scholarly journals Patency of ePTFE Arteriovenous Graft Placements in Hemodialysis Patients: Systematic Literature Review and Meta-Analysis

Kidney360 ◽  
2020 ◽  
Vol 1 (12) ◽  
pp. 1437-1446
Author(s):  
Ronald J. Halbert ◽  
Gina Nicholson ◽  
Robert J. Nordyke ◽  
Alison Pilgrim ◽  
Laura Niklason
Keyword(s):  
Meta Analysis ◽  
Hemodialysis Patients ◽  
Secondary Patency ◽  
Surgical Interventions ◽  
Individual Patient Level ◽  
Eptfe Graft ◽  
Kaplan Meier ◽  
Level Data ◽  
Date Estimate ◽  
High Degree

Arteriovenous grafts (AVGs) are an appropriate option for vascular access in certain hemodialysis patients. Expanded polytetrafluoroethylene (ePTFE) has become the dominant material for such grafts, due in part to innovations in graft design and surgical interventions to reduce complications and improve patency rates. Comprehensive evidence syntheses have not been conducted to update AVG performance in an era in which both access choice and ePTFE graft functioning may have changed. We conducted a systematic review and meta-analysis summarizing outcomes from recent studies of ePTFE AVGs in hemodialysis, following PRISMA standards. Literature searches were conducted in multiple databases to identify observational and interventional studies of AVG patency and infection risk. Primary, primary-assisted, and secondary patency rates were analyzed at 6, 12, 18, and 24 months postplacement. Kaplan–Meier graft survival plots were digitized to recreate individual patient-level data. Patency rates were pooled using a random effects model. We identified 32 studies meeting our selection criteria that were published from 2004 through 2019. A total of 38 study arms of ePTFE grafts were included, representing 3381 AVG accesses placed. The mean primary, primary-assisted, and secondary patency rates at 1 year were 41% (95% CI, 35% to 47%), 46% (95% CI, 41% to 51%), and 70% (95% CI, 64% to 75%), respectively. Mean 24-month patency rates were 28% (95% CI, 22% to 33%), 34% (95% CI, 27% to 41%), and 54% (95% CI, 47% to 61%), respectively. A high degree of heterogeneity across studies was observed. Overall risk of infection was not consistently reported, but among available studies the pooled estimate was 9% per patient-year (95% CI, 6% to 12%). This meta-analysis provides an up-to-date estimate of the performance of ePTFE AVGs, within the context of improved graft designs and improved interventional techniques.

Stenosis at the area of Transposition – An Under-Recognized Complication of Transposed Brachiobasilic Fistulas

2007 ◽  
Vol 8 (4) ◽  
pp. 268-274 ◽  
Author(s):  
M.C. Beaulieu ◽  
C. Gabana ◽  
C. Rose ◽  
P.S. Macdonald ◽  
J. Clement ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
High Rate ◽  
Secondary Patency ◽  
Basilic Vein ◽  
Av Fistula ◽  
Surgical Interventions ◽  
Secondary Patency Rate ◽  
One Year ◽  
The Impact

Background With an increased focus on native AV fistula creation in hemodialysis patients, a transposed brachiobasilic fistula (tBBF) is becoming an increasingly utilized option. This study describes the outcomes of tBBFs in a chronic hemodialysis population. In particular, we focus on the incidence and location of stenosis, and review the impact of angioplasty on these lesions. Methods A retrospective cohort study using all patients with a tBBF created between January 2001 and December 2004. Results Of the 543 fistulas created during the study period, 93 were tBBFs. The mean age of patients was 65 years, 56% were male and 55% were diabetic. Stenosis occurred in 54% (46/85) of fistulas; the location of stenosis in the majority (74%) was at or near the area of basilic vein transposition and 50% of fistulas with stenosis in this location required three or more angioplasties. Primary (unassisted) patency was 42% at one year in this cohort. Secondary patency was 68% at 1 year and 58% and 53% at 2 and 3 years respectively. Conclusion In a cohort of hemodialysis patients who received a tBBF, we describe a reasonable primary and secondary patency rate and a high rate of stenosis at the point of transposition of the basilic vein. Such stenosis usually requires multiple percutaneous or surgical interventions to ensure or reestablish conduit patency. Further study is required regarding the optimal surgical technique, monitoring, and treatment of stenosis of this fistula type including the utility of repeat angioplasty.

scholarly journals Forced vital capacity and cross-domain late-onset Pompe disease outcomes: an individual patient-level data meta-analysis

2019 ◽  
Vol 266 (9) ◽  
pp. 2312-2321
Author(s):  
Kenneth I. Berger ◽  
Steve Kanters ◽  
Jeroen P. Jansen ◽  
Andrew Stewart ◽  
Susan Sparks ◽  
...  
Keyword(s):  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Late Onset ◽  
Meta Analysis ◽  
Patient Level Data ◽  
Individual Patient Level ◽  
Patient Level ◽  
Cross Domain ◽  
Disease Outcomes ◽  
Level Data

Immune-related acute myocarditis in patients treated with immune checkpoints inhibitors: Systematic review with individual patient-level data meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24096-e24096
Author(s):  
Alexey Rumyantsev ◽  
Edgar Israelyan ◽  
Alexandra Tyulyandina ◽  
Elena Glazkova ◽  
Yury Sergeev ◽  
...  
Keyword(s):  
Systematic Review ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
High Dose ◽  
Autoimmune Myocarditis ◽  
Patient Level Data ◽  
Nccn Guidelines ◽  
Individual Patient Level ◽  
Patient Level ◽  
Level Data

e24096 Background: Immune checkpoint inhibitors can sometimes lead to fatal outcomes or significant morbidity due to immune-related adverse events (IRAE). Cardiac IRAE, especially myocarditis, are among the most fatal IRAE. There are scarce of the trials addressing the optimal therapeutic approaches for patients with IR-myocarditis. Initial therapy with high-dose steroids (1000 mg of prednisolone for 3-5 days) may be beneficial for many patients with this IRAE and this approach is endorsed by NCCN guidelines. We conducted a systematic review with individual patient-level data meta-analysis of published clinical cases to assess impact of various initial therapeutic modalities and adherence to NCCN guidelines on outcomes of immune-related myocarditis, associated with checkpoint inhibitors. Methods: We searched PubMed database for all full-text articles and abstracts on the treatment of patients with cardiac-related IRAE treated with various PD-1/PD-L1 or CTLA-4 inhibitors for years between 2012 and 2020 in English. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) tool was used to ensure transparent reporting. Main study inclusion criteria were: 1) morphologically confirmed immune-related myocarditis or highly clinically suspected autoimmune myocarditis (based on Bonaca et al, 2019 criteria); 2) clear association of IRAE and administration of check-point inhibitors; 3) availability of individual patient and treatment data. Pooled analysis of outcomes and multiple logistic regression analysis were conducted. The primary outcome of this study was rate of major cardiac adverse events (MACE) due to immune-related autoimmune myocarditis according to adherence to NCCN guidelines. MACE was defined as death or persisting significant disabilities due to myocarditis (ie, chronic heart failure, rhythm abnormalities or deterioration leading to impossibility of further anticancer treatment). Results: We identified 277 articles and screened them for title and abstract. After the review process we selected 81 studies for further analysis which described treatment course for 111 patients. Overall, 26 and 85 patients were treated with high-dose and non-high dose steroids. Among patients treated high-dose steroids therapy and non-high dose steroids 10 (38.5%) and 57 (67.1%) of patients respectively experienced MACE (HR 0.185; 95% CI 0.07-0.47; p = 0.0091). Initial treatment failure was associated with high rate of morbidity; however, 9 patients were rescued with various immunosuppressive drugs (eg, tacrolimus, alemtuzumab, tocilizumab). Conclusions: Our results support use of high-dose pulse therapy as a preferred therapeutic approach for all patients with suspected or proven immune-related myocarditis.

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