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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 713-719, 2020 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-32538561

RESUMO

Objective: To investigate the effectiveness of the reconstruction of posterior cruciate ligament (PCL) with platelet rich plasma (PRP) and 3-strand peroneal longus tendons under arthroscope. Methods: Between June 2014 and December 2017, 58 patients with PCL rupture were randomly divided into two groups: the trial group (PRP assisted reconstruction of 3-strand peroneal longus tendons) and the control group (4-strand hamstring tendon reconstruction alone), 29 cases in each group. There was no significant difference in gender, age, injury side, Kellgren-Lawrence grade, time from injury to operation, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, International Knee Documentation Committee (IKDC) score, Lysholm score between the two groups ( P>0.05). Before operation, at 3 months and 12 months after operation, the IKDC score and Lysholm score of the two groups were recorded to evaluate the knee joint function, AOFAS ankle-hindfoot score was used to evaluate ankle function; KT-2000 examination (knee flexion of 90°, 30 lbs) was used to evaluate the difference of bilateral knee joint posterior relaxation at 12 months after operation, and MRI was used to evaluate ligament reconstruction; CT was used to evaluate the bone tunnel expansion of femur and tibia at 3 months and 12 months after operation. Results: The operation was completed successfully in both groups, there was no complication in the donor tendon area. All the incisions healed by first intention. All the patients were followed up for more than 1 year. The follow-up time of the trial group was 13-17 months, with an average of 15.0 months; that of the control group was 15-20 months, with an average of 15.4 months. At 3 and 12 months after operation, there was no significant difference in AOFAS ankle-hindfoot score when compared with preoperative score and between the two groups ( P>0.05). At 3 and 12 months after operation, the IKDC score and Lysholm score of the two groups were significantly improved, and further improvement was found at 12 months when compared with at 3 months ( P<0.05); the scores in the trial group were significantly better than those of the control group ( P<0.05). At 12 months after operation, the difference of the posterior relaxation of the bilateral knees in the trial group was less than 5 mm in 27 cases, 6-10 mm in 2 cases; in the control group was less than 5 mm in 20 cases, 6-10 mm in 6 cases, and >10 mm in 3 cases; the difference between the two groups was not significant ( Z=0.606, P=0.544). At 12 months after operation, MRI of knee joint showed that all patients had good PCL graft. The MRI score of the trial group was better than that of the control group ( t=2.425, P=0.019). CT examination at 3 and 12 months after operation showed that the bone tunnel expansion of femur and tibia in the trial group were significantly better than those in the control group ( P<0.05). Conclusion: PRP combined with 3-stand peroneal longus tendons can significantly improve the function and stability of knee joint, effectively promote graft remodeling, and promote tendon bone healing, reduce the expansion of bone tunnel. The effectiveness is satisfactory.


Assuntos
Plasma Rico em Plaquetas , Ligamento Cruzado Posterior , Procedimentos Cirúrgicos Reconstrutivos , Tendões , Feminino , Humanos , Articulação do Joelho , Masculino , Ligamento Cruzado Posterior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/normas , Tendões/transplante , Transplantes/normas , Resultado do Tratamento
8.
Am J Transplant ; 20(7): 1773-1779, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32202064

RESUMO

The COVID-19 pandemic has rapidly evolved and changed our way of life in an unprecedented manner. The emergence of COVID-19 has impacted transplantation worldwide. The impact has not been just restricted to issues pertaining to donors or recipients, but also health-care resource utilization as the intensity of cases in certain jurisdictions exceeds available capacity. Here we provide a personal viewpoint representing different jurisdictions from around the world in order to outline the impact of the current COVID-19 pandemic on organ transplantation. Based on our collective experience, we discuss mitigation strategies such as donor screening, resource planning, and a staged approach to transplant volume considerations as local resource issues demand. We also discuss issues related to transplant-related research during the pandemic, the role of transplant infectious diseases, and the influence of transplant societies for education and disseminating current information.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Transplante de Órgãos/tendências , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Betacoronavirus , Tomada de Decisões , Seleção do Doador , Saúde Global , Humanos , Infectologia/organização & administração , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Transplantes , Populações Vulneráveis
10.
BMC Infect Dis ; 20(1): 181, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32106819

RESUMO

BACKGROUND: Hepatitis C virus is one of the leading causes of chronic liver disease and liver-related deaths worldwide. The estimated prevalence of chronic hepatitis C viral infection among the general Belgian population was 0.57% (n = 64,000) in 2015. Although Belgium has had a 'Hepatitis C Plan' since 2014, elimination efforts are unclear. This study employs the best available data and modelling estimates to define the burden of hepatitis C viral infection among key subgroups in Belgium, identify information gaps and propose potential approaches to screening, linkage to care and treatment, and cure. METHODS: We examined the peer-reviewed and grey literature since 2012 for data on the prevalence of hepatitis C viral infection in Belgium in key subgroups identified by national experts and in the literature. Ultimately, this research is primarily based on data provided by the key stakeholders themselves due to a lack of reliable data in the literature. Based on this, we modelled the treatment rates required to reach elimination of hepatitis C in several subgroups. RESULTS: Eleven potential subgroups were identified. There were no data available for two subgroups: generational cohorts and men who have sex with men. In six subgroups, fewer than 3000 people were reported or estimated to have hepatitis C infection. Migrants and people who inject drugs were the most affected subgroups, and children were the least affected subgroup. Only two subgroups are on target to achieve elimination by 2030: patients living with haemophilia and transplant recipients. CONCLUSIONS: Removing Belgian treatment reimbursement restrictions in January 2019 was a big step towards eliminating HCV. In addition, increasing surveillance, including with a national registry, treatment prescription by other health-care providers and availability of treatment in local pharmacies are central to improving the current situation and getting on track to reach the 2030 WHO hepatitis C elimination targets in Belgium.


Assuntos
Erradicação de Doenças/métodos , Hepatite C/prevenção & controle , Adolescente , Adulto , Antivirais/uso terapêutico , Bélgica , Criança , Pré-Escolar , Política de Saúde , Hemofilia A/complicações , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Homossexualidade Masculina , Humanos , Lactente , Masculino , Modelos Teóricos , Prisioneiros , Sistema de Registros , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transplantes , Adulto Jovem
11.
Am J Transplant ; 20(5): 1221-1222, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32037643
12.
Transplant Proc ; 52(1): 127-132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32000938

RESUMO

OBJECTIVE: The purpose of this study is to analyze varying predictive factors for improved graft function among renal transplant recipients. METHODS: Two hundred eleven consecutive donor and recipient pairs who underwent renal transplantation between January 2011 and December 2015 were enrolled in our study. Factors that affected renal graft function were analyzed. Statistical analyses were performed using SPSS version 16.0 software (SPSS Inc, Chicago, IL, United States). RESULTS: The mean age of donors in years was 30 (range, 17-62), with a mean body mass index (BMI) of 23.20 kg/m2 (range, 16.10-39.50). Mean total warm ischemic time in minutes was 44.80 (range, 26.10-83.45). The mean age of the recipients in years was 48 (range, 12-78) with a mean BMI of 22 kg/m2 (range, 14.80-37.30). Estimated glomerular filtration rate at 6 and 12 months post-transplantation were 69 mL per minute per 1.73 m2 (range, 10-137) and 65 (range, 16-110), respectively. Based on several parameters, there was no significant factor that improved renal graft function at 6 and 12 months after transplant. Total warm ischemic time almost showed statistical significance in predicting improved renal graft function after transplant. Future study with a longer period of observation and a larger sample size should be done for further investigation. CONCLUSIONS: Total warm ischemic time is a promising parameter to predict improved renal graft function post-transplantation.


Assuntos
Sobrevivência de Enxerto/fisiologia , Transplante de Rim , Rim/fisiopatologia , Transplantes/fisiopatologia , Isquemia Quente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Criança , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Tempo , Doadores de Tecidos/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
13.
PLoS One ; 15(2): e0229710, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101564

RESUMO

Patients with sickle cell disease (SCD) have access to fewer health care resources and therapies compared to other diseases, which contributes to increased morbidity and health care utilization. We compared health care utilization (inpatient hospital days, emergency care visits) and health care-related costs between SCD adults that underwent hematopoietic stem cell transplantation (HSCT) using a nonmyeloblative conditioning regimen versus those referred for HSCT but did not proceed due to lack of an HLA-matched sibling donor, denial by insurance, red blood cell antibodies to the potential donor, or declining further evaluation. Between 8/2011 and 4/2016, 83 SCD patients were referred for allogeneic HSCT and 16 underwent the procedure. The HSCT and non-HSCT groups were similar by age, sex, prior SCD-related therapy and complications. Compared to pre HSCT, significantly fewer inpatient hospital days (median of 1 versus 22 days, P = 0.003) and emergency care visits (median of 1 versus 4 visits, P = 0.04) were observed by the 2nd year post-HSCT. Similar results were observed in comparison to the standard-of-care group (median of 1 versus 12 hospital days, P = 0.002; median of 1 versus 3 emergency visits, P = 0.03). Lower health care costs were observed by the 2nd year post-HSCT (median of $16,281 versus $64,634 pre-HSCT (P = 0.01) and versus $54,082 in the standard-of-care group (P = 0.05). A median reduction of -$20,833/patient/year (IQR, -$67,078-+$4,442/patient/year) in health care costs compared to pre-HSCT was observed in the 2nd year post-HSCT. In conclusion, allogeneic HSCT leads to improvements in health care utilization and costs compared to standard-of-care therapy in high-risk SCD adults.


Assuntos
Anemia Falciforme/economia , Anemia Falciforme/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/economia , Humanos , Masculino , Irmãos , Doadores de Tecidos , Condicionamento Pré-Transplante/economia , Condicionamento Pré-Transplante/métodos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/economia , Transplantes/economia , Adulto Jovem
14.
PLoS One ; 15(1): e0227385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929557

RESUMO

Lifelong noninvasive rejection monitoring in heart transplant patients is a critical clinical need historically poorly met in adults and unavailable for children and infants. Cell-free DNA (cfDNA) donor-specific fraction (DF), a direct marker of selective donor organ injury, is a promising analytical target. Methodological differences in sample processing and DF determination profoundly affect quality and sensitivity of cfDNA analyses, requiring specialized optimization for low cfDNA levels typical of transplant patients. Using next-generation sequencing, we previously correlated elevated DF with acute cellular and antibody-mediated rejection (ACR and AMR) in pediatric and adult heart transplant patients. However, next-generation sequencing is limited by cost, TAT, and sensitivity, leading us to clinically validate a rapid, highly sensitive, quantitative genotyping test, myTAIHEART®, addressing these limitations. To assure pre-analytical quality and consider interrelated cfDNA measures, plasma preparation was optimized and total cfDNA (TCF) concentration, DNA fragmentation, and DF quantification were validated in parallel for integration into myTAIHEART reporting. Analytical validations employed individual and reconstructed mixtures of human blood-derived genomic DNA (gDNA), cfDNA, and gDNA sheared to apoptotic length. Precision, linearity, and limits of blank/detection/quantification were established for TCF concentration, DNA fragmentation ratio, and DF determinations. For DF, multiplexed high-fidelity amplification followed by quantitative genotyping of 94 SNP targets was applied to 1168 samples to evaluate donor options in staged simulations, demonstrating DF call equivalency with/without donor genotype. Clinical validation studies using 158 matched endomyocardial biopsy-plasma pairs from 76 pediatric and adult heart transplant recipients selected a DF cutoff (0.32%) producing 100% NPV for ≥2R ACR. This supports the assay's conservative intended use of stratifying low versus increased probability of ≥2R ACR. myTAIHEART is clinically validated for heart transplant recipients ≥2 months old and ≥8 days post-transplant, expanding opportunity for noninvasive transplant rejection assessment to infants and children and to all recipients >1 week post-transplant.


Assuntos
Biomarcadores/sangue , Ácidos Nucleicos Livres/sangue , Transplantes/metabolismo , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto , Transplante de Coração , Humanos , Lactente , Masculino , Doadores de Tecidos , Adulto Jovem
15.
Nurs Res ; 69(2): 142-148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31972852

RESUMO

BACKGROUND: Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress. Mobile health (mHealth) technologies can be leveraged to improve understanding of the patient's symptom experience by providing continuous, real-time, in situ, patient-generated symptom data. This rich data stream can subsequently enhance symptom management strategies. However, limited research has been conducted in this area. OBJECTIVES: This pilot study seeks to (a) explore the feasibility of integrating mHealth technologies to monitor symptom data for PBMT patients and (b) evaluate the study design, measures, and procedures. METHODS: An exploratory longitudinal design was employed to assess the feasibility of monitoring 10 PBMT patients' symptoms using data from two mHealth technologies: (a) a smartphone mHealth application (app) to collect symptom data and (b) a wearable tracking device (Apple watch) to collect physiological data. Feasibility was measured as usability and acceptability. Monthly patient interviews and an end-of-study feasibility survey were employed and analyzed to further understand reasons for sustained interest in and attrition from the study. RESULTS: Overall usability of the wearable was 51%, and app was 56%. Children reported devices were easy to use and acceptable. The study demonstrated acceptability with an enrollment rate of 83% and an attrition rate of 30%, with 70% of the children remaining in the study for at least 40 days. DISCUSSION: This pilot study is among the first to explore the feasibility of using mobile technologies to longitudinally obtain patient-generated symptom data to enhance understanding of the PBMT symptom experience. In addition, it will improve our understanding of how these data present, interact, and cluster together throughout the posttransplant period.


Assuntos
Tecnologia Biomédica , Pediatria , Smartphone , Avaliação de Sintomas , Telemedicina , Dispositivos Eletrônicos Vestíveis , Adolescente , Medula Óssea , Criança , Estudos de Viabilidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Cooperação do Paciente , Projetos Piloto , Inquéritos e Questionários , Transplantes
16.
Curr Urol Rep ; 21(1): 2, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960158

RESUMO

PURPOSE OF REVIEW: Classically, kidney transplantation (KT) consists of heterotopic implantation of the renal graft in the iliac fossa with vascular anastomosis on the iliac vessel and reimplantation of the graft ureter in the bladder of the recipient. However, a wide range of variations exist in both vascular anastomosis and urinary diversion that the non-transplant surgeon should know. RECENT FINDINGS: For any pelvic surgery in a KT patient, the non-transplant surgeon should preoperatively evaluate the anatomy of the graft, its vascularization and its urinary tract. The transplant ureter should be identified and secured by preoperative JJ stenting whenever needed. For any surgery, maintenance and control of both immunosuppressive treatment and renal function is crucial. The advice or even the assistance of a transplant surgeon should be required because any damage to vascularization or urinary drainage of the renal graft could have dramatic and definitive consequences on graft function.


Assuntos
Transplante de Rim/métodos , Pelve/cirurgia , Transplantes/anatomia & histologia , Humanos , Transplantados , Transplantes/irrigação sanguínea , Derivação Urinária/métodos
17.
Curr Urol Rep ; 21(1): 4, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960160

RESUMO

PURPOSE OF REVIEW: This review provides a critical literature overview of the risks and benefits of transplantectomy in patients with a failed allograft. Additionally, it offers a summary of related problems, primarily alloantibody sensitization in the event of nephrectomy and immunosuppression weaning. RECENT FINDINGS: Transplant nephrectomy has high morbidity and mortality rates. The morbidity of transplant nephrectomy (4.3 to 82%) is mostly due to hemorrhage or infection. Mortality rates range from 1.2 to 39%, and most are due to sepsis. Transvascular graft embolization has been described as a less invasive alternative technique for the management of symptomatic graft rejection, with minimal complications compared with transplantectomy. The number of patients with a failed allograft returning to dialysis is increasing. The role of allograft nephrectomy in the management of asymptomatic transplant failure is still controversial and up today continues to depend on the usual clinical practice of each institution. The less invasive transvascular embolization could have applicability in asymptomatic patients with the obvious lower morbidity and mortality rate.


Assuntos
Rejeição de Enxerto/cirurgia , Transplante de Rim/efeitos adversos , Nefrectomia/métodos , Transplantes/cirurgia , Aloenxertos/cirurgia , Rejeição de Enxerto/etiologia , Humanos
19.
Transplant Proc ; 52(1): 54-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31901324

RESUMO

BACKGROUND: Kidneys at higher risk for allograft failure are defined by the Kidney Donor Profile Index (KDPI) > 85% in the current kidney allocation system (KAS), replacing the historical concept of expanded criteria donor (ECD) kidneys in the previous KAS. Discrepancies exist in the classification of "high-risk kidneys" between the 2 KAS. In the current KAS, only recipients of KDPI > 85% kidneys are counseled about the high risk of allograft failure and are required to sign a consent. In this study, we evaluated the outcomes and allocation of kidneys with discordant classification. METHODS: Using the Scientific Registry of Transplant Recipients, kidneys transplanted between 01/2002 and 09/2016 were classified according to the old (standard criteria donor [SCD]/ECD) and current (KDPI) KAS. We then grouped them as concordant (KDPI ≤ 85% + SCD or KDPI > 85% + ECD) and discordant (KDPI ≤ 85% + ECD or KDPI > 85% + SCD) kidneys. RESULTS: Approximately 11% of transplanted kidneys were discordant in classification. Among kidneys with KDPI ≤ 85%, ECD status conferred a 64% (95% CI: 56%-73%) higher risk of allograft failure compared to SCD status. However, SCD/ECD status was not associated with differential outcomes in KDPI > 85% kidneys. These ECD kidneys have KDPIs > 50% and have been transplanted across all estimated post-transplant survival (EPTS) deciles. CONCLUSION: Adequate counseling about the risk and benefit of accepting ECD kidneys with KDPI ≤ 85% versus waiting on dialysis should be explored with the patients, especially those with lower EPTS.


Assuntos
Transplante de Rim , Seleção de Pacientes , Doadores de Tecidos/provisão & distribução , Transplantes/classificação , Transplantes/provisão & distribução , Adulto , Feminino , Sobrevivência de Enxerto , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Transplantados/classificação
20.
Transplant Proc ; 52(1): 119-126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31901319

RESUMO

PURPOSE: We investigated whether older donor kidneys aged >75 years have acceptable long-term function and if recipients can benefit sufficiently from the transplantation. METHODS: This single-center study retrospectively analyzed patient data from 217 deceased donor kidney transplants performed between 1998 and 2014 as part of the Eurotransplant Senior Program, where the organ donors were ≥65 years old. Depending on donor age, the groups "older donors" (OD; n = 161) and "very old donors" (VOD; n = 56) received transplants from donors aged 65 to 75 years and >75 years, respectively. Donor and recipient clinical characteristics, delayed graft function, estimated glomerular filtration rate, 1-year rejection rate, patient and graft survival, and postoperative complications were investigated. RESULTS: Comparing VOD group vs OD group, the 1-year, 3-year, and 5-year graft survival rates were 80.4% vs 76.4%, 62.5% vs 65.8%, and 42.6% vs 57.3%, respectively. Patient survival rates after 1, 3, and 5 years were 89.3% vs 88.2%, 71.4% vs 78.2%, and 57.5% vs 71.8%, respectively. There were no significant differences between the 2 groups (graft survival P = .107; patient survival P = .126). Kidney graft function after 1, 2, and 3 years was significantly better in the OD group than in the VOD group. No differences were found regarding postoperative complications, rejection rate, and delayed graft function. CONCLUSION: The utilization of selected kidney-grafts from donors >75 years resulted in acceptable outcomes after kidney transplantation and could expand the donor pool. In contrast to the high mortality rate during dialysis, recipients in both groups benefited from transplantation.


Assuntos
Transplante de Rim/métodos , Doadores de Tecidos/provisão & distribução , Transplantes/estatística & dados numéricos , Adulto , Idoso , Morte Encefálica , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/mortalidade , Feminino , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Rim , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
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