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Multiple intrahepatic arterio-portal fistulas are rare. The majority are isolated and occur secondary to liver trauma including iatrogenic interventions such as liver biopsy. Post–liver transplantation 18 cases have been reported, all secondary to an interventional radiological procedure. We report multiple bi-lobar arterio-portal fistulas in a liver transplant recipient recognized 1 year after transplantation. The donor died due to intracerebral bleeding following blunt head and abdominal trauma. In the present case, the etiology is not very clear. The patient was managed conservatively and to date has not required intervention. 相似文献
44.
J.C. Na J.S. Park M.-G. Yoon H.H. Lee Y.E. Yoon K.H. Huh Y.S. Kim W.K. Han 《Transplantation proceedings》2018,50(4):1018-1021
Background
Although renal function recovery of living kidney donors has been reported in a number of studies, many patients show poor recovery, and the long-term prognosis of these patients has not been well studied. In this investigation we explored the long-term prognosis of renal function in patients with chronic kidney disease (CKD) at 1 year after nephrectomy.Methods
Patients who underwent donor nephrectomy during the period from March 2006 to April 2014, with a follow-up creatinine study at 1 year postoperatively and more than 3 years of follow-up, were included in the study. Creatinine and estimated glomerular filtration rate (eGFR, using the Modification of Diet in Renal Disease formula) before and after surgery were studied. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood count, preoperative routine serum chemistry, and urine study results were reviewed.Results
Among 841 patients who had donor nephrectomy, 362 were included in the study. There were 111 patients (30.6%) with eGFR <60 mL/min/1.73 m2 at 1 year postsurgery, and the median follow-up period was 62.8 months (interquartile range [IQR] 42.0–86.3 months). The maximum eGFR after 3-year follow-up was studied, and 48 patients (43.2%) never recovered eGFR to >60 mL/min/1.73 m2. Age, history of hypertension, preoperative eGFR, and eGFR at 1 year were predictive factors at univariate analysis. Multivariate analysis of these factors was studied, and age (52.5 [IQR 47–55.7] vs 47 [IQR 7–53] years, odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02–1.15, P = .007), history of hypertension (16.7% vs 1.6%, OR 10.0, 95% CI 1.09–92.49, P = .042), and eGFR at 1 year (53.9 [IQR 50.3–56.0] vs 57.0 [IQR 54.2–58.4] mL/min/1.73 m2, OR 0.8, 95% CI 0.72–0.92, P = .002) remained as significant risk factors.Conclusion
Of all living donors, 15.7% had CKD after >3 years of follow-up. Close observation is warranted when donors have CKD after 1 year follow-up, as 43.2% fail to recover renal function. Patients who are older, have a history of hypertension, and have low eGFR at 1-year follow-up are especially at risk. 相似文献45.
Background
Single antigen bead assay (SAB) is a sensitive method for detecting HLA antibodies, but it does not specifically identify clinically relevant subsets. Recently, a new assay has been developed for detection of C3d bound to HLA antibody-antigen complex. We evaluated the C3d assay regarding its correlation with SAB in renal patients.Methods
A total of 138 serum samples from 109 sensitized patients were tested in parallel by SAB and C3d assay for detection of HLA class I antibodies. The relationship between C3d assay and SAB was analyzed for the numbers and median fluorescent intensity (MFI) values of the identified antibodies.Results
Of the 138 samples, 137 were positive on SAB; of the 137 SAB-positive samples, 76 were positive on C3d assay. A total of 3748 and 685 antibodies were identified by the SAB and the C3d assay, respectively. The maximal MFI values of the SAB in the 76 samples that were C3d assay-positive were significantly higher than those of the 61 samples that were C3d assay-negative (P < .05), with the median values of 17,057 and 6066, respectively. Only 11 (0.4%) of the 2905 antibodies with MFI < 10,000 on SAB vs 501 (59.4%) of the 843 antibodies with MFI > 10,000 on SAB were identified by C3d assay with MFI > 1000.Conclusions
The C3d assay positivity seems to be dependent on its MFI value on SAB. Further studies are needed to ascertain the clinical significance of C3d positivity by itself. 相似文献46.
A. Balhareth I.S. Reynolds J.G. Solon E. Gibbons Harte F. Boland J.M. O&#x;Sullivan J.P. Burke D. Little D.A. McNamara 《Transplantation proceedings》2018,50(10):3434-3439
Background
Renal transplantation is associated with an increased risk of neoplasia, including colorectal cancer (CRC). Advances in surgical techniques and immunosuppressive medications have resulted in increased survival rates of both patients and grafts, but the incidence of CRC in the Irish renal transplant population is currently unknown. The aim of this study is to review the incidence of CRC in the Irish renal transplant population and compare it to the general population.Methods
A retrospective review of a prospectively maintained database of all renal transplant recipients in Ireland between January 1980 and July 2017 was performed.Results
Thirty-three out of 4230 transplant recipients (men = 20, women = 13) developed CRC subsequent to transplantation and were eligible for inclusion in the series. The mean age at transplantation was 51.5 years, with patients developing CRC on average 10.9 years post-transplantation; 6.1% (n = 2/33) had stage IV disease at diagnosis. The majority of patients (87.8%) had a pathologic T stage of T3/T4 and 45.5% had involvement of locoregional lymph nodes (N1/N2); 42.4% also had a mucinous component at histopathologic assessment. The incidence of CRC was higher in the transplant population compared to the general population.Conclusion
This is the first population-based assessment of CRC development in the Irish renal transplant population. Our data suggest that Irish transplant recipients have an increased risk of being diagnosed with a more advanced tumor than the general population, with most being diagnosed almost a decade after transplantation. This highlights the need for increased awareness among patients and clinicians and the potential need for coordinated lifelong surveillance of this patient population to ensure early detection and treatment. 相似文献47.
Fenton H. McCarthy Sreekanth Vemulapalli Zhuokai Li Vinod Thourani Roland A. Matsouaka Nimesh D. Desai Ajay Kirtane Saif Anwaruddin Matthew L. Williams Jay Giri Prashanth Vallabhajosyula Robert H. Li Howard C. Herrmann Joseph E. Bavaria Wilson Y. Szeto 《The Annals of thoracic surgery》2018,105(4):1121-1128
48.
Andrea M. Steely Peter W. Callas Patrick K. Hohl David J. Schneider Randall R. De Martino Daniel J. Bertges 《Journal of vascular surgery》2018,67(1):279-286.e2
Objective
The objective of this study was to investigate adherence to practice guidelines for antiplatelet and statin use after postoperative myocardial infarction (POMI) and its effect on late mortality following vascular surgery in a multicenter registry.Methods
Antiplatelet and statin use was examined in 1749 vascular surgery procedures with POMI within the Vascular Quality Initiative (VQI) from 2005 to 2015. Our primary aim was to assess cardiac medication (CM) use at discharge, defined as (1) single antiplatelet therapy (SAPT; aspirin or P2Y12 inhibitor) or dual antiplatelet therapy (DAPT; aspirin and P2Y12 inhibitor) and (2) statin therapy. Long-term mortality in patients with POMI was analyzed on the basis of discharge CM. A proportional hazards model was developed to control for factors associated with mortality. Regional differences in CM use at discharge after POMI were compared.Results
Overall discharge CM use after POMI included aspirin (81%), P2Y12 inhibitor (38%), statin therapy (76%), and combined antiplatelet and statin (74%). At discharge, 26% of patients were not receiving combined antiplatelet and statin therapy. SAPT (50%) was more common than DAPT (35%; P < .001). Patients with POMI undergoing carotid endarterectomy were more likely to be discharged on CM (80%) compared with patients undergoing infrainguinal bypass (78%), suprainguinal bypass (72%), endovascular aneurysm repair (71%), and open abdominal aortic aneurysm repair (59%; P < .001). Patients receiving SAPT or DAPT plus statin therapy had improved survival (79%) compared with those receiving noncombination or no therapy (69%) with mean follow-up of 5.5 years and 4.9 years, respectively (log-rank, P = .001). After adjustment for covariates including preoperative medications, treatment with SAPT or DAPT plus statin at discharge was associated with lower late mortality compared with noncombination or no therapy (hazard ratio, 0.72; 95% confidence interval, 0.56-0.93; P = .01). Regional variation in CM at discharge following POMI was also observed with a range of 33% to 100% (P = .05).Conclusions
Within the VQI, regional and procedure-specific variation exists in CM regimen after POMI following vascular surgery. Absence of combined antiplatelet and statin therapy at discharge after POMI was associated with higher late mortality and represents an area for quality improvement in the care of these patients. 相似文献49.
50.