Increased Risk for EBV-Lymphoma after Allogeneic Hsct in Adult Lymphoma Patients?A Retrospective Study of Reduced Compared to Myeloablative Conditioning.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5116-5116
Author(s):  
Hans G. Hagglund ◽  
Mats Brune ◽  
Gunnar Oberg ◽  
Hans Hagberg ◽  
Niklas Theorin ◽  
...  
Keyword(s):  
Patient Survival ◽  
Group Versus ◽  
Myeloablative Conditioning ◽  
Term Survival ◽  
Allogeneic Hsct ◽  
Increased Risk ◽  
Unrelated Donors ◽  
Causes Of Deaths

Abstract The aim of this study was to compare the outcome of allogeneic HSCT after myeloablative versus reduced intensity conditioning (RIC) for lymphoma. From January 1984 to June 2004, 87 patients underwent HSCT for lymphoma (including 41 patients with RIC, all grafted after May 1998). The diagnoses were 15 and 24 aggressive, 18 and 17 indolent and 8 and 5 HD lymphomas, in the RIC and myeloablative groups, respectively. There were 64 males and 23 females. The median age was 40 (16–61). The donors were 3 identical twins, 55 related and 29 unrelated donors. The conditioning was based on chemotherapy only in 32 and 8 and irradiation in combination with chemotherapy in 9 and 38 patients (p<0.001), in the RIC and myeloablative groups, respectively. Immunosuppression consisted of MTX and CsA in 68, CsA and MMF in 10, MTX or CsA in 4, T-cell depletion in 2 and 3 patients had no prophylaxis. In the RIC group the median age was significantly higher 49 (25–61) years than in the myeloablative group 38 (16–53) years (p<0.001). PBSC was used in 36 (88%) patients in the RIC group versus 17 (37%) (p<.001) in the myeloablative group. The causes of deaths were 11 infections, 10 relapses, 6 EBV-lymphomas, 6 related to toxicity and 3 to GVHD and 1 renal cancer. Conclusions: Long term survival was seen in more than 50 % of patients with relapsing lymphoma after allogeneic HSCT. EBV lymphoma was the cause of death in 7% of the patients. The patient survival, TRM and relapse outcomes were similar after RIC and myeloablative conditioning but each subgroup is small. In the RIC group the patients were older, grafted in more advanced disease and the follow up shorter compared to the myeloablative group, therefore the results must be interpreted with care. Results RIC Myeloablative p GVHD (absolute incidence) Acute II-IV 43% 16% ns Chronic 32% 57% 0.06 Outcome (2-years probability) TRM 25% 39% ns Relapse 21% 16% ns Patient survival 61% 54% ns

Updated Analysis of Allogeneic HSCT after RIC for Hematological Malignancies from the Société Française de Greffe de Moelle Osseuse et de Thérapie Cellulaire (SFGM-TC) Registry.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1085-1085
Author(s):  
Mauricette Michallet ◽  
Quoc-Hung Le ◽  
Mohamad Mohty ◽  
Franck E. Nicolini ◽  
Jean-Michel Boiron ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Chronic Gvhd ◽  
Disease Status ◽  
Term Survival ◽  
Allogeneic Hsct ◽  
Unrelated Donors ◽  
Grade Ii ◽  
Long Term Survivors

Abstract This report updates a retrospective study from SFGM-TC registry concerning 1108 patients who underwent allogeneic hematopoeitic stem cell transplantation (HSCT) after reduced intensity conditioning (RIC) from HLA identical siblings (84%) and unrelated donors (16%) for hematological malignancies. At time of conditioning, 442 patients were in CR, 337 in PR, 107 in stable disease (SD) and 222 in progressive disease (PD). As conditioning, 255 patients received fludarabine and TBI (2 grays), 465 patients fludarabine, busulfan and ATG and 388 patients an other regimen. After transplant, 336 patients (30%) developed an acute GVHD ≥ grade II (grade II: 178, III: 80 and IV: 78). A chronic GVHD was present in 388 patients (35%) (185 limited and 203 extensive). With a median follow-up of 30 months, the 3 and 5-year probability of overall survival (OS) were 43.5% (40–47) and 32%(29–35) respectively and the 3 and 5-year probability of event-free survival (EFS) were 35%(31–39) and 28% (24.5–31) respectively. The TRM at 1 year, 2 years and 3 years was 15% (13–17), 18% (15.5–21) and 20% (17–23). A mixture model, gfcure with Splus statistical package determined the percentages of long-term survivors and its adequacy was verified graphically. The probability to be a long-survivor was 24% (17.5–32.5) (Fig.1) and to be a long event-free survivor was 23% (19–28) (Fig. 2). The multivariate analysis has tested recipient and donor age, disease status pre-transplant, number of transplants before RICT, HSC source, sex matching, HLA matching, CMV status and ABO compatibility. The only factor which had a significant impact on long-term survival after RICT was the disease status just prior conditioning: PR versus CR: HR: 3.63 [1.14–9.18] p<0.001 and PD versus CR: HR: 4.35 [2.22–8.51] p<0.0001. In conclusion, these updated data demonstrate that allogeneic HSCT after RIC was able to possibly cure 23% of patients with haematological malignancies and the most important factor to take into account remains to be in CR pre-transplant. Figure 1 Figure 1. Figure 2 Figure 2.

scholarly journals Non-Myeloablative Conditioning Regimen before T-Cell Replete Haploidentical Transplantation with Post-Transplant Cyclophosphamide for Advanced Lymphoma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4614-4614
Author(s):  
Catalina Montes De Oca ◽  
Thomas Pagliardini ◽  
Stefania Bramanti ◽  
Sabine Furst ◽  
Jean Marc Schiano de Collela ◽  
...  
Keyword(s):  
Research Funding ◽  
Chronic Gvhd ◽  
Disease Status ◽  
Research Support ◽  
Myeloablative Conditioning ◽  
Term Survival ◽  
Gvhd Prophylaxis ◽  
Increased Risk ◽  
Low Incidence

Introduction: allogeneic transplantation (allo-HSCT) is a curative treatment for patients with advanced lymphoma. Haploidentical (haplo-SCT) transplantation extended the accessibility to allo-HSCT, overcoming the issue of donor availability. However, alternative donor allo-HSCT is still considered at higher risk of non-relapse mortality due to the HLA disparity and thus an anticipated higher incidence of GVHD. In this context, the use of a non myeloablative conditioning (NMAC) regimen combined with post transplantation cyclophosphamide (PT-Cy) based GVHD prophylaxis may reduce procedure related toxicity. The aim was to evaluate the toxicity and efficacy of haplo-SCT using NMAC with PT-Cy in advanced lymphoma patients. Methods: We here report the retrospective experience of a bicentric transplantation program. We analyzed a cohort of lymphoma patients undergoing Haplo-SCT and homogeneously receiving NMAC and PT-Cy. Inclusion criteria were: 1) first allo-HSCT for advanced lymphoma between 2009 and 2018; 2) haploidentical donor; 3) NMAC (fludarabine cyclophosphamide and 2 gray TBI GVHD prophylaxis consisted of PT-Cy day+3 and +4 , cyclosporine A and MMF starting from day +5. Multivariate analyses included age, disease type (NHL vs HL), HCT-CI (< vs ≥ 3), graft source (PBSC vs BM), disease status at haplo-SCT (CR vs other). Results: One hundred forty seven patients (73 NHL; 74 HL) with a median age of 46 years (range: 19-71) were included. PBSC (peripheral blood stem cell) was used as graft source in 96 patients (65%). Patients received a median number of 3 conventional chemotherapy lines before haplo-SCT (1-8). Sixty-five (44%) had relapse after Auto-HCT. At the time of haplo-SCT, 96 patients (66%) were in complete remission. The cumulative incidences of day+100 grade 2-4 and 3-4 acute GVHD were 30% and 3%, respectively. The cumulative incidences of 2-year chronic and moderate or severe chronic GVHD were 13% and 8%, respectively. With a median follow up of 39 months (6-114), 2-year NRM was 14%, with a trend for higher risk in patients with HCT-CI ≥ 3 (HR 0.39, 95CI [0.15-1.04] p = 0.061) while age was not associated with an increased risk of NRM (HR 1.01, 95CI [0.98-1.05], p = 0.450). Two-year cumulative incidence of relapse (CIR) was 21% and 18% in HL and NHL patients, respectively. Disease status at the time of haplo-SCT was strongly associated with relapse (HR 2.99, 95CI [1.41-6.35], p = 0.004) In HL patients, 2-year PFS, OS and GRFS were 65%, 77% and 57%, respectively, while corresponding values in NHL patients were 65%, 69% and 55%, respectively. Two-year PFS and GRFS were significantly higher in patients who underwent haplo-SCT in CR (PFS: CR vs. no CR: 72% vs. 55%, p=0.045; GRFS: CR vs. no CR: 63% vs. 42%, p=0.010). There was a trend for better 2-year OS in CR (OS: CR vs. no CR: 78% vs. 63%, p=0.063. Conclusion: We confirm the feasibility of haplo-SCT using NMAC and PT-Cy with low incidence of GVHD (notably severe forms) and NRM. In addition, we observed a relatively low incidence of relapse (19%) in this cohort of heavily pretreated patients, underlining a potent graft-versus-lymphoma effect after haplo-SCT, leading to promising survivals, including high rate of GRFS (>50%), suggesting a preserved long term quality of life in survivors. We conclude that NMAC haplo-SCT with PT-Cy should be considered as a valuable curative option for advanced lymphoma patients, with a favorable toxicity profile and promising long term survival. Figure Disclosures Stoppa: celgene: Other: travel fees, lecture fees; takeda: Other: travel fees. Carlo-Stella:MSD: Honoraria; BMS: Honoraria; Janssen: Other: Travel, accommodations; Boehringer Ingelheim: Consultancy; Genenta Science sr: Consultancy; Sanofi: Consultancy, Research Funding; ADC Therapeutics: Consultancy, Other: Travel, accommodations, Research Funding; Novartis: Consultancy, Research Funding; Servier: Consultancy, Honoraria, Other: Travel, accommodations; F. Hoffmann-La Roche Ltd: Honoraria, Other: Travel, accommodations, Research Funding; Rhizen Pharmaceuticals: Research Funding; Celgene: Research Funding; Amgen: Honoraria; Takeda: Other: Travel, accommodations; Janssen Oncology: Honoraria; AstraZeneca: Honoraria. Chabannon:EBMT: Other: Working Party Chair, Board member; Fresenius Kabi: Other: research support; Miltenyi Biotech: Other: research support; Terumo BCT: Other: speaker's fees; Celgene: Other: speaker's fees; Novartis: Other: speaker's fees; Gilead: Other: speaker's fees, hospitalities; Sanofi SA: Other: research support, speaker's fees, hospitalities. Santoro:Takeda: Speakers Bureau; BMS: Speakers Bureau; Roche: Speakers Bureau; Abb-Vie: Speakers Bureau; Amgen: Speakers Bureau; Celgene: Speakers Bureau; Servier: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; AstraZeneca: Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Arqule: Consultancy, Speakers Bureau; Lilly: Speakers Bureau; Sandoz: Speakers Bureau; Eisai: Consultancy, Speakers Bureau; Novartis: Speakers Bureau; Bayer: Consultancy, Speakers Bureau; MSD: Speakers Bureau; BMS: Consultancy. Blaise:Sanofi: Honoraria; Jazz Pharmaceuticals: Honoraria; Molmed: Consultancy, Honoraria; Pierre Fabre medicaments: Honoraria.

scholarly journals Long-term kidney function in children with Wilms tumour and constitutional WT1 pathogenic variant

2021 ◽  
Author(s):  
Maria Pia Falcone ◽  
Kathryn Pritchard-Jones ◽  
Jesper Brok ◽  
William Mifsud ◽  
Richard D. Williams ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
Kidney Failure ◽  
Patient Survival ◽  
Pathogenic Variant ◽  
International Studies ◽  
Wilms Tumour ◽  
Increased Risk

Abstract Background Wilms tumour (WT) survivors, especially patients with associated syndromes or genitourinary anomalies due to constitutional WT1 pathogenic variant, have increased risk of kidney failure. We describe the long-term kidney function in children with WT and WT1 pathogenic variant to inform the surgical strategy and oncological management of such complex children. Methods Retrospective analysis of patients with WT and constitutional WT1 pathogenic variant treated at a single centre between 1993 and 2016, reviewing genotype, phenotype, tumour histology, laterality, treatment, patient survival, and kidney outcome. Results We identified 25 patients (60% male, median age at diagnosis 14 months, range 4–74 months) with WT1 deletion (4), missense (2), nonsense (8), frameshift (7), or splice site (4) pathogenic variant. Thirteen (52%) had bilateral disease, 3 (12%) had WT-aniridia, 1 had incomplete Denys-Drash syndrome, 11 (44%) had genitourinary malformation, and 10 (40%) had no phenotypic anomalies. Patient survival was 100% and 3 patients were in remission after relapse at median follow-up of 9 years. Seven patients (28%) commenced chronic dialysis of which 3 were after bilateral nephrectomies. The overall kidney survival for this cohort as mean time to start of dialysis was 13.38 years (95% CI: 10.3–16.4), where 7 patients experienced kidney failure at a median of 5.6 years. All of these 7 patients were subsequently transplanted. In addition, 2 patients have stage III and stage IV chronic kidney disease and 12 patients have albuminuria and/or treatment with ACE inhibitors. Four patients (3 frameshift; 1 WT1 deletion) had normal blood pressure and kidney function without proteinuria at follow-up from 1.5 to 12 years. Conclusions Despite the known high risk of kidney disease in patients with WT and constitutional WT1 pathogenic variant, nearly two-thirds of patients had sustained native kidney function, suggesting that nephron-sparing surgery (NSS) should be attempted when possible without compromising oncological risk. Larger international studies are needed for accurate assessment of WT1genotype-kidney function phenotype correlation.

Palifermin Does Not Influence the Incidence and Severity of GvHD Nor Long-Term Survival of Patients with Hematological Diseases Undergoing HSCT

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4301-4301
Author(s):  
Barbara Nasilowska-Adamska ◽  
Agnieszka Tomaszewska ◽  
Richard M. Szydlo ◽  
Piotr Rzepecki ◽  
Anna Czyz ◽  
...  
Keyword(s):  
Group Versus ◽  
Rank Test ◽  
Control Group ◽  
High Dose ◽  
Secondary Malignancies ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Hematological Diseases

Abstract AIMS: Oral mucositis (OM) is a frequent complication of myeloablative therapy and hematopoietic stem cell transplantation (HSCT). Palifermin was found to reduce the incidence, duration and severity of OM induced by high-dose chemotherapy with HSCT (Bone Marrow Transplant.2007;40:983–8). However, additional data on the long-term safety of palifermin and its potential influence on graft versus host disease (GvHD) were missing. In this multi-center, non-randomized, matched-control study we assessed overall survival (OS), incidence and severity of acute/chronicGvHD (a/cGvHD) and incidence of secondary malignancies in patients with hematological diseases treated with HSCT who received palifermin as a prophylaxis for OM. METHODS AND RESULTS: One hundred and twenty patients with hematological diseases transplanted between December 2001 and December 2007 were enrolled to this study. Sixty patients (50%) received palifermin (60μg/kg/day) for three consecutive days before and after conditioning therapy (palifermin group). Median age of patients was 37.5 years (range, 19 to 63) in the palifermin group and 35.5 years (range, 18 to 64) in the control group. There were no statistical differences between studied groups in terms of other clinical characteristics, including gender, diagnosis, type of transplant, conditioning regimens or GvHD prophylaxis. Kaplan-Meier curves for OS were calculated and compared using the log-rank test. Fisher’s exact and the χ2 trend tests were applied for the analysis of the GvHD data. Twenty one (35%) autologous and thirty nine (65%) allogeneic HSCT (HLA-matched related and unrelated) were performed in each group. Following allogeneic HSCT, the incidence of aGvHD grade 1–4 was 28.2% and 38.4% (p=0.34) and cGvHD was 41% and 53.8% (p=0.70) in the palifermin and control groups, respectively. The incidence of aGvHD severity grade 0,I,II,III,IV was 69.2%, 5.1%, 17.9%, 2.5%, 2.5% in the palifermin and 61.5%, 12.8%, 12.8%, 10.2%, 5.2% in the control group, respectively (p&gt;0.4 for each). The incidence of limited and extensive cGvHD was 17.9% and 23% in the palifermin group versus 25.6% and 28.2% in the control group (p=0.32 and p=0.50, respectively). The estimated 2-years OS (72.8% and 79.8%, respectively) also didn’t differ significantly between studied groups (p=0.13). We didn’t observe any secondary malignancies in patients enrolled into the study. CONCLUSIONS: Administration of palifermin doesn’t seem to influence the incidence and severity of a/cGvHD, secondary malignancies occurrence and OS in patients with hematological diseases undergoing HSCT.

scholarly journals Postoperative kidney injury does not decrease survival after liver transplantation

2012 ◽  
Vol 27 (11) ◽  
pp. 802-808 ◽  
Author(s):  
Olival Cirilo Lucena da Fonseca-Neto ◽  
Luiz Eduardo Correia Miranda ◽  
Thales Paulo Batista ◽  
Bernardo David Sabat ◽  
Paulo Sérgio Vieira de Melo ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Orthotopic Liver Transplantation ◽  
Multivariate Analyses ◽  
Patient Survival ◽  
Kidney Injury ◽  
Term Survival ◽  
Venovenous Bypass

PURPOSE: To explore the effect of acute kidney injury (AKI) on long-term survival after conventional orthotopic liver transplantation (OLT) without venovenous bypass (VVB). METHODS: A retrospective cohort study was carried out on 153 patients with end-stage liver diseases transplanted by the Department of General Surgery and Liver Transplantation of the University of Pernambuco, from August, 1999 to December, 2009. The Kaplan-Meier survival estimates and log-rank test were applied to explore the association between AKI and long-term patient survival, and multivariate analyses were applied to control the effect of other variables. RESULTS: Over the 12.8-year follow-up, 58.8% patients were alive with a median follow-up of 4.5-year. Patient 1-, 2-, 3- and 5-year survival were 74.5%, 70.6%, 67.9% and 60.1%; respectively. Early postoperative mortality was poorer amongst patients who developed AKI (5.4% vs. 20%, p=0.010), but long-term 5-year survival did not significantly differed between groups (51.4% vs. 65.3%; p=0.077). After multivariate analyses, AKI was not significantly related to long-term survival and only the intraoperative transfusion of red blood cells was significantly related to this outcome (non-adjusted Exp[b]=1.072; p=0.045). CONCLUSION: The occurrence of postoperative acute kidney injury did not independently decrease patient survival after orthotopic liver transplantation without venovenous bypass in this data from northeast Brazil.

Long-term patient survival in ANCA-associated vasculitis

2010 ◽  
Vol 70 (3) ◽  
pp. 488-494 ◽  
Author(s):  
Oliver Flossmann ◽  
Annelies Berden ◽  
Kirsten de Groot ◽  
Chris Hagen ◽  
Lorraine Harper ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Causes Of Death ◽  
Patient Survival ◽  
First Year ◽  
Term Survival ◽  
Risk Of Death ◽  
Anca Associated Vasculitis ◽  
Increased Risk ◽  
Age And Sex

BackgroundWegener's granulomatosis and microscopic polyangiitis are antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides with significant morbidity and mortality. The long-term survival of patients with ANCA associated vasculitis treated with current regimens is uncertain.ObjectiveTo describe the long-term patient survival and possible prognostic factors at presentation in an international, multicentre, prospectively recruited representative patient cohort who were treated according to strictly defined protocols at presentation and included the full spectrum of ANCA-associated vasculitis disease.MethodsOutcome data were collected for 535 patients who had been recruited at the time of diagnosis to four randomised controlled trials between 1995 and 2002. Trial eligibility was defined by disease severity and extent, covered the spectrum of severity of ANCA-associated vasculitis and used consistent diagnostic criteria. Demographic, clinical and laboratory parameters at trial entry were tested as potential prognostic factors in multivariable models.ResultsThe median duration of follow-up was 5.2 years and 133 (25%) deaths were recorded. Compared with an age- and sex-matched general population there was a mortality ratio of 2.6 (95% CI 2.2 to 3.1). Main causes of death within the first year were infection (48%) and active vasculitis (19%). After the first year the major causes of death were cardiovascular disease (26%), malignancy (22%) and infection (20%). Multivariable analysis showed an estimated glomerular filtration rate <15 ml/min, advancing age, higher Birmingham Vasculitis Activity Score, lower haemoglobin and higher white cell count were significant negative prognostic factors for patient survival.ConclusionPatients with ANCA-associated vasculitis treated with conventional regimens are at increased risk of death compared with an age- and sex-matched population.

scholarly journals Assessing Survival and Grading the Severity of Complications in Octogenarians Undergoing Pulmonary Lobectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Andrew Feczko ◽  
Elizabeth McKeown ◽  
Jennifer L. Wilson ◽  
Brian E. Louie ◽  
Ralph W. Aye ◽  
...  
Keyword(s):  
Clinical Stage ◽  
Lung Resection ◽  
Morbidity And Mortality ◽  
Term Survival ◽  
Clinical Stage Ia ◽  
Increased Risk ◽  
Complete Discussion ◽  
Stage Ia

Introduction. Octogenarians are at increased risk for complications after lung resection. With alternatives such as radiation, understanding the risks of surgery and associated survival are valuable. Data grading the severity of complications and long-term survival in this population is lacking. We reviewed our experience with lobectomy in octogenarians, grading complications using a validated thoracic morbidity and mortality schema. Methods. We retrospectively reviewed consecutive patients aged ≥80 undergoing lobectomy between 2004 and 2012. Demographics, clinical/pathologic stage, complications, recurrence, and mortality were collected. Complications were graded by the Seely thoracic morbidity and mortality model. Results. 45 patients (mean age 82.2 years) were analyzed. The majority of patients (28/45, 62%) were clinical stage IA/IB. 62% (28/45) of patients experienced a complication. Only 15.6% (7/45) were considered significantly morbid (≥ grade IIIB) per the Seely model. Perioperative mortality was 2% and half of patients were living at a follow-up of 53 months. Overall five-year survival was 52%. Conclusions. In carefully selected octogenarians, lobectomy carries a 15.6% rate of significantly morbid complications with encouraging overall survival. These data provide the basis for a more complete discussion with patients regarding lobectomy for lung cancer.

scholarly journals Long-Term Outcome of Liver Transplantation in HIV-1-Positive Patients: 15-Year Follow-Up

2013 ◽  
Vol 2013 ◽  
pp. 1-8
Author(s):  
Shinji Yamamoto ◽  
Robert Schwarcz ◽  
Ola Weiland ◽  
Antti Oksanen ◽  
Annika Wernerson ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Highly Active Antiretroviral Therapy ◽  
Patient Survival ◽  
Biliary Cirrhosis ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Hiv 1

Liver transplantation (LT) for patients with human immunodeficiency virus type-1 (HIV-1) infection has been associated with poor outcome. However, after the introduction of the highly active antiretroviral therapy, short-term patient survival after LT has improved significantly. We examined the long-term outcome of HIV-1-positive patients who underwent LT. Medical records were analysed in nine HIV-1-positive LT patients who underwent LT from August 1998 to May 2012. Eight were known to be HIV-1 positive at the time of listing for LT and had end-stage liver disease (ESLD) due to hepatitis C. One patient had primary biliary cirrhosis, and primary HIV-1 infection was found at the date of LT. Seven of the nine patients remain alive to date. So far, three have survived more than 12 years after LT. The overall patient survival rate for both five and 10 years is 77.8%. Four patients experienced acute rejection and six acquired biopsy-confirmed HCV recurrence. HIV-1 replication was effectively blocked during follow-up in all patients. We conclude that long-term survival of HIV-1-positive patients after LT can be achieved. Our study suggests that LT can offer an effective treatment option in selected HIV-1 infected patients with ESLD.

14-Year Results of Bilateral versus Single Internal Thoracic Artery Grafts for Left-Sided Myocardial Revascularization in Young Diabetic Patients

2016 ◽  
Vol 65 (04) ◽  
pp. 272-277 ◽  
Author(s):  
Alem Delalic ◽  
Edgar Eszlari ◽  
Walter Eichinger ◽  
Brigitte Gansera
Keyword(s):  
Internal Thoracic Artery ◽  
Survival Rates ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Diabetic Patients ◽  
Deep Sternal Wound Infection ◽  
Term Survival ◽  
Increased Risk

Objectives Despite encouraging late outcomes, the use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization in diabetic patients remains controversial because of an increased risk of sternal wound complications. In the present study, early- and long-term outcomes of the use of left-sided BITA versus single internal thoracic artery (SITA) grafting in young (< 65 years of age) diabetic patients were reviewed retrospectively. Methods A total of 250 propensity score pair-matched diabetic patients, operated on between February 2000 and December 2011, receiving either BITA (n = 125) or SITA (n = 125) grafting were analyzed retrospectively. In each group, 104 patients were males, and mean age was 60.1 ± 5.3 years. Follow-up was 2.1 to 14.8 years (mean, 9.3 ± 3.5 years) and complete for 100%. Results Incidence of deep sternal wound infection was 2.4 versus 3.2% (p = 0.722). Rethoracotomy due to bleeding occurred in 4.8 versus 3.2% (p = 0.608). The 5-, 10-, and 14-year estimates of survival were 93.4, 76.6, and 67.5% (BITA) versus 89.5, 81.5, and 32.8% (SITA); p = 0.288. Freedom from reangiography/intervention (60.5 vs. 63.9%) during follow-up was comparable (p = 0.507) as well as infarction rate (93.8 vs. 95.1%, p = 0.833) and redoes (p = 0.672, exclusively valve surgery) were comparable. Freedom from thromboembolic or cerebrovascular events did not show any significant differences (94.0 vs. 94.0%, p = 0.78). Multivariate analysis identified poor ejection fraction as predictor for decreased long-term survival. Neither age nor gender or urgency had an influence on long-term mortality. Conclusion Left-sided BITA grafting may be performed routinely even in diabetic patients without increased incidence of postoperative wound-healing complications. Survival rates after 5, 10, and 14 years were comparable for BITA and SITA grafting.

The Importance of the Thickness of the Femoral Cement Mantle

2003 ◽  
Vol 13 (2) ◽  
pp. 61-64 ◽  
Author(s):  
W.H. Harris
Keyword(s):  
Femoral Stem ◽  
Cement Mantle ◽  
Grading System ◽  
Term Survival ◽  
Long Term Survival ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Mantle Thickness

The importance of mantle thickness in the long-term survival of cemented femoral components remains controversial. One complexity in evaluating mantle thickness alone is the dominating fact that so many other factors can influence the incidence of failure. Nonetheless, a cement grading system has been applied to the assessment of the intermediate and long-term follow-up series of the following cemented femoral stem designs HD-2 (Howmedica, Rutherford, NJ), CAD (Howmedica, Rutherford, NJ), Precoat (Zimmer, Warsaw, IN), Iowa (Zimmer, Warsaw, IN), Ti32 (Zimmer, Warsaw, IN), and DF80 (Zimmer, Warsaw, IN). In each series, a statistically significant increased risk of failure was found in those cases with cement mantles that were thin or deficient. While these data do not mean that all such cases fail, the data strongly support the concept of avoiding such deficiencies in the cement mantle of these stem designs.

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