scholarly journals A májátültetés aneszteziológiai-intenzív terápiás vonatkozásai

2018 ◽  
Vol 159 (46) ◽  
pp. 1891-1897
Author(s):  
János Fazakas ◽  
Anikó Smudla
Keyword(s):  
Organ Transplantation ◽  
Intensive Therapy ◽  
Surgical Techniques ◽  
Interdisciplinary Approach ◽  
Liver Transplants ◽  
Term Survival ◽  
Successful Transplantation ◽  
Almost All ◽  
End Stage

Abstract: One of the most prominent results of our age is organ transplantation, the single treatment option for patients with end-stage organ failure. The success of transplants depends on the donor care, the patient preoperative preassessment, the perioperative care of organ transplantation and aftercare. Successful transplantation therefore requires a prominent level of continuous collaboration between the surgeon, anaesthesiologist, radiologist, internal medicine and hepatologist, laboratory physician and almost all their associates. The complex interdisciplinary approach based on the research results can be used to improve the patient’s condition through pharmacotherapy, physiotherapy and psychotherapy during the time spent on waiting lists. The emergence of more active, targeted therapeutic options in perioperative graft resuscitation may help the currently inferior quality transplantable grafts or resuscitation out (machine perfusion) or in the recipient, thereby increasing the number of liver transplants. Deeper knowledge of hemostatic processes, along with the development of surgical techniques, would increase the number of blood transplant free transplants, thus improving the long-term survival of grafts. The present study aims at presenting the anaesthesia and early intensive therapy aspects of liver transplantation from aptitude assessment, through anaesthesia to early intensive therapeutic treatment. Orv Hetil. 2018; 159(46): 1891–1897.

scholarly journals Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Daniella Levy Erez ◽  
Irit Krause ◽  
Amit Dagan ◽  
Roxana Cleper ◽  
Yafa Falush ◽  
...  
Keyword(s):  
Survival Rate ◽  
Medical Center ◽  
Significant Risk ◽  
Chronic Dialysis ◽  
Term Survival ◽  
Successful Transplantation ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Objective.Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality.Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center.Results.110 patients were enrolled in the study. Mean age was10.7±5.27 yrs. (range: 1 month–24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was13.5±5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90%for patients older than 5 years and 61%for younger patients.Conclusions.Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.

scholarly journals Immunohistochemical evaluation for P53 and VEGF (Vascular Endothelial Growth Factor) is not prognostic for long term survival in end stage esophageal adenocarcinoma

2009 ◽  
Vol 36 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Leandro Totti Cavazzola ◽  
André Ricardo Pereira da Rosa ◽  
Carlos Cauduro Schirmer ◽  
Richard Ricachenevski Gurski ◽  
João Pedro Bueno Telles ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Curative Resection ◽  
P53 Protein ◽  
Vascular Endothelial ◽  
Clinicopathological Factors ◽  
Term Survival ◽  
Long Term Survival ◽  
End Stage ◽  
Endothelial Growth Factor

OBJECTIVES: To correlate the expression of p53 protein and VEGF with the prognosis of patients submitted to curative resection to treat esophageal adenocarcinoma. METHODS: Forty-six patients with esophageal adenocarcinoma, submitted to curative resection, were studied. The expressions of p53 protein and VEGF were assessed by immunohistochemistry in 52.2% and 47.8% of tumors, respectively. RESULTS: P53 protein and VEGF expressions coincided in 26% of the cases, and no correlation between these expressions was observed. None of the clinicopathological factors showed a significant correlation with p53 protein or VEGF expressions. There was no significant association between p53 protein and VEGF expressions and long-term survival. CONCLUSION: The expression of p53 protein and VEGF did not correlate with prognosis in esophageal adenocarcinoma patients submitted to curative resection.

scholarly journals Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 1035 ◽  
Author(s):  
Chieh-Li Yen ◽  
Kun-Hua Tu ◽  
Ming-Shyan Lin ◽  
Su-Wei Chang ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Protein Diet ◽  
Low Protein Diet ◽  
Research Database ◽  
Negative Consequences ◽  
Term Survival ◽  
Low Protein ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

Background: A beneficial effect of a ketoanalogue-supplemented low-protein diet (sLPD) in postponing dialysis has been demonstrated in numerous previous studies. However, evidence regarding its effect on long-term survival is limited. Our study assessed the long-term outcomes of patients on an sLPD after commencing dialysis. Methods: This retrospective study examined patients with new-onset end-stage renal disease with permanent dialysis between 2001 and 2013, extracted from Taiwan’s National Health Insurance Research Database. Patients who received more than 3 months of sLPD treatment in the year preceding the start of dialysis were extracted. The outcomes studied were all-cause mortality, infection rate, and major cardiac and cerebrovascular events (MACCEs). Results: After propensity score matching, the sLPD group (n = 2607) showed a lower risk of all-cause mortality (23.1% vs. 27.6%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.70–0.84), MACCEs (19.2% vs. 21.5%, HR 0.86, 95% CI 0.78–0.94), and infection-related death (9.9% vs. 12.5%, HR 0.76, 95% CI 0.67–0.87) than the non-sLPD group did. Conclusion: We found that sLPD treatment might be safe without long-term negative consequences after dialysis treatment.

scholarly journals Biliary Obstruction: Endoscopic Approaches

2017 ◽  
Vol 34 (04) ◽  
pp. 369-375 ◽  
Author(s):  
Tomas DaVee ◽  
Jeffrey Lee
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Obstruction ◽  
Epigastric Pain ◽  
Surgical Techniques ◽  
Malignant Biliary Obstruction ◽  
Metal Stents ◽  
Biliary Stents ◽  
Term Survival ◽  
Painless Jaundice

AbstractPainless jaundice is a harbinger of malignant biliary obstruction, with the majority of cases due to pancreatic adenocarcinoma. Despite advances in treatment, including improved surgical techniques and neoadjuvant (preoperative) chemotherapy, long-term survival from pancreatic cancer is rare. This lack of significant improvement in outcomes is believed to be due to multiple reasons, including the advanced stage at diagnosis and lack of an adequate biomarker for screening and early detection, prior to the onset of jaundice or epigastric pain. Close attention is required to select appropriate patients for preoperative biliary decompression, and to prevent morbid complications from biliary drainage procedures, such as pancreatitis and cholangitis. Use of small caliber plastic biliary stents during endoscopic retrograde cholangiopancreatography should be minimized, as metal stents have increased area for improved bile flow and a reduced risk of adverse events during neoadjuvant therapy. Efforts are underway by translational scientists, radiologists, oncologists, surgeons, and gastroenterologists to augment lifespan for our patients and to more readily treat this deadly disease. In this review, the authors discuss the rationale and techniques of endoscopic biliary intervention, mainly focusing on malignant biliary obstruction by pancreatic cancer.

scholarly journals A case of rhabdomyolysis after atorvastatin therapy of a liver transplant recipient receiving immunosuppressive therapy with cyclosporine

2021 ◽  
Vol 13 (2) ◽  
pp. 158-164
Author(s):  
A. V. Shabunin ◽  
S. P. Loginov ◽  
P. A. Drozdov ◽  
I. V. Nesterenko ◽  
D. A. Makeev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Drug Interactions ◽  
Liver Transplant ◽  
Immunosuppressive Therapy ◽  
Organ Transplantation ◽  
Muscle Pain ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Term Survival

Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.

Impact of statin on long-term outcome among patients with end-stage renal disease with acute myocardial infarction (AMI): a nationwide case–control study

2021 ◽  
pp. postgradmedj-2019-137292
Author(s):  
Feng-You Kuo ◽  
Wei-Chun Huang ◽  
Pei-Ling Tang ◽  
Chin-Chang Cheng ◽  
Cheng-Hung Chiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Survival Rate ◽  
Statin Therapy ◽  
End Stage Renal Disease ◽  
Term Survival ◽  
Receptor Blockers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Statin Use

BackgroundUse of statin has been associated with reduced risk of cardiovascular diseases events and mortality. However, in patients with end-stage renal disease (ESRD), the protective effects of statin are controversial. To evaluate the impact of chronic statin use on clinical outcomes of patients with acute myocardial infarction (AMI) with ESRD.MethodsWe enrolled 8056 patients with ESRD who were initially diagnosed and admitted for first AMI from Taiwan’s National Health Insurance Research Database. Of which, 2134 patients underwent statin therapy. We randomly selected and use age, sex, hypertension, diabetes mellitus (DM), peripheral vascular diseases (PVD), heart failure (HF), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease, matched with the study group as controls (non-stain user). We compared the effects of statin use in term of all-cause death among patients with AMI with ESRD.ResultsStatin use resulted in a significantly higher survival rate in patients ith AMI with ESRD compared with non-statin users. After adjusted the comorbidities the male patients and patients with DM, PVD, HF and CVA had lower long-term survival rate (all p<0.001). Patients who underwent percutaneous coronary intervention (p<0.001), ACE inhibitors/angiotensin II receptor blockers (p<0.001), β receptor blockers (p<0.001) and statin therapy (p=0.007) had better long-term survival rate. Patients with AMI with ESRD on statin therapy exhibited a significantly lower risk of mortality compared with non-statin users (p<0.0001).ConclusionAmong patients with ESRD with AMI, statin therapy was associated with reduced all-cause mortality.

Current status of heart transplantation

2018 ◽  
pp. 223-240
Author(s):  
Ayyaz Ali ◽  
Robert L. Kormos
Keyword(s):  
Heart Transplantation ◽  
Cardiac Transplantation ◽  
Organ Procurement ◽  
Severe Heart Failure ◽  
Surgical Techniques ◽  
Current Status ◽  
Definitive Treatment ◽  
Term Survival ◽  
The Many ◽  
End Stage

Cardiac transplantation has extended and improved the lives of patients suffering from severe heart failure over many decades. Despite advances in medical therapy, cardiac transplantation remains the definitive treatment for end-stage heart disease. Surgical techniques for organ procurement and implantation, development of appropriate methods for preserving the heart, and understanding the immunological challenges associated with transplantation were among the many areas which required focused investigation. In the current era, heart transplantation is associated with a low operative mortality and excellent long-term survival, however, the major obstacle of shortage of suitable donor organs remains. In the following chapter, recipient selection and management, donor organ procurement and preservation, and surgical techniques of heart transplantation are described in detail.

scholarly journals Outcomes of Patients With Double-Hit Lymphoma Who Achieve First Complete Remission

2017 ◽  
Vol 35 (20) ◽  
pp. 2260-2267 ◽  
Author(s):  
Daniel J. Landsburg ◽  
Marissa K. Falkiewicz ◽  
Joseph Maly ◽  
Kristie A. Blum ◽  
Christina Howlett ◽  
...  
Keyword(s):  
Complete Remission ◽  
Intensive Therapy ◽  
Front Line ◽  
Term Survival ◽  
Disease Response ◽  
Line Therapy ◽  
Double Hit Lymphoma ◽  
Double Hit ◽  
First Complete Remission

Purpose Patients with double-hit lymphoma (DHL) rarely achieve long-term survival following disease relapse. Some patients with DHL undergo consolidative autologous stem-cell transplantation (autoSCT) to reduce the risk of relapse, although the benefit of this treatment strategy is unclear. Methods Patients with DHL who achieved first complete remission following completion of front-line therapy with either rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or intensive front-line therapy, and deemed fit for autoSCT, were included. A landmark analysis was performed, with time zero defined as 3 months after completion of front-line therapy. Patients who experienced relapse before or who were not followed until that time were excluded. Results Relapse-free survival (RFS) and overall survival (OS) rates at 3 years were 80% and 87%, respectively, for all patients (n = 159). Three-year RFS and OS rates did not differ significantly for autoSCT (n = 62) versus non-autoSCT patients (n = 97), but 3-year RFS was inferior in patients who received R-CHOP compared with intensive therapy (56% v 88%; P = .002). Three-year RFS and OS did not differ significantly for patients in the R-CHOP or intensive therapy cohorts when analyzed by receipt of autoSCT. The median OS following relapse was 8.6 months. Conclusion In the largest reported series, to our knowledge, of patients with DHL to achieve first complete remission, consolidative autoSCT was not associated with improved 3-year RFS or OS. In addition, patients treated with R-CHOP experienced inferior 3-year RFS compared with those who received intensive front-line therapy. When considered in conjunction with reports of patients with newly diagnosed DHL, which demonstrate lower rates of disease response to R-CHOP compared with intensive front-line therapy, our findings further support the use of intensive front-line therapy for this patient population.

scholarly journals BST-236, a novel cytarabine prodrug for patients with acute leukemia unfit for standard induction: a phase 1/2a study

2019 ◽  
Vol 3 (22) ◽  
pp. 3740-3749 ◽  
Author(s):  
Tsila Zuckerman ◽  
Ron Ram ◽  
Luiza Akria ◽  
Maya Koren-Michowitz ◽  
Ron Hoffman ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Leukemia ◽  
Phase 1 ◽  
Intensive Therapy ◽  
High Dose ◽  
Term Survival ◽  
Long Term Survival ◽  
Key Points ◽  
High Dose Cytarabine

Key Points The majority of older adults or unfit acute leukemia patients are not offered intensive therapy, resulting in dismal long-term survival. A novel cytarabine prodrug BST-236 enables delivery of high-dose cytarabine and appears to be safe and efficacious in these patients.

scholarly journals Review: Ischemia Reperfusion Injury—A Translational Perspective in Organ Transplantation

2020 ◽  
Vol 21 (22) ◽  
pp. 8549
Author(s):  
André Renaldo Fernández ◽  
Rodrigo Sánchez-Tarjuelo ◽  
Paolo Cravedi ◽  
Jordi Ochando ◽  
Marcos López-Hoyos
Keyword(s):  
Reperfusion Injury ◽  
Organ Transplantation ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Graft Loss ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Donation Process ◽  
End Stage ◽  
Significant Injury

Thanks to the development of new, more potent and selective immunosuppressive drugs together with advances in surgical techniques, organ transplantation has emerged from an experimental surgery over fifty years ago to being the treatment of choice for many end-stage organ diseases, with over 139,000 organ transplants performed worldwide in 2019. Inherent to the transplantation procedure is the fact that the donor organ is subjected to blood flow cessation and ischemia during harvesting, which is followed by preservation and reperfusion of the organ once transplanted into the recipient. Consequently, ischemia/reperfusion induces a significant injury to the graft with activation of the immune response in the recipient and deleterious effect on the graft. The purpose of this review is to discuss and shed new light on the pathways involved in ischemia/reperfusion injury (IRI) that act at different stages during the donation process, surgery, and immediate post-transplant period. Here, we present strategies that combine various treatments targeted at different mechanistic pathways during several time points to prevent graft loss secondary to the inflammation caused by IRI.

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