Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 5 Articles
Epstein-Barr virus (EBV)-associated B-cell post-transplantation lymphoproliferative\ndisorder (PTLD) is a severe complication following solid-organ\ntransplantation (SOT) and allogeneic hematopoietic stem cell transplantation\n(HSCT). We present a case of a 15-year-old male developing a monomorphic\nB-cell PTLD after receiving an allogenic stem cell transplant for acute acute\nmyeloid leukemia. A diagnostic lymph node biopsy revealed monomorphic\ntype, B cell phenotype, associated with Epstein-Barr virus, consistent with\npost-transplant lymphoproliferative disorder (PTLD). The morbidity and\nmortality of PTLD are high, and there is no standard protocol for treatment\nof PTLD. To prevent the occurrence of PTLD and early intervention are important\nfor the prognosis of patients....
Background: The effect of a kidney transplant on a recipient extends beyond the restoration of kidney function.\nHowever, there is limited qualitative analysis of recipient perspectives on life following transplantation, particularly\nin the United States. To understand the full patient experience, it is necessary to understand recipient views on life\nadjustments after kidney transplantation, medical management, and quality of life. This could lead to improvements\nin recipient care and sense of well-being.\nMethods: We conducted a paper-based survey from March 23 to October 1, 2015 of 476 kidney transplant recipients\nat the University of Michigan Health System in Ann Arbor, Michigan. We analyzed their open-ended responses using\nqualitative research methods. This is a companion analysis to a previous quantitative report on the closed-ended\nresponses to that survey.\nResults: Common themes relating to changes following transplantation included: improvements in quality of life, a\nreturn to normalcy, better health and more energy. Concerns included: duration of graft survival, fears about one day\nreturning to dialysis or needing to undergo another kidney transplant, comorbidities, future quality of life, and the cost\nand quality of their healthcare. Many recipients were grateful for their transplant, but some were anxious about the\nburdens transplantation placed on their loved ones.\nConclusions: While most recipients reported meaningful improvements in health and lifestyle after kidney transplantation,\na minority of participants experienced declines in energy or health status. Worries about how long the transplant will\nfunction, future health, and cost and quality of healthcare are prevalent. Future research could study the effects\nof providing additional information, programs, and interventions following transplantation that target these concerns.\nThis may better prepare and support kidney recipients and lead to improvements in the patient experience....
Background. In China, the cases of liver transplantation (LT) from donation after citizensâ?? death have rose year by year since the\ncitizen-based voluntary organ donor system was initiated in 2010. The objective of our research was to investigate the early\npostoperative and late long-term outcomes of LT from donation after brain death (DBD) and donation after circulatory death\n(DCD) according to the current organ donation system in China. Methods. Sixty-two consecutive cases of LT from donation\nafter citizensâ?? death performed in our hospital between February 2012 and June 2017 were examined retrospectively for shortand\nlong-term outcomes. These included 35 DCD LT and 27 DBD LT. Result. Subsequent median follow-up time of 19 months\nand 1- and 3-year graft survival rates were comparative between the DBD group and the DCD group (81.5% and 66.7% versus\n67.1% and 59.7%; P = 0 550), as were patient survival rates (85.2% and 68.7% versus 72.2% and 63.9%; P = 0 358). The duration\nof ICU stay of recipients was significantly shorter in the DBD group, in comparison with that of the DCD group (1 versus 3\ndays, P = 0 001).........................
Background: Inflammation is more common among African Americans (AAs), and it is associated with frailty, poor\nphysical performance, and mortality in community-dwelling older adults. Given the elevated inflammation levels\namong end-stage renal disease (ESRD) patients, inflammation may be associated with adverse health outcomes\nsuch as frailty, physical impairment, and poor health-related quality of life (HRQOL), and these associations may\ndiffer between AA and non-AA ESRD patients.\nMethods: One thousand three ESRD participants were recruited at kidney transplant evaluation (4/2014-5/2017),\nand inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-a receptor-1 [TNFR1], C-reactive protein [CRP])\nwere measured. We quantified the association with frailty (Fried phenotype), physical impairment (Short Physical\nPerformance Battery [SPPB]), and fair/poor HRQOL at evaluation using adjusted modified Poisson regression and\ntested whether these associations differed by race (AA vs. non-AA).\nResults: Non-AAs had lower levels of TNFR1 (9.7 ng/ml vs 14.0 ng/ml, p < 0.001) and inflammatory index (6.7 vs 6.8,\np < 0.001) compared to AAs, but similar levels of IL-6 (4.5 pg/ml vs 4.3 pg/ml, p > 0.9) and CRP (4.7 microg/ml vs 4.9 microg/ml,\np = 0.4). Non-AAs had an increased risk of frailty with elevated IL-6 (RR = 1.58, 95% CI:1.27-1.96, p < 0.001), TNFR1\n(RR = 1.60, 95% CI:1.25-2.05, p < 0.001), CRP (RR = 1.41, 95% CI:1.10-1.82, p < 0.01), and inflammatory index (RR = 1.82,\n95% CI:1.44-2.31, p < 0.001). The associations between elevated inflammatory markers and frailty were not present\namong AAs. Similar results were seen with SPPB impairment and poor/fair HRQOL.\nConclusions: Non-AAs with elevated inflammatory markers may need closer follow-up and may benefit from\nprehabilitation to improve physical function, reduce frailty burden, and improve quality of life prior to transplant....
Background: The diagnostic and prognostic utility of risk factors proposed by the 2012 American Heart Association\nand American College of Cardiology Foundation (AHA/ACCF) Scientific Statement on the cardiac assessment of\nasymptomatic liver transplantation candidates have not been validated. We investigated whether the sum of risk\nfactors proposed by the AHA/ACCF can identify liver transplant candidates at increased cardiac risk.\nMethods: In a retrospective cohort of consecutive liver transplantation recipients, we calculated, for each subject,\nthe pre-transplantation sum of AHA/ACCF risk factors (age > 60 years, prior cardiovascular disease, hypertension,\ndyslipidemia, diabetes mellitus, smoking, and left ventricular hypertrophy).........................
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