Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 5 Articles
Background: Health related quality of life (HRQOL) is patient-reported, and an important treatment outcome\nfor patients undergoing renal replacement therapy. Whether HRQOL in dialysis can affect mortality or graft\nsurvival after renal transplantation (RTX) is not determined. The aims of the present study were to investigate\nwhether pretransplant HRQOL is associated with post-RTX patient survival or graft function, and to assess\nwhether improvement in HRQOL from dialysis to RTX is associated with patient survival.\nMethods: In a longitudinal prospective study, HRQOL was measured in 142 prevalent dialysis patients\n(67 % males, mean age 51 Ã?± 15.5 years) who subsequent underwent renal transplantation. HRQOL could\nbe repeated in 110 transplant patients 41 (IQR 34ââ?¬â??51) months after RTX using the self-administered Kidney\nDisease and Quality of Life Short Form (KDQOL-SF) measure. Kaplan-Meier plots were utilized for survival\nanalyses, and linear regression models were used to address HRQOL and effect on graft function.\nResults: Follow-up time was 102 (IQR 97ââ?¬â??108) months after RTX. Survival after RTX was higher in patients\nwho perceived good physical function (PF) in dialysis compared to patients with poorer PF (p = 0.019). Low\nscores in the domain mental health measured in dialysis was associated with accelerated decline in graft\nfunction (p = 0.048). Improvements in the kidney-specific domains ââ?¬Å?symptomsââ?¬Â and ââ?¬Å?effect of kidney diseaseââ?¬Â\nin the trajectory from dialysis to RTX were associated with a survival benefit (p = 0.007 and p = 0.02,\nrespectively).\nConclusion: HRQOL measured in dialysis patients was associated with survival and graft function after RTX.\nThese findings may be useful in clinical pretransplant evaluations. Improvements in some of the kidney-specific\nHRQOL domains from dialysis to RTX were associated with lower mortality. Prospective and interventional\nstudies are warranted....
Background: Post-transplant lymphoproliferative disorder (PTLD) adversely affects patientsââ?¬â?¢ long-term outcome.\nMethods: The paired t test and McNemarââ?¬â?¢s test were applied in a retrospective 1:1 matched-pair analysis including\n36 patients with PTLD and 36 patients without PTLD after kidney or liver transplantation. Matching criteria were age,\ngender, indication, type of transplantation, and duration of follow-up. All investigated PTLD specimen were histologically\npositive for EBV. Risk-adjusted multivariable regression analysis was used to identify independence of risk factors for PTLD\ndetected in matched-pair analysis. The resultant prognostic model was assessed with ROC-curve analysis.\nResults: Patients suffering with PTLD had shorter mean survival (p = 0.004), more episodes of CMV infections or\nreactivations (p = 0.042), and fewer recipient HLA A2 haplotypes (p = 0.007), a tacrolimus-based immunosuppressive\nregimen (p = 0.052) and higher dosages of tacrolimus at hospital discharge (Tac dosage) (p = 0.052). Significant\nindependent risk factors for PTLD were recipient HLA A2 (OR = 0.07, 95 % CI = 0.01ââ?¬â??0.55, p = 0.011), higher Tac\ndosages (OR = 1.29, 95 % CI = 1.01ââ?¬â??1.64, p = 0.040), and higher numbers of graft rejection episodes (OR = 0.38,\n95 % CI = 0.17ââ?¬â??0.87, p = 0.023). The following prognostic model for the prediction of PTLD demonstrated good\nmodel fit and a large area under the ROC curve (0.823): PTLD probability in % = Exp(y)/(1 + Exp(y)) with y = 0.671\nâË?â?? 1.096 Ã?â?? HLA A2-positive recipient + 0.151 Ã?â?? Tac dosage âË?â?? 0.805 Ã?â?? number of graft rejection episodes.\nConclusions: This study suggests prognostic relevance for recipient HLA A2, CMV, and EBV infections or reactivations\nand strong initial tacrolimus-based immunosuppression. Patients with risk factors may benefit from intensified\nscreening for PTLD....
Although mesenchymal stromal cells (MSCs) possess immunomodulatory properties and exhibit\npromising efficacy against chronic graft-versus-host disease (cGVHD), little is known about the\nefficacy of MSCs in the prophylaxis of cGVHD after HLA-haploidentical hematopoietic stem-cell\ntransplantation (HLA-haplo HSCT).\nPatients and Methods\nIn this multicenter, double-blind, randomized controlled trial, we investigated the incidence and\nseverity of cGVHD among patients, and the changes in T, B, and natural killer (NK) cells after the\nrepeated infusion of MSCs.\nResults\nThe 2-year cumulative incidence of cGVHD in the MSCs group was 27.4% (95% CI, 16.2% to\n38.6%), compared with 49.0% (95% CI, 36.5% to 61.5%) in the non-MSCs control group (P = .021).\nSeven patients in the non-MSCs control group had severe lung cGVHD, but no patients in the MSCs\ngroup developed typical lung cGVHD (P = .047). After the MSC infusions, increasing memory\nB lymphocytes and regulatory T cells, as well as the ratio of type 1 T helper to type 2 T helper cells,\nwere observed, whereas the number of NK cells decreased.\nConclusion\nOur findings suggest that the repeated infusion of MSCs might inhibit cGVHD symptoms in patients\nafter HLA-haplo HSCT, accompanied by changes in the numbers and subtypes of T, B, and NK cells,\nleading to the acquisition of immune tolerance....
Background: Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive\nprocedure in the UK. The introduction of techniques to augment the subpectoral pocket has revolutionised the\nprocedure, but there is a lack of high-quality outcome data to describe the safety or effectiveness of these\ntechniques. Randomised controlled trials (RCTs) are the best way of comparing treatments, but surgical RCTs are\nchallenging. The iBRA (implant breast reconstruction evaluation) study aims to determine the feasibility, design\nand conduct of a pragmatic RCT to examine the effectiveness of approaches to IBBR.\nMethods/design: The iBRA study is a trainee-led research collaborative project with four phases:\nPhase 1 ââ?¬â?? a national practice questionnaire (NPQ) to survey current practice\nPhase 2 ââ?¬â?? a multi-centre prospective cohort study of patients undergoing IBBR to evaluate the clinical and\npatient-reported outcomes\nPhase 3ââ?¬â?? an IBBR-RCT acceptability survey and qualitative work to explore patientsââ?¬â?¢ and surgeonsââ?¬â?¢ views of\nproposed trial designs and candidate outcomes.\nPhase 4 ââ?¬â?? phases 1 to 3 will inform the design and conduct of the future RCT All centres offering IBBR will be encouraged to participate by the breast and plastic surgical professional\nassociations (Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons).\nData collected will inform the feasibility of undertaking an RCT by defining current practice and exploring issues\nsurrounding recruitment, selection of comparator arms, choice of primary outcome, sample size, selection criteria,\ntrial conduct, methods of data collection and feasibility of using the trainee collaborative model to recruit patients\nand collect data.\nDiscussion: The preliminary work undertaken within the iBRA study will determine the feasibility, design and\nconduct of a definitive RCT in IBBR. It will work with the trainee collaborative to build capacity by creating an\ninfrastructure of research-active breast and plastic surgeons which will facilitat...
Background: Ventricular assist devices (VAD) are valuable options for patients with heart failure awaiting cardiac\ntransplantation. We assessed the impact of pre-transplant VAD implantation on the incidence of post-transplant\ninfections in a nationwide cohort of heart transplant recipients.\nMethods: Heart transplant recipients included in the Swiss Transplant Cohort Study between May 2008 and December\n2012 were analyzed. Cumulative incidence curves were used to calculate the incidence of bacterial or Candida\ninfections (primary endpoint) and of other infections (secondary endpoint) after transplant. Cox regression models\ntreating death as a competing risk were used to identify risk factors for the development of infection after transplant.\nResults: Overall, 119 patients were included in the study, 35 with a VAD and 84 without VAD. Cumulative incidences\nof post-transplant bacterial or Candida infections were 37.7 % in VAD patients and 40.4 % in non-VAD patients. In\nmultivariate analysis, the use of cotrimoxazole prophylaxis was the only variable associated with bacterial/Candida\ninfections after transplant (HR 0.29 [95 % CI 0.15-0.57], p < 0.001), but presence of a VAD was not (HR 0.94, [95 % CI\n0.38-2.32], p = 0.89, for continuous-flow devices, and HR 0.45 [0.15 ââ?¬â?? 1.34], p = 0.15, for other devices). Risk for\npost-transplant viral and all fungal infections was not increased in patients with VAD. One-year survival was\n82.9 % (29/35) in the VAD group and 82.1 % (69/84) in the non-VAD group. All 6 patients in the VAD group\nthat died after transplant had a history of pre-transplant VAD infection.\nConclusion: In this nationwide cohort of heart transplant recipients, the presence of VAD at the time of transplant\nhad no influence on the development of post-transplant infections....
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