Short and long term outcomes of cardiac amyloidosis patients listed for heart transplantation in the united states: a propensity-matched analysis

Abstract Background Heart transplantation (HT) in cardiac amyloidosis (CA) patients has been historically controversial due to the risk of amyloid recurrence. However, recent single-center experiences suggest good outcomes in carefully selected patients. We sought to evaluate contemporary outcomes of CA patients listed for HT in the U.S. and evaluate predictors of survival Methods Using data from the United Network for Organ Sharing database on adult patients listed for a donor heart in the U.S. between 2010 and 2019, we identified 3 cohorts of patients, namely CA, dilated cardiomyopathy (DCM), and non-CA restrictive cardiomyopathy (RCM). Propensity-match analysis was used to compare primary outcomes of waitlist mortality and post-transplant graft survival between CA and DCM. Results Over the study period, 411 CA patients (mean age 62.7 years, 16.1% female) were added to the waitlist. In the propensity-matched cohorts, the rates of waitlist mortality were 33.7, 15.8, and 15.6 per 100 person-years for CA, DCM, and non-CA RCM, respectively. Compared to DCM, there was significantly higher waitlist mortality for CA (HR=1.75, 95% CI=1.16–2.65). Over the study period, 330 CA patients were transplanted with donor hearts. The 1-year graft survival rates for CA, DCM, and non-CA RCM were 89%, 92%, and 86%, respectively; and 5-year graft survival rates were 78%, 82%, and 76%, respectively. Graft survival for CA was significantly worse than DCM (HR=1.46, 1.03–2.08), and the two most significant risk factors for poor graft survival among CA patients were renal failure requiring dialysis while on the waitlist (HR=5.4, 1.6–17) and prior history of malignancy (HR=1.7, 1.0–29). CA patients with neither of the risk factor had 1- and 5-year graft survival that is comparable to those of DCM (HR=1.18, 0.81–1.74). On the other hand, CA patients with either of the risk factor had 1- and 5-year graft survival of 81% and 65%, respectively, (HR=2.33, 1.40–3.87, compared to DCM). Conclusion CA patients experience higher waitlist mortality and worse post-transplant graft survival compared to DCM. However, we identified two risk factors that can be used for further risk-stratification in these patients to achieve comparable graft survival as DCM. FUNDunding Acknowledgement Type of funding sources: None.

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Changing demographics, temporal trend in waitlist and post-transplant outcomes after heart transplantation in the United States: analysis of unos database 1991–2019

European Heart Journal ◽

10.1093/eurheartj/ehab724.0953 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Akintoye ◽

P Alvarez ◽

D Shin ◽

A Egbe ◽

A Panos ◽

...

Keyword(s):

Heart Transplantation ◽

Patient Selection ◽

Patient Characteristics ◽

The United States ◽

National Database ◽

Allocation Policy ◽

Post Transplant ◽

Transplant Outcomes ◽

Waitlist Mortality ◽

The U.S

Abstract Background The landscape of heart transplantation (HT) has changed significantly with respect to patient selection, surgical techniques, and patient outcomes. We sought to investigate temporal trends in patient characteristics, waitlist and post-transplant outcomes after HT in the U.S. Methods We queried the national database of the United Network of Organ Sharing (UNOS) to identify adults listed for HT in the U.S. between 1991 and 2019. Patients were divided into four eras based on the three time points in which changes were made to the patient selection/allocation policy (1999, 2006, and 2018), and patient characteristics as well as waitlist and post-transplant outcomes were evaluated for each era. Results Between 1991 and 2019, a total of 95,179 patients were added to the waitlist for HT in the U.S. Compared to era 1, patients listed in era 4 were older (mean age: 52.4 years), more female (27.6%) and ethnic minorities (40%), and with higher-risk comorbidities (28.8% diabetes, 35.6% obese). Over the study period, there were 22,070 waitlist deaths and 61,687 transplants. Compared to the preceding era, there was significant decrease in waitlist mortality in the last 2 eras (e.g., sub-hazard ratio for era 4 vs era 3 =0.37, 95% CI=0.32–0.44). For each year, only 27.1% to 40.5% of those on the waitlist were transplanted. Among those who were transplanted, there was increase in the rates of in-hospital stroke (2.8% in era 1 to 3.7% in era 4), renal failure requiring dialysis (7.2% to 17.1%), and hospital length of stay (14 to 17 days), p-values<0.001 for all. However, this has not negatively impacted short-term survival when compared to the preceding era (1-year graft survival = 89.7% in era 4). Based on a projection model, we predict a 47% increase in living adult heart transplant recipients to to 44,366 in 2040. Conclusion There have been significant changes in the characteristics of patients listed for HT in the U.S., including an increasing proportion of high-risk co-morbidities. Although the transplant volume has increased, the wide supply-demand gap persisted. The last 2 changes in the allocation policy in 2006 and 2018 achieved their primary objective of reducing waitlist mortality. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract 18229: Heart Transplantation for Genetic Cardiomyopathies is Associated With Favorable Long-Term Survival and Graft Outcomes

Circulation ◽

10.1161/circ.130.suppl_2.18229 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ziad Taimeh ◽

Kairav Vakil ◽

Cindy Martin ◽

Renuka Jain ◽

Monica Colvin

Keyword(s):

Heart Transplantation ◽

Graft Failure ◽

Cox Regression ◽

Survival Rates ◽

The United States ◽

Left Ventricular ◽

Term Survival ◽

Cox Regression Analysis ◽

Transplant Survival ◽

Post Transplant

Introduction and hypothesis: Genetic cardiomyopathies (GNCM) are a spectrum of myocardial disorders that can lead to heart failure, and frequently portend the need for heart transplantation. Post-transplant outcomes in this subgroup of patients have not been examined in a large, multicenter transplant cohort. Methods: Patients who underwent first-time heart transplantation in the United States between 1987 and 2012 were retrospectively identified from the United Network for Organ Sharing database. Patients with hypertrophic cardiomyopathy (HOCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and left ventricular non-compaction (LVNC) constituted the GNCM group. Primary outcome was survival. Secondary outcomes included rejection, cardiac allograft vasculopathy (CAV), and graft failure. Results: Of the 49,417 transplant recipients identified, 997 recipients (mean age 36±20 years; 55% males; 79% Caucasian) had GNCM (HOCM n=836; ARVC n=83; LVNC n=78). Patients transplanted for GNCM had significantly higher 1, 5 and 10 year survival rates compared to those without GNCM (86%, 76%, 66% vs. 82%, 69%, 50%, respectively, log-rank p<0.001) (Figure 1A). After adjusting for age, sex, and race in multivariate Cox regression analysis; GNCM was associated with favorable post-transplant survival, with a hazard ratio of 0.70 (95% confidence interval 0.58-0.86; p=0.001). While the incidence of rejection was similar in GNCM compared to non-GNCM (43% vs. 40%, p=0.11), the incidences of CAV and graft failure were significantly lower compared to non-GNCM (24% vs 32%, p<0.001, and 9% vs 15%, p<0.001, respectively). The survival rates for HOCM, ARVC, and LVNC, were all similar to each other but significantly higher compared to non-GNCM (log-rank p<0.001) (Figure 1B). Conclusions: Patients with GNCM seem to have better post-transplant survival and graft outcomes than patients transplanted for other cardiomyopathies.

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Urological Complications in Kidney Transplant Recipients: Analysis of the Risk Factors and Impact on Transplant Outcomes in the Era of “Extended Criteria Donors”

Transplantology ◽

10.3390/transplantology2010003 ◽

2021 ◽

Vol 2 (1) ◽

pp. 22-36

Author(s):

Roberta Angelico ◽

Marco Pellicciaro ◽

Francesca Venza ◽

Tommaso Maria Manzia ◽

Roberto Cacciola ◽

...

Keyword(s):

Risk Factors ◽

Graft Survival ◽

Survival Rates ◽

Graft Function ◽

Significant Risk ◽

Kidney Transplant Recipients ◽

Post Transplant ◽

Extended Criteria Donors ◽

Urological Complications

Urological complications (UC) following kidney transplantation (KT) are associated with increased morbidity. The aim of this study is to evaluate the risk factors for UC in the era of “extended criteria donors” (ECD) and their impact on patient and graft survivals. A retrospective monocentric study of all patients undergoing KT from 2010 to 2019 with a follow-up ≥30 days was performed. Out of 459 patients (males: 296 (64.5%); age: 57 (19–77) years) enrolled, 228 (49.7%) received ECD organs, moreover, 166 (67.2%) grafts had a cold ischemia time ≥10 h. UCs were reported in 32 (7%) patients. In 21 (65.6%) cases UC occurred within 3 months post-KT and 24 (5.2%) were associated with early urinary tract infection (UTI). The overall 5 year patient and graft survival rates were 96.5% and 90.6%, respectively. UC decreased graft survival (UC-group: 75.0% vs. noUC-group: 91.8%, p < 0.001), especially if associated with early UTI (UC-group: 71.4% vs. noUC-group: 77.8%, p < 0.001). At multivariate analysis, early UTI after KT (OR: 9.975, 95%-IC: 2.934–33.909, p < 0.001) and delayed graft function (DGF) (OR: 3.844, 95%-IC: 1.328–11.131, p: 0.013) were significant risk factors for UC, while ECD graft did not increase the risk of post-transplant UC. ECD grafts are not associated with UC. DGF and early UTI post-KT increase the risks of UC and reduce graft survival in the long-term. Therefore, aggressive management of early post-transplant UTI and strategies to reduce DGF incidence, such as machine preservation, are essential to prevent UC after KT.

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Abstract 6072: Waitlist Mortality for Infants Awaiting Heart Transplantation in the United States in the Current Era: Analysis of Data from the United Network for Organ Sharing

Circulation ◽

10.1161/circ.118.suppl_18.s_1055-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Doug Mah ◽

Tajinder Singh ◽

Ravi R Thiagarajan ◽

Kimberlee Gauvreau ◽

Gary E Piercey ◽

...

Keyword(s):

Risk Factors ◽

Heart Transplantation ◽

The United States ◽

Ecmo Support ◽

Ventilator Support ◽

White Race ◽

The Us ◽

Transplant Candidates ◽

Waitlist Mortality ◽

United Network

BACKGROUND UNOS (United Network for Organ Sharing) data suggest that of all pediatric transplant candidates, infants awaiting heart transplantation face the highest waitlist mortality. We sought to determine the mortality rate for waitlisted infants in the current era and to identify the risk factors associated with waitlist mortality. METHODS In this multi-center cohort study using the US Scientific Registry of Transplant Recipients, we analyzed all infants <12 months of age listed for first heart transplant between January 1999 and July 2006. Clinical and demographic characteristics were recorded at the time of listing. Multivariate logistic regression modeling was used to identify predictors of waitlist mortality. RESULTS In this six year period, 1133 patients less than 12 months of age were identified with a median age of 1 month (IQR 0 to 5 mo) and median weight of 4.0 kg (IQR 3.2 to 5.6 kg). 516 (45%) were female, 438 (39%) were non-white, 724 (64%) had congenital heart disease (CHD) and 910 (80%) were listed status 1A. Overall, 250 (22%) died while waiting including 179 (72%) listed at age <3 mo, 190 (76%) with CHD, 89 (35%) listed on mechanical ventilation, and 68 (27%) on ECMO. In multivariate analysis, risk factors for waitlist mortality (reported as hazard ratio, 95% CI) included age <3 months (1.5, 1.1–2.0), CHD (2.0, 1.5–2.7), ventilator support (2.0, 1.5–2.7), ECMO support (5.0, 3.6 –7.0) and non-white race (1.7, 1.4 –2.2). CONCLUSION Mortality of infants waiting for heart transplantation remains high with a 22% waitlist mortality in the current era. ECMO support, ventilator support, CHD, age less than 3 months, and non-white race were independently associated with waitlist mortality whereas listing status was not. Measures to improve donor availability for this age group and refinements in organ allocation to lower waitlist mortality are urgently needed.

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Outcome of Heart Transplants 15 to 20 Years Ago: Graft Survival, Post-transplant Morbidity, and Risk Factors for Mortality

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2008.01.019 ◽

2008 ◽

Vol 27 (5) ◽

pp. 486-493 ◽

Cited By ~ 47

Author(s):

Jean C. Roussel ◽

Olivier Baron ◽

Christian Périgaud ◽

Philippe Bizouarn ◽

Sabine Pattier ◽

...

Keyword(s):

Risk Factors ◽

Graft Survival ◽

Heart Transplants ◽

Post Transplant

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Characteristics of Hepatitis B virus induced Hepatocellular Carcinoma in Egyptian patients

QJM ◽

10.1093/qjmed/hcab107.006 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Mahmoud Fathy Barakat ◽

Khalid Mahmoud AbdAlaziz ◽

Mohamed Mahmoud Mahmoud El Tabbakh ◽

Mohamed Kamal Alden Ali

Keyword(s):

United States ◽

Risk Factors ◽

Hepatocellular Carcinoma ◽

Risk Factor ◽

Hepatitis C ◽

Hepatitis B ◽

The United States ◽

Age Difference ◽

Co Morbidity ◽

Incidence And Mortality

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is a leading cause of cancer-related death worldwide. In the United States, HCC is the ninth leading cause of cancer deaths. Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, incidence and mortality continue to rise. Cirrhosis remains the most important risk factor for the development of HCC regardless of etiology. Hepatitis B and C are independent risk factors for the development of cirrhosis. Alcohol consumption remains an important additional risk factor in the United States as alcohol abuse is five times higher than hepatitis C. Diagnosis is confirmed without pathologic confirmation. Screening includes both radiologic tests, such as ultrasound, computerized tomography, and magnetic resonance imaging, and serological markers such as αfetoprotein at 6-month interval. Aim To compare characteristics and behavior of Hepatocellular carcinoma (HCC) in chronic HCV patients and HVB patients Patients and Methods The current study was conducted on patients with de HCC presented at HCC clinic, Tropical medicine department Ain Shams University Hospitals between December 2017 and D ecember 2018, aged (18-70 years old) . Results eline characteristics of study population shown in Table 1 at enrolment, including gender, Education status, co-morbidity, underlying presence or absence of cirrhosis, Child-Pugh class of patients infected with viral hepatitis, and alpha-fetoprotein levels. Male proportion observed to be predominant in both HCV (62%) and HBV (75.4%) infected HCC population. Overall prevalence of HCV and HBV in patients having HCC was 65.95% and 34.04%, respectively. Presence of underlying liver cirrhosis was more significantly associated with HCV seropositives as compared to HBV seropositive patients (p0.05). Table 2 shows comparison of means between HCV and HBV seropositive patients with HCC. In univariate analysis, mean age difference (11.6 years), and total bilirubin levels (-1.91mg/dl) were the only statistically significant observations noted among HCV-HCC group (p = 0.05) Conclusion Hepatocellular carcinoma is mainly caused by Hepatitis C and Hepatitis B viruses, but latter showed predominance, comparatively worldwide and correlated HBV directly as a cause of HCC rather than HCV whose relation with HCC is still unclear (Shepard et al., 2006; Di Bisceglie, 2009). Because of the geographical differences and risk factors, the epidemiological burden of HCV and HBV has been observed different in different areas of the world. In developing countries due to high burden of HCV infection as compared to HBV such as in Taiwan (HCV 17.0%, HBV 13.8%) (Kao et al., 2011), Guam (HCV 19.6%, HBV 18%) (Haddock et al., 2013), and Pakistan (HCV 4.8%, HBV 2.5%) (Rehman et al., 1996; Raza et al., 2007; Qureshi et al., 2010; Butt et al., 2012;) will possibly

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Predictors for the Immediate and Long-Term Outcome of Avascular Surgical Procedure

Scandinavian Journal of Surgery ◽

10.1177/145749690909800307 ◽

2009 ◽

Vol 98 (3) ◽

pp. 164-168 ◽

Cited By ~ 4

Author(s):

J. Virkkunen ◽

M. Venermo ◽

J. Saarinen ◽

J. Salenius

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Predictive Value ◽

Surgical Procedure ◽

Operative Mortality ◽

Survival Rates ◽

Term Outcome ◽

Long Term Outcome

Background and Aims: The ability to predict post-operative mortality reliably will be of assistance in making decisions concerning the treatment of an individual patient. The aim of this study was to test the GAS score as a predictor of post-operative mortality in vascular surgical patients. Material and Methods: A total of 157 consecutive patients who underwent an elective vascular surgical procedure were included in the study. The Cox proportional hazards model was used in analyzing the importance of various preoperative risk factors for the postoperative outcome. ASA and GAS were tested in predicting the short and long-term outcome. On the basis of the GAS cut-off value 77, patients were selected into low-risk (GAS low: GAS < 77) and high-risk (GAS high: GAS > = 77) groups, and the examined risk factors were analyzed to determine which of them had predictive value for the prognosis. Results: None of the patients in the GAS low group died, and mortality in the GAS high group was 4.8% (p = 0.03) at 30 days' follow-up. The 12-month survival rates were 98.6% and 78.6% (p = 0.0001), respectively, with the respective 5-year survival rates of 76.7% and 44.0% (p = 0.0001). The only independent risk factor for 30-day mortality was the renal risk factor (OR 20.2). The combination of all three GAS variables(chronic renal failure, cardiac disease and cerebrovascular disease), excluding age, was associated with a 100% two-year mortality. Conclusions: Mortality is low for patients with GAS<77. For the high-risk patients (GAS> = 77), due to its low predictive value for death, GAS yields limited value in clinical practice. In cases of patients with all three risk factors (renal, cardiac and cerebrovascular), vascular surgery should be considered very carefully.

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Disparity in Risk Factor Severity for Early Childhood Blood Lead among Predominantly African-American Black Children: The 1999 to 2010 US NHANES

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17051552 ◽

2020 ◽

Vol 17 (5) ◽

pp. 1552 ◽

Cited By ~ 5

Author(s):

Deniz Yeter ◽

Ellen C. Banks ◽

Michael Aschner

Keyword(s):

Risk Factors ◽

Early Childhood ◽

African American ◽

Risk Factor ◽

Low Income ◽

Racial Disparity ◽

Blood Lead ◽

Black Children ◽

The United States ◽

American Black

There is no safe detectable level of lead (Pb) in the blood of young children. In the United States, predominantly African-American Black children are exposed to more Pb and present with the highest mean blood lead levels (BLLs). However, racial disparity has not been fully examined within risk factors for early childhood Pb exposure. Therefore, we conducted secondary analysis of blood Pb determinations for 2841 US children at ages 1–5 years with citizenship examined by the cross-sectional 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). The primary measures were racial disparities for continuous BLLs or an elevated BLL (EBLL) ≥5 µg/dL in selected risk factors between non-Hispanic Black children (n = 608) and both non-Hispanic White (n = 1208) or Hispanic (n = 1025) children. Selected risk factors included indoor household smoking, low income or poverty, older housing built before 1978 or 1950, low primary guardian education <12th grade/general education diploma (GED), or younger age between 1 and 3 years. Data were analyzed using a regression model corrected for risk factors and other confounding variables. Overall, Black children had an adjusted +0.83 µg/dL blood Pb (95% CI 0.65 to 1.00, p < 0.001) and a 2.8 times higher odds of having an EBLL ≥5 µg/dL (95% CI 1.9 to 3.9, p < 0.001). When stratified by risk factor group, Black children had an adjusted 0.73 to 1.41 µg/dL more blood Pb (p < 0.001 respectively) and a 1.8 to 5.6 times higher odds of having an EBLL ≥5 µg/dL (p ≤ 0.05 respectively) for every selected risk factor that was tested. For Black children nationwide, one in four residing in pre-1950 housing and one in six living in poverty presented with an EBLL ≥5 µg/dL. In conclusion, significant nationwide racial disparity in blood Pb outcomes persist for predominantly African-American Black children even after correcting for risk factors and other variables. This racial disparity further persists within housing, socio-economic, and age-related risk factors of blood Pb outcomes that are much more severe for Black children.

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U.S. Center for SafeSport: Preventing Abuse in Sports

Women in Sport and Physical Activity Journal ◽

10.1123/wspaj.2019-0049 ◽

2020 ◽

Vol 28 (1) ◽

pp. 66-71 ◽

Cited By ~ 3

Author(s):

Nicole Johnson ◽

Katie Hanna ◽

Julie Novak ◽

Angelo P. Giardino

Keyword(s):

United States ◽

Risk Factors ◽

Sexual Abuse ◽

Preliminary Data ◽

The United States ◽

Sport Organizations ◽

The Many ◽

And Training ◽

The U.S

While society at large recognizes the many benefits of sport, it is important to also recognize and prevent factors that can lead to an abusive environment. This paper seeks to combine the current research on abuse in the sport environment with the work of the U.S. Center for SafeSport. The inclusion of risk factors unique to sport and evidence-informed practices provides framing for the scope and response to sexual abuse in sport organizations in the United States. The paper then explores the creation and mission of the U.S. Center for SafeSport, including the role of education in prevention and of policy, procedures, audit, and compliance as important aspects of a comprehensive safeguarding strategy. This paper provides preliminary data on the reach of the Center, established in 2017. This data captures the scope of education and training and the increase in reports to the Center from within the U.S. Olympic and Paralympic Movement.

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Risk Factors for Development of Symptoms Post Autologous Transplant for Multiple Myeloma.

Blood ◽

10.1182/blood.v106.11.1771.1771 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1771-1771

Author(s):

Erica Campagnaro ◽

Rima Saliba ◽

Karen Anderson ◽

Linda Roden ◽

Floralyn Mendoza ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Symptom Burden ◽

Disease Status ◽

Female Gender ◽

Patient Characteristics ◽

The United States ◽

Charlson Score ◽

Female Ratio ◽

Post Transplant

Abstract Background: Multiple myeloma (MM) is the most common indication for autografting in the United States. Although safe, autografting can be associated with substantial morbidity due to the toxic side effects of chemotherapy. Strategies aimed at minimizing symptoms post autografting may result in better tolerance. The risk factors for symptom development post autografting for MM have not been well characterized. Purpose: To define pretransplant conditions which may be predictive of post-transplant symptom burden. Methods: We performed prospective evaluation of symptom burden among 64 myeloma patients undergoing autograft at MDACC as well as retrospective review of pretransplant variables including patient demographics, performance status, albumin, disease status, and Charlson Comorbidity Index (CCI). Univariate analysis was performed to correlate pretransplant variables with posttransplant symptom burden as defined by M.D. Anderson Symptom Inventory (MDASI) scores at different timepoints post transplant. Results: 64 patients were studied from 6/2000 to 5/2003. Patient characteristics are summarized in Table 1. Symptom burden increased from baseline to day 0 to nadir, with most patients returning to their baseline by day 30 post transplant (Figure 1). Table 2 summarizes the potential impact of pre-transplant variables on median MDASI scores at nadir. Patients with the highest MDASI scores at baseline had the highest MDASI scores at nadir in quartile analysis(p=.001). Patients with Charlson score of ≥ 3, age > 60, β 2M > 3, albumin ≤ 4, and female gender had a trend towards higher nadir MDASI scores. Other pre-transplant variables, including Durie-Salmon stage, LDH, hemoglobin, disease status at time of autograft, and time from diagnosis to autograft had no apparent correllation with symptom burden throughout transplant (data not shown). Conclusions: Autografting for MM is associated with significant but reversible symptom burden during the first 30 days of the procedure. Baseline symptom burden is the most important predictor of post transplant symptom burden. Other potential predictors include Charlson score, age, β 2M, albumin, and female gender. The MDASI scoring system is a potentially useful means of following symptom burden post autografting that could be used to assess interventions aimed at reducing transplant related morbidity in MM patients. Patient Characteristics Median (range) Age at transplantation, years 55.2 (30–74) Time to SCT, months 7.5 (2.5–73.3) Albumin at transplantation 3.74 (2.9–4.5) β2M at transplantation 3.79 (1.4–19.3) Charlson score at transplantation 3.48 (2–6) Disease status at transplantation n (%) First remission 42 (65.6) Primary refractory 14 (21.9) Other 8 (13.6) Preparative regimen n (%) Melphalan 53 (82.8) Other 11 (17.2) Male to female ratio 1.5 : 1 Impact of Pre-transplant Variables on Nadir MDASI Scores n Median (range) Charlson score < 3 50 22 (1–97) ≥ 3 14 41 (3–72) .09 Age ≤ 60 years 43 23 (1–97) > 60 years 21 31 (3–72) .2 β 2M ≤3.0 34 20 (1–85) > 3.0 27 28 (4–97) .2 Albumin ≤ 4.0 50 27 (1–97) > 4.0 14 19 (1–16) .2 Gender Female 26 30 (5–85) Male 38 23 (1–97) .2 Figure Figure

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