scholarly journals Role of pre-transplant corneal injective anti VEGF treatment in high risk transplantation corneas

2021 ◽  
Author(s):  
Romina Fasciani ◽  
Emanuele crincoli ◽  
Luigi Mosca ◽  
Laura Guccione ◽  
Alice Caristia ◽  
...  
Keyword(s):  
High Risk ◽  
Graft Rejection ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Corneal Neovascularization ◽  
Control Group ◽  
Preoperative Treatment ◽  
Group 5

Abstract Background In “high-risk” corneal graft recipients, like those with neovascularization of the cornea, the failure rate can exceed 35% at three years, the main cause being graft rejection. The main purpose of the study is to demonstrate the efficacy of pre-transplant Bevacizumab corneal injection in long term lowering of the prevalence of graft failure and rejection in high risk corneal transplantations. Methods This retrospective single-centre case-control study analyzed 37 eyes with significant corneal neovascularization and eligible for corneal transplantation at baseline. One group (BT group) included patients who were treated with a 3 months preoperative cycle of subconjunctival and/or intrastromal 5 mg/0.2 ml Bevacizumab injected at the limbus with a 27 G needle. The control group (NT group) didn’t receive the preoperative treatment. The main outcome was the prevalence of graft failures and rejections during the follow up period. Secondary outcomes included the prevalence of adverse events and the prevalence of patients who avoided corneal transplantation due to the treatment. Results BT group included 24 eyes with a follow up duration of 61.2 ± 24 months. Eight patients (33.3%) avoided transplant surgery after the injection. In the BT group 5 cases of graft failure (20.8%), 1 of which due to graft rejection (4%), occurred during the follow up. The NT group registered 6 cases (46.1%) of immune rejection of the graft and no additional graft failures from other causes. Conclusions Pre-transplant bevacizumab corneal injections are a safe and effective method to prevent graft rejection in neovascularized corneas.

Effectiveness of Histocompatibility Matching in High-Risk Corneal Transplantation

2020 ◽  
pp. 1-8
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
High Risk ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Corneal Graft ◽  
Hla Dr ◽  
Risk Patients ◽  
Graft Success ◽  
Group Matching ◽  
Corneal Graft Failure

The Collaborative Cornea Transplant Studies (CCTS) comprised two randomized, double-masked, clinical trials, the Antigen Matching Study (AMS) and the Crossmatch Study (CS), designed to determine whether matching HLA-A, -B, and/or HLA-DR antigens, donor-recipient crossmatching, or ABO compatibility reduced the risk of corneal allograft rejection and failure in high-risk patients. The studies showed that for patients needing a corneal graft with uncompromised immune systems and at high risk for corneal graft rejection: (1) neither HLA-A, -B, nor HLA-DR antigen matching substantially reduces the likelihood of corneal graft failure; (2) a positive donor-recipient crossmatch does not dramatically increase the risk of corneal graft failure; and (3) ABO blood group matching may be effective in reducing the risk of graft failure. Intensive steroid therapy after transplantation, frequent follow-up, medication and follow-up compliance, and patient education appear to play a significant role in corneal graft success.

scholarly journals Approaches toward enhancing survival probability following deep anterior lamellar keratoplasty

2020 ◽  
Vol 12 ◽  
pp. 251584142091301
Author(s):  
Sepehr Feizi ◽  
Amir A Azari
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Corneal Neovascularization ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Vernal Keratoconjunctivitis ◽  
Full Thickness ◽  
Appropriate Treatment ◽  
Anterior Lamellar Keratoplasty

The greatest advantage of deep anterior lamellar keratoplasty over full-thickness corneal transplantation is the elimination of graft failure caused by endothelial rejection. Despite this advantage, a deep anterior lamellar keratoplasty graft can fail because of several factors, such as complications related to the donor–recipient interface, graft epithelial abnormalities, graft vascularization, stromal graft rejection, and recurrence of herpetic keratitis. Increased deep anterior lamellar keratoplasty graft survival is mainly built upon optimization of the ocular surface to provide a hospitable environment for the graft. Any predisposing factors for graft epithelial abnormalities, corneal neovascularization, and preexisting vernal keratoconjunctivitis should be identified and treated preoperatively. Prompt recognition and appropriate treatment of interface-related complications and stromal graft rejection usually result in good anatomic outcomes, with no detrimental effects on vision.

scholarly journals SURGICAL TREATMENT OF ATRIAL FIBRILLATION IN ELDERLY PATIENTS UNDERGOING HIGH RISK CARDIAC SURGERY

2021 ◽  
Author(s):  
Mohsin Uzzaman ◽  
Imthiaz Manoly ◽  
Mohini Panikkar ◽  
Maciej Matuszewski ◽  
Nicolas Nikolaidis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Surgical Treatment ◽  
High Risk ◽  
Elderly Patients ◽  
Control Group ◽  
Surgical Ablation ◽  
Af Ablation

BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

Outcome of Kidney Transplantation in Patients with Antiphospholipid Antibodies: A Case Series

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1230-1230
Author(s):  
Karen A Breen ◽  
Kaji Sritharan ◽  
Jonathon Olsburgh ◽  
Beverley J Hunt
Keyword(s):  
Kidney Transplantation ◽  
Antiphospholipid Antibodies ◽  
Graft Failure ◽  
Control Group ◽  
Cardiolipin Antibodies ◽  
Long Term Follow Up ◽  
History Of ◽  
Thrombotic Complications

Abstract Abstract 1230 Background: Thrombotic and obstetric complications occur in association with antiphospholipid antibodies (aPL), as do intrarenal vascular changes in primary and secondary APS. There are a limited number of studies reporting the outcome of patients with aPL receiving kidney allografts. Materials & Methods: A retrospective chart review of patients who underwent kidney transplantation in our institution between 2005 and 2010 (inclusive) was performed. Patients who had at least 1 positive aPL at the time of transplantation were identified, their demographic, immediate and long-term outcome details obtained including any aPL related complications (thrombotic episodes including intrarenal vascular complications). Comparison was made with a control group consisting of transplant recipients not known to have aPL, matched for age, sex, transplant type and year of transplant. Results: 884 patients underwent kidney transplantation between 2005 and 2010. 87 patients were screened for aPL(9.8%), 41 patients with aPL were identified(4.6%), 34 patients had a lupus anticoagulant, 1 had anti-cardiolipin antibodies and 6 both lupus anticoagulant and anti-cardiolipin antibodies. Long-term follow up was available for 31 patients. 25/31 patients were found to have persistent aPL (25/31 had repeated aPL screening). Patients included 17 males, 24 females, mean age 42 (range 19–61) years). 14 patients were known to have persistent aPL prior to transplantation and 5 of these were receiving long-term anticoagulation because of a history of thrombosis prior to renal transplant. 3 of the 27 patients not known to have persistent aPL prior to transplantation had a history of thrombosis prior to renal transplant; none of these were receiving long-term anticoagulation. 13 patients had aPL in association with other autoimmune disease (SLE). 30 patients had screening for other thrombophilic disorders performed. Other risk factors included hypercholesterolaemia, hypertension and cigarette smoking. The table below summarises short and long-term aPL related complications. 25 patients had a cadaveric transplant, 2 had live unrelated donor transplants and 14 had live-related donor kidney transplants. Immediate thrombotic complications in patients with aPL included 4 patients who had graft failure due to renal vessel thrombosis resulting in graft excision because of ischaemia of the transplanted organ and 2 had a lower limb DVT (receiving perioperative thromboprophylaxis with aspirin, n=6) compared to 1 patient in the control group who experienced a lower limb DVT(significantly higher in patients with aPL compared to controls p=0.03). Of the patients for whom long term follow up was available, long-term thrombotic complications were significantly higher in patients with aPL compared to controls (5/31 patients with aPL compared to 0/31 controls, p=0.02). Complications included fatal PE in 1 patient (on warfarin with subtherapeutic INR), bowel ischaemia secondary to mesenteric artery occlusion in another (on aspirin), and 1 patient had graft failure 9 months following transplant due to thrombotic microangiopathy (commenced on warfarin 6 months post transplant due to persistent aPL). Renal artery stenosis occurred in 2 patients (both receiving aspirin). Conclusions: There is a high risk of thrombotic complications in patients with aPL who are undergoing renal allograft. These patients should be considered for perioperative and longterm thromboprophylaxis. Disclosures: No relevant conflicts of interest to declare.

Long-term topical bevacizumab for prevention of corneal graft rejections

2020 ◽  
pp. 112067212093950
Author(s):  
Hua-Hsuan Kuo ◽  
Elizabeth P Shen
Keyword(s):  
Graft Rejection ◽  
Corneal Transplantation ◽  
Case Series ◽  
Corneal Neovascularization ◽  
Corneal Graft ◽  
Retrospective Case ◽  
Efficient Treatment ◽  
Corneal Graft Rejection ◽  
Donor Graft

Purpose: To evaluate the safety and efficacy of 1% topical bevacizumab (10 mg/mL) on newly formed corneal neovascularization (NV) after penetrating keratoplasty (PK). Methods: This is a retrospective case series reporting three eyes (three patients) of with newly formed corneal NV after corneal transplantation. All eyes had pre-existing corneal NVs and were high risk corneal graft rejection cases. One percent topical bevacizumab was started immediately after corneal NV formation post-PK. Topical bevacizumab was kept at twice weekly throughout the follow-up period. Results: Regression of corneal NV without donor graft invasion was noted in all three patients (100%). Duration of topical bevacizumab use was 13 to 36 months. All three corneal grafts (100%) remained clear and no signs of graft rejection were noted for the period of observation. There were no associated systemic or ocular adverse effects. Conclusion: Long-term use of topical 1% bevacizumab may be a safe and efficient treatment for corneal NVs and prevention of graft rejections after corneal transplantation.

Long Term Follow-up and Matched Pair Analysis of Adjuvant Donor Lymphocyte Transfusions Following Allogeneic Stem Cell Transplantation after Reduced Intensity Conditioning for High-Risk AML.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2142-2142
Author(s):  
Michael Schleuning ◽  
Christoph Schmid ◽  
Christian Koenecke ◽  
Bernd Hertenstein ◽  
Herrad Baurmann ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Control Group ◽  
Reduced Intensity Conditioning ◽  
Reduced Intensity

Abstract Adjuvant transfusion of donor lymphocytes (aDLT) may reduce the risk of relapse after allogeneic stem cell transplantation. We report our data on aDLT in high-risk AML. Cells were given within a prospective protocol that contained a sequence of chemotherapy, reduced intensity conditioning for allogeneic transplantation, and aDLT. For aDLT, patients had to be in CR at least 120 days from transplantation, off immunosuppression and free of GvHD. 30% of patients (n=46) alive at day +120 fulfilled the criteria for aDLT. They had been transplanted for refractory (n=11) or relapsed leukemia (n=24) or in CR1 because of unfavourable cytogenetics (n=7) or other unfavourable criteria (n=2) or in CR2 with unfavourable cytogenetics (n=2). 24 patients had an unfavourable karyotype, 10 with complex aberrations. Thirty-one patients with similar disease characteristics and fulfilling similar selection criteria (being alive in CR at d +120, no cGVHD and no history of aGVHD&gt; II°) transplanted during the same time period served as control. Of these, 10 pts. were transplanted at a different center not using aDLT and 21 at the center in Wiesbaden during 2000 and 2002 prior to the introduction of the protocol at this center. The median time from transplant to first aDLT was 160 days (range 71–303). Median follow up of the surviving transfused patients is 3.6 years (range 1.8–7.8). Seven patients received 1, 15 patients received 2, and 24 patients received 3 transfusions in escalating doses, containing a median of 1x106, 5x106 and 1x107 CD3+ cells/kg at aDLT 1, 2 and 3, respectively. Reasons for giving less than 3 transfusions were GvHD, relapse or patient’s refusal. Induction of GvHD was the main complication; grade II/III acute GvHD developed in 4, and chronic GvHD in 8 patients. So far, 9 (19.6%) patients have relapsed despite aDLT, as compared to 52.9% in the control group (Fisher-exact: p=0.004). Of these, 8 pts. finally died despite adoptive immunotherapy and only one patient is now surviving more than 3 years after relapse was treated by a second transplantation. Non relapse mortality post DLT was low with patients dying from infection, severe cGvHD, and secondary solid tumour one each. At the time of analysis, 35/46 patients are alive and all are in CR at a median of 3.2 years post first DLT. The actuarial overall survival four years after transplant is 79% as compared to 34% in the control group and at six years 63% vs. 31%, respectively (p=0.000). In conclusion, aDLT is safe, when given in escalating doses and to a selected group of patients. Results are encouraging, and improved long term leukemia-free survival can be achieved.

Long-term follow-up in high risk hypertensive patients with carotid dolicoarteriopathies

2020 ◽  
Vol 39 (1) ◽  
Author(s):  
Antonio Valvano ◽  
Giorgio Bosso ◽  
Valentina Apuzzi ◽  
Valentina Mercurio ◽  
Valeria Di Simone ◽  
...  
Keyword(s):  
High Risk ◽  
Hypertensive Patients ◽  
Long Term Follow Up

Long-Term Follow-Up of Early Cochlear Implant Device Activation

2021 ◽  
pp. 1-11
Author(s):  
Stefanie Bruschke ◽  
Uwe Baumann ◽  
Timo Stöver
Keyword(s):  
Speech Recognition ◽  
Side Effects ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Control Group ◽  
First Year ◽  
Safe Procedure ◽  
Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

scholarly journals Lichtenstein inguinal hernia repairs with porcine small intestine submucosa: a 5- year follow-up. a prospective randomized controlled study

2021 ◽  
Author(s):  
Baoshan Li ◽  
Xin Zhang ◽  
Yi Man ◽  
Jiadong Xie ◽  
Wei Hu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Term Effect ◽  
Control Group ◽  
Small Intestine Submucosa ◽  
Long Term Effect ◽  
Porcine Small Intestine Submucosa

Abstract Porcine small intestine submucosa (SIS) biologic patch has been used in inguinal hernia repair. However, there are little data available to assess the long-term effect after repair. This study aimed to explore the long-term effect of SIS patch in open inguinal hernia repair. Sevent-six patients with unilateral inguinal hernia were treated with Lichtenstein tension-free hernia repair using SIS patch (Beijing Datsing Bio-Tech Co., Ltd.) and Surgisis patch (COOK, USA) in Tianjin Union Medical Center and China-Japan Friendship Hospital. In the trial, the long-term efficacy of the treatment group and the control group were compared. A total of 66 patients in both groups received long-term follow-up (&gt; 5 years) after surgery, with a follow-up rate of 86.8%. During the follow-up period, there was one case of recurrence, one case of chronic pain in the control group. There was no statistically significant difference (P &gt; 0.05) in terms of recurrence, chronic pain, foreign body sensation and infection between the two groups of patients. After long-term observations, it has been found that the porcine small intestinal submucosa (SIS) biological patch is safe and effective for inguinal hernia Lichtenstein repair, and has a low recurrence rate and complication rate.

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