scholarly journals CTLA4Polymorphisms and De Novo Malignancy Risk after Renal Transplantation in Chinese Recipients

2015 ◽  
Vol 2015 ◽  
pp. 1-8
Author(s):  
Yi-feng Guo ◽  
Jian-xin Qiu ◽  
Fang Guo ◽  
Yong Liu ◽  
Ming-hua Shang
Keyword(s):  
Risk Factors ◽  
Renal Transplantation ◽  
De Novo ◽  
Cytotoxic T Lymphocyte ◽  
Nucleotide Polymorphisms ◽  
Kidney Transplant Recipients ◽  
De Novo Malignancy ◽  
Tumor Group

Genetic polymorphisms in cytotoxic T lymphocyte-associated antigen 4 (CTLA4) play an influential role in graft rejection and the long-term clinical outcome of organ transplantation. We investigated the association of fiveCTLA4single-nucleotide polymorphisms (SNPs) (rs733618 C/T, rs4553808 A/G, rs5742909 C/T, rs231775 A/G, and rs3087243 G/A) with de novo malignancy in 1463 Chinese renal transplantation (RT) recipients who underwent a 192-month follow-up. Multivariate analyses revealed that recipient rs231775 genotype is significantly associated with tumorigenesis (P=0.012). Multiplicative interaction between rs231775 AA and possible risk factors of malignancy revealed two significant results: rs231775 AA × primary diseases and rs231775 AA × number of HLA-mismatch. The frequency of haplotype TACAG was significantly higher in the tumor group (17.07%) than that in the nontumor group (1.53%). In addition, aristolochic acid nephropathy (P=0.003) and the time of discovery of tumor (P=0.000) also were independently associated with tumorigenesis. Our data show that theCTLA4genotype rs231775 AA may be one of risk factors for the development of malignancy and haplotype TACAG was susceptible haplotype in Chinese kidney transplant recipients.

scholarly journals Cumulative incidence and risk factors for radiation induced leukoencephalopathy in high grade glioma long term survivors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Robert Terziev ◽  
Dimitri Psimaras ◽  
Yannick Marie ◽  
Loic Feuvret ◽  
Giulia Berzero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
High Grade Glioma ◽  
High Grade ◽  
Nucleotide Polymorphisms ◽  
Increased Risk ◽  
Radiation Induced ◽  
Long Term Survivors

AbstractThe incidence and risk factors associated with radiation-induced leukoencephalopathy (RIL) in long-term survivors of high-grade glioma (HGG) are still poorly investigated. We performed a retrospective research in our institutional database for patients with supratentorial HGG treated with focal radiotherapy, having a progression-free overall survival > 30 months and available germline DNA. We reviewed MRI scans for signs of leukoencephalopathy on T2/FLAIR sequences, and medical records for information on cerebrovascular risk factors and neurological symptoms. We investigated a panel of candidate single nucleotide polymorphisms (SNPs) to assess genetic risk. Eighty-one HGG patients (18 grade IV and 63 grade III, 50M/31F) were included in the study. The median age at the time of radiotherapy was 48 years old (range 18–69). The median follow-up after the completion of radiotherapy was 79 months. A total of 44 patients (44/81, 54.3%) developed RIL during follow-up. Twenty-nine of the 44 patients developed consistent symptoms such as subcortical dementia (n = 28), gait disturbances (n = 12), and urinary incontinence (n = 9). The cumulative incidence of RIL was 21% at 12 months, 42% at 36 months, and 48% at 60 months. Age > 60 years, smoking, and the germline SNP rs2120825 (PPARg locus) were associated with an increased risk of RIL. Our study identified potential risk factors for the development of RIL (age, smoking, and the germline SNP rs2120825) and established the rationale for testing PPARg agonists in the prevention and management of late-delayed radiation-induced neurotoxicity.

Risk of hemorrhage from de novo cerebral aneurysms

2013 ◽  
Vol 118 (1) ◽  
pp. 58-62 ◽  
Author(s):  
William J. Kemp ◽  
Daniel H. Fulkerson ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
Terry G. Horner ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Patient Age ◽  
Patient Âgé ◽  
Long Term Follow Up ◽  
De Novo Aneurysm ◽  
The Mean ◽  
Risk Of Hemorrhage

Object A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH). Methods A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976–2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors. Results Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011). Conclusions While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.

scholarly journals Long‐term, prolonged‐release tacrolimus‐based immunosuppression in de novo kidney transplant recipients: 5‐year prospective follow‐up of the ADHERE study patients

2019 ◽  
Vol 33 (2) ◽  
pp. 161-173
Author(s):  
Oleg Rummo ◽  
Mario Carmellini ◽  
Nassim Kamar ◽  
Antoine Durrbach ◽  
Christiane Mousson ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Prolonged Release ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation

2017 ◽  
Vol 126 (3) ◽  
pp. 819-824 ◽  
Author(s):  
Mason A. Brown ◽  
Jonathan Parish ◽  
Cristian F. Guandique ◽  
Troy D. Payner ◽  
Terry Horner ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Cerebral Aneurysms ◽  
Objective Evaluation ◽  
Multiple Aneurysms ◽  
Long Term Study ◽  
Surveillance Imaging ◽  
Long Term Follow Up

OBJECTIVE With the recent evolution of endovascular therapies, objective evaluation of the efficacy of clip ligation for cerebral aneurysms should be performed. This study was undertaken to evaluate the durability of microsurgical clip ligation, identify risk factors for recurrence, and assess the need for long-term follow-up imaging. METHODS A retrospective review of medical records identified 616 consecutive patients (156 male and 460 female patients; mean age 48.4 ± 12.4 years; range 6–90 years) who underwent microsurgical clip ligation and follow-up imaging at least 1 year after discharge between 1990 and 2010 at our institution. Of a total of 926 aneurysms in 616 patients, 758 aneurysms were microsurgically clip-ligated. At presentation, 431 of these aneurysms were ruptured and 327 aneurysms were unruptured. All patients underwent postoperative baseline imaging within the 1st month of their operation. A logistic regression analysis was performed to identify which variables are more likely to predict recurrence. RESULTS Late follow-up angiographic imaging was obtained at a mean of 7.2 ± 4.7 years postdischarge (median 5.7 years; range 1–23 years). Of the 699 clipped aneurysms without residua, late follow-up angiography revealed only 1 (0.14%) recurrent aneurysm. Of the 59 residual aneurysms that remained after initial clip ligation on early postoperative imaging, 8 (13.6%) demonstrated growth. All of these aneurysms required treatment. None of the recurrences were due to broken or delayed displacement of clips. A total of 111 patients presented with multiple aneurysms. De novo aneurysm formation occurred in 8 (0.97%) patients, all of whom initially presented with multiple aneurysms. CONCLUSIONS This study provides additional evidence to support the long-term efficacy of aneurysm clip ligation. The chance of aneurysm recurrence after complete clip ligation is very small. However, there is a regrowth risk of 1.83% per year for aneurysm remnants after incomplete clip ligation. These findings support the necessity for continued followup, late angiographic imaging, and the potential need for further intervention of incompletely ligated aneurysms. Furthermore, completely clip-ligated aneurysms may not require additional surveillance imaging unless multiple aneurysms were evident at presentation.

scholarly journals Post-Transplant Diabetes Mellitus in Kidney Transplant Recipients: A Multi-Center Study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0000862021
Author(s):  
Rubab F. Malik ◽  
Yaqi Jia ◽  
Sherry G. Mansour ◽  
Peter P. Reese ◽  
Isaac E. Hall ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Kidney Transplant ◽  
Graft Failure ◽  
De Novo ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Kidney Recipients ◽  
Recipient Age

Background: De novo post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplant (KT). Most recent studies are single-center with various approaches to outcome ascertainment. Methods: In a multi-center longitudinal cohort of 632 non-diabetic adult kidney recipients transplanted in 2010-2013, we ascertained outcomes through detailed chart review at 13 centers. We hypothesized that donor characteristics such as sex, HCV infection, and kidney donor profile index (KDPI) and recipient characteristics such as age, race, BMI, and increased HLA mismatches would affect the development of PTDM among KT recipients. We defined PTDM as hemoglobin A1c ≥6.5%, pharmacological treatment for diabetes, or documentation of diabetes in electronic medical records. We assessed PTDM risk factors and evaluated for an independent time-updated association between PTDM and graft failure using regression. Results: Mean recipient age was 52±14 years, 59% were male, 49% were Black. Cumulative PTDM incidence 5 years post-KT was 29% (186). Independent baseline PTDM risk factors included older recipient age (p<0.001) and higher BMI (p=0.006). PTDM was not associated with all-cause graft failure [adjusted Hazard Ratio (aHR) 1.10 (95% CI: 0.78-1.55)], death-censored graft failure [aHR 0.85 (0.53-1.37)], or death [aHR 1.31 (0.84-2.05)] at median follow-up of 6 (4.0,6.9) years post-KT. Induction and maintenance immunosuppression were not different between patients who did and did not develop PTDM. Conclusions: PTDM occurred commonly, and higher baseline BMI was associated with PTDM. PTDM was not associated with graft failure or mortality during the 6-year follow-up, perhaps due to short follow-up.

Abstract WP131: Is 3 Years Adequate for Tracking Completely Occluded Coiled Aneurysms?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eung Koo Yeon
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Medical Records ◽  
De Novo ◽  
Complete Occlusion ◽  
Imaging Surveillance ◽  
Almost All ◽  
Annual Risk

Objective: To ascertain the long-term durability of coiled aneurysms completely occluded at 36 months during follow-up given the potential for delayed recanalization. Methods: As a retrospective review, we examined 299 patients with 339 aneurysms, all completely occluded at 36 months in follow-up images obtained between 2011 and 2013. Medical records and radiologic data acquired during extended monitoring (mean, 74.3±22.5 months) were retrieved, analyzing incidence (including average annual risk) and risk factors of delayed recanalization. Results: A total of five coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46 % per aneurysm-year) during continued long-term surveillance (1081.9 aneurysm-years), two surfacing within 60 months and three developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In multivariate analysis, second embolization for recurred aneurysm (HR=22.088, p=0.003) independently correlated with delayed recanalization. Conclusion: Almost all coiled aneurysms (98.5%) showing complete occlusion at 36 months post-embolization proved to be stable in extended observation. Therefore, it is reasonable to suspend imaging surveillance of coiled aneurysms after 3 years in the absence of demonstrable recanalization. However, recurrent aneurysms were predisposed to delayed recanalization.

scholarly journals Risk factors for long-term renal survival after renal transplantation: a role for angiotensin-converting enzyme (insertion/deletion) polymorphism?

1998 ◽  
Vol 9 (11) ◽  
pp. 2075-2081 ◽  
Author(s):  
J Broekroelofs ◽  
C A Stegeman ◽  
G Navis ◽  
A M Tegzess ◽  
D De Zeeuw ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Renal Transplantation ◽  
High Risk ◽  
Graft Survival ◽  
Graft Loss ◽  
Converting Enzyme ◽  
Function Loss

Chronic progressive renal function loss is a main cause of long-term graft loss after initially successful renal transplantation. Transplanted kidneys share some risk factors for renal function loss, such as hypertension or proteinuria, with diseased native kidneys. Recently, it has been shown that renal function loss is influenced by the angiotensin-converting enzyme (ACE) (insertion/deletion [I/D]) genotype in renal disease in diseased native kidneys. This study examines whether donor or recipient ACE (I/D) genotype is a risk factor for graft loss after renal transplantation. To avoid bias by acute events, graft survival was studied, with patients dying with a functioning graft censored, starting at 12 mo after transplantation in a cohort of 367 patients transplanted between 1987 and 1994 with at least 2 yr of follow-up. Mean follow-up was 58 mo. ACE (I/D) genotype was determined by PCR on stored donor and recipient lymphocytes. Neither donor nor recipient ACE (I/D) genotype was associated with graft survival. However, Cox proportional hazards analysis identified recipient, but not donor, ACE (I/D) genotype D-allele to be independently associated with a shorter time to graft loss in subgroups of patients at high risk for graft loss defined by a creatinine clearance <50 ml/min (n = 108, P = 0.017) or proteinuria > or =0.5 g/24 h at 12 mo (n = 97, P = 0.0051) after transplantation. In conclusion, recipient ACE (I/D) genotype was associated with time to graft loss in a specific high-risk subgroup of the study population. This suggests that the effect of ACE (I/D) genotype on graft survival only becomes apparent when other risk factors are simultaneously present.

scholarly journals Case Report: Splenic Irradiation for the Treatment of Chronic Active Antibody-Mediated Rejection in Kidney Allograft Recipients With De Novo Donor-Specific Antibodies

2021 ◽  
Vol 12 ◽  
Author(s):  
Lan Zhu ◽  
Zhiliang Guo ◽  
Rula Sa ◽  
Hui Guo ◽  
Junhua Li ◽  
...  
Keyword(s):  
Conventional Treatment ◽  
De Novo ◽  
Treatment Options ◽  
Intravenous Immunoglobulins ◽  
Kidney Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Splenic Irradiation ◽  
Living Related

Chronic active antibody-mediated rejection (AMR) in renal transplantation is usually refractory to current conventional treatment with rituximab, plasmapheresis (PP), and intravenous immunoglobulins (IVIG). Splenic irradiation has been reported to be effective in the rescue of early severe acute AMR after kidney transplantation; however, its effect in chronic active AMR has not been reported to date. In order to reduce donor-specific antibody (DSA) and prevent the progression of chronic AMR, we used repetitive low-dose splenic irradiation, together with rituximab and PP/IVIG, in two living-related kidney transplant recipients with pathologically diagnosed chronic active AMR and the presence of long-term class II-de novo DSA. DSA monitoring and repeated renal biopsy revealed significantly reduced DSA levels as well as alleviated glomerulitis and peritubular capillaritis in both patients after treatment, and these therapies may have played a role in delaying the progression of chronic AMR. Although DSA levels in both patients eventually rebounded to some extent after treatment, serum creatinine increased slowly in one patient during the 16-month follow-up period and remained stable in the other during the 12-month follow-up period. Given the poor efficacy of conventional treatment at present, splenic irradiation may still be one of the treatment options for chronic active AMR.

Long-term follow-up of polyneuropathy in diabetic kidney transplant recipients

Diabetes ◽  
1988 ◽  
Vol 37 (9) ◽  
pp. 1247-1252 ◽  
Author(s):  
J. A. Van der Vliet ◽  
X. Navarro ◽  
W. R. Kennedy ◽  
F. C. Goetz ◽  
J. J. Barbosa ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Diabetic Kidney ◽  
Long Term Follow Up
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