Predictors of adverse events in the mid-term postoperative period in patients who underwent carotid endarterectomy

Aim. Emphasis in the study was placed on the identification of unfavorable prognosis factors associated with carotid endarterectomy (CEE) during mid-term follow-up. Methods. Over a period from 2015 to 2016, 222 CEE operations were performed. Most patients (n = 190; 85.5%) underwent CEE using a patch of xenopericardium, 14.4% (n = 32) received eversion CEE, and a temporary shunt was used in 14.4% (n = 32). Hybrid revascularization in the volume of percutaneous coronary intervention (PCI) + CEE was performed in 9.9% (n = 22) patients. The groups under study were compared by using a chi-square test followed by subsequent analysis of the shares, or if ordinal characters or quantitative traits with a distribution different from the normal one occurred—by using a Mann – Whitney U-test. Correction of multiple comparisons was done by calculating an average fraction of false discoveries of the hypotheses (false discovery rate). The analysis of prognostic factors was done using the odds ratio (OR) by means of the 2 × 2 tables. Results. Among the complications detected in the mid-term follow-up, the most common adverse event was the development of MI in 3.6% (n = 8) of patients. According to color duplex scanning of brachiocephalic arteries, restenosis of the operated ICA was observed in 4.5% of patients. The following risk factors significantly increased the risk of adverse events: angina pectoris II–III functional class (OR = 3.84%, CI = 1.24–11.9), SYNTAX Score >22 (OR = 2.83, CI = 1.137–7.086). Conclusion. Based on the results of a single-center prospective retrospective study, significant risk factors for adverse outcome in the mid-term postoperative period were identified.Received 10 May 2017. Revised 27 September 2017. Accepted 5 October 2017.Funding: The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).Conflict of interest: The authors declare no conflict of interest.Author contributions Conception and study design: R.S. Tarasov, A.I. Anufriyev Data collection and analysis: A.R. Shabaev Drafting the article: A.N. Kazantsev, N.N. Burkov Critical revision of the article: A.V. Mironov Final approval of the version to be published: L.S. Barbarash

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The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

Psychological Medicine ◽

10.1017/s0033291721002932 ◽

2021 ◽

pp. 1-11

Author(s):

Yini Wang ◽

Xueqin Gao ◽

Zhenjuan Zhao ◽

Ling Li ◽

Guojie Liu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Significant Risk ◽

Type D Personality ◽

Adverse Outcomes ◽

Combined Effect ◽

Continuous Variables ◽

Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

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Long-term follow-up results of medial opening wedge high tibia osteotomy with a pre-countered non-locking steel plate

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03927-8 ◽

2021 ◽

Author(s):

Simo S. A. Miettinen ◽

Hannu J. A. Miettinen ◽

Jussi Jalkanen ◽

Antti Joukainen ◽

Heikki Kröger

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Mechanical Axis ◽

Steel Plate ◽

Cox Regression ◽

Opening Wedge ◽

Cumulative Survival ◽

Long Term Follow Up

Abstract Introduction This retrospective study investigated the long-term follow-up results of medial opening wedge high tibial osteotomy (MOWHTO) with a pre-countered non-locking steel plate implant (Puddu plate = PP) used for medial knee osteoarthrosis (OA) treatment. Materials and methods Consecutive 70 MOWHTOs (66 patients) were performed between 01.01.2004 and 31.12.2008 with the mean follow-up time of 11.4 (SD 4.5; range 1.2–16.1) years. The Kaplan–Meier survival analysis was used to evaluate the cumulative survival of the implant in terms of age (< 50 years old and ≥ 50 years old) and gender. Adverse events were studied and Cox regression analysis was used to evaluate risk factors [age, gender, body mass index (BMI), preoperative mechanical axis, severity of OA, use of bone grafting or substitution and undercorrection of mechanical axis from varus to valgus] for revisions. Results The estimates for the cumulative survival with no need for TKA after MOWHTO were 86% at 5 years, 67% at 10 years and 58% at 16.1 years (SE 0.6, CI 95% 11.1–13.5). A total of 33/70 (47%) adverse events occurred and 38/70 (54%) knees required some revision surgery during the follow-up. Cox regression did not show any statistically significant risk factors for revision. Conclusions The PP has feasible MOWHTO results with a cumulative survival of 67% at 10 years with no need for conversion to TKA. Many adverse events occurred and revision rate due to any reason was high. Age or gender did not have statistically significant differences in terms of survival.

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Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0837.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 285-293 ◽

Cited By ~ 6

Author(s):

A. Nakamae ◽

N. Adachi ◽

M. Deie ◽

M. Ishikawa ◽

T. Nakasa ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Articular Cartilage ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Cartilage Damage ◽

Significant Risk ◽

Articular Cartilage Damage ◽

Anterior Cruciate

Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.

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Abstract P023: Risk Factors Associated with Progression of Subclinical Diastolic Dysfunction in a Multiethnic Population

Circulation ◽

10.1161/circ.129.suppl_1.p023 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Lili Zhang ◽

Jian Shan ◽

Cynthia Taub

Keyword(s):

Risk Factors ◽

Renal Disease ◽

Diastolic Dysfunction ◽

Significant Risk ◽

Left Ventricular ◽

Cumulative Probability ◽

Factors Associated ◽

Hispanic Patients ◽

Multiethnic Population

Background: Subclinical diastolic dysfunction is defined as echocardiographic evidence of left ventricular diastolic dysfunction and normal ejection fraction (EF) without congestive heart failure (HF) symptoms/diagnosis. Our study, for the first time, sought to examine risk factors associated with progression from subclinical diastolic dysfunction to overt HF in a large multiethnic population. Methods: The study population included patients with asymptomatic diastolic dysfunction and EF ≥ 50% assessed by transthoracic echocardiogram between 2003 and 2008 at Montefiore Medical Center, Bronx, NY. Patients with preexisting HF, valvular heart disease or atrial fibrillation prior were excluded. The end point was the development of HF by September 1, 2013. Multivariable adjusted Cox proportional hazards models, determined by stepwise selection method, were performed to examine risk factors associated with the development of HF. All analyses were also performed with adjustment and stratification of race. Results: A total of 7,879 patients, with 21% European Americans (EA), 36% African Americans (AA), 31% Hispanics, and 12% others or unknown, were included in the analysis. Mean follow up time was 6.3 years. Mean age of the cohort was 68±12, with 63% women. The overall cumulative probability of development of HF was 17% (19% in EA, 17% in AA, 19% in Hispanic patients) during the follow up period. In multivariable Cox proportional hazard regression analysis, renal disease (hazard ratio (HR)=1.6, 95% confidence interval (CI) 1.3-2.0, P<0.001) and hemoglobin levels (HR=0.9, 95% CI 0.9-1.0, P=0.001) were significantly associated with the development of HF in overall population. In stratification analysis, age (P=0.012) and hypertension (P=0.007) were independent risk factors for HF in Hispanic patients, but not in EA and AA. Conclusions: In a large multiethnic population with subclinical diastolic dysfunction, renal disease and hemoglobin levels were independently associated with development of HF in overall population.. Age and hypertension were significant risk factors for HF only in Hispanic patients. These results may have important implications in preventing the development of HF from subclinical stage.

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Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/588567 ◽

2008 ◽

Vol 29 (7) ◽

pp. 600-606 ◽

Cited By ~ 38

Author(s):

Christine Moore ◽

Jastej Dhaliwal ◽

Agnes Tong ◽

Sarah Eden ◽

Cindi Wigston ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Acute Care ◽

Significant Risk ◽

Acute Care Hospital ◽

Skin Lesions ◽

Care Hospital ◽

Methicillin Resistant ◽

The Impact

Objective.To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.Design.Retrospective cohort study.Setting.A 472-bed acute-care teaching hospital in Toronto, Canada.Patients.Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.Methods.Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.Results.Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.Conclusions.Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

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Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00317 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0031

Author(s):

Justin W. Arner ◽

Sachidhanand Jayakumar ◽

Dharmesh Vyas ◽

James P. Bradley

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Revision Surgery ◽

Significant Risk ◽

Return To Sport ◽

Significant Risk Factor ◽

Return To Play ◽

Bone Width ◽

Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

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Early Postoperative Arrhythmias after Paediatric Cardiac Surgery

Delta Medical College Journal ◽

10.3329/dmcj.v6i1.35964 ◽

2018 ◽

Vol 6 (1) ◽

pp. 22-28

Author(s):

Kazi Zahidul Hoque ◽

Akhand Tanzih Sultana ◽

Mamun Mia ◽

Masumul Gani Chowdhury ◽

Makbul Hossein

Keyword(s):

Risk Factors ◽

Body Weight ◽

Cardiac Surgery ◽

Postoperative Period ◽

Significant Risk ◽

Radical Change ◽

Paediatric Cardiac Surgery ◽

Number Of Patients ◽

Paediatric Age ◽

A Prospective Study

Background: The radical change in techniques in paediatric cardiac surgery has dramatically reduced the morbidity and mortality. The different varieties of arrhythmia that are frequently observed in postoperative period in our country are still not well documented.Objectives: To determine the incidence and risk factors of arrhythmia immediately after cardiac surgery in paediatric age group.Materials and method: It was a prospective study. A total of 100 paediatric patients (age <18 years) who underwent cardiac surgery at Dhaka Shishu Hospital between 2013 and 2016 were selected purposivelyResults: Out of 100 patients maximum 41% were from 13-72 months age group. The mean age was 49.73±37.17 months with range of 0.5-231 months, 58% patients were male and rest were female. Postoperatively 31% subjects were arrhythmic and of these the highest number of patients suffered from junctional ectopic tachycardia. Out of these 100 patients, 39% were diagnosed as VSD followed by TOF (35%). Among 31 arrhythmic patients 59.83%, 41.93% and 3.22% manifested onset of arrhythmia at 1st, 1st to 2nd and 2nd to 7th postoperative period respectively. In this study age, body weight, cyanosis, CPB time, postoperative acidosis, ventilation support days, hypertension on arrival in ICU as well as ICU stay days were recognized as significant risk factors (p <0.05).Conclusion: Proper and careful monitoring of younger patient with lower body weight undergoing corrective cardiac surgery with long cardiopulmonary bypass (CPB) time may reduce the episodes of post operative arrhythmia. These patients may require high inotropic support post operatively. So, medical prevention and early diagnosis as well as proper management may improve the operative outcome.Delta Med Col J. Jan 2018 6(1): 22-28

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Identification of Intermediate- to High-Risk Papillary Thyroid Carcinoma Patients Who May Be Safely Managed without the Performance of Delayed Stimulated Thyroglobulin Measurements following Total Thyroidectomy and Radioactive Iodine Therapy

International Journal of Endocrinology ◽

10.1155/2015/318916 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Kyung-Hee Kim ◽

Min-Hee Kim ◽

Ye-Jee Lim ◽

Ihn Suk Lee ◽

Ja-Seong Bae ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Total Thyroidectomy ◽

Radioactive Iodine ◽

Significant Risk ◽

Disease Status ◽

Radioactive Iodine Therapy ◽

Papillary Thyroid ◽

Independent Risk Factors

Background. The measurement of stimulated thyroglobulin (sTg) after total thyroidectomy and remnant radioactive iodine (RAI) ablation is the gold standard for monitoring disease status in patients with papillary thyroid carcinomas (PTCs). The aim of this study was to determine whether sTg measurement during follow-up can be avoided in intermediate- and high-risk PTC patients.Methods. A total of 346 patients with PTCs with an intermediate or high risk of recurrence were analysed. All of the patients underwent total thyroidectomy as well as remnant RAI ablation and sTg measurements. Preoperative and postoperative parameters were included in the analysis.Results. Among the preoperative parameters, age below 45 years and preoperative Tg above 19.4 ng/mL were significant risk factors for predicting detectable sTg during follow-up. Among the postoperative parameters, thyroid capsular invasion, lymph node metastasis, and ablative Tg above 2.9 ng/mL were independently correlated with a detectable sTg range. The combination of ablative Tg less than 2.9 ng/mL with pre- and postoperative independent risk factors for detectable sTg increased the negative predictive value for detectable sTg up to 98.5%.Conclusions. Based on pre- and postoperative parameters, a substantial proportion of patients with PTCs in the intermediate- and high-risk classes could avoid aggressive follow-up measures.

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Long Term Follow-Up of Pediatric Sickle Cell Disease Patients with Conditional Velocities on Transcranial Doppler (TCD).

Blood ◽

10.1182/blood.v106.11.2338.2338 ◽

2005 ◽

Vol 106 (11) ◽

pp. 2338-2338

Author(s):

Lena Coïc ◽

Suzanne Verlhac ◽

Emmanuelle Lesprit ◽

Emmanuelle Fleurence ◽

Francoise Bernaudin

Keyword(s):

Risk Factors ◽

Color Doppler ◽

Significant Risk ◽

Biological Data ◽

Treatment Intensification ◽

Significant Difference ◽

History Of ◽

The Mean

Abstract Abnormal TCD defined as high mean maximum velocities > 200 cm/sec are highly predictive of stroke risk and justify long term transfusion program. Outcome and risk factors of conditional TCD defined as velocities 170–200 cm/sec remains to be described. Patients and methods Since 1992, 371 pediatric SCD patients (303 SS, 44 SC, 18 Sß+, 6 Sß0) were systematically explored once a year by TCD. The newborn screened cohort (n=174) had the first TCD exploration between 12 and 18 months of age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. Biological data were assessed at baseline, after the age of 1.5 years and remotely of transfusion or VOC. We report the characteristics and the outcome in patients (n=43) with an history of conditional TCD defined by mean maximum velocities ranging between 170 and 200 cm/s in the ACM, the ACA or the ICA. Results: The mean follow-up of TCD monitoring was 5,5 years (0 – 11,8 y). All patients with an history of conditional doppler were SS/Sb0 (n=43). Mean (SD) age of patients at the time of their first conditional TCD was 4.3 years (2.2) whereas in our series the mean age at abnormal TCD (> 200 cm/sec) occurrence was 6.6 years (3.2). Comparison of basal parameters showed highly significant differences between patients with conditional TCD and those with normal TCD: Hb 7g4 vs 8g5 (p<0.001), MCV 82.8 vs 79 (p=0.047). We also had found such differences between patients with normal and those with abnormal TCD (Hb and MCV p< 0.001). Two patients were lost of follow-up. Two patients died during a trip to Africa. Conditional TCD became abnormal in 11/43 patients and justified transfusion program. Mean (SD) conversion delay was 1.8 (2.0) years (range 0.5–7y). No stroke occurred. 16 patients required a treatment intensification for other indications (frequent VOC/ACS, splenic sequestrations): 6 were transplanted and 10 received HU or TP. Significant risk factors (Pearson) of conversion to abnormal were the age at time of conditional TCD occurrence < 3 y (p<0.001), baseline Hb < 7g/dl (p=0.02) and MCV > 80 (p=0.04). MRI/MRA was performed in 31/43 patients and showed ischemic lesions in 5 of them at the mean (SD) age of 7.1 y (1.8) (range 4.5–8.9): no significant difference was observed in the occurrence of lesions between the 2 groups. Conclusions This study confirms the importance of age as predictive factor of conditional to abnormal TCD conversion with a risk of 64% when first conditional TCD occured before the age of 3 years. TCD has to be frequently controled during the 5 first years of life.

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Pre-Emptive Rituximab Treatment for Epstein-Barr Virus (EBV) Reactivation After Allogeneic Hematopoietic Stem Cell Transplantation (HSCT): High Incidence of Infections and Delayed Immune Reconstitution

Blood ◽

10.1182/blood.v116.21.2303.2303 ◽

2010 ◽

Vol 116 (21) ◽

pp. 2303-2303

Author(s):

Anna D. Petropoulou ◽

Raphael Porcher ◽

Regis Peffault de Latour ◽

Alienor Xhaard ◽

Patricia Ribaud ◽

...

Keyword(s):

Risk Factors ◽

Stem Cell ◽

Viral Infection ◽

Immune Reconstitution ◽

Fungal Infections ◽

Conditioning Regimen ◽

Significant Risk ◽

Ebv Reactivation ◽

Anti Cd20

Abstract Abstract 2303 Aim: Before pre-emptive treatment with Rituximab, the incidence of EBV-associated post-transplant lymphoproliferative disease (PTLD) was about 15 to 20% of patients (pts) following allogeneic HSCT with an 80% overall mortality. Rituximab (anti-CD20) in this context has dramatically decreased EBV-PTLD incidence. The aim of this single-center study was to evaluate the incidence on infections and on immune reconstitution following Rituximab for EBV reactivation. Patients and Methods: Sixty-nine pts received Rituximab for EBV reactivation at Saint-Louis Hospital (Paris, France) between January 2005 and January 2010, 44 males and 25 females, mean age 33 years (range, 10–68). Primary diseases were malignant hematopoietic disorders (70%) and aplastic anemia (30%). Fifty-two per cent received peripheral blood stem cells, 39% bone marrow and 9% cord blood. Myeloablative conditioning regimen was given in 71% of pts and reduced-intensity in 29%. Antithymocyte globulin (ATG) was given in 70% of pts before Rituximab therapy. EBV-quantitative polymerase chain reaction (PCR) was performed weekly during the first 3 months post-HSCT and then monthly until 1 year post-HSCT. Rituximab was administered weekly at the dose of 375mg/m2 after a positive PCR result (>10.000copies/ml) and discontinued as soon as a negative PCR result was available. Median time from transplant to Rituximab treatment was 43 days. Patients were followed-up until death or relapse. Median follow-up from the date of first Rituximab infusion was 27 months (range 4 to 61). Results: All treated pts cleared their EBV viremia after Rituximab. However, one patient developed PTLD despite Rituximab. Incidence of relapse was 5.9% (95%CI: 1.9–13.4) and non-relapse mortality was 41% (95%CI: 29–53) at 36 months. During follow-up, 43 pts developed a bacterial infection, 44 a viral infection and 16 a fungal infection. Infections occurred mainly during the first 12 months after Rituximab. The cumulative incidence of infection at 36 months was 64% (95%CI 50.7 to 74.6) for bacterial, 62.5% (95%CI 49.7 to 72.9) for viral and 24.6% (95%CI 14.7 to 35.8) for fungal infections. Reconstitution of lymphocytes, neutrophils and gammaglobulins after Rituximab therapy was assessed in the 36pts alive and relapse-free at 12 months. Starting from one month after initiation of Rituximab, lymphocyte counts gradually increased, by an average of 11.3% per month (95%CI 10.8 to 11.5; P<0.0001). Gammaglobulins significantly decreased during the first month after Rituximab, on average by 1.54g/L (95%CI 2.34 to 0.75; P=0.0002). After 3 months, a significant mean increase of 0.13 per month was observed (95%CI 0.01 to 0.26; P=0.037). CD19+ B and CD3+ T-lymphocytes reached normal values only at 1.5 years post-HSCT (median=172/μ L and 1339/μ L respectively at 1.5 years). Age, gender, stem cell source, type of donor, conditioning regimen, use of ATG and acute graft-versus-host disease (aGVHD) were assessed as possible risk factors for the development of infection. Acute GVHD grade≥3 or steroid-resistant aGVHD were statistically significant risk factors for bacterial (HR: 2.84, 95%CI: 1.12–7.23, P=0.028) or viral infection (HR: 4.03, 95%CI: 1.58–10.2, P=0.003). Cord blood transplantation and HLA-mismatch were significant risk factors for viral infection (HR: 2.62, 95%CI: 0.96–7.18, P=0.018 and HR: 3.47, 95%CI: 1.24–9.72, P=0.033 respectively). No significant risk factor was found for fungal infections. Conclusions: Rituximab pre emptive treatment has decreased PTLD incidence but is associated with high infection rate and prolonged immune defect. The question of over-treatment can be raised and further studies are needed to select candidates for pre-emptive treatment in order to avoid systematic anti-CD20 treatment and its later potential complications. Disclosures: No relevant conflicts of interest to declare.

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