scholarly journals Thyroid cancer and renal transplantation: a meta-analysis

2010 ◽  
Vol 17 (1) ◽  
pp. 159-167 ◽  
Author(s):  
Dheeraj Karamchandani ◽  
Ramiro Arias-Amaya ◽  
Nora Donaldson ◽  
Jackie Gilbert ◽  
Klaus-Martin Schulte
Keyword(s):  
Thyroid Cancer ◽  
Renal Transplantation ◽  
Meta Analysis ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Post Transplantation ◽  
Post Transplant ◽  
Increased Risk

Kidney transplantation and the associated immune suppression are associated with a significantly increased risk of developing cancer during long-term follow-up. Thyroid cancer has been recognised as a potential post-transplant risk but has not yet been subject of a focused review. We therefore performed a meta-analysis on data of 50 861 patients with a total follow-up of 198 595 patient-years and identified a 6.9-fold higher standardised incidence ratio (95% confidence interval 5.6–8.7, P<0.001) of thyroid cancer post renal transplantation as compared with a non-transplant group. All such cancers were of papillary type as far as histopathology was known. The mean time to discovery was 6.0 years post transplantation. This puts thyroid cancer into the group of high cancer risk following solid organ transplantation which already includes cervical cancer, non-melanoma skin cancer, oral and lip cancer and haematological malignancies. It is unclear what causes the increased cancer incidence. Inclusion of thyroid ultrasound in long-term post-transplant evaluation may help to ensure timely recognition of this condition.

scholarly journals Angiogenesis Inhibitors as Anti-Cancer Therapy Following Renal Transplantation: A Case Report and Review of the Literature

2021 ◽  
Vol 28 (1) ◽  
pp. 661-670
Author(s):  
Lawrence Kasherman ◽  
Jeffrey Doi ◽  
Katherine Karakasis ◽  
Jeffrey Schiff ◽  
Abhijat Kitchlu ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Organ Transplant ◽  
Angiogenesis Inhibitors ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Immunosuppressive Medication ◽  
Increased Risk ◽  
Anti Cancer ◽  
Solid Organ Transplant Recipients

Solid organ transplant recipients on long-term immunosuppressive medication are at increased risk of developing malignancy, and treatment of advanced cancers with angiogenesis inhibitors in this context has not been widely studied. We present a case of recurrent high-grade serous ovarian carcinoma treated with paclitaxel and bevacizumab in the context of prior renal transplantation where the patient responded well to treatment with controlled toxicities, discussing the potential for increased rates of adverse events and drug interactions in this select population.

scholarly journals Exploring the Epidemiology of Cancer after Solid Organ Transplantation (EpCOT): an observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043731
Author(s):  
Adnan Sharif ◽  
Javeria Peracha ◽  
David Winter ◽  
Raoul Reulen ◽  
Mike Hawkins
Keyword(s):  
Organ Transplantation ◽  
Record Linkage ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Study Cohort ◽  
Solid Organ ◽  
Post Transplantation ◽  
Increased Risk ◽  
Risk Of Cancer

IntroductionSolid organ transplant patients are counselled regarding increased risk of cancer (principally due to their need for lifelong immunosuppression) and it ranks as one of their biggest self-reported worries. Post-transplantation cancer is common, associated with increased healthcare costs and emerging as a leading cause of post-transplant mortality. However, epidemiology of cancer post-transplantation remains poorly understood, with limitations including translating data from different countries and national data being siloed across different registries and/or data warehouses.Methods and analysisStudy methodology for Epidemiology of Cancer after Solid Organ Transplantation involves record linkage between the UK Transplant Registry (from NHS Blood and Transplant), Hospital Episode Statistics (for secondary care episodes from NHS Digital), National Cancer Registry (from cancer registration data hosted by Public Health England) and the National Death Registry (from NHS Digital). Deterministic record linkage will be conducted by NHS Digital, with a fully anonymised linked dataset available for analysis by the research team. The study cohort will consist of up to 85 410 solid organ transplant recipients,who underwent a solid organ transplant in England between 1 January 1985 and 31 December 2015, with up-to-date outcome data.Ethics and disseminationThis study has been approved by the Confidentiality Advisory Group (reference: 16/CAG/0121), Research Ethics Committee (reference: 15/YH/0320) and Institutional Review Board (reference: RRK5471). The results of this study will be presented at national and international conferences, and manuscripts with results will be submitted for publication in high-impact peer-reviewed journals. The information produced will also be used to develop national evidence-based clinical guidelines to inform risk stratification to enable risk-based clinical follow-up.Trial registration numberNCT02991105.

Abstract 13315: Long-term Risk of Cardiovascular Events Following Hospitalization for Sepsis: A Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Leah B Kosyakovsky ◽  
Federico Angriman ◽  
Emma Katz ◽  
Neill Adhikari ◽  
Lucas C Godoy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cumulative Incidence ◽  
Meta Analysis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Significant Difference ◽  
Sepsis Survivors ◽  
Risk Ratios

Introduction: Sepsis results in dysregulated inflammation, coagulation, and metabolism, which may contribute to increased cardiovascular disease (CVD) risk. We conducted a systematic review and meta-analysis to determine the association between sepsis and subsequent long-term CVD events. Methods: MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception to May 2020 to identify observational studies of adult sepsis survivors (defined by diagnostic codes or consensus definitions) measuring long-term CV outcomes. The primary outcome was a composite of myocardial infarction, CV death, and stroke. Random-effects models estimated the pooled cumulative incidence and adjusted hazard ratios of CV events relative to hospital or population controls. Odds ratios were included as risk ratios assuming <10% incidence in non-septic controls, and risk ratios were taken as hazard ratios (HR) assuming no censoring. Outcomes were analyzed at maximum follow-up (primary analysis) and stratified by time (<1 year, 1-2 years, and >2 years) since sepsis. Results: Of 11,235 abstracts screened, 25 studies (22 cohort studies, 2 case-crossover studies, and 1 case-control) involving 1,949,793 sepsis survivors were included. The pooled cumulative incidence of CVD events was 9% (95% CI; 5-14%). Sepsis was associated with an increased risk (HR 1.59, 95% CI 1.37-1.86) of CVD events at maximum follow-up ( Figure ); between-study heterogeneity was substantial (I 2 =97.3%). There was no significant difference when comparing studies using population and hospital controls. Significantly elevated risk was observed up to 5 years following sepsis. Conclusions: Sepsis survivors experience an approximately 50% increased risk of CVD events, which may persist for years following the index episode. These results highlight a potential unmet need for early cardiac risk stratification and optimization in sepsis survivors.

scholarly journals Viral Enteritis in Solid-Organ Transplantation

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2019
Author(s):  
Anum Abbas ◽  
Andrea J. Zimmer ◽  
Diana Florescu
Keyword(s):  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Organ Transplant Recipients ◽  
Increased Risk ◽  
Viral Enteritis ◽  
Solid Organ Transplant Recipients

Solid organ transplant recipients are at increased risk for infections due to chronic immunosuppression. Diarrhea is a commonly encountered problem post transplantation, with infectious causes of diarrhea being a frequent complication. Viral infections/enteritides in solid organ transplant recipients often result from frequently encountered pathogens in this population such as cytomegalovirus, adenovirus, and norovirus. However, several emerging viral pathogens are increasingly being recognized as more sensitive diagnostic techniques become available. Treatment is often limited to supportive care and reduction in immunosuppression, though antiviral therapies mayplay a role in the treatment in certain diseases. Viral enteritis is an important entity that contributes to morbidity and mortality in transplant recipients.

Bilateral sequential lung transplantation in Jehovah’s Witnesses

Perfusion ◽  
2020 ◽  
pp. 026765912093936
Author(s):  
Ernest G Chan ◽  
Matthew R Morrell ◽  
Patrick G Chan ◽  
Pablo G Sanchez
Keyword(s):  
Lung Transplantation ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Limited Resource ◽  
Solid Organ ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Long Term Follow Up

The ethical concerns of refusing lifesaving treatments after receiving an already limited resource such as a solid organ transplantation in a Jehovah’s Witness patient have been discussed in the literature. Many of these studies have concluded that with a multidisciplinary approach, solid organ transplantation is possible in the setting of Jehovah’s Witness patients. To date, there are no reported cases of bilateral sequential lung transplantation in the literature. We report two successful cases of bilateral sequential lung transplantation in Jehovah’s Witness patients with excellent long-term follow-up.

P1769POST TRANSPLANT MALIGNANCY - OUR EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
George Kurian ◽  
Gauri Shankar Jagadesh ◽  
Sandeep Sreedharan ◽  
Zachariah Paul ◽  
Anil Mathew ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Solid Organ ◽  
Oncogenic Viruses ◽  
Factors Affecting ◽  
Post Transplant ◽  
Transplant Patients ◽  
Cell Immunity ◽  
Number Of Patients ◽  
Increased Risk ◽  
Histological Variant

Abstract Background and Aims Cancer is now increasingly recognized as a major cause of death among patients especially after kidney transplantation. Malignancy represent a major burden in transplantation medicine. The Incidence is about 12 fold higher for PTLD and 3.5 fold higher for non-cutaneous malignancy compare to age-matched population. The increased risk is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. In the era of longer graft survival and with the introduction of more potent immunosuppressive medication, malignancy represents a major burden. The incidence of malignancy after renal transplantation is 3 to 5 times higher. Incidence is higher in transplant patients even when compared to patients on hemodialysis. Aim: We attempted to assess the incidence of post-transplant malignancies in patients who underwent renal transplantation at our centre, along with studying the presentation, type and other factors affecting their development. Method We analysed data retrospectively from 626patients who underwent renal transplantation atour centre from January 2003 to September 2018.Pre transplant history, post transplant course including duration on hemodialysis, immunosuppression details and duration till diagnosis of malignancies were collected. Details regarding type of malignancy, histopathology, staging and treatment given and outcome were collected. Results Number of transplant recipient-626. The total number of patients with malignancy is 12. Incidence of malignancy posttransplant is 1.9%.Male-7 and female-6.One patient was detected with 2 malignanciesduring her post transplant period. The types of malignancies encountered were Conclusion The incidence of malignancy – 1.9%.Probable reason for decreased incidence of malignancy is the decreased immunosuppression needed by South Asian people. The most common malignancy was solid organ tumour; tongue being the most common organ. Most common histological variant is squamous cell carcinoma.Non-Hodgkin is more common than Hodgkin. Incidence of malignancy is low. Decision regarding cancer screening should be made on individual basis.

scholarly journals Long-Term All-Cause Mortality and Its Association with Cardiovascular Risk Factors in Thyroid Cancer Survivors: An Israeli Population-Based Study

2020 ◽  
Author(s):  
Elena Izkhakov ◽  
Lital Keinan-Boker ◽  
Micha Barchana ◽  
Yacov Shacham ◽  
Iris Yaish ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Thyroid Cancer ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cox Regression ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

scholarly journals Association between Cardiovascular Risk Factors and Long-Term All-Cause Mortality in Thyroid Cancer Survivors: An Israeli Population-Based Study

2020 ◽  
Author(s):  
Elena Izkhakov ◽  
Lital Keinan-Boker ◽  
Micha Barchana ◽  
Yacov Shacham ◽  
Iris Yaish ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Thyroid Cancer ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cox Regression ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the association between long-term all-cause mortality and cardiovascular risk factors in TC survivors compared to the general population. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

scholarly journals Long-term glycemic variability and risk of stroke in patients with diabetes: a meta-analysis

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiaoli Ren ◽  
Zhiyun Wang ◽  
Congfang Guo
Keyword(s):  
Standard Deviation ◽  
Coefficient Of Variation ◽  
Meta Analysis ◽  
Glycemic Variability ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Follow Up Studies ◽  
Patients With Diabetes

Abstract Objectives Long-term glycemic variability has been related to increased risk of vascular complication in patients with diabetes. However, the association between parameters of long-term glycemic variability and risk of stroke remains not fully determined. We performed a meta-analysis to systematically evaluate the above association. Methods Medline, Embase, and Web of Science databases were searched for longitudinal follow-up studies comparing the incidence of stroke in diabetic patients with higher or lower long-term glycemic variability. A random-effect model incorporating the potential heterogeneity among the included studies were used to pool the results. Results Seven follow-up studies with 725,784 diabetic patients were included, and 98% of them were with type 2 diabetes mellitus (T2DM). The mean follow-up duration was 7.7 years. Pooled results showed that compared to those with lowest category of glycemic variability, diabetic patients with the highest patients had significantly increased risk of stroke, as evidenced by glycemic variability analyzed by fasting plasma glucose coefficient of variation (FPG-CV: risk ratio [RR] = 1.24, 95% confidence interval [CI] 1.11 to 1.39, P < 0.001; I2 = 53%), standard deviation of FPG (FPG-SD: RR = 1.16, 95% CI 1.02 to 1.31, P = 0.02; I2 = 74%), HbA1c coefficient of variation (HbA1c-CV: RR = 1.88, 95% CI 1.61 to 2.19 P < 0.001; I2 = 0%), and standard deviation of HbA1c (HbA1c-SD: RR = 1.73, 95% CI 1.49 to 2.00, P < 0.001; I2 = 0%). Conclusions Long-term glycemic variability is associated with higher risk of stroke in T2DM patients.

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