P0840RENAL FUNCTION AND RISK FACTORS IN LIVER TRANSPLANT PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gun Woo Kang ◽  
Seoung Gyu Kim ◽  
In Hee Lee ◽  
Ki Sung Ahn
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Univariate Analysis ◽  
Surgical Techniques ◽  
University Hospital ◽  
Post Transplantation ◽  
Term Survival ◽  
Significant Difference

Abstract Background and Aims Advanced surgical techniques and medical managements play major roles in improving patient survival after liver transplantation (LT). At the same time, identifying the causes and risk factors for long-term survival after LT are also important. Renal dysfunction following malignancy and infection is known as an important cause of mortality after LT. Various causes such as pre/post transplantation factors are known to affect renal function. The purpose of this study is to investigate the changes of renal function in patients undergoing LT and to identify factors that can predict long-term renal dysfunction. Method A retrospective study was performed on 113 patients aged 15 years or older who had undergone LT at Daegu Catholic University Hospital form January 2012 to December 2013. 97 patients survived and were followed up. Changes of renal function after LT were identified using serum creatinine every year up to 4 years. And all patients were divided into groups with increased creatinine (70 patients) and non-increased creatinine (27 patients) at 4 years after LT. pre-transplantation factors were blood urea nitrogen (BUN), creatinine, protein, albumin, hemoglobin, total bilirubin, international normalized ratio. Subsequent BUN and creatinine were compared by independent t test. Statistical analysis was performed with IBM SPSS Statistics for Window, Version 19.0. Results 58 were male (59.7%) and the mean age was 49.5 years old. 83 patients (85.6%) received liver transplantations from living donors. There were no significant differences in the donor types and recipient’s sex between the two groups with the increased and non-increased creatinine at 4 years after LT. However, the age of recipients was a significant difference between the two groups (51.3 and 45.4 years old) (p=0.018). Annual mean creatinine levels from pre-transplantation to 4 years after LT were 0.88 ± 0.39 (before transplant), 1.19 ± 0.54 (1 year after LT), 1.07 ± 0.44 (2 years), 1.12 ± 0.68 (3 years), and 1.19 ± 0.99 (4 years). Renal function decreased in 1 year after LT and improved in 2 years, then decreased again. In univariate analysis, the increased creatinine group was older than the non-increased group, and BUN and creatinine at 1 year after LT were significant differences in the two groups (p = 0.018, p = 0.031, p = 0.013). Multivariate analysis identified the creatinine at 1 year was an independent risk factor for long-term renal function after LT (OR 14.31, 95% CI: 1.5-133.3, p = 0.019). Conclusion This study explored that renal function was continuously decreased after LT and renal function at 1 year after LT had a significant effect on long-term renal function. Therefore, management of renal function during one year after LT is important for long-term renal function and may reduce mortality.

scholarly journals Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2455 ◽  
Author(s):  
Tsai-Jung Wang ◽  
Ching-Heng Lin ◽  
Hao-Ji Wei ◽  
Ming-Ju Wu
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Heart Transplantation ◽  
Renal Dysfunction ◽  
Heart Transplant ◽  
Kidney Injury ◽  
Dialysis Patients ◽  
Term Survival

Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.

scholarly journals Risk Factors in and Long-Term Survival of Patients with Post-Transplantation Diabetes Mellitus: A Retrospective Cohort Study

2020 ◽  
Vol 17 (12) ◽  
pp. 4581
Author(s):  
Ching-Yao Cheng ◽  
Cheng-Hsu Chen ◽  
Ming-Fen Wu ◽  
Ming-Ju Wu ◽  
Jun-Peng Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
High Body Mass Index ◽  
Post Transplantation ◽  
Term Survival ◽  
Cardiovascular Morbidity And Mortality

Post-transplant diabetes mellitus (PTDM) is associated with infection, cardiovascular morbidity, and mortality. A retrospective cohort study involving patients who underwent renal transplantation in a transplantation center in Taiwan from January 2000 to December 2018 was conducted to investigate the incidence and risk factors of PTDM and long-term patient and graft survival rates. High age (45–65 vs. <45 years, adjusted odds ratio (aOR) = 2.90, 95% confidence interval (CI) = 1.64–5.13, p < 0.001), high body mass index (>27 vs. <24 kg/m2, aOR = 5.35, 95% CI = 2.75–10.42, p < 0.001), and deceased organ donor (cadaveric vs. living, aOR = 2.01, 95% CI = 1.03–3.93, p = 0.04) were the three most important risk factors for the development of PTDM. The cumulative survival rate of patients and allografts was higher in patients without PTDM than in those with PTDM (p = 0.007 and 0.041, respectively). Concurrent use of calcineurin inhibitors and mammalian target of rapamycin inhibitors (mTORis) decreased the risk of PTDM (tacrolimus vs. tacrolimus with mTORi, aOR = 0.28, 95% CI = 0.14–0.55, p < 0.001). Investigating PTDM risk factors before and modifying immunosuppressant regimens after transplantation may effectively prevent PTDM development.

Abstract 15412: Long-term Outcomes of the Truncal Valve in Truncus Arteriosus

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Laura Gellis ◽  
Geoffrey Binney ◽  
Minmin Lu ◽  
Laith Alshawabkeh ◽  
John E Mayer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Discharge ◽  
Univariate Analysis ◽  
Truncus Arteriosus ◽  
Coronary Ostium ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Factors Associated ◽  
Single Coronary Ostium

Objectives: Long-term survival in patients with truncus arteriosus (TA) is favorable, but there remains significant morbidity associated with need for ongoing re-interventions. The purpose of this study was to understand the long-term outcomes of the truncal valve (TV) and identify risk factors associated with the need for TV intervention. Methods: We retrospectively reviewed 170 patients who underwent initial TA repair at our institution from 1985-2015. Analysis of long-term outcomes was performed on the 148 patients who survived greater than 30 days post-operatively and to hospital discharge using multivariable competing risks Cox regression modeling. Results: Median follow up time was 12.6 years (IQR 5.0, 22.1 years) after full repair. Freedom from death or transplant at 1, 5, 10, and 20 years was 93.1 ± 2.1%, 88.0 ± 2.7%, 86.2 ± 3.0% and 78.3 ± 4.1%. Thirty patients (20%) underwent at least one intervention on the TV (22 repairs, 21 replacements). Freedom from any TV intervention at 1, 5, 10 and 20 years was 99 ± 1%, 94 ± 8%, 82 ± 9%, and 70 ± 5%. Of those with TV repair, 59% subsequently underwent TV replacement. Independent risk factors for need for TV intervention included ≥moderate TV regurgitation (TVR) (HR 4.77, p<0.001) or stenosis (HR 4.12, p<0.001) prior to full repair, and ≥moderate TVR at initial hospital discharge after full repair (HR 8.6, p<0.001). A single coronary ostium was also independently associated with need for TV intervention (HR 6.94, p=0.01). Quadricuspid valve morphology and TV repair at initial TA repair, risk factors in univariate analysis, were not independent predictors on multivariable analysis. Overall, 28% of patients progressed to ≥moderate TVR and to Z-scores of greater than 5 for valve dimensions. Conclusion: Long-term need for TV intervention remains significant. Moderate or worse initial TVR or stenosis, residual TVR after initial TA repair, and single coronary ostium are risk factors associated with need for subsequent TV intervention.

Risk factors for long-term survival and renal function in 64 patients with rapidly progressive glomerulonephritis (RPGN)

1994 ◽  
Vol 4 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Frieder Keller ◽  
Christian Michaelis ◽  
Petra Büttner ◽  
Irmingard Bennhold ◽  
Anke Schwarz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Rapidly Progressive Glomerulonephritis ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Long-term clinical outcome of cardiogenic shock patients undergoing Impella CP treatment vs. standard of care

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Scherer ◽  
E Luesebrink ◽  
S Massberg ◽  
M Orban
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Vascular Complications ◽  
University Hospital ◽  
Circulatory Support ◽  
Term Survival ◽  
Long Term Outcome ◽  
Number Of Patients ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of patients treated with the mechanical circulatory support device Impella Cardiac Power (CP) for cardiogenic shock is steadily increasing. The aim of this study was to investigate long-term survival and complications related to this modality. Methods Patients undergoing Impella CP treatment for cardiogenic shock were retrospectively enrolled and matched with cardiogenic shock patients not treated with mechanical circulatory support between 2010 and 2020. Data were collected from the cardiogenic shock registry of our university hospital. Results 68 patients with refractory cardiogenic shock without mechanical circulatory support were matched with 68 patients treated with Impella CP. At presentation, the mean age was 67 ± 14 years with 82% being male in the group without support and 68 ± 14 years (p = 0.65) with 77% being male (p = 0.52) in the group with Impella. There was no significant difference in the rate of cardiac arrest (57% vs. 54%, p = 0.86) and myocardial infarction was the predominant cause of cardiogenic shock in both groups (66% vs. 74%, p = 0.34). A total of 46% of patients without cardiocirculatory support and 54% of patients with Impella support died during the first month (p = 0.32). After one year, mortality rates were similar in both groups (53% in conventional vs. 59% in Impella CP group, p = 0.51) as was mortality rate at long-term 5-years follow-up (73% in conventional vs. 72% in Impella CP group, p = 0.50). The rate of clinically significant bleedings during ICU stay was much lower in the conventional group than in the Impella support group (25% vs. 42%, p = 0.03). Conclusion In this small observational and non-randomized analysis no difference in long-term outcome between patients treated with Impella CP vs. guideline directed cardiogenic shock therapy without mechanical circulatory support could be detected. Care must be taken regarding the high rate of bleeding and vascular complications when using Impella CP. Large, adequately powered studies are urgently needed to investigate the efficacy and safety of Impella CP in cardiogenic shock.

Long-term follow-up of a phase III study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorable-prognosis germ-cell tumors: the Indian University experience.

1998 ◽  
Vol 16 (2) ◽  
pp. 702-706 ◽  
Author(s):  
S B Saxman ◽  
D Finch ◽  
R Gonin ◽  
L H Einhorn
Keyword(s):  
Germ Cell ◽  
Univariate Analysis ◽  
Germ Cell Tumors ◽  
Phase Iii ◽  
Term Survival ◽  
Favorable Prognosis ◽  
Significant Difference ◽  
Long Term Follow Up

PURPOSE In a previously reported randomized Southeastern Cancer Study Group (SECSG) trial, three cycles of chemotherapy were found to be equivalent to four cycles in patients with favorable-prognosis germ-cell cancer. We have conducted a follow-up analysis of patients treated at Indiana University (Indianapolis, IN) to compare long-term survival between the two groups and to examine factors associated with survival. PATIENTS AND METHODS Sixty-nine patients with minimal-stage and 49 patients with moderate-stage disseminated germ-cell tumors were randomized to either three or four courses of bleomycin, etoposide, and cisplatin (BEP) administered every 3 weeks. Median follow-up time is 10.1 years (range, 7 months to 12.6 years). Ninety-two percent of patients have an actual follow-up time of > 5 years, and 97.5% of patients have an actual follow-up time of > 3 years. RESULTS Survival analysis shows no significant difference between the two treatment groups in terms of overall (P = .80) or disease-free (P = .93) survival. Several clinical variables were examined by univariate analysis; only serum human chorionic gonadotropin (HCG) had an impact on survival. There were two disease-related deaths in 104 patients with HCG < or = 1,000 mIU/mL and five disease-related deaths in 14 patients with HCG greater than 1,000 mIU/mL (P < .001). Ninety-eight percent (95% CI, 95.2 to 100) of patients with favorable prognosis germ-cell tumor with an initial HCG of < or = 1,000 mIU/mL are alive without evidence of disease at 5+ years. CONCLUSION With long-term follow-up, there is no statistically significant difference in survival between three or four cycles of BEP chemotherapy in patients with favorable prognosis germ-cell carcinoma. Serum HCG elevation of greater than 1,000 mIU/mL is a significant predictor of poor outcome in patients with otherwise good-risk disease.

Long-term outcome and anaesthetic management for non-cardiac surgery after Fontan palliation: a single-centre retrospective analysis

2014 ◽  
Vol 25 (6) ◽  
pp. 1148-1154 ◽  
Author(s):  
Thomas Palumbo ◽  
Thierry Sluysmans ◽  
Jean E. Rubay ◽  
Alain J. Poncelet ◽  
Mona Momeni
Keyword(s):  
Cardiac Surgery ◽  
Surgical Techniques ◽  
Bleeding Complications ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Extracardiac Conduit ◽  
Lateral Tunnel ◽  
Significant Difference

AbstractObjectives: The improved management of Fontan patients has resulted in good outcome. As such, these patients may necessitate care for non-cardiac surgery. We sought to determine the long-term outcome of our Fontan series palliated with the most recent surgical techniques. Our second objective was to report the incidence and the perioperative course after non-cardiac procedures. We reviewed the records of all patients with either a lateral tunnel or an extracardiac conduit Fontan between 1996 and 2008. Follow-up was recorded until June, 2013, including records regarding non-cardiac interventions. Results: Overall, 58 patients were included. Of them, one patient underwent a takedown of his Fontan, and five patients died in the immediate postoperative course. The cumulative survival of the remaining 52 patients was 81%. There was no significant difference in survival between right and left ventricle morphologies (p=0.56), nor between both types of Fontan (p=0.9). Chronic arrhythmias (25%), fatigue/dyspnoea (40%), thrombotic complications (19%), and embolic events (10%) were among the most recurrent comorbidities. In total, 45 non-cardiac interventions were performed on 26 patients, with three bleeding complications and one death. Conclusions: This study shows excellent long-term survival after both lateral tunnel and extracardiac conduit Fontan. The incidence of cardiovascular morbidity remains high, however. We also report a high number of non-cardiac interventions. Thorough understanding of the Fontan physiology is mandatory when non-cardiac anaesthesiologists are in charge of these patients.

scholarly journals Clinical features of severe fever with thrombocytopenia syndrome and analysis of risk factors for mortality

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feng He ◽  
Xinxin Zheng ◽  
Zhaoru Zhang
Keyword(s):  
Risk Factors ◽  
Creatine Kinase ◽  
Renal Dysfunction ◽  
Clinical Symptoms ◽  
Univariate Analysis ◽  
Clinical Results ◽  
Consciousness Disturbance ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
Severe Fever

Abstract Background To understand the clinical characteristics of and explore the risk factors for mortality in patients with severe fever with thrombocytopenia syndrome (SFTS). Methods Data from SFTS patients diagnosed by laboratory examination at Chaohu Hospital affiliated with Anhui Medical University from June 2017 to January 2021 were retrospectively analysed. According to the clinical results, all confirmed patients were divided into the surviving group (80 patients) and non-surviving group (20 patients). The two groups were compared in terms of general characteristics, clinical symptoms and signs, laboratory indicators and other aspects. The independent risk factors for mortality in SFTS patients were analysed by multivariate binary logistic regression. Results Univariate analysis showed a significant difference in age and the incidence of consciousness disturbance, respiratory failure, haemorrhagic manifestations, renal dysfunction, shock, aspartate aminotransferase (AST) ≥400 U/L, creatine kinase (CK)≥1000 U/L, creatine kinase isoenzymes (CK-MB) ≥100 U/L, lactate dehydrogenase (LDH) ≥1000 U/L, serum creatinine ≥100 mmol/L, blood urea nitrogen ≥7.5 mmol/L and C-reactive protein ≥8 mg/L between the two groups (P < 0.05). Conclusions Consciousness disorder, haemorrhagic manifestations, renal dysfunction, AST ≥ 400 U/L, and LDH ≥ 1000 U/L are independent risk factors for mortality in SFTS patients and merit close attention in clinical treatment to avoid fatal consequences.

scholarly journals Exploring risk factors for intraoperative aneurysm rupture during clipping

2020 ◽  
Author(s):  
Zhi Zhu ◽  
Ningning Song ◽  
Yoko Kato ◽  
Xi Chen ◽  
Weichao Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Clinical Status ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Aneurysm Rupture ◽  
University Hospital ◽  
Significant Difference ◽  
Intraoperative Rupture

Abstract Objective To investigate risk factors for aneurysm rupture in intracranial aneurysm clipping (IAC). Methods Patients admitted for IAC from April 2010 to December 2017 in the Fujita Health University Hospital or the First Affiliated Hospital of Xiamen University were retrospectively reviewed. Clinical parameters were recorded and analyzed using univariate and multivariate analysis. The Hunt-Hess grade was used to assess the preoperative clinical status of patients. Modified Rankin Scale was applied to evaluate the prognosis of patients 6 months after surgery. Results Univariate analysis showed that the preoperative clinical status ( p = 0.015) and the preoperative aneurysm rupture ( p = 0.005) were significantly associated with intraoperative aneurysm rupture (IAR) during clipping. Multivariate logistic regression analysis showed that the preoperative aneurysm rupture was an independent risk factor of IAR ( p < 0.001, OR = 10.518). There was no significant difference in the prognosis between patients with and without IAR ( p > 0.05). No significant differences existed on aspects of incidences and time points of rupture in the operations conducted by experienced surgeons compared with that conducted by less-experienced surgeons ( p > 0.05). Conclusion Preoperative aneurysm rupture is the independent risk factor for aneurysm rupture during IAC. Intraoperative rupture, if treated properly in time, has no influence on the prognosis of patients receiving IAC. Less-experienced surgeons can also reduce the incidence rate of IAR by strictly controlling surgical indications.

scholarly journals Long-Term Clinical Outcome of Cardiogenic Shock Patients Undergoing Impella CP Treatment vs. Standard of Care

2020 ◽  
Vol 9 (12) ◽  
pp. 3803
Author(s):  
Clemens Scherer ◽  
Enzo Lüsebrink ◽  
Danny Kupka ◽  
Thomas J. Stocker ◽  
Konstantin Stark ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Vascular Complications ◽  
University Hospital ◽  
Circulatory Support ◽  
Term Survival ◽  
Long Term Outcome ◽  
Number Of Patients ◽  
Significant Difference

The number of patients treated with the mechanical circulatory support device Impella Cardiac Power (CP) for cardiogenic shock is steadily increasing. The aim of this study was to investigate long-term survival and complications related to this modality. Patients undergoing Impella CP treatment for cardiogenic shock were retrospectively enrolled and matched with cardiogenic shock patients not treated with mechanical circulatory support between 2010 and 2020. Data were collected from the cardiogenic shock registry of the university hospital of Munich (DRKS00015860). 70 patients with refractory cardiogenic shock without mechanical circulatory support were matched with 70 patients treated with Impella CP. At presentation, the mean age was 67 ± 15 years with 80% being male in the group without support and 67 ± 14 years (p = 0.97) with 76% being male (p = 0.68) in the group with Impella. There was no significant difference in the rate of cardiac arrest (47% vs. 51%, p = 0.73) and myocardial infarction was the predominant cause of cardiogenic shock in both groups (70% vs. 77%). A total of 41% of patients without cardiocirculatory support and 54% of patients with Impella support died during the first month (p = 0.17). After one year, mortality rates were similar in both groups (55% in conventional vs. 59% in Impella CP group, p = 0.30) as was mortality rate at long-term 5-years follow-up (64% in conventional vs. 73% in Impella CP group, p = 0.33). The rate of clinically significant bleedings during ICU stay was lower in the conventional group than in the Impella support group (15% vs. 43%, p = 0.002). In this small observational and non-randomized analysis no difference in long-term outcome between patients treated with Impella CP vs. guideline directed cardiogenic shock therapy without mechanical circulatory support could be detected. Care must be taken regarding the high rate of bleeding and vascular complications when using Impella CP. Large, adequately powered studies are urgently needed to investigate the efficacy and safety of Impella CP in cardiogenic shock.

Sign in / Sign up

Export Citation Format

Share Document