypes 1 and 3 were evenly distributed between the regimens. Sustained virologic response (SVR) was obtained in 24 out of 28 patients (85.7%) who received daclatasvir-sofosbuvir and in all patients (100%) who received daclatasvir-sofosbuvir-ribavirin (global SVR 89.7%). All patients that failed treatment had genotype 3 HCV. Fibrosis was evaluated in 79.5% of the sample: 48.4% had early and 51.6% had moderate to advanced fibrosis, for which ribavirin was more commonly prescribed (P = .001).Conclusions
The SVR rate in our LT recipients was similar to that previously reported in the literature. The addition of ribavirin to DAA treatment appears to be justified in this population. 相似文献7.
J. Pliszczyński K. Jasztal A. Jóźwik M. Kosieradzki R. Danielewicz P. Małkowski J. Czerwiński 《Transplantation proceedings》2018,50(6):1691-1696
Kidney transplant (KTx) is the best method of renal insufficiency treatment. In dialyzed patients, mortality rises with the time on dialysis. There is a continuing shortage of organs for transplantation, hence a propensity to expand the donor pool with expanded-criteria donors, anti-hepatitis C virus-positive included. In the above case a transmission of hepatitis C virus (HCV) genotype to recipient is present. It has been proven that contamination with more than 1 HCV genotype did not worsen KTx outcomes. There are 2.6% anti-HCV(+) donors in Poland. Use is only possible in cases of anti-HCV(+) and anti-HCV RNA(+) recipients.
Methods
Retrospective analysis covered 8675 deceased donors (1998-2012 Polish data from Poltransplant). The early (after 12 months) and late (after 60 months) graft and patient survival was assessed in KTx recipients, with documented recipient and donor data spanning at least 1 year after KTx. In comprehensive analysis, 7016 KTx recipients with known anti-HCV status were included according to anti-HCV profile of recipient and donor. The results are in absolute and percentage values and P < .05 assessed with χ2 test.Results
Twelve-month survival: recipient (R) (95%), graft (G) (89%), total; R (95% vs 89%, P < .001), G (88 vs 79, P < .001) in HCV(?) to HCV(+/?) vs HCV(+) to HCV(+); R (95 vs 94, P = .2), G (88 vs 83, P < .001), HCV(?) to HCV(?) vs HCV(?) to HCV(+); R (93 vs 95, P = .004), G (82 vs 89, P < .001) in HCV(+/?) to HCV(+) vs HCV(?) to HCV(?); R (95 vs 89, P < .001), G (88 vs 79, P < .001) in HCV(?) to HCV(?) vs HCV(+) vs HCV (+). Sixty-month survival: R (86%), G (75%), total; R (84 vs 88, P = .01), G (63 vs 71, P = .001) in HCV(+/?) to HCV(+) vs HCV(?) to HCV(?); R (88 vs 80, P = .003) in HCV(?) to HCV(?) vs HCV(+) to HCV(+).Conclusions
The worst anti-HCV serological profile was HCV(+) to HCV(+), although transplanting HCV(+) to HCV(+) did not worsen outcomes in that group. Worse KTx outcomes of HCV(+) over HCV(?) donors can be attributed to HCV(+) status of the recipient. 相似文献8.
Introduction
End-stage renal disease (ESRD) has a significant impact on a patient's quality of life (QoL). The optimal treatment for ESRD is kidney transplantation (KTx), which aims to extend and improve QoL. The aim of the study was to assess a QoL in KTx recipients.Methods
Our study included 118 post-KTx patients. The research tool employed for assessment was a questionnaire consisting of standardized instruments: the 36-item Short Form (SF-36); the Kidney Disease Quality of Life (KDQOL) instrument; and the Depression, Anxiety, and Stress (DASS) scale. In addition, patients were provided with information on their own weight and height, followed by calculation of body mass index.Results
Correlation analysis showed a statistically significant influence of age on general health (R = 0.191, P = .039), physical functioning (R = ?0.295, P = .001), and general physical health (R = ?0.275, P = .003) assessment. The mean severity of depression, anxiety, and stress among subjects changed over time since KTx. For the post-KTx periods studied (ie, <1 year, 1–10 years, and >10 years), the following changes were observed: for depression, 14.0 vs 11.2 vs 13.1, respectively; for anxiety, 15.6 vs 9.8 vs 14.0, respectively; and for stress, 22.0 vs 13.5 vs 16.8, respectively.Conclusion
In this study we found that: 1. QoL in patients after KTx showed a good level for everyday life functioning, and 2. general health assessment, physical functioning, pain, sleep quality, occupational status, vitality, social activity, staff support, and quality of care were major factors associated with QoL after KTx. 相似文献9.
M. Bieniasz R. Kieszek M. Kwapisz K. Jędrzejko M. Durlik L. Pączek A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1602-1604
Background
Transforming growth factor-β (TGF-β) is involved in the pathogenesis of hypertension and the development of hypertensive target organ damage. TGF-β may promote blood pressure elevation through several mechanisms. The identification of risk factors of hypertension in living kidney donors may provide proper postoperative management.Objective
The objective of the study was to determine the serum TGF-β concentration in living kidney donors after nephrectomy.Patients and Methods
A total of 66 living donor open nephrectomies were performed in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 1995 and 2005. Forty living kidney donors reported for the follow-up. Physical examination, blood and urine tests, ECG, ambulatory blood pressure monitoring, cardiac sonography, and ophthalmoscopy were performed. Serum TGF-β concentration was measured by ELISA. Statistical analysis was performed using SPSS version 13.0.Results
The mean observation period was 65.6 months. The mean donor age at the time of donation and at the follow-up visit was 40.7 and 46.2, respectively. Hypertension was observed in 24% women and in 37% men after surgery. The significantly higher frequency of hypertension was observed after nephrectomy (P = .001). The strongest predictor of hypertension was age. The mean serum TGF-β concentration was 39.3 ng/mL. No significant differences were observed between hypertensive and normotensive donors (P = .061). A significantly higher TGF-β concentration was found 4 and 5 years after donation (P = .02).Conclusions
TGF-β is not associated with hypertension and glomerular filtration rate in living kidney donors after nephrectomy. Careful monitoring of hypertension in living kidney donors after nephrectomy is essential. 相似文献10.
Introduction
Arterial stiffness depends on both genetic and environmental factors. The aim of this study was to assess arterial stiffness in patients after heart transplant.Methods
The study was conducted between May and June 2017. Fifty patients from the Transplantology Clinic of the Institute of Cardiology in Anin, Warsaw, Poland, were enrolled in the study. Pulse wave velocity (PWV), central systolic blood pressure (CSBP), and central diastolic blood pressure (CDBP) were measured and patients' medical records were also analyzed.Results
In the study, 50 patients aged 57.9 years on average were evaluated, of whom 88% were male patients, with average PWV of 8.94 m/s and an average time after transplant of 9.7 years. The study has shown that age (R = 0.77), total cholesterol concentration (R = 0.22, P = .017) and creatinine concentration (R = 0.34; P = .15) show positive correlation with PWV.Conclusions
Our data indicates that age has significant impact on arterial stiffness and the type of immunosuppressive drugs and transplant rejection episodes do not impact an increase in arterial stiffness. 相似文献11.
T.-L. Huang T.-Y. Chen L.-C. Tsang H.-Y. Ou C.-Y. Yu H.-W. Hsu W.-X. Lim Y.-F. Cheng C.-L. Chen 《Transplantation proceedings》2018,50(9):2695-2698
Objective
The aim of the study was to evaluate the efficacy of liver fibrosis (LF) with acoustic radiation force impulse (ARFI) elastography for post-transplant (post-LT) HCV recurrence.Patients and methods
We enrolled 89 adult recipients of living donor liver transplantation (LDLT) who had HCV, with or without post-LT HCV recurrence and treated or not treated. The post-LT HCV recurrence was diagnosed on the basis of RNA viral load present. ARFI examination was performed every 3 months for all patients, with shear wave velocity (SWV) obtained quantitatively in m/s and correlated with histopathologic fibrosis scoring of liver biopsy (LB).Results
There were 50 (50 of 89) patients without HCV recurrence and 39 (39 of 89) with post-LT recurrence in the 89 patients studied. The recurrent group had significantly higher median SWVs (1.87 ± 0.52 vs 1.37 ± 0.52 m/s, P < .0001), in which 18 (18 of 39) patients had antiviral drug treatment and obtained significant improvement with SWVs from 1.83 ± 0.49 to 1.68 ± 0.56 m/s, P = .043. The correlations of LF staging between ARFI elastography and Ishak histopathologic LF scores showed great significance, P = .045. The HCV RNA titer after antiviral treatment decreased from 3,831,750 to 0, P < .0001, but the RNA titer of nontreated patients remained high and the median SWV increased. The Ishak LF staging in the nontreated group progressed from stage 1 to 2, P = .012 and SWV increased from 1.69 ± 0.54 to 1.91 ± 0.66 m/s, P = .085 at 1-year follow-up.Conclusion
ARFI elastography has efficient quantitative LF monitoring correlated with histopathologic staging for post-LT HCV recurrence. It could be an alternative, noninvasive method for frequent LB in the disease follow-up. 相似文献12.
J. Zegarska E. Hryniewiecka D. Zochowska E. Samborowska R. Jazwiec K. Maciej S. Nazarewski M. Dadlez L. Paczek 《Transplantation proceedings》2018,50(7):2235-2239
Background
Tacrolimus (Tac), an essential component of immunosuppressive therapy after solid-organ transplantation, has a narrow therapeutic index and requires therapeutic drug monitoring. Monitoring of Tac predose blood concentrations seems to be not always sufficient to avoid adverse effects. The aim of the study was to evaluate the levels of main Tac metabolites, 13-O-demethyl tacrolimus (13-DMT), 31-O-demethyl tacrolimus (31-DMT), and 15-O-demethyl tacrolimus (15-DMT), in kidney transplant recipients and to link them to clinical and biochemical parameters.Methods
In 63 kidney transplant patients, concentrations of 13-DMT, 31-DMT, and 15-DMT were quantified using liquid chromatography combined with tandem mass spectrometry (LC/MS/MS).Results
None of the patients had detectable 31-DMT blood levels. There was a positive correlation between 13-DMT/Tac and alanine aminotransferase (ALAT) (r = 0.29, P = .046) and a negative correlation between 13-DMT/Tac and hemoglobin (r = ?0.33, P = .008). Tac level did not correlate with ALAT nor with hemoglobin. There was no relationship between 13-DMT/Tac or 15-DMT/Tac and other biochemical or hematologic parameters or data, such as age, body mass index, arterial pressure, or time posttransplant. We observed significantly higher Tac concentrations in patients with hypercholesterolemia or hypertriglyceridemia compared with those without these comorbidities (6.45 ± 2.32 vs 5.16 ± 2.12 ng/mL, P = .043; 6.60 ± 2.30 vs 5.34 ± 2.20 ng/mL, P = .033, respectively).Conclusion
Our data may reflect 13-DMT accumulation in liver dysfunction and higher Tac clearance in anemia. However, these results may suggest that 13-DMT/Tac ratio is a marker of myelotoxicity and hepatotoxicity. Further studies should be carried out to determine whether monitoring of 13-DMT could be beneficial in minimizing the adverse effects. 相似文献13.
F.J. León Díaz J.L. Fernández Aguilar S. Nicolás de Cabo M. Pérez Reyes B. Sánchez Pérez C. Montiel Casado J.A. Pérez Daga J.M. Aranda Narváez M.A. Suárez Muñoz F. Arenas González M.M. Florez Rías J.L. Pelaez Angulo J. Santoyo Santoyo 《Transplantation proceedings》2018,50(2):539-542
Introduction
Ischemia reperfusion injury (IRI) is the main cause of early allograft dysfunction (EAD) and subsequent primary allograft failure (PAF).Objectives
The purpose of this study is to compare IRI, EAD, and PAF in liver transplantation in a cohort of patients perfused with histidine-tryptophan-ketoglutarate (HTK) solution and University of Wisconsin (UW) solution versus HTK alone.Methods
A randomized trial was performed to compare outcomes in liver recipients who underwent transplantation surgery in the University Regional Hospital of Malaga, Spain. Forty patients were randomized to two groups. Primary endpoints included IRI, EAD, PAF, re-intervention, acute cellular rejection, retransplantation, arterial complications, and biliary complications at postoperative day 90.Results
Postoperative glutamic oxaloacetic transaminase (1869.15 ± 1559.75 UI/L vs. 953.15 ± 777.27 UI/L; P = .004) and glutamic pyruvic transaminase (1333.60 ± 1115.49 U/L vs. 721.70 ± 725.02 U/L; P = .023) were significantly higher in patients perfused with HTK alone. A clear tendency was observed in recipients perfused with HTK alone to present moderate to severe IRI (7 patients in the HTK + UW solution group vs. 15 patients in the HTK-alone solution group; P = .06), EAD (0 patients in the HTK + UW solution group vs. 0 patients in the HTK-alone solution group; P = .76), and PAF (3 patients in the HTK + UW solution group vs. 8 patients in the HTK-alone solution group; P = .15).Conclusions
Initial perfusion with HTK solution followed by UW solution in liver transplantation improves early liver function as compared to perfusion with HTK alone. 相似文献14.
Danielle Y. Ponzio Lazaros A. Poultsides Anthony Salvatore Yuo-yu Lee Stavros G. Memtsoudis Michael M. Alexiades 《The Journal of arthroplasty》2018,33(5):1421-1425.e1
Background
The direct anterior approach (DAA) offers the potential for less soft tissue insult, improved early recovery, and reduced dislocation rates. However, complications are associated with the DAA, particularly during the learning curve. We compare the DAA learning curve experience with the posterior approach regarding in-hospital complications and revision rate.Methods
We evaluated systemic and local in-hospital complications associated with primary unilateral cementless THAs from January 1, 2010 to December 31, 2012 in 4249 patients through a posterior approach and 289 patients through a DAA. All procedures were performed consecutively by high-volume surgeons who use a single approach in a nonselective manner. The DAA was performed by surgeon transitioning from the posterior approach, thus incorporating the learning curve. Demographics were comparable. Revision procedures were captured through a minimum 4-year follow-up. Analyses compared complication and revision rates.Results
The DAA group demonstrated shorter length of stay, procedure time, lower blood transfusion rate, and increased discharge to home rate. Local and major systemic in-hospital complications were rare and comparable between groups. The minor systemic complication rate was significantly greater for the posterior group (10.9% posterior vs 6.2% DAA, P < .05). Revision rate was significantly greater for the posterior group (2.7% posterior vs 0.7% DAA, P < .032). The incidence of revision for dislocation was 1.5% for the posterior approach vs 0.4% for the DAA.Conclusion
There was an increased rate of in-hospital minor systemic complications and overall revision, predominantly due to instability, after THA by the posterior approach, in comparison with the DAA. 相似文献15.
Introduction
Arterial stiffness and central arterial pressure are important factors in the diagnosis of cardiovascular diseases. The tendency of patients after liver transplantation to reach above-normal BMI values promotes the development of arterial stiffness and lipid disorders.Methods
The study was conducted on a group of 42 patients after liver transplantation at the Nephrology and Transplantology Outpatient Clinic, Medical University of Warsaw, the Infant Jesus Teaching Hospital, Warsaw 0.5–17 years after surgery. The body composition test was carried out with the Tanita Mc780 device, and the central pressure and pulse wave velocity (PWV) with the Schiller BR-102 PLUS PWA device, using the oscillometric method on the brachial artery. Medical documentation was analyzed and the laboratory parameters values routinely determined during follow-up visits were assessed.Results
There was a statistically significant correlation between central diastolic pressure and BMI (r = 0.46, P < .05), and a lack of correlation between patients' age and PWV value (r = 0.06, P < .05), which indicated the age of patients in this study was not associated the stiffness of their arteries. PWV level in patients after liver transplantation whose BMI value is within the normal range was 7.62 m/s, while overweight and obese patients had PVW values of 8.58 m/s (P < .05).Conclusions
In conclusion, our data indicate that 1. the level of central arterial pressure increases with the development of stiffness in the arteries; 2. patients after liver transplantation tend to grow in terms of body weight and body fat content over time after surgery; and 3. the level of bilirubin in the blood is significantly increased among patients with fat content above the upper limit of the normal range. 相似文献16.
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17.
M. Krasnodębski M. Grąt J. Stypułkowski E. Bik K. Maria Wronka W. Patkowski K. Zieniewicz 《Transplantation proceedings》2018,50(7):2006-2008
Background
Hepatic artery thrombosis (HAT) is one of the most severe complications after liver transplantation (LT). HAT can lead to early graft loss and retransplantation or death of the recipient.Methods
This retrospective cohort study was conducted using data from patients treated between January 2008 and December 2013 in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw. A total of 750 patients underwent LT over this period.Results
HAT occurred in 27 patients (2.1%). The median DRI was 1.414 (IQR 1.103–1.578) points and median donor age was 47 (IQR 33–56) years. The optimal cut-off value of DRI in predicting HAT was ≥1.328 points. The cutoff point was characterized by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88.0%, 41.3%, 5.5% and 98.9%, respectively (AUC = 0.605, 95% CI 0.477–0.733). A DRI ≥1.328 was a significant risk factor for HAT (OR = 5.16, 95% confidence interval [CI] 1.529–17.48, P = .008). The optimal cutoff point for donor age was 50 years and was characterized by sensitivity, specificity, PPV, and NPV of 66.7%, 55.8%, 5.3%, and 97.8%, respectively. Donor age ≥50 years (OR = 2.53, 95% CI 1.123–5.714, P = .025) was a significant risk factor for HAT.Conclusion
DRI is a clinically relevant factor that allows estimating the risk of HAT after liver transplantation from a deceased donor. To reduce the incidence of this complication, the allocation of organs taken from donors at DRI exceeding 1.328 for recipients without other HAT risk factors should be considered. 相似文献18.
G. Niewińsk J. Raszeja-Wyszomirska R. Główczyńska W. Figiel K. Zając O. Kornasiewicz K. Zieniewicz M. Grąt 《Transplantation proceedings》2018,50(7):2014-2017
Background
Prolonged initial intensive care unit (ICU) stay after liver transplantation (LT) is associated with prolonged total hospitalization, increased hospital mortality, and impaired patient and graft survival. Recent data suggested that model for end-stage liver disease (MELD) score at the time of LT and the length of surgery were the two independent risk factors for an ICU stay longer than 3 days after LT. We further identified factors influencing prolonged ICU stay in single-center liver graft recipients.Patients and methods
One hundred fifty consecutive LT recipients (M/F 94/56, median age 55 (range, 39–60), 36% with viral hepatitis, were prospectively enrolled into the study. Associations between clinical factors and prolonged ICU stay were evaluated using logistic regression models. Receiver operating characteristic curves were analyzed to determine the appropriate cutoffs for continuous variables. Threshold for significance was P ≤ .05.Results
Highly prolonged (≥8 days) and moderately prolonged (≥6 days) postoperative ICU stay was noted in 19 (12.7%) and 59 (39.3%) patients, respectively. Serum bilirubin (P = .001) and creatinine concentrations (P = .011), international normalized ratio (P = .004), and sodium-MELD (P < .001) were all significantly associated with postoperative intensive care unit stay over or equal to 75th percentile (6 days). Sodium-MELD was significantly associated with postoperative care unit stay greater or equal to the 90th percentile (8 days; P = .018).Conclusions
Sodium-MELD might be a novel risk factor of prolonged ICU stay in this single-center experience. 相似文献19.
Shai S. Shemesh Jonathan Robinson Aakash Keswani Michael J. Bronson Calin S. Moucha Darwin Chen 《The Journal of arthroplasty》2017,32(6):1884-1889
Background
The direct anterior approach (DAA) has gained recent popularity for total hip arthroplasty (THA), as it provides immediate feedback on cup position and limb length using fluoroscopy. The purpose of this study is to evaluate any differences in the accuracy of digital templating for preoperative planning of THA, performed with 2 different surgical approaches: DAA using a radiolucent table with intraoperative fluoroscopy and the posterior approach (PA).Methods
One hundred thirty-one consecutive patients (148 hips) underwent a THA by a single surgeon, using the same cup and stem designs. Seventy-five hips were performed using the DAA using a fracture table and fluoroscopy. Seventy-three hips were performed using the PA with the patient positioned in lateral decubitus using standard positioners without fluoroscopy. Preoperative radiographs were digitally templated by the same surgeon.Results
The PA patients had a higher mean body mass index and were more likely to have a preoperative diagnosis of avascular necrosis. The accuracy of templating for predicting the cup size to be within 2 mm was 91% for DAA vs 88% for PA (P = .61). For stem size, the accuracy was 85% (to within 1 size) for the DAA vs 77% for the PA (P = .71). Likewise, there was no significant difference in predicting the final stem's neck angle or femoral offset.Conclusion
Digital templating was found to be a reliable and highly accurate method for predicting component sizes and offset for THA, regardless of using either the PA or the DAA with fluoroscopy. 相似文献20.
Kyrill Rykov Inge H.F. Reininga Maurits S. Sietsma Bas A.S. Knobben Bas L.E.F. ten Have 《The Journal of arthroplasty》2017,32(12):3652-3658.e1