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1.
D. Olivari V. Mainardi K. Rando G. Rey J. Menendez J. Prieto J. Medina M. Valverde J. Castelli G. Grecco A. Leites G. Zunini S. Gozalez M. Harguindeguy S. Gerona 《Transplantation proceedings》2018,50(2):499-502
Introduction
Identification of predictive factors of mortality in a liver transplant (LT) program optimizes patient selection and allocation of organs.Objective
To determine survival rates and predictive factors of mortality after LT in the National Liver Transplant Program of Uruguay.Methods
A retrospective study was conducted analyzing data prospectively collected into a multidisciplinary database. All patients transplanted since the beginning of the program on July 2009 to April 2017 were included (n = 148). Twenty-nine factors were analyzed through the univariate Kaplan-Meier model. A Cox regression model was used in the multivariate analysis to identify the independent prognostic factors for survival.Results
Overall survival was 92%, 87%, and 78% at discharge, 1 year, and 3 years, respectively. The Kaplan-Meier survival curves were significantly lower in: recipients aged >60 years, Model for End-Stage Liver Disease score >21, LT due to hepatocellular carcinoma (HCC) and acute liver failure (ALF), donors with comorbidities, intraoperative blood loss beyond the median (>2350 mL), red blood cell transfusion requirement beyond the median (>1254 mL), intraoperative complications, delay of extubation, invasive bacterial, and fungal infection after LT and stay in critical care unit >4 days. The Cox regression model (likelihood ratio test, P = 1.976 e?06) identified the following independent prognostic factors for survival: LT for HCC (hazard ratio [HR] 4.511; P = .001) and ALF (HR 6.346; P = .004), donors with comorbidities (HR 2.354; P = .041), intraoperative complications (HR 2.707; P = .027), and invasive fungal infections (HR 3.281; P = .025).Conclusion
The survival rates of LT patients as well as the mortality-associated factors are similar to those reported in the international literature. 相似文献2.
R. Główczyńska J. Raszeja-Wyszomirska M. Janik K. Kostrzewa M. Zygmunt H. Zborowska M. Krawczyk M. Galas G. Niewińsk M. Krawczyk K. Zieniewicz P. Milkiewicz G. Opolski 《Transplantation proceedings》2018,50(7):2022-2026
Background
Cardiovascular events (CVE) might occur in 20% to 70% of liver transplant recipients, and major CVE are associated with poor long-term survival. Overall, the ability to identify patients at the highest risk of death after liver transplantation (LT) has been improved. Abnormal pretransplant troponin I (TnI) level is regarded as one of predictors of postoperative CVE. We evaluated the number of early CVE after LT and the impact of pretransplant TnI on cardiovascular morbidity.Patients and methods
We prospectively enrolled 110 consecutive liver transplant recipients (M/F 67/43, age 53.3 ± 10.4 years, 32.7% with hepatitis C virus). Seven of them (6.4%) were on urgent protocol and 3 patients (2.7%) had re-LT. TnI level was measured at listing for LT and directly after LT; clinical outcomes were observed within the first 7 days after LT.Results
CVE during LT occurred in 51 recipients (46.4%). CVE after LT at the intensive care unit were noticed in 13 patients (11.8%). One patient (0.9%) died in the first 7 days after LT. The level of TnI >0.07 did not correlate with CVE during operation and 7 days after LT (P > .05), but the subgroup with TnI >0.07 before LT had a trend with higher TnI after LT (P?=?.065). Recipients with hepatitis C virus had a trend for higher TnI after LT (P?=?.061). CVE directly after LT correlated significantly with Child-Pugh (P?=?.01), Model for End-Stage Liver Disease (MELD), MELD incorporating serum sodium, and integrated MELD scales (P < .001).Conclusion
In our single-center algorithm, TnI with canonical cutoff value of 0.07 was not an effective predictor for cardiac outcomes shortly after LT in our population. 相似文献3.
J. Raszeja-Wyszomirska R. Glowczynska K. Kostrzewa M. Janik M. Zygmunt H. Zborowska M. Krawczyk G. Niewinski M. Galas M. Krawczyk K. Zieniewicz P. Milkiewicz G. Opolski 《Transplantation proceedings》2018,50(7):1997-2001
Background
Cardiovascular events (CVE) contribute to serious complications and death after liver transplantation (LT). Troponin I (TnI) level >0.07 mg/L and prior cardiac disease are known to be the independent predictors for posttransplant CVE. We evaluated single-center cardiac workup to predict early cardiovascular morbidity and mortality after LT.Patients and methods
We recruited 105 consecutive liver transplant recipients (male/female, 59/46; mean age, 51.66?±?11.67 years). The cardiological assessment at evaluation for LT included medical history, electrocardiogram, echocardiography, Holter monitoring, and exercise test. We collected data regarding CVE including hypotonia with catecholamine usage, arrhythmia, sudden cardiac death, pulmonary edema, and myocardial infarction within 7 days after LT.Results
CVE during LT occurred in 42 recipients (40%) and after LT in 9 patients (8.57%). Proposed cutoff level of TnI >0.07 mg/L did not correlate with CVE during operation (P?=?.73) or after LT (P?=?.47). CVE during LT was associated with arterial hypertension in medical history (P?<.001), right ventricular systolic pressure (P<?.05), and clinical scores: Child-Pugh (P = .04), Model for End-Stage Liver Disease (MELD) (P = .04), MELD incorporating serum sodium (P<.03), and integrated MELD score (P?=?.01). CVE after LT correlated only with arrhythmia (P<.001) and catecholamine usage (P?<?.05) perioperatively. Of interest, catecholamine usage during LT was associated with prolonged stay at the intensive care unit (P?<?.05).Conclusion
The single-center algorithm with noninvasive cardiac procedures without TnI assessment is optimal in evaluation before LT; however, medical history and severity of the liver disease are crucial for short-term cardiovascular morbidity after LT. 相似文献4.
C.-C. Lin H.-Y. Ou Y.-H. Chuang H.-J. Chiang C.-C. Yu M. Lazo L.L.-C. Tsang T.-L. Huang C.-C. Lin C.-L. Chen Y.-F. Cheng 《Transplantation proceedings》2018,50(9):2675-2678
Objective
The purpose of this study is to evaluate the use of diffusion-weighted magnetic resonance imaging (DWMRI) in the assessment of graft rejection after liver transplantation (LT).Methods
From June 2017 to January 2018, 32 patients were included in the study with a mean age of 52.3 years. All patients underwent LT. The DWMRI was performed using the apparent diffusion coefficient map and measuring the different b-values (b-400, b-600, b-800, and b-1000). These measurements were compared with the histopathology results. Statistical analysis included t test, analysis of variance, and area under the curve for receiver operating characteristic (ROC).Results
There were 17 patients without rejection and 15 patients with liver graft rejection diagnosed by histopathology. The mean (SD) results between the nonrejection and rejection groups were as follows: b-400 = 1.568 (0.265) vs 1.519 (0.119) (P = .089), b-600 = 1.380 (0.181) vs 1.284 (0.106) (P = .039), b-800 = 1.262 (0.170) vs 1.170 (0.086) (P = .035), b-1000 = 1.109 (0.129) vs 1.098 (0.078) (P = .095); B-values × 10?3 mm2/s. Only b-600 (P?=?.04) and b-800 (P?=?.04) values have significant differences between the 2 groups. B-600 showed 90.48% sensitivity and 83.33% specificity (ROC area under the curve = 0.784; P < .001), and b-800 showed 90.38% sensitivity and 83.03% specificity (ROC area under the curve = 0.816; P < .001). The values obtained with the apparent diffusion coefficient in b-800 were clearly differentiated between the mild, moderate, and severe degrees of rejection (P < .001).Conclusion
Measurement of b-600 and b-800 values using DWMRI may be used for the diagnosis of graft rejection after LT. 相似文献5.
M. Serwanska-Swietek M. Wszola P. Domagala A. Berman M. Bieniasz R. Kieszek E. Karpeta L. Gorski M. Kwapisz A. Ostaszewska M. Sobol K. Bednarska M. Gniewkiewicz A. Perkowska-Ptasinska D. Deborska-Materkowska J. Gozdowska M. Durlik A. Chmura A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1686-1690
Introduction
The approach toward transplanting kidneys from expanded-criteria donors (ECDs) in Poland is largely site-dependent. The Kidney Donor Risk Index (KDRI) allows for obtaining a more precise characteristic of ECDs and further stratification into “better” and “worse” quality grafts.Methods
Comparison of the incidence of delayed graft function (DGF) and biopsy-proven acute rejection (BPAR), median of hospitalization time and median of estimated glomerular filtration rate (eGFR) at 1 year after transplantation among kidney graft recipients (n = 468), divided by donor status (ECD/standard-criteria donor [SCD]) and KDRI value (I: 0.67–1.2, II: 1.21–1.6, III: 1.61–2.0, IV: 2.01–3.48).Results
ECD kidneys have been transplanted to 32.47% of recipients. There were no ECD recipients in KDRI compartment I, 16.55% in compartment II, 79.22% in compartment III, and 100% in IV. In KDRI compartment II, DGF was diagnosed in 34.9% of SCDs and 56% of ECDs (P = .003), BPAR occurred in 7.8% of SCDs and 16% of ECDs (P = .073), median hospital stay was 12 days for SCDs and ECDs (P = 1), and eGFR was 50.7 mL/min for SCDs and 49.4 mL/min for ECDs (P = .734). In KDRI compartment III, DGF was diagnosed in 43.8% of SCDs and 49.2% of ECDs (P = .139), BPAR occurred in 6.3% of SCDs and 31.7% of ECDs (P = .001), median hospital stay was 10 days for SCDs and 12 days for ECDs (P = .634), and eGFR was 49.5 mL/min for SCDs and 45.2 mL/min for ECDs (P = .382). Among ECD recipients, DGF was diagnosed in 56.0%, 49.2%, and 47.7% of patients for KDRI compartments II, III, and IV respectively (P = .776); BPAR occurred in 16% (compartment II), 31.7% (compartment III), and 23.1% (compartment IV) (P = .273); the median hospital stay was 12 days (compartment II), 12 days (compartment III), and 12.5 days (compartment IV) (P = 1); and eGFR was 49.5 mL/min (compartment II), 45.4 mL/min (compartment III), and 36.1 mL/min (compartment IV) (P = .002).Conclusion
Assessment using both the ECD and KDRI systems allows for a more precise evaluation of prognosis and predicting complications among recipients. 相似文献6.
Joyce T. Johnson Jacob F. Wilkes Shaji C. Menon Lloyd Y. Tani Hsin-yi Weng Bradley S. Marino Nelangi M. Pinto 《The Journal of thoracic and cardiovascular surgery》2018,155(6):2606-2614.e5
Objective
Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality.Methods
We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004 and 2013 by using the Pediatric Health Information Systems database (44 children's hospitals). Multivariate generalized estimating equations adjusted for center- and patient-specific risk factors and stratified by age at admission were performed to examine the association of admission intensive care unit (ICU) with total hospital costs, mortality, and length of stay.Results
Of 19,984 neonates (60% male) identified, 39% were initially admitted to a cardiac ICU (CICU), 48% to a neonatal ICU (NICU), and 13% to a pediatric ICU. In adjusted models, admission to a CICU versus NICU was associated with a $20,440 reduction in total hospital cost for infants aged 2 to 7 days at admission (P = .007) and a $23,700 reduction in total cost for infants aged 8 to 14 days at admission (P = .01). Initial admission to a CICU or pediatric ICU versus NICU at <15 days of age was associated with shorter hospital and ICU length of stay and fewer days of mechanical ventilation. There was no difference in adjusted mortality by admission location.Conclusions
Admission to an ICU specializing in cardiac care is associated with significantly decreased hospital costs and more efficient resource use for neonates requiring cardiac surgery. 相似文献7.
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8.
Short-term Results of Heartmate 3 Ventricular Assist Device Implantation for End-Stage Heart Failure
P. Ozturk S. Ertugay C. Sahutoglu C. Engin S. Nalbantgil T. Yagdi M. Ozbaran 《Transplantation proceedings》2017,49(3):599-602
Objective
To report our initial experience with Heartmate 3 ventricular assist device (HM3) in cases with end-stage heart failure (ESHF).Methods
Charts of 8 ESHF patients who underwent HM3 implantation in our clinic from January to June 2016 (group 1) and 16 patients who underwent HM2 implantation during 2015 (group 2) were reviewed retrospectively. Demographics as well as pre- and early postoperative medical data were noted and statistically analyzed between the 2 groups.Results
No statistical difference was found in age or sex distribution between groups (P > .05). Mean Interagency Registry for Mechanically Assisted Circulatory Support scores were 2.13 ± 0.99 and 3.38 ± 0.72 in groups 1 and 2, respectively (P = .020). Mean cardiopulmonary bypass time, and chest tube drainage fluid volume and blood product requirement during intensive care unit (ICU) stay were 64.0 ± 13.9 minutes, 1,112.5 ± 516.7 mL, and 318.8 ± 271.2 mL, respectively, in group 1 and 89.0 ± 33.3 minutes, 2,081.3 ± 1,696.0 mL, and 1,118.8 ± 1,010.8 mL in group 2 (P = .027, P = .019, and P = .040, respectively). Need for surgical revision and early mortality were not evident for group 1, although 4 cases (25.0%) required revision surgery, and early mortality was seen in 3 cases (18.8%) in group 2 (P = .121 and P = .190, respectively). Mean durations of ICU stay and total postoperative hospitalization were 5.9 ± 2.0 and 18.3 ± 5.5 days, respectively in group 1 and 6.2 ± 4.3 and 18.0 ± 6.9 days in the surviving 13 patients of the group 2 (P = .645 and P = .697, respectively).Conclusions
With its shorter implantation time and reduced blood product requirement in the early postoperative period, the HM3 system was found to be safe and effective in ESHF treatment. 相似文献9.
M.F. Chedid H.R. Bosi A.D. Chedid M.R. Alvares-da-Silva I. Leipnitz T.J.M. Grezzana-Filho M.J. Reis G.M. Filho A.J. Ghissi P.R. Neto A. de Araujo S. Arruda A.B. Lopes M.T. Michalczuk A.N. Backes C.D.P. Kruel C.R.P. Kruel 《Transplantation proceedings》2017,49(4):848-851
Background
There are only 4 prior studies reporting on outcomes of liver transplantation (LT) using Institutes Georges Lopez-1 (IGL-1) preservation solution. Detection of negative predictors of LT using IGL-1 may help finding strategies to protect selected recipients at higher risk of graft failure and death.Methods
Review of all consecutive adult patients who underwent a first whole-graft LT using IGL-1 at authors' institution from 2013 to 2016. Primary end point was graft failure within the first 90 postoperative days (PODs). Graft losses due to any cause (including all deaths with a functioning graft) were recorded as graft failures.Results
Of all 100 patients included in this study, 37 were women; median age was 58 years (range 18–71). There were 12 graft losses during the first 90 PODs (including 3 cases of primary nonfunction of the liver allograft), and 10 of the 12 graft losses occurred on first 30 PODs. All 12 patients who experienced graft loss (including 1 patient who underwent liver retransplantation) died within the first 90 PODs. Of the total 100 patients, 14 experienced biliary complications. Univariate analysis revealed prolonged warm ischemic time (WIT) as the only predictor of 90-day graft failure (odds ratio = 23.5, confidence interval = 1.29–430.18, P = .03). The cutoff by receiver operating characteristic curve for WIT was 38 minutes (area under the curve = 0.70). Positive predictive value for WIT >38 minutes was 94.3%.Conclusions
LT using IGL-1 can be performed safely. Similar to prior reports on LT using other preservation solutions, prolonged WIT was associated with adverse outcomes. 相似文献10.
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11.
Y.-S. Park Y.-J. Moon I.-G. Jun J.-G. Song G.-S. Hwang 《Transplantation proceedings》2018,50(4):1108-1113
Introduction
Although the revised cardiac risk index (RCRI) is a useful tool for estimating the risk of postoperative cardiac events, whether it improves the prediction of cardiac events in patients undergoing liver transplantation (LT) has not been sufficiently demonstrated.Methods
We retrospectively analyzed 1429 patients who underwent LT. Cardiac events were defined as myocardial infarction, death, or combined events within 30 days after surgery. The RCRI was defined as the number of independent predictors including high-risk surgery, ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin treatment, and creatinine level >2 mg/dL. Multivariate logistic regression analysis was performed to identify factors independently associated with cardiac events. The additive predictability of RCRI for the Model for End-Stage Liver Disease (MELD) score was assessed using receiver operating characteristic curve analysis.Results
Forty-four (3.1%) cardiac events occurred within 30 days after surgery. Both the MELD score (adjusted odds ratio [aOR], 1.05; P = .005) and RCRI (aOR, 4.35; P < .001 for RCRI score 2; aOR, 6.27; P = .009 for RCRI score 3 compared with RCRI score 1) independently predicted postoperative 30-day cardiac events. The model with MELD score plus RCRI was significantly more predictive for postoperative 30-day cardiac events than the model with MELD score alone (C-statistics 0.800 vs 0.757; P = .030).Conclusions
For preoperative risk stratification, RCRI showed additive value to MELD score in predicting postoperative 30-day cardiac events after LT. 相似文献12.
Introduction
and aim. Poor functional status is associated with increased mortality in cirrhosis patients awaiting liver transplantation (LT); however, the optimal assessment of functional status remains unknown. This study sought to determine the relationship between 6-minute walk distance (6MWD) and Karnofsky Performance Status (KPS) and their association with waitlist mortality in LT candidates.Material and methods
Two hundred seventy-eight consecutive patients listed for LT were included. KPS and 6MWD were assessed at the time of evaluation. KPS was recorded as a percentage from 0 to 100, with 0 representing death and 100 representing no presence of disease. Patients were followed from time of listing until transplantation, death, removal from the waitlist or end of the study period.Results
The mean KPS and 6MWD were 77.4 ± 13.5 and 323.6 ± 163.9 m, respectively. A mild correlation between 6MWD and KPS was demonstrated (Spearman ρ = 0.4317, P < .0001). KPS was significantly lower in patients with 6MWD < 250 meters (P < .0001). The 6MWD was significantly lower in patients who suffered waitlist mortality (266.1 vs 331.8 m, P = .05).Conclusion
In conclusion, 6MWD is a better predictor of waitlist mortality than KPS score in candidates for LT. The addition of 6MWD as a standard assessment may help to identify patients at risk of dying on the waitlist. 相似文献13.
A. Pacek Ł. Czyżewski M. Saran J. Wyzgał Ł. Szarpak 《Transplantation proceedings》2018,50(6):1824-1828
Introduction
Laboratory tests and anthropometric assessments are essential in determining the risk for cardiovascular disease in patients after kidney transplantation (KTx). Patients with hypertension and elevated pulse wave velocity (PWV) are at a higher risk of cardiovascular mortality. The purpose of this study was to determine the role of blood pressure, arterial stiffness, and selected laboratory and anthropometric parameters in estimating the risk of cardiovascular disease in KTx patients.Methods
A total of 17 KTx patients of the Clinical Department of Gastroenterological Surgery and Transplantation at Central Clinical Hospital of Ministry of the Interior and Administration (MSWiA Hospital) in Warsaw, Poland, were enrolled in this study between 3 to 7 days after undergoing kidney transplantation. Medical records of these patients were reviewed for the selected laboratory parameters. The patients' blood pressure and PWV values were monitored for 24 hours and their body mass index (BMI) values were calculated (BMI ≥ 25.0 is considered overweight).Results
Hemoglobin concentration showed a negative correlation with PWV (r = –0.6), whereas red blood cell distribution width (RDW) showed a positive correlation with the PWV value (r = 0.29). There was a significant correlation (r = 0.21) between overweight measured via BMI and the PWV values. For results of kidney function blood tests, the estimated glomerular filtration rate (GFR) and creatinine levels showed no significant correlation with 24-hour PWV values (GFR r = ?0.03; creatinine r = 0.03).Conclusions
The following were shown to be important indices of cardiovascular risk in the evaluated population of KTx patients: age, BMI, blood pressure, PWV, hemoglobin levels, red blood cells, and RDW%. 相似文献14.
V. Mainardi K. Rando D. Olivari G. Rey J. Castelli G. Grecco A. Leites M. Harguindeguy S. Gerona 《Transplantation proceedings》2018,50(2):465-471
Background
Acute liver failure (ALF) is a syndrome with high mortality.Objective
Describe characteristics and outcomes of patients with ALF in Uruguay, and identify factors associated with mortality.Methods
A retrospective analysis of 33 patients with ALF was performed between 2009 and 2017.Results
The patients' median age was 43 years, and 64% were women. Average Model for End-Stage Liver Disease (MELD) score at admission was 33. The median referral time to the liver transplant (LT) center was 7 days. The most common etiologies were viral hepatitis (27%), indeterminate (21%), autoimmune (18%), and Wilson disease (15%). Overall mortality was 52% (71% of transplanted and 46% of nontransplanted patients). Dead patients had higher referral time (10 vs 4 days, P = .008), higher MELD scores at admission (37 vs 28) and highest achieved MELD scores (42 vs 29; P < .001), and higher encephalopathy grade III to IV (94% vs 25%, P < .001) than survivors. Patients without LT criteria (n = 4) had lower MELD score at admission (25 vs 34, P = .001) and highest achieved MELD score (27 vs 37, P = .008) compared with the others. Patients with LT criteria but contraindications (n = 7) had higher MELD scores at admission (38 vs 31, P = .02), highest achieved MELD scores (41 vs 34, P = .03), and longer referral time (10 days) than those without contraindications (3.5 days) or those without LT criteria (7.5 days, P = .02). Twenty-two patients were listed; LT was performed in 7, with a median time on waiting list of 6 days.Conclusions
ALF in Uruguay has high mortality associated with delayed referral to the LT center, MELD score, and encephalopathy. The long waiting times to transplantation might influence mortality. 相似文献15.
K. Nanmoku T. Shinzato T. Kubo T. Shimizu T. Kimura T. Yagisawa 《Transplantation proceedings》2018,50(4):1050-1055
Background
The effectiveness of everolimus (EVR) for ABO-incompatible (ABOi) kidney transplantation is unknown. We evaluated outcomes of conversion from steroid to EVR in ABOi kidney transplant recipients.Methods
We performed a retrospective observational cohort study of 33 de novo consecutive adult ABOi living donor kidney transplant recipients. Desensitization was performed using 0 to 4 sessions of plasmapheresis and 1 to 2 doses of 100 mg rituximab according to the anti-A/B antibody titer. ABOi recipients were administered a combination of tacrolimus, mycophenolate mofetil, and methylprednisolone. Diabetic patients were converted from methylprednisolone to EVR at 1 to 15 months post-transplantation to prevent diabetes progression. Graft outcomes, hemoglobin A1c (HbA1c) levels, and cytomegalovirus infection rates were compared between the EVR (n = 11) and steroid (n = 22) groups.Results
Mean postoperative duration was 814 and 727 days in the EVR and steroid groups, respectively (P = .65). Between the 2 groups, graft survival rate (100% vs 95.5%, P > .99), acute rejection rate (9.1% vs 18.2%, P = .64), and serum creatinine levels (1.46 mg/dL vs 1.68 mg/dL, P = .66) were comparable. Although HbA1c levels were elevated in the steroid group (5.47%, 5.87%; P = .003), no significant deterioration was observed in the EVR group without additional insulin administration (6.10%, 6.47%; P = .21). Cytomegalovirus infection rate was significantly lower in the EVR group than in the steroid group (18.2% vs 63.6%, P = .026).Conclusion
Conversion from steroid to EVR in ABOi kidney transplant recipients maintained excellent graft outcomes and avoided diabetes progression and cytomegalovirus infection. 相似文献16.
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17.
S. González Martínez A. Molina Raya A. Becerra Massare K. Muffak Granero T. Villegas Herrera J.M. Villar del Moral Y. Fundora Suárez 《Transplantation proceedings》2018,50(2):595-597
Objectives
The score in the Model of End-stage Liver Disease, or MELD, is a good indicator of the survival in patients on the liver transplant waiting list. In this study, an analysis is performed on the benefits of liver transplant on those patients with a very high MELD score and who thus start from a very severe baseline state that could affect the surgical outcome.Materials and methods
A prospective study was conducted on a cohort of 331 patients that received a liver transplant between 2002 and 2014. The patients were divided into 2 groups according to the MELD score (<28 vs ≥28), and differences in age, postoperative complications, stay in the intensive care unit (ICU), hospital stay, and survival were compared.Results
Of the total of 331 patients, 21 (6.3%) had a MELD score ≥ 28. The mean age of the group with MELD score ≥ 28 was lower than the age in the group with MEDL score < 28 (42.5 vs 53.7 years; P < .0001). No significant increase was observed in postoperative complications. Although there were also no differences in survival, the group with MELD score ≥ 28 did have a longer stay in ICU and a longer hospital stay (with a mean of 6.7 days in ICU and 41.5 days admission vs 4.1 and 26.9, respectively).Conclusions
A very high MELD score is associated with a longer stay in ICU and more days of hospital admission, although no differences were observed in postoperative complications or survival. Therefore, there does not seem to be any contraindication in transplantation in this group of patients. 相似文献18.
P. Nadziakiewicz B. Szyguła-Jurkiewicz J. Pacholewicz M. Zakliczyński P. Przybyłowski A. Krauchuk M. Łowicka M. Zembala 《Transplantation proceedings》2018,50(7):2075-2079
Background
Model for End-Stage Liver Disease (MELD) score predicts multisystem dysfunction and death in patients with heart failure (HF). Left ventricular assist devices (LVADs) have been used for the treatment of end-stage HF.Aim of the study
We evaluated the prognostic values of MELD, MELD-XI, and MELD-Na scores in patients with POLVAD MEV LVAD.Materials and methods
We retrospectively analyzed data of 25 consecutive pulsatile flow POLVAD MEV LVAD patients (22 men and 3 women) divided in 2 groups: Group S (survivors), 20 patients (18 men and 2 women), and Group NS (nonsurvivors), 5 patients (4 men and 1 woman). Patients were qualified in INTERMACS class 1 (7 patients) and class 2 (18 patients). Clinical data and laboratory parameters for MELD, MELD-XI, and MELD-Na score calculation were obtained on postoperative days 1, 2, and 3. Study endpoints were mortality or 30 days survival. MELD scores and complications were compared between Groups S and NS.Results
20 patients survived, and 5 (4 men and 1 woman) died during observation. Demographics did not differ. MELD scores were insignificantly higher in patients who died (Group 2). Values were as follows: 1. MELD preoperatively (21.71 vs 15.28, P = .225) in day 1 (22.03 vs 17.14, P = .126), day 2 (20.52 vs 17.03, P = .296); 2. MELD-XI preoperatively (19.28 vs 16.39, P = .48), day 1 (21.55 vs 18.14, P = .2662), day 2 (20.45 vs 17.2, P = .461); and 3. MELD-Na preoperatively (20.78 vs 18.7, P = .46), day 1 23.68 vs 18.12, P = .083), day 2 (22.00 vs 19.19, P = .295) consecutively.Conclusions
The MELD scores do not identify patients with pulsatile LVAD at high risk for mortality in our series. Further investigation is needed. 相似文献19.
M. Yanishi H. Kinoshita H. Tsukaguchi Y. Kimura Y. Koito M. Sugi T. Matsuda 《Transplantation proceedings》2018,50(10):3371-3375
Introduction
Sarcopenia and osteopenia are highly prevalent in older patients, and are associated with a high risk for falls, fractures, and further functional decline. However, related factors in kidney transplant recipients suffering from osteosarcopenia, the combination of sarcopenia and osteopenia, remain unknown.Material and methods
Fifty-eight transplant recipients (42 men and 16 women), with a mean age of 46.6 ± 12.7 years, were enrolled in this study. Sarcopenia was diagnosed according to the criteria of the Asia Working Group for Sarcopenia. Osteopenia was diagnosed according to World Health Organization criteria using bone mineral density (BMD) of the lumbar spine. Patients who met the diagnostic criteria of both diseases were defined as having osteosarcopenia.Results
Ten patients had osteosarcopenia. According to univariate analyses, there were significant differences between osteosarcopenia group and non osteosarcopenia group in age (P = .002), duration of dialysis (P = .013), vitamin D levels (P = .002), and MET (P = .007). There was a significant positive correlation between vitamin D level and MET (r = .464; P < .001). The results of the multivariate analysis indicated that only MET was a relevant factor in osteosarcopenia.Conclusion
Duration of dialysis, low vitamin D levels, and physical activity after kidney transplantation were related to osteosarcopenia. These results suggested that osteosarcopenia in kidney transplant recipients is a carryover from the dialysis period. 相似文献20.
Mild to Moderate Intrapulmonary Shunting in Pediatric Liver Transplantation: Is Screening Necessary?
V.P. Mali A. Fukuda T. Shigeta H. Uchida H. Kanazawa Y. Hirata T. Rahayatri B. Chiaki K. Sasaki M. Kitamura S. Sakamoto M. Kasahara 《Transplantation proceedings》2018,50(10):3496-3500