Long-Term Tacrolimus Blood Trough Level and Patient Survival in Adult Liver Transplantation

Tacrolimus is the most widely used immunosuppressant in liver transplant (LT) patients. However, the ideal long-term target level for these patients is unknown. This retrospective study aimed to investigate the impact of tacrolimus blood concentration five years after LT on long-term patient survival outcomes in adult LT recipients. Patients who underwent LT between January 2004 and July 2014 at a tertiary medical center were included in this study (n = 189). The mean tacrolimus blood concentrations of each patient during the fifth year after LT were recorded and the overall survival rate was determined. A multivariate analysis of factors associated with long-term survival was conducted using a Cox’s model. The median follow-up period was 9.63 years, and 144 patients (76.2%) underwent live donor LT. Sixteen patients died within 5 years of LT. In the Cox’s model, patients with a mean tacrolimus blood trough level of 4.6–10.2 ng/mL had significantly better long-term survival than those with a mean tacrolimus blood trough level outside this range (estimated hazard ratio = 4.76; 95% confidence interval: 1.34–16.9, p = 0.016). Therefore, a tacrolimus level no lower than 4.6 ng/mL would be recommended in adult LT patients.

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Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.01.074 ◽

2020 ◽

Vol 71 (1) ◽

pp. 46-55.e4 ◽

Cited By ~ 9

Author(s):

Elizabeth L. George ◽

Rui Chen ◽

Amber W. Trickey ◽

Benjamin S. Brooke ◽

Larry Kraiss ◽

...

Keyword(s):

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Term Survival ◽

Long Term Survival ◽

Abdominal Aortic ◽

Elective Repair ◽

The Impact

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Clinical and Oncological Value of Preoperative BMI in Gastric Cancer Patients: A Single Center Experience

Gastroenterology Research and Practice ◽

10.1155/2015/810134 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Costantino Voglino ◽

Giulio Di Mare ◽

Francesco Ferrara ◽

Lorenzo De Franco ◽

Franco Roviello ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Blood Proteins ◽

Term Survival ◽

Long Term Survival ◽

Single Center Experience ◽

Group B ◽

Gastric Cancer Patients ◽

The Impact

Introduction. The impact of preoperative BMI on surgical outcomes and long-term survival of gastric cancer patients was investigated in various reports with contrasting results.Materials & Methods. A total of 378 patients who underwent a surgical resection for primary gastric cancer between 1994 and 2011 were retrospectively studied. Patients were stratified according to BMI into a normal group (<25, group A), an overweight group (25–30, group B), and an obesity group (≥30, group C). These 3 groups were compared according to clinical-pathological characteristics, surgical treatment, and long-term survival.Results. No significant correlations between BMI and TNM (2010), UICC stage (2010), Lauren’s histological type, surgical results, lymph node dissection, and postoperative morbidity and mortality were observed. Factors related to higher BMI were male genderP<0.05, diabetesP<0.001, and serum blood proteinsP<0.01. A trend to fewer lymph nodes retrieved during gastrectomy with lymphadenectomy in overweight patients (B and C groups) was observed, although not statistically significant. There was no difference in overall survival or disease-specific survival between the three groups.Conclusion. According to our data, BMI should not be considered a significant predictor of postoperative complications or long-term result in gastric cancer patients.

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The impact of thoracic endovascular aortic repair on long-term survival in type B aortic dissection

Annals of Translational Medicine ◽

10.21037/atm.2017.10.13 ◽

2017 ◽

pp. 496-496

Author(s):

Christos D. Karkos ◽

Ignacio Hernandez-Lahoz ◽

Nikolaos Asaloumidis ◽

Konstantinos O. Papazoglou

Keyword(s):

Aortic Dissection ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Term Survival ◽

Long Term Survival ◽

Aortic Repair ◽

The Impact

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Multicentre study of the impact of morbidity on long-term survival following hepatectomy for intrahepatic cholangiocarcinoma

British Journal of Surgery ◽

10.1002/bjs.10296 ◽

2016 ◽

Vol 103 (13) ◽

pp. 1887-1894 ◽

Cited By ~ 25

Author(s):

A. Doussot ◽

C. Lim ◽

C. Gómez-Gavara ◽

D. Fuks ◽

O. Farges ◽

...

Keyword(s):

Multicentre Study ◽

Intrahepatic Cholangiocarcinoma ◽

Term Survival ◽

Long Term Survival ◽

The Impact

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Abstract 2143: Improved Long-Term Survival in a High Risk Population Following Drug Eluting Stent Availability

Circulation ◽

10.1161/circ.116.suppl_16.ii_464-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Maheer Gandhavadi ◽

Kendrick A Shunk ◽

Edward J McNulty

Keyword(s):

High Risk ◽

Independent Predictor ◽

Drug Eluting Stent ◽

High Risk Population ◽

Term Survival ◽

Risk Population ◽

Long Term Survival ◽

Drug Eluting ◽

The Impact

Background Data regarding the impact of drug eluting stent (DES) use on long-term outcomes outside trial populations are limited. Methods 1,547 consecutive patients underwent stent implantation from January 2000 until December 2006 at the San Francisco Veterans Affairs Medical Center. To assess the impact of DES availability on mortality, that population was partitioned into a pre-DES cohort (N=591) and a post-DES availability cohort (N=956). Kaplan-Meier survival curves for the two cohorts were compared. Results The entire population was relatively high risk: 37% had diabetes, 38% a reduced ejection fraction, and 53% a prior MI or elevated troponin prior to the procedure. Median follow up was 4.7 years for the pre-DES cohort and 1.8 years for the post-DES cohort. DES were used in 83% of procedures in the post-DES cohort. Survival improved significantly in the post-DES cohort (P = .04, Log Rank)(see Figure ). Baseline characteristics, procedural variables and discharge medications were analyzed in a Cox proportional hazards model (see Table ). DES use was an independent predictor of improved survival (Hazard Ratio for death 0.52, 95% CI .28–.95). Conclusions In an unselected, high risk population, long-term survival improved following the availability of drug eluting stents. After adjusting for potential confounding factors, DES use was an independent predictor of improved survival. Independent Predictors of Death in all 1,547 Patients

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The impact of sarcopenia and myosteatosis in liver transplant candidates on peritransplant course and patient and graft survival

Gastroenterologie a hepatologie ◽

10.48095/ccgh2021311 ◽

2021 ◽

Vol 75 (4) ◽

pp. 311-322

Author(s):

Irena Míková ◽

Denisa Kyselová ◽

Dana Kautznerová ◽

Marek Tupý ◽

Marek Kysela ◽

...

Keyword(s):

Liver Transplant ◽

Graft Survival ◽

Blood Transfusions ◽

Term Survival ◽

Skeletal Muscle Index ◽

Long Term Survival ◽

Psoas Major Muscle ◽

The Impact ◽

Patient And Graft Survival

Introduction: Sarcopenia (severe muscle depletion) and myosteaosis (pathological fat accumulation in muscle) are frequent muscle abnormalities in patients with cirrhosis associated with unfavorable prognosis. The aim of our study was to evaluate the impact of sarcopenia and myosteatosis in liver transplant (LT) candidates in our center on the peritransplant course and patient and graft survival. Methods: This prospective study included adult LT candidates who underwent clinical and laboratory examination. The skeletal muscle index (SMI) at L3 level and radiodensity of psoas major muscle (PM-RA) were evaluated by CT. Results: Pretransplant sarcopenia was found in 49 of 103 patients (47.6%) and myosteatosis in 53 (51.5%) patients. Patients with sarcopenia had lower BMI, waist circumference, occurrence of hypertension and metabolic syndrome and lower triglyceride and C-peptide levels than patients without sarcopenia. Patients with myosteatosis had higher Child-Pugh score and lower HDL-cholesterol levels than patients without myosteatosis. Pretransplant SMI negatively correlated with the amount of blood transfusions given during LT and occurrence of biliary complications. Patients with myosteatosis had higher need for blood transfusions during LT and after LT, and higher number of surgical revisions. Occurrence of sarcopenia had no significant effect on patient and graft survival. Patients with myosteatosis had worse long-term survival than patients without myosteatosis, the graft survival did not differ. Conclusion: Sarcopenia and myosteatosis are frequent muscle abnormalities in LT candidates with negative impact on peritransplant course. Myosteatosis was associated with a worse long-term survival in our study. Key words: sarcopenia – myosteatosis – liver transplantation – prevalence – complications – survival

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O193 ROLE OF MALNUTRITION IN 0ESOPHAGEAL SURGERY FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doz092.193 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

R Alfieri ◽

M Nardi ◽

V Moretto ◽

E Pinto ◽

M Briarava ◽

...

Keyword(s):

Weight Loss ◽

Postoperative Complications ◽

Nutritional Status ◽

Term Survival ◽

Long Term Outcome ◽

Long Term Survival ◽

Oesophagogastric Junction ◽

Significant Difference ◽

The Impact

Abstract Aim To investigate whether preoperative malnutrition is associated with long term outcome and survival in patients undergoing radical oesophagectomy for oesophageal or oesophagogastric junction cancer. Background & Methods Dysphagia, weight loss, chemo-radiationtherapy frequently lead to malnutrition in patients with oesophageal or oesophagogastric junction cancer. Severe malnutrition is associated with higher risk of postoperative complications but little is known on the correlation with long term survival. We conducted a single center retrospective study on a prospectively collected database of patients undergoing oesophagectomy from 2008 and 2012 in order to evaluate the impact of preoperative malnutrition with postoperative outcome and long term survival. Preoperative malnutrition was classified as: prealbumin level less than 220 mg/dL (PL), MUST index (Malnutrition Universal Screeening Tool) >2 and weight loss >10%. Results 177 consecutive patients were considered: due to incomplete data 60 were excluded from the analysis that was performed on 117 patients. PL was reported in 52 (44%) patients, MUST index was recorded in 62 (53%), 58 (49%) patients presented more than 10% weight loss at the preoperative evaluation. PL was associated with more postoperative Clavien-Dindo 1-2 complications (p=0.048, OR 2.35 95%IC 1.001-5.50), no differences were observed in mortality, anastomotic leak, major pulmonary complications. MUST index was not correlated with postoperative complications nor mortality but resulted worse in patients treated with chemo-radiotherapy (p=0.046, OR 1.92 95%CI 1.011-3.64). Weight loss >10% was not associated with postoperative complications or mortality. Overall 7 years survival rate was 69%. and DFS was 68%. Malnourished patients did not differ from non-malnourished regarding age, sex, tumor site, tumor stage and histology. No significant difference in 7 years survival rates was observed in patients with PL <220 mg/dL ( 55 % vs 67%), neither in patients with MUST score>2 (58% vs 72%), nor in patients with weight loss >10% (53% vs 70%). Conclusions Malnutrition is more common in patients treated with chemoradiation therapy and it is associated with postoperative complications. However, both long term and disease free survival are not affected by preoperative nutritional status. Larger patient population and data on long term postoperative nutritional status will be analyzed in further studies.

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