No association between sleep apnoea and macular telangiectasia type 2 and its markers of severity and progression: a case-control study and retrospective cohort study.

IMPORTANCE: Idiopathic Macular Telangiectasia Type 2 (MacTel) is an uncommon, progressive retinal disease usually affecting both eyes. Currently there is no know treatment however with similar comorbidities to Obstructive Sleep Apnoea (OSA) there is plausibility of an association which may accelerate disease progression. BACKGROUND: To identify an association between MacTel and OSA and whether OSA may result in increased disease progression. DESIGN: Matched case-control study and retrospective cohort analysis. PARTICIPANTS: Fifty-seven patients with MacTel and 165 matched controls from the Busselton Health Study. METHODS: MacTel participants were matched based on age, gender and body mass index (BMI) (and where possible hypertension and diabetes) on a 3:1 ratio with controls from the Busselton Health Study. Participants undertook a sleep questionnaire using a previously validated questionnaire. In a subset sleep apnoea severity was objectively measured via overnight ambulatory polygraphy (30 cases and 83 matched controls; ApneaLink device; ResMed, Sydney, Australia). In a retrospective analysis of the suspected MacTel cases we assessed whether major markers of OSA severity and MacTel progression were associated. MAIN OUTCOME MEASURES: Apnoea Hypopnea Index along with key markers of MacTel progression. RESULTS: MacTel patients did not have a higher risk of sleep apnoea when compared to age, sex and BMI -matched controls (mean ± SD Apnoea hypopnea index [AHI] cases 9.6 ± 14.7 vs. controls 9.7 ± 10.8, P = 0.95). No markers of disease progression in the cases were associated with any marker of OSA severity. CONCLUSIONS AND RELEVANCE: Sleep apnoea does not increase the risk or accelerate the progression of MacTel.

[Late complications after heart transplantation]. / Complicaciones alejadas postrasplante cardíaco.

Heart transplantation is currently a procedure of choice for patients with advanced heart failure. Despite a continuous improvement in morbidity and mortality made to date, complications requiring hospitalization continue to be high. The main objective of this study was to describe complications that required hospitalization after a heart transplant, and the secondary objective is to evaluate its incidence according to age group in a cohort of heart transplant recipients in Argentina. A retrospective cohort study was carried out. One hundred and ninety-eight heart transplant recipients were consecutively included in the period between January 2010 and May 2019. During follow-up, 105 patients (53%) had at least one readmission, and the most frequent cause of cardiovascular readmission was graft rejection (31%), while infections were the most frequent non-cardiovascular causes (21%). Mortality density incidence was 8 (95% CI 5.4-11.7) per 100-patients/year for the group that had readmission and 1 per 100-patients/year (95% CI 0.4-2.8) for the group that did not have. We conclude that complications requiring hospitalization are frequent in transplanted patients and affect long-term survival. The main causes of readmission are graft rejection and infections, and they had similar incidence in the age groups we analyzed.

El trasplante cardíaco es en la actualidad un procedimiento de elección para los pacientes con insuficiencia cardíaca avanzada. A pesar de los avances logrados hasta la fecha, las complicaciones con requerimiento de internación siguen siendo elevadas. El objetivo principal de este trabajo fue describir las complicaciones post trasplante cardíaco que requirieron internación durante el seguimiento, y el objetivo secundario evaluar su incidencia según el grupo etario en una cohorte de receptores de trasplante cardíaco en la Argentina. Se realizó un estudio de cohorte retrospectivo. Se incluyeron de forma consecutiva 198 pacientes receptores de trasplante cardíaco realizados en el período enero 2010 a mayo 2019. Durante el seguimiento se reinternaron al menos una vez 105 pacientes (53%) y la causa de reinternación cardiovascular más frecuente fue el rechazo del injerto (31%), mientras que las infecciones lo fueron dentro de las de causas no cardiovasculares (21%). La densidad de incidencia de mortalidad fue de 8 (IC95% 5.4-11.7) cada 100-pacientes/año para el grupo que tuvo reinternación y de 1 cada 100-pacientes/año (IC 95% 0.4-2.8) para el grupo que no la tuvo. Concluimos que las complicaciones con requerimiento de internación son frecuentes en los trasplantados en nuestro medio y condicionan la supervivencia a largo plazo. Las principales causas de reinternación son el rechazo del injerto y las infecciones, con una incidencia similar en los grupos etarios analizados.

Complicaciones alejadas postrasplante cardíaco / Late complications after heart transplantation

Resumen El trasplante cardíaco es en la actualidad un procedimiento de elección para los pacientes con insuficiencia cardíaca avanzada. A pesar de los avances logrados hasta la fecha, las complicacio nes con requerimiento de internación siguen siendo elevadas. El objetivo principal de este trabajo fue describir las complicaciones post trasplante cardíaco que requirieron internación durante el seguimiento, y el objetivo secundario evaluar su incidencia según el grupo etario en una cohorte de receptores de trasplante cardíaco en la Argentina. Se realizó un estudio de cohorte retrospectivo. Se incluyeron de forma consecutiva 198 pacientes receptores de trasplante cardíaco realizados en el período enero 2010 a mayo 2019. Durante el seguimiento se reinternaron al menos una vez 105 pacientes (53%) y la causa de reinternación cardiovascular más frecuente fue el rechazo del injerto (31%), mientras que las infecciones lo fueron dentro de las de causas no cardiovasculares (21%). La densidad de incidencia de mortalidad fue de 8 (IC95% 5.4-11.7) cada 100-pacientes/año para el grupo que tuvo reinternación y de 1 cada 100-pacientes/año (IC 95% 0.4-2.8) para el grupo que no la tuvo. Concluimos que las complicaciones con requerimiento de internación son frecuentes en los trasplantados en nuestro medio y condicionan la supervivencia a largo plazo. Las principales causas de reinternación son el rechazo del injerto y las infecciones, con una incidencia similar en los grupos etarios analizados.

Abstract Heart transplantation is currently a procedure of choice for patients with advanced heart failure. Despite a continuous improvement in morbidity and mortality made to date, complications requiring hospitalization continue to be high. The main objective of this study was to describe complications that required hospitalization after a heart transplant, and the secondary objective is to evaluate its incidence according to age group in a cohort of heart transplant recipients in Argen tina. A retrospective cohort study was carried out. One hundred and ninety-eight heart transplant recipients were consecutively included in the period between January 2010 and May 2019. During follow-up, 105 patients (53%) had at least one readmission, and the most frequent cause of cardiovascular readmission was graft rejection (31%), while infections were the most frequent non-cardiovascular causes (21%). Mortality density incidence was 8 (95% CI 5.4-11.7) per 100-patients/year for the group that had readmission and 1 per 100-patients/year (95% CI 0.4-2.8) for the group that did not have. We conclude that complications requiring hospitalization are frequent in transplanted patients and affect long-term survival. The main causes of readmission are graft rejection and infections, and they had similar incidence in the age groups we analyzed.