Journal of Transplantation最新文献_第5页

The Kinetics of Anti-HLA Antibodies in the First Year after Kidney Transplantation: In Whom and When Should They Be Monitored? 肾移植后第一年抗hla抗体的动态:在谁和何时应该监测?

IF 2.5

Journal of Transplantation Pub Date : 2018-04-23 eCollection Date: 2018-01-01 DOI: 10.1155/2018/8316860

Maria Cristina Ribeiro de Castro, Erick A Barbosa, Renata P Souza, Fabiana Agena, Patrícia S de Souza, Gabriella Maciel, Hélcio Rodrigues, Nicolas Panajotopoulos, Daísa S David, Flávio J de Paula, Elias David-Neto

{"title":"The Kinetics of Anti-HLA Antibodies in the First Year after Kidney Transplantation: In Whom and When Should They Be Monitored?","authors":"Maria Cristina Ribeiro de Castro, Erick A Barbosa, Renata P Souza, Fabiana Agena, Patrícia S de Souza, Gabriella Maciel, Hélcio Rodrigues, Nicolas Panajotopoulos, Daísa S David, Flávio J de Paula, Elias David-Neto","doi":"10.1155/2018/8316860","DOIUrl":"https://doi.org/10.1155/2018/8316860","url":null,"abstract":"The impact of the kinetics of the anti-HLA antibodies after KTx on the occurrence of acute rejection as well as the better time-point to monitor anti-HLA Abs after transplantation is not completely defined. This prospective study followed 150 patients over 12 months after transplantation. Serum IgG anti-HLA Abs were detected by single antigen beads after typing donors and recipients for loci A, B, C, DR, and DQ. Before KTx, 89 patients did not present anti-HLA Abs and 2% developed \"de novo\" Abs during the 1st year, 39 patients were sensitized without DSAs, and 13% developed DSA after surgery; all of them presented ABMR. Sensitized patients presented higher acute rejection rates (36.4% versus 13.5%, p < 0.001), although 60% of the patients did not present ABMR. Patients, in whom DSA-MFI decreased during the first two weeks after surgery, did not develop ABMR. Those who sustained their levels presented a rate of 22% of ABMR. 85% of patients developed ABMR when MFIs increased early after transplantation (which occurred in 30% of the DSA positive patients). In the ABMR group, we observed an iDSA-MFI sharp drop on the fourth day and then an increase between the 7th and 14th POD, which suggests DSA should be monitored at this moment in sensitized patients for better ABMR prediction.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2018 ","pages":"8316860"},"PeriodicalIF":2.5,"publicationDate":"2018-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/8316860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36177855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Preoperative Low-Density Lipoprotein Apheresis for Preventing Recurrence of Focal Segmental Glomerulosclerosis after Kidney Transplantation. 术前低密度脂蛋白分离预防肾移植术后局灶节段性肾小球硬化复发。

IF 2.5

Journal of Transplantation Pub Date : 2018-04-02 eCollection Date: 2018-01-01 DOI: 10.1155/2018/8926786

Akihito Sannomiya, Toru Murakami, Ichiro Koyama, Kosaku Nitta, Ichiro Nakajima, Shohei Fuchinoue

{"title":"Preoperative Low-Density Lipoprotein Apheresis for Preventing Recurrence of Focal Segmental Glomerulosclerosis after Kidney Transplantation.","authors":"Akihito Sannomiya, Toru Murakami, Ichiro Koyama, Kosaku Nitta, Ichiro Nakajima, Shohei Fuchinoue","doi":"10.1155/2018/8926786","DOIUrl":"https://doi.org/10.1155/2018/8926786","url":null,"abstract":"Background: Focal segmental glomerulosclerosis (FSGS) often develops rapidly and frequently progresses to renal failure, while the recurrence rate after kidney transplantation is 20-50%. We performed low-density lipoprotein (LDL) apheresis before kidney transplantation in FSGS patients to prevent recurrence.Methods: Five adult patients with chronic renal failure due to FSGS undergoing living related donor kidney transplantation were investigated retrospectively. LDL apheresis was done 1-2 times before transplantation. Postoperative renal function and recurrence of FSGS were assessed.Results: The patients were two men and three women aged 24 to 41 years. The observation period ranged from 60 days to 22 months. Preoperative LDL apheresis was performed once in one patient and twice in four patients. Blood LDL cholesterol levels were normal before LDL apheresis and remained normal both after LDL apheresis and after kidney transplantation. Additional LDL apheresis was performed once in one patient with mild proteinuria after transplantation. The renal graft survived in all patients and there was no evidence of recurrent FSGS.Conclusions: Although the observation period was short, FSGS did not recur in all 5 patients receiving preoperative LDL apheresis. These results suggest that LDL apheresis can be effective in preventing recurrence of FSGS after kidney transplantation.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2018 ","pages":"8926786"},"PeriodicalIF":2.5,"publicationDate":"2018-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/8926786","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36138550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Role of Direct Antiviral Agents in Treatment of Chronic Hepatitis C Infection in Renal Transplant Recipients. 直接抗病毒药物在治疗肾移植受者慢性丙型肝炎感染中的作用。

IF 2.5

Journal of Transplantation Pub Date : 2018-03-28 eCollection Date: 2018-01-01 DOI: 10.1155/2018/7579689

Sourabh Sharma, Debabrata Mukherjee, Ranjith K Nair, Bhaskar Datt, Ananth Rao

{"title":"Role of Direct Antiviral Agents in Treatment of Chronic Hepatitis C Infection in Renal Transplant Recipients.","authors":"Sourabh Sharma, Debabrata Mukherjee, Ranjith K Nair, Bhaskar Datt, Ananth Rao","doi":"10.1155/2018/7579689","DOIUrl":"10.1155/2018/7579689","url":null,"abstract":"Background: Since the introduction of direct antiviral agents (DAAs), morbidity of HCV has considerably decreased but still no guidelines have been formulated in renal transplant recipients (RTRs). We studied efficacy and tolerability of direct antiviral agents in RTRs.Methods: This prospective observational study was conducted at Army Hospital Research & Referral, Delhi, from June 2016 to May 2017. Forty-five HCV infected RTRs with stable graft function were included.Results: Median time between renal transplantation and the start of anti-HCV therapy was 36 months (1-120 months). The majority (66.7%) were infected with genotype 3. Baseline median HCV RNA level was 542648 IU/ml (1189-55028534 IU/ml). Sofosbuvir-Ribavirin combination (24 weeks) was given to 30 patients including 3 cirrhotics, Ledipasvir-Sofosbuvir combination to 8 patients, and Daclatasvir-Sofosbuvir combination to 7 patients, including 2 cirrhotics. Rapid virological response was observed in 29 patients treated with Sofosbuvir/Ribavirin, all 8 patients on Sofosbuvir/Ledipasvir, and all 7 patients on Sofosbuvir/Daclatasvir. End treatment response and sustained virological response (12 weeks) were achieved in all patients irrespective of genotype or treatment regimen. Decrease in mean HCV RNA level and transaminase level was statistically significant (p < 0.01). Ribavirin was significantly associated with anaemia (p = 0.032).Conclusions: DAA regimens are well tolerated and highly efficacious. Response to DAA is good irrespective of genotype, drug combination, initial HCV RNA level, age or sex of patient, or graft age. However, Sofosbuvir/Ledipasvir and Sofosbuvir/Daclatasvir combination is preferable.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2018 ","pages":"7579689"},"PeriodicalIF":2.5,"publicationDate":"2018-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36127275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level. 稳定心脏移植患者的皮质类固醇断奶:血清皮质醇水平的指导。

IF 2.5

Journal of Transplantation Pub Date : 2018-02-18 eCollection Date: 2018-01-01 DOI: 10.1155/2018/3740395

David A Baran, Cheryl Rosenfeld, Mark J Zucker

{"title":"Corticosteroid Weaning in Stable Heart Transplant Patients: Guidance by Serum Cortisol Level.","authors":"David A Baran, Cheryl Rosenfeld, Mark J Zucker","doi":"10.1155/2018/3740395","DOIUrl":"https://doi.org/10.1155/2018/3740395","url":null,"abstract":"Background: Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement.Methods: We assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into one of two groups based on a screening morning cortisol level. Patients with a cortisol < 8 micrograms/deciliter were assigned to a \"maintenance\" group and the others were assigned to the weaning group and steroids were tapered off over 4-6 weeks. Patients were monitored on subsequent office visits for adrenal insufficiency and allograft rejection.Results: Thirty-one patients were enrolled (6 patients in the maintenance group and 25 in the steroid-weaning group). Mean follow-up was 10.2 ± 4 years for the weaning group and 9.0 ± 4.9 years in the maintenance group (p = 0.6). No cases of rejection were noted, nor did any patient resume steroid treatment following discontinuation.Conclusion: Steroids can be safely discontinued in stable heart transplant patients with an AM serum cortisol ≥ 8 micrograms/deciliter with appropriate outpatient follow-up. In this study, no patient suffered late rejection or clinically noted adrenal insufficiency.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2018 ","pages":"3740395"},"PeriodicalIF":2.5,"publicationDate":"2018-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3740395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36024408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation. 修补破碎的心:实体器官移植后应激性心力衰竭的治疗。

IF 2.5

Journal of Transplantation Pub Date : 2018-02-18 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9739236

N Thao Galván, Kayla Kumm, Michael Kueht, Cindy P Ha, Dor Yoeli, Ronald T Cotton, Abbas Rana, Christine A O'Mahony, Glenn Halff, John A Goss

{"title":"Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation.","authors":"N Thao Galván, Kayla Kumm, Michael Kueht, Cindy P Ha, Dor Yoeli, Ronald T Cotton, Abbas Rana, Christine A O'Mahony, Glenn Halff, John A Goss","doi":"10.1155/2018/9739236","DOIUrl":"https://doi.org/10.1155/2018/9739236","url":null,"abstract":"Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo's Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2018 ","pages":"9739236"},"PeriodicalIF":2.5,"publicationDate":"2018-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/9739236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36024409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Validation of a Survey Questionnaire on Organ Donation: An Arabic World Scenario. 器官捐献调查问卷的验证：阿拉伯世界的情况。

IF 2.5

Journal of Transplantation Pub Date : 2018-02-08 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9309486

Rajvir Singh, Tulika Mehta Agarwal, Hassan Al-Thani, Yousuf Al Maslamani, Ayman El-Menyar

{"title":"Validation of a Survey Questionnaire on Organ Donation: An Arabic World Scenario.","authors":"Rajvir Singh, Tulika Mehta Agarwal, Hassan Al-Thani, Yousuf Al Maslamani, Ayman El-Menyar","doi":"10.1155/2018/9309486","DOIUrl":"10.1155/2018/9309486","url":null,"abstract":"Objective: To validate a questionnaire for measuring factors influencing organ donation and transplant.Methods: The constructed questionnaire was based on the theory of planned behavior by Ajzen Icek and had 45 questions including general inquiry and demographic information. Four experts on the topic, Arabic culture, and the Arabic and English languages established content validity through review. It was quantified by content validity index (CVI). Construct validity was established by principal component analysis (PCA), whereas internal consistency was checked by Cronbach's Alpha and intraclass correlation coefficient (ICC). Statistical analysis was performed by SPSS 22.0 statistical package.Results: Content validity in the form of S-CVI/Average and S-CVI/UA was 0.95 and 0.82, respectively, suggesting adequate relevance content of the questionnaire. Factor analysis indicated that the construct validity for each domain (knowledge, attitudes, beliefs, and intention) was 65%, 71%, 77%, and 70%, respectively. Cronbach's Alpha and ICC coefficients were 0.90, 0.67, 0.75, and 0.74 and 0.82, 0.58, 0.61, and 0.74, respectively, for the domains.Conclusion: The questionnaire consists of 39 items on knowledge, attitudes, beliefs, and intention domains which is valid and reliable tool to use for organ donation and transplant survey.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2018 ","pages":"9309486"},"PeriodicalIF":2.5,"publicationDate":"2018-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5822804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35956765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management Strategies for Posttransplant Diabetes Mellitus after Heart Transplantation: A Review. 心脏移植术后糖尿病的治疗策略综述

IF 2.5

Journal of Transplantation Pub Date : 2018-01-29 eCollection Date: 2018-01-01 DOI: 10.1155/2018/1025893

Matthew G Cehic, Nishant Nundall, Jerry R Greenfield, Peter S Macdonald

{"title":"Management Strategies for Posttransplant Diabetes Mellitus after Heart Transplantation: A Review.","authors":"Matthew G Cehic, Nishant Nundall, Jerry R Greenfield, Peter S Macdonald","doi":"10.1155/2018/1025893","DOIUrl":"10.1155/2018/1025893","url":null,"abstract":"Posttransplant diabetes mellitus (PTDM) is a well-recognized complication of heart transplantation and is associated with increased morbidity and mortality. Previous studies have yielded wide ranging estimates in the incidence of PTDM due in part to variable definitions applied. In addition, there is a limited published data on the management of PTDM after heart transplantation and a paucity of studies examining the effects of newer classes of hypoglycaemic drug therapies. In this review, we discuss the role of established glucose-lowering therapies and the rationale and emerging clinical evidence that supports the role of incretin-based therapies (glucagon like peptide- (GLP-) 1 agonists and dipeptidyl peptidase- (DPP-) 4 inhibitors) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of PTDM after heart transplantation. Recently published Consensus Guidelines for the diagnosis of PTDM will hopefully lead to more consistent approaches to the diagnosis of PTDM and provide a platform for the larger-scale multicentre trials that will be needed to determine the role of these newer therapies in the management of PTDM.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2018 ","pages":"1025893"},"PeriodicalIF":2.5,"publicationDate":"2018-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1025893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35981200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 19

A Single Perioperative Injection of Dexamethasone Decreases Nausea, Vomiting, and Pain after Laparoscopic Donor Nephrectomy 腹腔镜供肾切除术后单次围手术期注射地塞米松可减少恶心、呕吐和疼痛

IF 2.5

Journal of Transplantation Pub Date : 2017-01-22 DOI: 10.1155/2017/3518103

Shigeyoshi Yamanaga, A. Posselt, C. Freise, Takaaki Kobayashi, M. Tavakol, Sang-Mo Kang

{"title":"A Single Perioperative Injection of Dexamethasone Decreases Nausea, Vomiting, and Pain after Laparoscopic Donor Nephrectomy","authors":"Shigeyoshi Yamanaga, A. Posselt, C. Freise, Takaaki Kobayashi, M. Tavakol, Sang-Mo Kang","doi":"10.1155/2017/3518103","DOIUrl":"https://doi.org/10.1155/2017/3518103","url":null,"abstract":"Background. A single dose of perioperative dexamethasone (8–10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). Methods. We performed a retrospective cohort study of living donors who underwent LDN between 2013 and 2015. Donors who received a lower dose (4–6 mg) (n = 70) or a higher dose (8–14 mg) of dexamethasone (n = 100) were compared with 111 donors who did not receive dexamethasone (control). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching. Results. The higher dose of dexamethasone reduced postoperative nausea and vomiting incidences by 28% (P = 0.010) compared to control, but the lower dose did not. Total opioid use was 29% lower in donors who received the higher dose than in control (P = 0.004). The higher dose was identified as an independent factor for preventing postoperative nausea and vomiting. Postoperative complication rates and hospital stays did not differ between the groups. After propensity-score matching, the results were the same as for the unmatched analysis. Conclusion. A single perioperative injection of 8–14 mg dexamethasone decreases antiemetic and narcotic requirements in the first 24 h, with no increase in surgical complications.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2017 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2017-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/3518103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44377671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 15

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss 冷缺血时间与夜班手术的风险平衡可能降低再手术率和围手术期移植物损失

IF 2.5

Journal of Transplantation Pub Date : 2017-01-19 DOI: 10.1155/2017/5362704

N. Emmanouilidis, Julius Boeckler, B. Ringe, A. Kaltenborn, F. Lehner, Hans-Friedrich Koch, J. Klempnauer, H. Schrem

{"title":"Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss","authors":"N. Emmanouilidis, Julius Boeckler, B. Ringe, A. Kaltenborn, F. Lehner, Hans-Friedrich Koch, J. Klempnauer, H. Schrem","doi":"10.1155/2017/5362704","DOIUrl":"https://doi.org/10.1155/2017/5362704","url":null,"abstract":"Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,…, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best R2 was identified. First and second derivative were then implemented into the curvature formula k(x) = f′′(x)/(1 + f′(x)2)3/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern f(x) = A · (1 + k · e(I · x)) with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM–6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2017-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/5362704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44677765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

Blood Transfusions and Tumor Biopsy May Increase HCC Recurrence Rates after Liver Transplantation 输血和肿瘤活检可能增加肝移植后HCC的复发率

IF 2.5

Journal of Transplantation Pub Date : 2017-01-05 DOI: 10.1155/2017/9731095

D. Seehofer, R. Öllinger, T. Denecke, M. Schmelzle, A. Andreou, E. Schott, J. Pratschke

{"title":"Blood Transfusions and Tumor Biopsy May Increase HCC Recurrence Rates after Liver Transplantation","authors":"D. Seehofer, R. Öllinger, T. Denecke, M. Schmelzle, A. Andreou, E. Schott, J. Pratschke","doi":"10.1155/2017/9731095","DOIUrl":"https://doi.org/10.1155/2017/9731095","url":null,"abstract":"Introduction. Beneath tumor grading and vascular invasion, nontumor related risk factors for HCC recurrence after liver transplantation (LT) have been postulated. Potential factors were analyzed in a large single center experience. Material and Methods. This retrospective analysis included 336 consecutive patients transplanted for HCC. The following factors were analyzed stratified for vascular invasion: immunosuppression, rejection therapy, underlying liver disease, age, gender, blood transfusions, tumor biopsy, caval replacement, waiting time, Child Pugh status, and postoperative complications. Variables with a potential prognostic impact were included in a multivariate analysis. Results. The 5- and 10-year patient survival rates were 70 and 54%. The overall 5-year recurrence rate was 48% with vascular invasion compared to 10% without (p < 0.001). Univariate analysis stratified for vascular invasion revealed age over 60, pretransplant tumor biopsy, and the application of blood transfusions as significant risk factors for tumor recurrence. Blood transfusions remained the only significant risk factor in the multivariate analysis. Recurrence occurred earlier and more frequently in correlation with the number of applied transfusions. Conclusion. Tumor related risk factors are most important and can be influenced by patient selection. However, it might be helpful to consider nontumor related risk factors, identified in the present study for further optimization of the perioperative management.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2017-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/9731095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45163375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 13