Abstract 1852: The Association Between Perioperative Complications, Intermediate Survival and Use of Aprotinin During Isolated Coronary Bypass Grafting Surgery

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Niv Ad ◽  
Alan M Speir ◽  
Michelle Harrison ◽  
Sharon L Hunt ◽  
Scott D Barnett
Keyword(s):  
Renal Failure ◽  
Adverse Outcome ◽  
Perioperative Complications ◽  
Coronary Bypass ◽  
Coronary Bypass Grafting ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Mortality Estimates ◽  
Long Term Mortality

Introduction: Aprotinin during CABG has been linked to increased rates of perioperative complications and increased long-term mortality. We report our results for the association of CABG, aprotinin use and intermediate survival. Methods: Subjects were 1,679 isolated CABG, on-pump, cases with no prior hx of renal failure or dialysis between 2001 and 2002. Aprotinin pts were additionally propensity matched to non-aprotinin pts to control for pt acuity. Increased EuroSCORE (E) indicates increased pt acuity. Results: Aprotinin pts (n=817) presented as older (63.7 vs. 61.2, p=0.05), increased E (6.5 vs. 4.1, p=0.05), and urgent operative status (61.7% vs. 41.6%, p=0.05). This group experienced greater rates of perioperative prolonged ventilation (8.7%% vs. 4.8%, p=0.01), acute renal failure (4.3% vs. 2.0%, p=0.01), 30d mortality (2.2% vs. 1.0%, p=0.06) and signif. decreased unmatched 5-year survival (86.1%, vs. 92.8%, p=0.001). Aprotinin use was not signif. assoc. with increased intermediate mortality (HR: 1.26; 95% CI: 0.66–2.41) but cases with high E (6+) were (HR: 5.47; 95% CI: 2.98–10.08). Moderate E was not signif. assoc. with mortality (HR: 1.75; 95% CI: 0.91–3.35) nor was any aprotinin-E interaction term (HR: 1.00; 95% CI: 0.93–1.08). After matching, controls were signif. less at risk of mortality at 5 years, (91.3% vs. 88.1%, p=0.05; Figure 1 ). Conclusions: Our results suggest that pts with aprotinin experienced higher rates of perioperative complications; however, the pts in this group were generally at higher risk for adverse outcome. Aprotinin use may convey an increased risk of intermediate mortality, but after matching, mortality estimates are greatly reduced.

Long-term mortality rates and associated risk factors following primary and revision knee arthroplasty

2022 ◽  
Vol 104-B (1) ◽  
pp. 45-52
Author(s):  
Liam Zen Yapp ◽  
Nick D. Clement ◽  
Matthew Moran ◽  
Jon V. Clarke ◽  
A. Hamish R. W. Simpson ◽  
...  
Keyword(s):  
General Population ◽  
Knee Arthroplasty ◽  
Mortality Rates ◽  
Factors Associated ◽  
Revision Knee Arthroplasty ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Male Sex ◽  
Long Term Mortality

Aims The aim of this study was to determine the long-term mortality rate, and to identify factors associated with this, following primary and revision knee arthroplasty (KA). Methods Data from the Scottish Arthroplasty Project (1998 to 2019) were retrospectively analyzed. Patient mortality data were linked from the National Records of Scotland. Analyses were performed separately for the primary and revised KA cohorts. The standardized mortality ratio (SMR) with 95% confidence intervals (CIs) was calculated for the population at risk. Multivariable Cox proportional hazards were used to identify predictors and estimate relative mortality risks. Results At a median 7.4 years (interquartile range (IQR) 4.0 to 11.6) follow-up, 27.8% of primary (n = 27,474/98,778) and 31.3% of revision (n = 2,611/8,343) KA patients had died. Both primary and revision cohorts had lower mortality rates than the general population (SMR 0.74 (95% CI 0.73 to 0.74); p < 0.001; SMR 0.83 (95% CI 0.80 to 0.86); p < 0.001, respectively), which persisted for 12 and eighteight years after surgery, respectively. Factors associated with increased risk of mortality after primary KA included male sex (hazard ratio (HR) 1.40 (95% CI 1.36 to 1.45)), increasing socioeconomic deprivation (HR 1.43 (95% CI 1.36 to 1.50)), inflammatory polyarthropathy (HR 1.79 (95% CI 1.68 to 1.90)), greater number of comorbidities (HR 1.59 (95% CI 1.51 to 1.68)), and periprosthetic joint infection (PJI) requiring revision (HR 1.92 (95% CI 1.57 to 2.36)) when adjusting for age. Similarly, male sex (HR 1.36 (95% CI 1.24 to 1.49)), increasing socioeconomic deprivation (HR 1.31 (95% CI 1.12 to 1.52)), inflammatory polyarthropathy (HR 1.24 (95% CI 1.12 to 1.37)), greater number of comorbidities (HR 1.64 (95% CI 1.33 to 2.01)), and revision for PJI (HR 1.35 (95% 1.18 to 1.55)) were independently associated with an increased risk of mortality following revision KA when adjusting for age. Conclusion The SMR of patients undergoing primary and revision KA was lower than that of the general population and remained so for several years post-surgery. However, approximately one in four patients undergoing primary and one in three patients undergoing revision KA died within tenten years of surgery. Several patient and surgical factors, including PJI, were associated with the risk of mortality within ten years of primary and revision surgery. Cite this article: Bone Joint J 2022;104-B(1):45–52.

scholarly journals Increased mortality in patients with corticosteroid-dependent asthma: a nationwide population-based study

2019 ◽  
Vol 54 (5) ◽  
pp. 1900804 ◽  
Author(s):  
Hyun Lee ◽  
Jiin Ryu ◽  
Eunwoo Nam ◽  
Sung Jun Chung ◽  
Yoomi Yeo ◽  
...  
Keyword(s):  
Baseline Period ◽  
Population Based ◽  
High Dose ◽  
Population Based Study ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Korean National Health Insurance ◽  
Independent Cohort ◽  
Long Term Mortality

IntroductionChronic systemic corticosteroid (CS) therapy is associated with an increased risk of mortality in patients with many chronic diseases. However, it has not been elucidated whether chronic systemic CS therapy is associated with increased mortality in patients with asthma. The aim of this study was to determine the effects of chronic systemic CS therapy on long-term mortality in adult patients with asthma.MethodsA population-based matched cohort study of males and females aged ≥18 years with asthma was performed using the Korean National Health Insurance Service database from 2005 to 2015. Hazard ratio (HR) with 95% confidence interval for all-cause mortality among patients in the CS-dependent cohort (CS use ≥6 months during baseline period) relative to those in the CS-independent cohort (CS use <6 months during baseline period) was evaluated.ResultsThe baseline cohort included 466 941 patients with asthma, of whom 8334 were CS-dependent and 458 607 were CS-independent. After 1:1 matching, 8334 subjects with CS-independent asthma were identified. The HR of mortality associated with CS-dependent asthma relative to CS-independent asthma was 2.17 (95% CI 2.04–2.31). In patients receiving low-dose CS, the HR was 1.84 (95% CI 1.69–2.00); in patients receiving high-dose CS, the HR was 2.56 (95% CI 2.35–2.80).ConclusionsIn this real-world, clinical practice, observational study, chronic use of systemic CS was associated with increased risk of mortality in patients with asthma, with a significant dose–response relationship between systemic CS use and long-term mortality.

Magnitude of bacteraemia is a predictor of mortality during 1 year of follow-up

2008 ◽  
Vol 137 (1) ◽  
pp. 94-101 ◽  
Author(s):  
K. O. GRADEL ◽  
M. SØGAARD ◽  
C. DETHLEFSEN ◽  
H. NIELSEN ◽  
H. C. SCHØNHEYDER
Keyword(s):  
Surgical Patients ◽  
Adjusted Risk ◽  
High Magnitude ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Cox's Regression ◽  
First Time ◽  
Long Term Mortality

SUMMARYWe evaluated magnitude of bacteraemia as a predictor of mortality, comprising all adult patients with a first-time mono-microbial bacteraemia. The number of positive bottles [1 (reference), 2, or 3] in the first positive blood culture (BC) was an index of magnitude of bacteraemia. We used Cox's regression analysis to determine age and comorbidity adjusted risk of mortality at days 0–7, 8–30, and 31–365. Of 6406 patients, 31·1% had BC index 1 (BCI 1), 18·3% BCI 2, and 50·6% BCI 3. BCI 3 patients had increased risk of mortality for days 0–7 (1·30, 95% CI 1·10–1·55) and days 8–30 (1·37, 95% CI 1·12–1·68), but not thereafter. However, in surgical patients mortality increased only beyond day 7 (8–30 days: 2·04, 95% CI 1·25–3·33; 31–365 days: 1·27, 95% CI 0·98–1·65). Thus, high magnitude of bacteraemia predicted mortality during the first month with a shift towards long-term mortality in surgical patients.

Management of Less-Than-Severe Aortic Stenosis During Coronary Bypass: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 14 (4) ◽  
pp. 291-298
Author(s):  
Bobby Yanagawa ◽  
Kevin R. An ◽  
Maral Ouzounian ◽  
Mario Gaudino ◽  
John D. Puskas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Failure ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Operative Mortality ◽  
Meta Analysis ◽  
Coronary Bypass ◽  
Long Term Mortality

Objective The management of concomitant mild-to-moderate aortic stenosis (AS) at the time of coronary artery bypass graft (CABG) is controversial. Here we perform a systematic review and meta-analysis of CABG and aortic valve replacement (AVR) versus CABG alone in patients with mild–moderate AS. Methods We searched MEDLINE and EMBASE databases until July 2018 for studies comparing CABG & AVR versus CABG in patients with mild–moderate AS undergoing coronary bypass. Data were extracted by 2 independent investigators. The main outcomes were operative mortality, long-term survival, and reintervention for AS. Results There were 6 unmatched retrospective observational studies with 1,172 patients (median follow-up 4.7 [interquartile range: 4.3 to 5.3] years). Patients undergoing CABG & AVR had less severe coronary artery disease. There were no differences in operative mortality (relative risk [RR]: 1.07; 95% CI, 0.59 to 1.94; P = 0.8). CABG & AVR was associated with greater incidence of stroke, bleeding, renal failure, and mediastinitis. At median follow-up of 5 years, there was no difference in long-term mortality (incidence rate ratio [IRR]:1.44; 95% CI, 0.83 to 2.51; P = 0.19), but CABG & AVR was associated with 73% lower risk of reoperation for AS ( n = 13/485 versus n = 71/702; IRR: 0.27; 95% CI, 0.14 to 0.51; P < 0.001). Conclusions In patients undergoing CABG with mild–moderate AS, combining AVR with CABG was associated with no difference in operative mortality but with increased risk of stroke, bleeding, renal failure, and mediastinitis. Long-term mortality was not different, but a risk of reoperation for AS at 5 years was 73% lower. Given the increasingly wide availability and safety of transcatheter aortic valve replacement (TAVR), one may consider a conservative approach toward concomitant mild–moderate AS.

scholarly journals Relationship between cardiac biomarker concentrations and long-term mortality in subjects with osteoarthritis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242814
Author(s):  
Martin Rehm ◽  
Gisela Büchele ◽  
Raphael Simon Peter ◽  
Rolf Erwin Brenner ◽  
Klaus-Peter Günther ◽  
...  
Keyword(s):  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Continuous Variables ◽  
Prognostic Information ◽  
Cardiac Biomarker ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Long Term Mortality

Osteoarthritis (OA) is associated with adverse cardio-metabolic features. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponins T and I (hs-cTnT and hs-cTnI) are well-characterized cardiac markers and provide prognostic information. The objective was to assess the association of cardiac biomarker concentrations with long-term mortality in subjects with OA. In a cohort of 679 OA subjects, undergoing hip or knee replacement during 1995/1996, cardiac biomarkers were measured and subjects were followed over 20 years. During a median follow-up of 18.4 years, 332 (48.9%) subjects died. Median of hs-cTnT, hs-cTnI, and NT-proBNP at baseline was 3.2 ng/L, 3.9 ng/L, and 96.8 ng/L. The top quartile of NT-proBNP was associated with increased risk of mortality (Hazard Ratio (HR) 1.79, 95% confidence interval (CI) 1.17–2.73) after adjustment for covariates including troponins (hs-cTnT HR 1.30 (95% CI 0.90–1.89), hs-cTnI HR 1.32 (95% CI 0.87–2.00) for top category). When biomarker associations were evaluated as continuous variables, only NT-proBNP (HR per log-unit increment 1.34, 95% CI 1.16–1.54) and hs-cTnI (HR 1.38, 95% CI 1.11–1.72) showed robust results. Elevated cardiac biomarker concentrations predicted an increased risk of long-term mortality and strongest for NT-proBNP and hs-cTnI. These results might help to identify subjects at risk and target preventive efforts early.

Lymphopenia and risk for long-term mortality among patients undergoing coronary angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Zafrir ◽  
R Jaffe ◽  
H Sliman ◽  
O Barnett-Griness ◽  
W Saliba
Keyword(s):  
Coronary Angiography ◽  
Mortality Risk ◽  
Predictive Accuracy ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Cross Sectional ◽  
Distribution Width ◽  
Increased Risk ◽  
Long Term Mortality

Abstract Background Lymphopenia has been shown to be associated with adverse prognosis in chronic disease states that are related to immune dysregulation. Purpose We aimed to determine the association between lymphopenia and all-cause mortality in patients presenting to coronary angiography with or without acute coronary syndromes (ACS). We also investigated whether elevated red blood cell distribution width (RDW), an established cardiovascular prognostic marker, further refines risk stratification and improves predictive accuracy beyond lymphocytes count. Methods Retrospective cohort analysis of patients undergoing coronary angiography for evaluation or treatment of coronary artery disease between 2003 and 2018. Long-term mortality risk associated with relative (1000–1500 /μL) or severe (&lt;1000 /μL) lymphopenia was analyzed using Cox proportional hazards regression models, adjusting for comorbidities, ACS and RDW. Results Overall, 15179 patients underwent coronary angiography, at a mean age of 65±12 years. On cross-sectional analysis, lymphopenia was associated with kidney disease, cancer, heart failure and presentation with ACS, but lower rates of smoking and obesity. During a median follow-up of 7 (IQR 3.5–11.5) years, 4253 patients died. Compared to normal lymphocytes count (1500–5000 /μL), the multivariable adjusted hazard ratio (HR) (95% confidence interval) for mortality was 1.31 (1.21–1.41) and 1.97 (1.75–2.22) for relative and severe lymphopenia, respectively. The increase in mortality associated with severe lymphopenia was significant in patients presenting with non-ACS [HR 2.18 (1.74–2.73)], ST-segment elevation myocardial infarction (STEMI) [HR 1.59 (1.15–2.21)], or unstable angina/non-STEMI [HR 2.00 (1.70–2.34)]; p-for-interaction 0.626. The association of lymphopenia with mortality remained significant after additional adjustment to RDW. High RDW (&gt;14.5%) was associated with increased mortality risk in each of the lymphocytes count groups, and improved the predictive accuracy with AUC increase from 0.609 (0.601–0.616) to 0.646 (0.639–0.654) (p&lt;0.001). Conclusions Lymphopenia is associated with increased risk for long-term mortality in patients undergoing coronary angiography, regardless of coronary presentation. High RDW may enhance the predictive ability of lymphopenia. Lymphocyte count and mortality risk Funding Acknowledgement Type of funding source: None

scholarly journals Role of diuretics on long-term mortality may differ in volume status in patients with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kawai ◽  
D Nakatani ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Plasma Volume ◽  
Cox Regression ◽  
Volume Status ◽  
Increased Risk ◽  
Long Term Mortality

Abstract Background Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status. Methods To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years. Results During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247). Conclusion Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status. Funding Acknowledgement Type of funding source: None

scholarly journals Undifferentiated Embryonal Sarcoma of the Liver in Children Versus Adults: A National Cancer Database Analysis

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2918
Author(s):  
Ioannis A. Ziogas ◽  
Irving J. Zamora ◽  
Harold N. Lovvorn III ◽  
Christina E. Bailey ◽  
Sophoclis P. Alexopoulos
Keyword(s):  
Surgical Treatment ◽  
Cox Regression ◽  
Clinicopathological Characteristics ◽  
National Cancer Database ◽  
Term Survival ◽  
Long Term Survival ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Embryonal Sarcoma

This study evaluates the clinicopathological characteristics and outcomes of children vs. adults with undifferentiated embryonal sarcoma of the liver (UESL). A retrospective analysis of 82 children (<18 years) and 41 adults (≥18 years) with UESL registered in the National Cancer Database between 2004–2015 was conducted. No between-group differences were observed regarding tumor size, metastasis, surgical treatment, margin status, and radiation. Children received chemotherapy more often than adults (92.7% vs. 65.9%; p < 0.001). Children demonstrated superior overall survival vs. adults (log-rank, p < 0.001) with 5-year rates of 84.4% vs. 48.2%, respectively. In multivariable Cox regression for all patients, adults demonstrated an increased risk of mortality compared to children (p < 0.001), while metastasis was associated with an increased (p = 0.02) and surgical treatment with a decreased (p = 0.001) risk of mortality. In multivariable Cox regression for surgically-treated patients, adulthood (p = 0.004) and margin-positive resection (p = 0.03) were independently associated with an increased risk of mortality. Multimodal treatment including complete surgical resection and chemotherapy results in long-term survival in most children with UESL. However, adults with UESL have poorer long-term survival that may reflect differences in disease biology and an opportunity to further refine currently available treatment schemas.

Abstract P53: Long-Term Mortality Among Ischemic Stroke Patients With Pre-Existing Mild Cognitive Impairment or Dementia

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Farhaan S Vahidy ◽  
Thomas Potter ◽  
Jennifer Meeks ◽  
Alan Pan ◽  
Osman Khan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
National Sample ◽  
Healthcare Organizations ◽  
Pooled Data ◽  
Increased Risk ◽  
Icd 10 ◽  
Long Term Mortality

Introduction: The contribution of preexisting mild cognitive impairment (MCI) or dementia (MCID) towards long term mortality in Ischemic Stroke (IS) patients is under studied. Methods: We conducted a propensity score (PS) matched analysis of pooled data from 39 healthcare organizations to evaluate the association between MCID and post stroke mortality (PSM) through a 5-year period. Using ICD-10 codes for MCI, Alzheimer disease, vascular/other dementias, and MCID specific medications; we flagged preexisting MCID diagnoses up till 1 month prior to the index IS event (MCID group). The non-MCID group had no documented MCID diagnoses till after 1 month of the index event. Groups were PS matched on demographic (age, sex, race, ethnicity) and comorbidity variables. Risk Ratios (RR) and 95% confidence intervals (CI) were calculated. Results: Among 544,700 IS patients, 124,892 (22.9%) had preexisting MCID. MCID patients (vs. non-MCID) were older (mean age: 67.8 vs. 64.8 years), had higher proportion (%) of females (52.8 vs. 49.4) and Blacks (21.1 vs. 17.1). A higher proportion (%) of MCID patients had hypertension (77.3 vs. 36.0), diabetes (36.9 vs. 17.4), ischemic heart disease (31.6 vs 13.5), chronic kidney disease (21.4 vs. 7.8) and liver disease (9.5 vs. 3.1). Optimal co-variate balance was achieved post PS match (figure). In the unmatched sample, 8.6% of MCID and 6.0% of non-MCID patients experienced PSM by the 1-year time point; representing 56.2% and 64.2% of the total 5-year PSM, respectively. Matched and unmatched RR (CI) for PSM at 3 month and 1,3,5-year are reported (figure). An increasing risk of PSM was observed across the four time-points which was significantly higher for years 1,3, and 5 in the matched sample. Conclusion: A 24% long term increased risk of PSM was observed in a large national sample of IS patients with preexisting MCID. Majority of PSM burden is experienced by 1 year. MCID screening and exploring mechanisms of MCID-linked PSM is critical among IS patients.

Abstract 2099: Pretransplant Toxoplasma Gondii Seropositivity Amongst Heart Transplant Recipients Is Associated With An Increased Risk Of All-cause And Cardiac Mortality

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Satish Arora ◽  
Pål Jenum ◽  
Pål Aukrust ◽  
Halvor Rollag ◽  
Arne Andreassen ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Heart Transplant ◽  
Acute Cellular Rejection ◽  
Serum Samples ◽  
Regulatory Changes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Cellular Rejection

Chronic Toxoplasma gondii (T. gondii ) infection is known to trigger potentially adverse immuno-regulatory changes, but the long-term implication for heart transplant (HTx) recipients has not been assessed previously. Hence, we evaluated the risk of mortality, development of cardiac allograft vasculopathy (CAV) and acute cellular rejection amongst T. gondii seropositive HTx recipients and the four donor/recipient seropairing groups. Methods: Frozen pre-HTx serum samples of 288 recipients and 246 donors were evaluated for T. gondii serostatus using Platelia IgG immunoassay method. All patients had also undergone prospective serostatus evaluation using alternative assays and results determined by the two methods were compared. Follow-up data regarding mortality, CAV development and acute cellular rejection was available for all patients. Results: Overall, 211 (73%) recipients were seronegative and 77 (27%) were seropositive. In total, 82 recipients died, 76 developed CAV and 82 had significant cellular rejection. Recipient seropositivity was associated with a significantly higher risk of all-cause mortality (hazard ratio [HR], 1.9; 95% CI, 1.1–3.4; p= 0.02) and CAV mortality (HR=4.4; 95% CI, 1.3–15.6, p=0.02), but was not associated with earlier CAV development or higher rejection score. Donor/recipient seropairing status was not a risk factor for any endpoint. Conclusions: T. gondii seropositivity amongst HTx recipients is associated with a significantly increased risk of long-term total, and in particular CAV-related, mortality. This may be mediated via immunoregulatory changes triggered by chronic T. gondii infection and needs to be explored further.

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