Liver transplantation in patients aged 65 and over: a case–control study

Montalti R, Rompianesi G, Di Benedetto F, Ballarin R, Gerring RC, Busani S, De Pietri L, De Ruvo N, Iemmolo RM, Guerrini GP, Smerieri N, Gerunda GE. Liver transplantation in patients aged 65 and over: a case–control study.
Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2010.01230.x.
© 2010 John Wiley & Sons A/S. Abstract: Introduction: The average age of patients undergoing liver transplantation (LT) is consistently increasing. The aim of this case–control study is to evaluate survival and outcome of patients ≥65 yr compared to younger patients undergoing LT. Materials and methods: From 10/00 to 4/08 we performed 330 primary LT, 31 (9.4%) of these were in patients aged 65–70. Following a case–control approach, we compared these patients with 31 patients aged between 41 and 64 yr and matched according to sex, LT indication, viral status, cadaveric/living donor, LT timing, and Model for End‐Stage Liver Disease (MELD) score. Results: There were no statistically significant differences in demographic and surgical donor characteristics. The mean MELD score was under 18 in both groups. Post‐LT complications occurred with a similar incidence in the two groups. one‐, three‐, and five‐yr survival was 83.9%, 80.6%, and 80.6%, respectively, for the elderly group, and 80.6%, 73.8%, and 73.8%, respectively, for the young group (p = 0.61). Discussion: Patients aged between 65 and 70 with low MELD score who undergo LT have the same short‐ and middle‐term survival expectancy, morbidity, and outcome quality as younger patients with the same indication and same pre‐LT pathology severity, whatever they might be. Thus, chronological age alone should not deter LT workup in patients >65 and <70.     

Association between male accesory gland infections and prostate cancer in Turkish men: A case–control study

It is well known that chronic inflammation contributes to several forms of human cancer. Although several studies have investigated the association between prostatitis and prostate cancer, there is a lack of specifically designed study about male accessory gland infections (MAGI) and prostate cancer co‐occurrence. We aimed to investigate this association with a case–control study in Turkish men. A total of 155 patients were enrolled to the study. After the pathological examination of the transrectal ultrasound‐guided prostate biopsy specimens, patients were divided the two groups as control and prostate cancer and the presence of MAGI was determined. Of 155 patients, 145 met inclusion criteria. In the prostate cancer group, MAGI diagnose was determined in 18 of 31 patients (58.06%), while it was determined in 25 of 114 (21.93%) patients in the control group (p = .001). A significant correlation between MAGI and pathological Gleason score also revealed (p = .0001). We demonstrated that men with MAGI have increased risk for the development of prostate cancer. Moreover, in this population, most of the prostate cancers tend to be clinically significant or high grade.     

Calcium, dairy products, and the risk of prostate cancer.

BACKGROUND: Calcium intake has been suggested to play a role in the etiology of prostate cancer, since it is inversely related to vitamin D levels, which, in turn, would have an antiproliferative effect on human cancer cell lines. The hypothesis that high calcium and low vitamin D levels are associated with prostate cancer risk, however, remains unconvincingly demonstrated. METHODS: This relation was investigated in a case-control study of prostate cancer conducted in Northern Italy between 1985 and 1992 on 288 cases and 762 controls admitted to hospital for acute non-neoplastic diseases. RESULTS: No significant relation was found for calcium intake: compared to the lowest quintile of intake, the multivariate odds ratios (OR) of prostatic cancer, after adjusting for age, study center, education, body mass index, and meat intake, for increasing intake quintiles were 1.21, 0.68, 0.64, 1.12, with no trend in risk. The OR was 0.99 for an increment of 500 mg per day of calcium. The risk estimates were consistent in two strata of age (< 65 and > or = 65 years at diagnosis). CONCLUSIONS: Our results do not support an association between calcium and the risk of prostate cancer. However, the present study cannot address the effect of calcium in the ranges where an increased risk of prostate cancer has been noted previously, and with specific reference to advanced disease.     

Improvement in late renal allograft survival between 1990 and 2002 in Spain: results from a multicentre case–control study

Epidemiological studies have failed to show an improvement in graft survival beyond 1 year after kidney transplantation possibly because of an increased number of expanded donors and older recipients. Thus, we performed a case–control study matching patients transplanted in different eras by donor and recipient characteristics. We considered renal transplant recipients included in the database of the Spanish Chronic Allograft Dysfunction Study Group in 1990, 1994, 1998 and 2002 (n = 4842). We matched patients from these cohorts considering the following variables: donor and recipient age, cause of donor death, hepatitis C virus, panel reactive antibodies and re‐transplantation. We identified a total of 896 patients distributed in four cohorts of 224 matched patients. Between 1990 and 2002, the use of cyclosporin decreased (96%, 94%, 80% and 23% respectively, P = 0.001), while the use of tacrolimus increased (0%, 1%, 15% and 63% respectively, P = 0.001) and the prevalence of acute rejection decreased (46%, 37.9%, 20.6% and 15.8% respectively, P < 0.001). One‐year serum creatinine was 1.63 ± 0.66, 1.64 ± 0.70, 1.44 ± 0.52 and 1.38 ± 0.75 respectively, P = 0.001. Graft survival beyond the first year between 1990 and 2002 significantly improved while patient survival did not. Transplant outcome has improved between 1990 and 2002 when donors and recipients of similar characteristics are compared.     

Farm‐level risk factors associated with bovine tuberculosis in the dairy sector in Eritrea

The aim of our study was to determine the association of selected potential risk factors with the presence of bovine tuberculosis (BTB ) in dairy herds in Eritrea. A case–control study was conducted in the three major milk‐producing regions of the country by stratified random sampling of 61 case and 65 control herds combined with completion of a standardized pretested questionnaire pertaining 36 relevant risk factors (variables). The variables were divided into two clusters, based on potential association with either “introduction” or “establishment” of BTB on the farms to elucidate association with incident or prevalent cases separately. Subsequent to univariable analysis of the 36 risk factors at herd level, 14 of these were offered to multivariable logistic regression models. Farms with higher numbers of cows, and those with concrete floors, were 3.6, and 7.5 times more at risk for presence of BTB , respectively, compared with their references. These findings will be useful as entry points for future informed decision‐making towards BTB control and eradication programme in the country.     

Liver transplantation using grafts of living donors with isolated unconjugated hyperbilirubinemia: a matched case–control study

Unconjugated bilirubin has shown both cytotoxic and cytoprotective effects, acting as either an oxidant or an antioxidant. Elevated unconjugated bilirubin with otherwise normal, so‐called isolated unconjugated hyperbilirubinemia (IUHB), is encountered frequently in living liver donor evaluation. However, the significance of IUHB on transplantation‐related outcomes has not been clarified in donors and recipients. Forty‐six living donors with IUHB were matched 1:1 with the control donors and 43 recipients who received grafts from donors with IUHB were matched 1:1 with the control recipients. Matched variables included donor/recipient age, residual liver volume, steatosis, cold ischemic time, graft versus recipient weight ratio, the MELD score and others. Donors in the control and IUHB group were comparable regarding the maximum postoperative transaminase concentrations, postoperative complications, and hospital stay. Recipients in the control and IUHB group were comparable regarding primary graft dysfunction, major postoperative complications, long‐term ICU/hospital stay, 1‐year mortality, and rejection rate, as well as recipient/graft survival rates. Recipients' unconjugated bilirubin concentration at 3 years after transplantation was higher in IUHB group with otherwise comparable liver function. It was concluded that living donor liver transplantation is safe for donors with IUHB and their recipients.     

Interstitial pneumonitis caused by everolimus: a case–cohort study in renal transplant recipients

The use of inhibitors of the mammalian target of rapamycin (mTORi) in renal transplantation is associated with many side effects, the potentially most severe being interstitial pneumonitis. Several papers have reported on sirolimus‐induced pneumonitis, but less is published on everolimus‐induced pneumonitis (EIP). Data on risk factors for contracting EIP are even more scarce. In the present case–cohort study in renal transplant recipients (RTR), we aimed to assess the incidence and risk factors of EIP after renal transplantation. This study is a retrospective substudy of a multicenter randomized controlled trial. All patients included in the original trial and treated with prednisolone/everolimus were included in this substudy. RTR who developed EIP were identified as cases. RTR without pulmonary symptoms served as controls. Thirteen of 102 patients (12.7%) developed EIP. We did not find any predisposing factors, especially no correlation with everolimus concentration. On pulmonary CT scan, EIP presented with an organizing pneumonia‐like pattern, a nonspecific interstitial pneumonitis‐like pattern, or both. Median time (range) to the development of EIP after start of everolimus was 162 (38–407) days. In conclusion, EIP is common in RTR, presenting with an organizing pneumonia, a nonspecific interstitial pneumonitis‐like pattern, or both. No predisposing factors could be identified (Trial registration number: NTR567 ( www.trialregister.nl ), ISRCTN69188731).     

Association of the ABCG2 C421A polymorphism with prostate cancer risk and survival

OBJECTIVE

To determine if the C421A single nucleotide polymorphism (SNP) in the ATP‐binding cassette transporter ABCG2 increases prostate cancer risk or affects survival.

PATIENTS, SUBJECTS AND METHODS

Numerous studies have suggested that dietary, hormonal and environmental factors all play a role in the initiation in prostate cancer; among these, the carcinogenic heterocyclic amine 2‐amino‐1‐methyl‐6‐phenylimidazo[4,5‐b]pyridine (PhIP), a known substrate of the ABCG2. A SNP of ABCG2, C421A, resulting in a glutamine to lysine change at amino acid 141, has been shown to result in decreased function of the protein. Due to the expression of ABCG2 in the prostate, together with the purported role of dietary carcinogens and steroids in the development and progression of prostate cancer, 311 individuals were genotyped for the ABCG2 C421A SNP, 170 patients with androgen‐independent prostate cancer (AIPC) and 141 ‘healthy’ controls. We also evaluated the effect of this SNP on the intracellular accumulation of PhIP and testosterone in vitro.

RESULTS

There were no significant differences in the prevalence of prostate cancer based on ABCG2 genetic variation in this population. However, survival was significantly longer for individuals with wild‐type ABCG2, as compared with those hetero‐ or homozygous for the C421A SNP (7.4 years vs 5.3 years, P = 0.044). Intracellular accumulation of PhIP was 80% higher in HEK293 cells transfected with Q141K ABCG2 than in wild‐type cells, confirming that this SNP decreases transport of PhIP. In contrast, testosterone was not transported by either wild‐type or variant transfected cells, nor did it act as in inhibitor of ABCG2 in subsequent transport assays.

CONCLUSION

Increased exposure to PhIP may decrease survival, but the ABCG2 C421A polymorphism does not appear to increase the risk of prostate cancer.     

Gestational Age and the Risk of Maternal Breast Cancer: A Population‐Based Case–Control Study

There is limited evidence that the gestational age at delivery may influence the risk of maternal breast cancer. While extreme prematurity has been suggested to increase the risk, there seems to be no study available so far that investigates the due effects of a late delivery. This research aimed to identify the impact of both preterm and late deliveries on the risk of maternal breast cancer within a period of 5 years after birth. Our dataset was created by linking data from the Nevada Cancer Registry database (1995–2008) and the birth certificates issued by the Nevada State Health Division (1994–2003). The study cohort consisted of 213,250 women who gave birth from January 1, 1994 to December 31, 2003. We performed a nested population‐based case – control study on 126 Nevada mothers with a first lifetime breast cancer diagnosed from January 1, 1995 through December 31, 2003, and 504 Nevada cancer‐free mothers. Women with pregnancies who progressed beyond 40 weeks of gestation were at a significantly lower risk of developing breast cancer for the 5‐year period following a delivery, when compared to women who delivered at 37–40 weeks of gestation (OR: 0.33, 95% CI: 0.11–0.92) in a multivariate model. Additional pregnancy characteristics did not significantly predict the risk of maternal breast cancer. Pregnancies that extended beyond 40 weeks of gestation were strongly associated with a lower likelihood of premenopausal breast cancer. Biological plausibility for this association may correspond to the fact that as pregnancy develops into more advanced stages, mammary cells have more time to attain complete differentiation and maturation; a process that starts early in the third trimester.