Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

With scarce organ supply, a selection of suitable elderly candidates for transplant is needed, as well as auditing the long-term outcomes after transplant. We conducted an observational cohort study among our patient cohort >60 years old with a long follow up. (1). Patients and Methods: We used our database to study the results after transplant for 593 patients >60 years old who underwent a transplant between 2000–2017. The outcome was compared between live donor (LD; n = 257) recipients, an old-to-old (OTO, n = 215) group using an extended criteria donor (ECD) kidney, and a young-to-old (YTO, n = 123) group using a standard-criteria donor. The Kaplan−Meir method was used to calculate the patient and graft survival and Cox regression analysis in order to find risk factors associated with death. (2). Results: The 5- and 10-year patient survival was significantly better in the LD group (92.7% and 66.9%) compared with the OTO group (73.3% and 42.8%) and YTO group (70.9% and 40.6%) (p < 0.0001). The 5- and 10-year graft survival rates were 90.3% and 68.5% (LD), 61.7% and 30.9% (OTO), and 64.1% and 39.9%, respectively (YTO group; p < 0.0001 between the LD and the two DD groups). There was no difference in outcome between patients in their 60’s and their 70’s. Factors associated with mortality included: age (HR-1.060), DM (HR-1.773), IHD (HR-1.510), and LD/DD (HR-2.865). (3). Conclusions: Our 17-years of experience seems to justify the rational of an old-to-old allocation policy in the elderly population. Live-donor transplant should be encouraged whenever possible. Each individual decision of elderly candidates for transplant should be based on the patient’s comorbidity and predicted life expectancy.

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Abstract 2262: No Impact Of The Mitral Annuloplasty On Overall Survival In Patients With Ischemic Cardiomyopathy - Long-term Follow-up Study.

Circulation ◽

10.1161/circ.116.suppl_16.ii_493-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Krzysztof S Golba ◽

Jolanta Biernat ◽

Marek A Deja ◽

Wojciech Domaradzki ◽

Marek Jasiński ◽

...

Keyword(s):

Overall Survival ◽

Mitral Regurgitation ◽

Ischemic Cardiomyopathy ◽

Cox Regression ◽

Coronary Bypass ◽

Left Ventricular ◽

Long Term Results ◽

Mitral Annuloplasty ◽

Cox Regression Analysis

Good long-term results are reported after the mitral valve (MV) repair for ischemic regurgitation. The aim of the study was to identify predictors of the overall survival after routine MV repair in patients with ischemic cardiomyopathy. Methods. 164 patients, 60.9±8.66 years old, with chronic ischemic mitral regurgitation and left ventricle ejection fraction (EF) = 30.7±6.04 undergoing coronary bypass with or without MV repair were prospectively followed for 5.1±1.63 years. A Cox proportional hazards model evaluated overall survival as a function of baseline age, sex, EF, mitral regurgitation jet area, left atrial area, atrial fibrillation, NYHA class, prior anterior or inferior myocardial infarction, medical comorbidities, MV repair, left ventricular plasty, left main and 3 vessel disease, venous graft to left anterior descending artery, number of grafts and year of operation. Treatment selection bias was controlled by deriving a propensity score for mitral annuloplasty. Results. Predictors included in the Cox regression model of overall survival are presented in table . The ROC curve analysis revealed EF <30.0, (sensitivity and specificity - 61.7% and 59.0%, respectively) and serum creatinine >1.17, (45.6% and 77.2%) as a cut-off values in the prediction of overall survival. Conclusions. There is no impact of the mitral annuloplasty on overall survival in these patients. MV repair can be safely added to coronary bypass grafting in patients with ischemic cardiomyopathy. Multivariable Cox regression analysis results

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Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort

Surgical Endoscopy ◽

10.1007/s00464-019-06861-4 ◽

2019 ◽

Vol 34 (3) ◽

pp. 1132-1141 ◽

Cited By ~ 2

Author(s):

Valentin Schnitzbauer ◽

Michael Gerken ◽

Stefan Benz ◽

Vinzenz Völkel ◽

Teresa Draeger ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Cox Regression ◽

Survival Rates ◽

Relative Survival ◽

Laparoscopic Group ◽

Cancer Registries ◽

Long Term Results

Abstract Background Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. Methods The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan–Meier plots and multivariable Cox regression conducted separately for UICC stages I–III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable survival analysis. Results Of 16,378 patients, 4540 (27.7%) underwent laparoscopic surgery, a trend which increased during the observation period. Patients undergoing laparoscopy attained better results for 90-day mortality (odds ratio, OR 0.658, 95% confidence interval, CI 0.526–0.822). The 5-year OS rate in the laparoscopic group was 82.6%, vs. 76.6% in the open surgery group, with a hazard ratio (HR) of 0.819 in multivariable Cox regression (95% CI 0.747–0.899, p < 0.001). The laparoscopic group showed a better 5-year RFS, with 81.8 vs. 74.3% and HR 0.770 (95% CI 0.705–0.842, p < 0.001). The 5-year relative survival rates were also in favor of laparoscopy, with 93.1 vs. 88.4% (p = 0.012). Conclusion Laparoscopic surgery for rectal cancer can be performed safely and, according to this study, is associated with an oncological outcome superior to that of the open procedure. Therefore, in the absence of individual contraindications, it should be considered as a standard approach.

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Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00067 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0006

Author(s):

Eliezer Sidon ◽

Ryan Rogero ◽

Timothy Bell ◽

Elizabeth McDonald ◽

Daniel Fuchs ◽

...

Keyword(s):

Regression Analysis ◽

Pain Relief ◽

Retrospective Studies ◽

Cox Regression ◽

Hallux Rigidus ◽

Long Term Results ◽

Cox Regression Analysis ◽

Long Term Follow Up

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is the most common arthritic condition in the foot. The surgical treatment options involve cheilectomy, interposition arthroplasty, or arthrodesis of the 1st metatarsophalangeal joint (MTPJ). 1st MTPJ cheilectomy has been shown to produce satisfactory results in retrospective studies. Previous retrospective studies have reported up to 97% good to excellent results and 92% success in pain relief and function. The results of cheilectomy for higher grades of HR are less favorable, with conversion rates ranging from 25 to 56%. The purpose of this study is to evaluate the long-term functional results and survivorship of cheilectomy for treatment of HR. Methods: This is a retrospective study investigating the long-term results of cheilectomy for treatment of HR, performed by 3 fellowship-trained foot & ankle surgeons. Patient demographics, diagnoses, medical comorbidities, and physical examination notes were collected from our electronic medical record system. A fellowship-trained foot & ankle surgeon not involved in any patient’s care evaluated preoperative radiographs and assigned a HR grade (1-3, Hattrup & Johnson). All patients without available preoperative radiographs or who underwent concomitant procedures other than cheilectomy were excluded. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, satisfaction with surgery, shoe wear limitations, and details about need for further intervention of the great toe, including MTPJ injections or revision procedures. Cox regression analysis was performed to investigate patient factors contributing to lack of pain recurrence, which was treated as survival time. Results: One-hundred sixty-five patients (169 cases) were included, with a mean follow-up time of 6.6 years (range, 5.0-10.9 years). Most cases (118, 70%) were grade 2, with 30 (18%) grade 1 and 21 (12%) grade 3 cases. One-hundred forty-three of 169 (85%) cases experienced pain relief in the immediate period following surgery. The satisfaction rate was 69% (117/169), and the overall pain-free survival rate was 68%, without any significant difference between arthritic grades. In 75% of cases with pain recurrence, pain returned within the first 2 years following surgery. Nine cases (5%) required a revision procedure at a mean postoperative 3.6 years (range, 1.6-7.4 years). Cox regression analysis revealed older age (p=.062) and male sex (p=.058) to be marginally related to having less pain recurrence. Conclusion: Our study supports the use of cheilectomy for treatment of HR as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision surgery rate and a moderately low rate of pain recurrence, with most pain recurrence occurring within the first 2 years. These results were not influenced by the preoperative arthritic grade, as long as the cheilectomy was performed on patients with no mid-range pain. These results can be used in treatment selection and anticipatory guidance for patients presenting with HR.

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Comparison of clinical characteristics and outcomes of infective endocarditis between haemodialysis and non-haemodialysis patients in China

Journal of International Medical Research ◽

10.1177/0300060520940435 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052094043

Author(s):

Wei Zhang ◽

Ping Ju ◽

Xuemei Liu ◽

Haiyan Zhou ◽

Feng Xue

Keyword(s):

Infective Endocarditis ◽

Antibiotic Therapy ◽

Clinical Characteristics ◽

Heart Surgery ◽

Cox Regression ◽

Survival Rates ◽

Venous Catheter ◽

Cox Regression Analysis ◽

Long Term Prognosis

Objective To clarify differences in clinical characteristics and outcomes between patients with infective endocarditis (IE) receiving long-term haemodialysis (HD group) and those not receiving haemodialysis (non-HD group). Methods Medical records of patients with IE, admitted to hospital between January 2010 and December 2017, were retrospectively studied. Clinical characteristics and outcomes were compared between HD and non-HD groups. Risk factors for IE were assessed by COX regression. Results Twenty-one HD and 143 non-HD patients were included. Predisposing heart conditions were more frequently observed in the non-HD versus HD group (90.9% versus 19.0%). Inappropriate antibiotic therapy rate before admission and proportion of methicillin-resistant Staphylococcus aureus and Enterococcus-associated IE was higher in the HD versus non-HD group. In the HD group, fewer patients underwent heart surgery (9.5% versus 51.7%), all-cause in-hospital mortality was higher (52.4% versus 21%), and survival rate was lower versus the non-HD group. COX regression analysis revealed that haemodialysis, use of central venous catheter (CVC) and inappropriate antibiotic therapy before admission increased IE mortality, while surgery improved long-term prognosis. Conclusions Haemodialysis patients with IE may have higher mortality and lower survival rates than patients with IE not receiving haemodialysis. Haemodialysis, use of CVC and inappropriate antibiotic therapy before admission may increase IE mortality. Surgery may improve long-term prognosis.

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Graft Survival and Clinical Outcomes of Descemet Membrane Endothelial Keratoplasty: Long Term Results

10.21203/rs.3.rs-263813/v1 ◽

2021 ◽

Author(s):

NILAY KANDEMIR BESEK ◽

Gülay Yalçınkaya ◽

Ahmet Kırgız ◽

Semih Çakmak ◽

Selim Genç ◽

...

Keyword(s):

Clinical Outcomes ◽

Graft Survival ◽

Graft Failure ◽

Survival Rates ◽

Long Term Results ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane

Abstract Purpose: The aim is to report long-term graft survival rates, clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK).Methods: In this study 150 eyes, that underwent DMEK whether for Fuchs endothelial corneal dystrophy (FECD) or for bullous keratopathy (BK), surveilled for 7 years at 6 time-points to evaluate graft survival rates and clinical outcomes of post-corneal transplantation.Results: Overall, the estimated survival probability of 95% confidence interval at 7 years of post-DMEK was 0.58 (0.72-0.77) and the survival probabilities of eyes operated for FECD (0.53) were higher than eyes operated for BK (0.42) (Log Rank 26.87, [p=0.197]). Post-transplant eyes with FECD achieved better visual acuity levels than eyes with BK (p=0.006). Primary graft failure occurred in 11.3% eyes. Secondary graft failure rate was 9.3%, and allograft rejection rate was 4.7%.Conclusion: Although DMEK is effective, safe in long-term, visual results and graft survival rates are better in cases with FECD.

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Effect of changing treatment to high-flux hemodialysis (HFHD) on mortality in patients with long-term low flux hemodialysis (LFHD): a propensity score matched cohort study

BMC Nephrology ◽

10.1186/s12882-020-02145-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shuxin Liu ◽

Hong Liu ◽

Zhihong Wang ◽

Lanbo Teng ◽

Cui Dong ◽

...

Keyword(s):

Regression Analysis ◽

Propensity Score ◽

Cox Regression ◽

Survival Rates ◽

Stable Condition ◽

Rank Test ◽

Control Group ◽

High Flux ◽

Cox Regression Analysis

Abstract Background The purpose of this study was to explore the effect of changing treatment to high-flux hemodialysis (HFHD) on mortality rate in patients with long-term low flux hemodialysis (LFHD). Methods The patients with end-stage renal disease (ESRD) who underwent LFHD with dialysis age more than 36 months and stable condition in our hospital before December 31, 2014 were included in this study. They were divided into control group and observation group. Propensity score matched method was used to select patients in the control group. The hemodialysis was performed 3 times a week for 4 h. The deadline for follow-up is December 31, 2018. End-point event is all-cause death. The survival rates of the two groups were compared and multivariate Cox regression analysis was carried out. Results K-M survival analysis showed that the 1-year, 2-year, 3-year and 4-year survival rates of HFHD group were 98, 96, 96 and 96%, respectively. The 1-year, 2-year, 3-year and 4-year survival rates of LFHD group were 95, 85, 80 and 78%, respectively. Log-rank test showed that the survival rate of HFHD group was significantly higher than that of LFHD group (x2= 7.278, P = 0.007). Multivariate Cox regression analysis showed that male, age, hemoglobin and low-throughput dialysis were independent predictors of death (P < 0.05). Compared with LFHD, HFHD can significantly reduce the mortality risk ratio of patients, as high as 86%. Conclusion The prognosis of patients with ESRD who performed long-term LFHD can be significantly improved after changing to HFHD.

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Prognostic Factors and Long-Term Survival in Locally Advanced NSCLC with Pathological Complete Response after Surgical Resection Following Neoadjuvant Therapy

Cancers ◽

10.3390/cancers12123572 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3572

Author(s):

Filippo Lococo ◽

Carolina Sassorossi ◽

Dania Nachira ◽

Marco Chiappetta ◽

Leonardo Petracca Ciavarella ◽

...

Keyword(s):

Adjuvant Therapy ◽

Advanced Nsclc ◽

Cox Regression ◽

Pathological Complete Response ◽

Locally Advanced ◽

Complete Response ◽

Long Term Results ◽

Cox Regression Analysis ◽

Locally Advanced Nsclc

Background: Outcomes for locally advanced NSCLC with pathological complete response (pCR), i.e., pT0N0 after induction chemoradiotherapy (IT), have been seldom investigated. Herein, long-term results, in this highly selected group of patients, have been evaluated with the aim to identify prognostic predictive factors. Methods: Patients affected by locally advanced NSCLC (cT1-T4/N0-2/M0) who underwent IT, possibly following surgery, from January 1992 to December 2019, were considered for this retrospective analysis. Survival rates and prognostic factors have been studied with Kaplan-Meier analysis, log-rank and Cox regression analysis. Results: Three-hundred and forty-three consecutive patients underwent IT in the considered period. Out of them, 279 were addressed to surgery; among them, pCR has been observed in 62 patients (18% of the total and 22% of the operated patients). In the pCR-group, clinical staging was IIb in 3 (5%) patients, IIIa in 28 (45%) patients and IIIb in 31 (50%). Surgery consisted of (bi)lobectomy in the majority of cases (80.7%), followed by pneumonectomy (19.3%). Adjuvant therapy was administered in 33 (53.2%) patients. Five-year overall survival and disease-free survival have been respectively 56.18% and 48.84%. The relative risk of death, observed with the Cox regression analysis, was 4.4 times higher (95% confidence interval (CI): 1.632–11.695, p = 0.03) for patients with N2 multi-station disease, 2.6 times higher (95% CI: 1.066–6.407, p = 0.036) for patients treated with pneumonectomy and 3 times higher (95% CI: 1.302–6.809, p = 0.01) for patients who did not receive adjuvant therapy. Conclusions: Rewarding long-term results could be expected in locally advanced NSCLC patients with pCR after IT followed by surgery. Baseline N2 single-station disease and adjuvant therapy after surgery seem to be associated with better prognosis, while pneumonectomy is associated with poorer outcomes.

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Comparison of open liver resection and RFA for the treatment of solitary 3–5-cmhepatocellular carcinoma: a retrospective study

BMC Surgery ◽

10.1186/s12893-019-0663-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Lei Jianyong ◽

◽

Yan Lunan ◽

Li Dajiang ◽

Wang Wentao

Keyword(s):

Liver Resection ◽

Cox Regression ◽

Survival Rates ◽

Significant Risk ◽

Significant Risk Factor ◽

Clinical Results ◽

Small Hepatocellular Carcinoma ◽

Free Survival ◽

Cox Regression Analysis

Abstract Background The goal of this study was to compare the postoperative results of liver resection and radiofrequency ablation (RFA) for the treatment of small hepatocellular carcinoma (HCC) (3–5 cm). Patients and methods We retrospectively collected 122 cases of small solitary HCC treated at our center from Jan 2011 to Dec 2015, with diameters in the range of 3–5 cm. According to the treatment program received at our center, the patients were divided into liver resection (72 patients) and RFA (50 patients) groups. Result In comparison with the RFA group, the resection group had a longer operative time, greater intraoperative blood loss (P < 0.01), more hepatic inflow occlusion, and a longer postoperative hospital stay (P < 0.01). The 1-, 3-, and 5-year expected overall survival rates and tumor-free survival rates were comparable between the two groups. Cox regression analysis showed that neither resection nor RFA was a significant risk factor for overall or tumor-free survival in HCC. Conclusions For solitary HCC of 3–5 cm in diameter, RFA can achieve better in-hospital clinical results and similar long-term outcomes than resection and can be considered for wide application, especially for central-location cases.

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Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

The Heart Surgery Forum ◽

10.1532/hsf98.20111084 ◽

2012 ◽

Vol 15 (1) ◽

pp. 4 ◽

Cited By ~ 23

Author(s):

David M. Holzhey ◽

William Shi ◽

A. Rastan ◽

Michael A. Borger ◽

Martin H�nsig ◽

...

Keyword(s):

Aortic Valve ◽

Survival Rates ◽

Long Term Results ◽

Term Survival ◽

Kaplan Meier ◽

Risk Patients ◽

Short And Long Term ◽

Good Treatment Option ◽

Matched Comparison

Introduction: The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).Patients and Methods: All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.Results: The 30-day mortality rate was 10.8% and 8.4% (P = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, P = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, P = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).Conclusion: Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.

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Pulmonary Homografts for Aortic Valve Replacement: Long-term Comparison with Aortic Grafts

The Heart Surgery Forum ◽

10.1532/hsf98.20101162 ◽

2011 ◽

Vol 14 (4) ◽

pp. 237 ◽

Cited By ~ 3

Author(s):

Ferdinand Vogt ◽

Anke Kowert ◽

Andres Beiras-Fernandez ◽

Martin Oberhoffer ◽

Ingo Kaczmarek ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Survival Rates ◽

Long Term Results ◽

Rank Test ◽

Aortic Graft ◽

Valve Prostheses ◽

Retrospective Comparative Study

Objective: The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.Methods: Since 1992, 366 adult patients have undergone AVR with homografts at our center. We compared 320 homografts of aortic origin and 46 homografts of pulmonary origin. The grafts were implanted via either a subcoronary technique or the root replacement technique. We performed a multivariate analysis to identify independent factors that influence survival. Freedom from reintervention and survival rates were calculated as cumulative events according to the Kaplan-Meier method, and differences were tested with the log-rank test.Results: Overall mortality within 1 year was 6.5% (21/320) in the aortic graft group and 17.4% (8/46) in the pulmonary graft group. In the pulmonary graft group, 4 patients died from valve-related complications, 1 patient died after additional heterotopic heart transplantation, and 1 patient who entered with a primary higher risk died from a prosthesis infection. Two patients died from non-valve-related causes. During the long-term follow-up, the 15-year survival rate was 79.9% for patients in the aortic graft group and 68.7% for patients in the pulmonary graft group (P = .049). The rate of freedom from reoperation was 77.7% in the aortic graft group and 57.4% in the pulmonary graft group (P < .001). The reasons for homograft explantation were graft infections (aortic graft group, 5.0%; pulmonary graft group, 6.5%) and degeneration (aortic graft group, 7.5%; pulmonary graft group, 32.6%).Conclusion: Our study demonstrated superior rates of survival and freedom from reintervention after AVR with aortic homografts. Implantation with a pulmonary graft was associated with a higher risk of redo surgery, owing to earlier degenerative alterations.

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