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Objective: To summarize the clinical value of fetoscopy in the prenatal diagnosis and treatment of amniotic band syndrome (ABS). Methods: A retrospective analysis was conducted on the clinical data of seven ABS fetuses who underwent prenatal fetoscopic intervention at the Third Affiliated Hospital of Zhengzhou University from December 2020 to August 2023. Literatures related to fetoscopic treatment of ABS were searched in databases including China National Knowledge Infrastructure, Wanfang Data, and PubMed. Clinical data were extracted and the characteristics and intervention effects of fetoscopic surgery in the treatment of ABS were summarized. Results: (1) Preoperative evaluation: the gestational age at diagnosis for the seven ABS fetuses was (19.8±4.4) weeks, and the gestational age at fetoscopic intervention was (22.2±2.8) weeks. The indications for fetoscopic intervention included umbilical cord involvement (3 cases), limb amniotic band with circular constriction (2 cases), and unclear visualization of digits (3 cases). (2) Pregnancy outcomes: among the seven ABS fetuses, four cases underwent selective termination of pregnancy due to severe intrauterine limb amputation, and three cases underwent fetoscopic lysis of amniotic bands. Among the latter three cases, one case experienced intrauterine fetal death (IUFD) two weeks after the procedure, and two cases had good postoperative outcomes. (3) Literature review: a total of 40 cases, including 37 cases from 17 articles and three cases from our institution, were included in the analysis. The indications for fetoscopic surgery included limb amniotic band with circular constriction and involvement of the umbilical cord. The success rate of the surgery was 82% (33/40), and 78% (29/37) of the affected limbs retained good functionality. Premature rupture of membranes was the most common complication, with an incidence rate of 48% (16/33). The average interval from the surgery to membrane rupture was (6.1±5.1) weeks, and the average interval from the surgery to delivery was (10.5±4.1) weeks, with an average gestational age at delivery of (33.7±3.6) weeks. The pregnant women were divided into single Trocar group (27 cases) and double Trocar group (13 cases) based on the surgical approach. The success rates in single Trocar group and double Trocar group were 78% (21/27) and 12/13, respectively, and the difference was not statistically significant (χ2=0.474, P=0.491). The gestational age of delivery in the single Trocar group and double Trocar group was (32.7±3.4) and (35.4±3.2) weeks, respectively, and the difference was statistically significant (t=-2.185, P<0.05). There were no statistically significant differences in the success rate of the surgery, incidence of premature rupture of membranes, interval between surgery and membrane rupture, interval between surgery and delivery, and preterm delivery rate between the two groups (all P>0.05). Conclusions: Fetoscopy could be used for prenatal assessment and intrauterine treatment of ABS. Fetoscopic lysis of amniotic bands may be an effective method for treating ABS, which helps preserve limb function and prevent intrauterine limb amputation and IUFD.
Subject(s)
Amniotic Band Syndrome , Fetoscopy , Pregnancy Outcome , Humans , Amniotic Band Syndrome/diagnosis , Amniotic Band Syndrome/surgery , Fetoscopy/methods , Female , Pregnancy , Retrospective Studies , Umbilical Cord/surgery , Prenatal Diagnosis/methods , Gestational Age , Adult , Ultrasonography, PrenatalABSTRACT
INTRODUCTION: Telemedicine services worldwide have experienced unprecedented growth since the early days of the coronavirus disease 2019 (COVID-19) pandemic. Multiple studies have shown that telemedicine is an effective alternative to conventional in-person patient care. This study explored the public perception of telemedicine in Hong Kong, specifically among older adults who are most vulnerable to COVID-19. METHODS: Medical students from The Chinese University of Hong Kong conducted in-person surveys of older adults aged ≥60 years. Each survey collected socio-demographic information, medical history, and concerns regarding telemedicine use. Univariate and multivariate logistic regression analyses were conducted to identify statistically significant associations. The primary outcomes were acceptance of telemedicine use during a hypothetical severe outbreak and after the COVID-19 pandemic. RESULTS: There were 109 survey respondents. Multivariate logistic regression analyses revealed that the expectation of government subsidies for telemedicine services was the strongest common driver and the only positive independent predictor of telemedicine use during a hypothetical severe outbreak (P=0.016) and after the COVID-19 pandemic (P=0.003). No negative independent predictors of telemedicine use during a hypothetical severe outbreak were identified. Negative independent predictors of telemedicine use after the COVID-19 pandemic included older age and residence in the New Territories (both P=0.001). CONCLUSION: Government support, such as telemedicine-specific subsidies, will be important for efforts to promote telemedicine use in Hong Kong during future severe outbreaks and after the COVID-19 pandemic. Robust dissemination of information regarding the advantages and disadvantages of telemedicine for the public, especially older adults, is needed.
Subject(s)
COVID-19 , Telemedicine , Humans , Aged , COVID-19/epidemiology , Hong Kong/epidemiology , Pandemics , Cross-Sectional StudiesABSTRACT
The sound propagation across a sound leaking section along an infinite rectangular duct-like structure near to the lower order duct eigenfrequencies is investigated numerically in the present study. The sound leakage is achieved by finite length rectangular slots located at a corner of the duct-like structure cross section. The finite-element simulations are performed, in the first place, to gain insights into the modal development inside the structure. A semi-analytical model, which considers the wavy air motions along the slots with oblique sound radiation patterns, is developed. An empirical framework is also proposed to estimate the complex longitudinal wavenumber along the slot using the numerical results and dimensional analysis. The performance of the proposed semi-analytical model, together with the complex wavenumber prediction framework, is tested using two duct-like structures with different cross section aspect ratios. The results show that the present proposed approach gives predictions close to the finite-element simulations. The deviations are well within engineering tolerance.
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AIM: This study aimed to assess the intent to enrol in a master of nursing programme among Bangladesh nurses, identify preferred programme options and measure the association among intent to enrol in the programme, clinical competency and job satisfaction. BACKGROUND: Personal and professional aspects of potential students pursuing graduate education are beneficial in devising educational strategies. However, considering the pressing needs for higher nursing education, there are no masters of nursing programmes in Bangladesh. METHODS: This study used a descriptive correlational design. Nurses working in Bangladesh public sector were recruited to participate in a self-administered survey (n = 260). The questionnaire consisted of perception of job satisfaction, clinical competency and the need for educational options, including the intent to enrol in a master of nursing programme, preferred specialty area, curriculum content and career goals after graduation. Data were analysed using descriptive statistics and point-biserial correlation. RESULTS: Ninety per cent of the respondents reported that they intended to enrol in a master of nursing programme. Intention was significantly correlated with clinical competency but not with job satisfaction. The most preferred specialty areas were nursing management and education. Half of the respondents responded that teaching at nursing schools was a career goal after graduation. DISCUSSION: The results of the needs assessment for the programme reflected the unique interest and priorities of the current status of Bangladesh. CONCLUSIONS: The results indicate a strong motivation to enrol in a master of nursing programme, confidence in clinical competence and high demand for programme in nursing management and education. These findings should be considered to design the programme in order to meet the interest of Bangladesh nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Educational needs assessments should take precedence to ensure the best possible educational outcome and to produce competent nurses who will contribute in achieving the Millennium Development Goals of Bangladesh.
Subject(s)
Clinical Competence , Education, Nursing, Graduate/organization & administration , Job Satisfaction , Needs Assessment , Bangladesh , Humans , Nursing Education Research , Surveys and QuestionnairesABSTRACT
PURPOSE: The purpose of this study was to investigate the relationship between immunosuppressant-related symptom experience (SE) and adherence to immunosuppressant regimens among kidney transplant (KT) recipients. METHODS: A total of 239 KT recipients on an immunosuppressant regimen who were followed up after transplantation participated in this study. Data was collected through a self-reported questionnaire survey (medication adherence, SE, and quality of life) and medical record review. RESULTS: Low adherence in the immunosuppressant group was associated with longer time since KT, less comorbidity (<3), and a higher rehospitalization rate. Low adherence among KT recipients showed significantly greater overall symptom occurrence (P = .001) and symptom distress (P = .002) levels than patients with high or medium adherence after adjusting for a number of covariates. The most common symptom both in terms of occurrence (96.4%) and distress (91.1%) among poorly adherent KT recipients was tiredness. CONCLUSION: Low adherence to an immunosuppressant regimen was significantly associated with high SE among KT recipients. Strategies to decrease immunosuppressant-related SE are needed to improve adherence to immunosuppressants.
Subject(s)
Immunosuppressive Agents/therapeutic use , Kidney Transplantation/psychology , Medication Adherence/statistics & numerical data , Postoperative Complications/psychology , Transplant Recipients/psychology , Adult , Fatigue/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Quality of Life , Self Report , Time FactorsABSTRACT
Right diaphragmatic hernia after donor hepatectomy is extremely rare. The occurrence is usually late. We present a case with early occurrence complicated with small bowel strangulation. Early detection and emergency surgical repair relieved the problem quickly. Predisposing factors are discussed. To avoid such a complication is very important.
Subject(s)
Hepatectomy/adverse effects , Hernia, Diaphragmatic/etiology , Adult , Female , Hernia, Diaphragmatic/complications , Hernia, Diaphragmatic/surgery , Humans , Intestinal Diseases/etiology , Liver Transplantation , Living Donors , Time Factors , Tissue and Organ Harvesting/adverse effectsABSTRACT
BACKGROUND: Despite recent advances in preoperative diagnostic imaging and operative techniques, biliary variation of the donor still remains a challenge in the procurement of graft. The supraportal right bile duct (BD) variant including presentation as trifurcation is a potential trap for injuring the remnant bile duct of donor. METHODS: Before living/related-donor liver transplantation (LRLT), cholangiogram with magnetic resonance images of each donor was performed as a routine. After exploration of the donor before hilar dissection, intraoperative chloangiography (IOC) was routinely performed. Among the supraportal right bile duct variants, if the preoperative cholangiography showed a suspected trifurcation of the bile duct, we then performed 3 sessions of IOC during liver graft procurement, including prior to hilar dissection, before the division of bile ducts and after the division. We reviewed the cholangiogram and the postoperative laboratory data of a consecutive series of 25 donors of LRLT. RESULTS: There was no division injury of the remnant bile duct of all of the donors. CONCLUSIONS: Repeated IOC is suggested as a routine for variants of supraportal right bile ducts especially trifurcation pattern in graft procurement to avoid the injury of donor remnant bile ducts.
Subject(s)
Bile Ducts/anatomy & histology , Cholangiography/methods , Liver Transplantation , Living Donors , Patient Safety , Bile Ducts/injuries , Humans , Intraoperative Period , Magnetic Resonance ImagingABSTRACT
INTRODUCTION: Loss of speech after living-related liver transplantation is uncommon. Either immunosuppressive agents, related sequelae, or a neurological event may cause it. CASE REPORT: A 46-year-old man developed dysarthria and dysphagia on the 10th day after living-related donor liver transplantation for alcoholic cirrhosis with Child-Pugh class C. Brain magnetic resonance images and electroencephalograms could not detect any lesion, but the diffusion tensor image showed a subacute lacunar infarction at right midbrain. The patient's speech improved 1 month after rehabilitation. CONCLUSIONS: Some unexpected neurological events, such as loss of speech, may occur after liver transplantation. The differential diagnosis becomes very important before active treatment. Magnetic resonance imaging supplemented with diffusion tensor imaging is an effective imaging study in establishing the diagnosis.
Subject(s)
Aphonia/etiology , Diffusion Tensor Imaging , Liver Transplantation/adverse effects , Living Donors , Aphonia/pathology , Aphonia/physiopathology , Brain/pathology , Brain/physiopathology , Electroencephalography , Humans , Liver Cirrhosis/surgery , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
PURPOSE: We reviewed the national results of heart transplantation in Taiwan. METHODS: From July 1987 to December 2012, 1354 patients underwent heart transplantation in 18 qualified heart centers in Taiwan. The transplantation volume and survival rate were reviewed. RESULTS: The median age of recipients was 49 years at surgery, with 37% in the International Society for Heart and Lung Transplantation (ISHLT)-1A, 30% in ISHLT-1B, and 32% in ISHLT-2. The allograft 1-, 3-, 5-, and 10-year survival rates were 78%, 68%, 61%, and 47%, respectively. Mostly difficult recipients were bridged by extracorporeal membrane oxygenation (ECMO) instead of ventricular assist device (VAD). CONCLUSION: The results of heart transplantation in Taiwan are comparable with ISHLT world results. In Taiwan, we use more ECMO than VAD for mechanical circulatory support to bridge critical recipients to heart transplantation.
Subject(s)
Heart Transplantation , Female , Humans , Male , Middle Aged , Survival Rate , TaiwanABSTRACT
AIM: Limited realworld data existed for miniparasternotomy approach with good sample size in Asian cohorts and most previous studies were eclipsed by case heterogeneity. The goal of this study was to compare safety and quality outcomes of cardiac noncoronary valve operations by miniparasternotomy and full sternotomy approaches on riskadjusted basis. METHODS: From our hospital database, we retrieved the cases of non-coronary valve operations from 1 January 2005 to 31 December 2012, including re-do, emergent, and combined procedures. Estimated EuroScore-II and propensity score for choosing mini-parasternotomy were adjusted for in the regression models on hospital mortality, complications (pneumonia, stroke, sepsis, etc.), and quality parameters (length of stay, ICU time, ventilator time, etc.). Non-complicated cases, defined as survival to discharge, ventilator use not over one week, and intensive care unit stay not over two weeks, were used for quality parameters. RESULTS: There were 283 miniparasternotomy and 177 full sternotomy cases. EuroScore-II differed significantly (medians 2.1 vs. 4.7, p<0.001). Propensity scores for choosing miniparasternotomy were higher with lower EuroScore-II (OR=0.91 per 1%, p<0.001), aortic regurgitation (OR=2.3, p=0.005), and aortic non-mitral valve disease (OR=3.9, p<0.001). Adjusted for propensity score and EuroScore-II, mini-parasternotomy group had less pneumonia (OR=0.32, p=0.043), less sepsis (OR=0.31, p=0.045), and shorter non-complicated length of stay (coefficient=7.2 (day), p<0.001) than full sternotomy group, whereas Kaplan-Meier survival, non-complicated ICU time, non-complicated ventilator time, and 30-day mortality did not differ significantly. CONCLUSION: The propensity-adjusted analysis demonstrated encouraging safety and quality outcomes for mini-parasternotomy valve operation in carefully selected patients.
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BACKGROUND: Obesity has been related to poor renal graft function. The aim of this study was to compare the long-term graft outcomes of living-related kidney recipients regarding donor-to-recipient body mass index (BMI) parameters using the old Quetelet BMI formula and the new Trefethen BMI formula. METHODS: From November 2002 to November 2010, 62 consecutive living-related kidney transplantations were reviewed retrospectively. Four donor-to-recipient BMI parameters were used: (1) BMI difference by the old formula, (2) BMI difference by the new formula, (3) BMI ratio by the old formula, and (4) BMI ratio by the new formula. Long-term outcomes, including graft survival (GS) and rejection-free graft survival (RFGS) either overall or at 5 years post-transplantation, were analysed according to these parameters. RESULTS: The baseline demography was similar among tertiles according to the four BMI parameters tested. Although there is no significant difference in the long-term survivals by the old and new BMI formula, we found that the area under receiver operating characteristic (ROC) curve is larger using the new formula, either by BMI difference (0.584 vs 0.559 in 5-year GS and 0.658 vs 0.636 in 5-year RFGS) or by BMI ratio (0.584 vs 0.561 in 5-year GS and 0.644 vs 0.626 in 5-year RFGS). The same trend was observed in overall survival outcomes. CONCLUSION: The new Trefethen BMI formula seems to predict long-term renal graft outcomes better than the old Quetelet BMI formula.
Subject(s)
Body Mass Index , Graft Rejection , Graft Survival , Kidney Transplantation , Humans , Tissue DonorsABSTRACT
Our previous study showed that solute carrier family 22 (organic cation transporter) member 18 (SLC22A18) downregulation via promoter methylation was associated with the development and progression of glioma, and the elevated expression of SLC22A18 was found to increase the sensitivity of glioma U251 cells to the anticancer drug 1,3-bis(2-chloroethyl)-1-nitrosourea. In this study, we investigated the possible upregulated expression of SLC22A18-induced enhancement of radiosensitivity of human glioma U251 cells in order to provide evidence in support of further clinical investigations. Stably overexpressing SLC22A18 human glioma U251 cells were generated to investigate the effect of SLC22A18 on the sensitivity of cells to irradiation in vitro using clonogenic survival assay. The apoptosis of U251 cells was examined with terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay. DNA damage and repair were measured using γH2AX foci. The effect of SLC22A18 on the in vivo tumor radiosensitivity was investigated in the orthotopic mice model. Upregulated expression of SLC22A18 enhanced the radiosensitivity of glioma U251 cells and also enhanced irradiation-induced apoptosis of U251 cells, but irradiation-induced apoptosis did not correlate with radiosensitizing effect of upregulated expression of SLC22A18. The repair of irradiation-induced double-strand-breaks was retarded in stably overexpressing SLC22A18 U251 cells. In the orthotopic mice model, the upregulated expression of SLC22A18 in U251 cells enhanced the effect of irradiation treatment and increased the survival time of mice. These results show that upregulated expression of SLC22A18 radiosensitizes human glioma U251 cells by suppressing DNA repair capacity.
Subject(s)
Glioma/metabolism , Glioma/radiotherapy , Organic Cation Transport Proteins/biosynthesis , Animals , Apoptosis/genetics , Apoptosis/radiation effects , Cell Line, Tumor , DNA Damage , DNA Repair , Glioma/genetics , Humans , Mice , Mice, Inbred BALB C , Mice, Nude , Organic Cation Transport Proteins/genetics , Radiation Tolerance , Up-RegulationABSTRACT
INTRODUCTION: Ventricular assist devices have benefited patients with end-stage heart failure as a bridge to heart transplantation (HTx). We present our experiment of HTx using extracorporeal membrane oxygenation (ECMO) with Thoratec pneumatic ventricular assist device (TpVAD). METHODS: From May 1996 to June 2011, among 410 patients who underwent HTx 23 required mechanical circulatory support (MCS) with implantation of the TpVAD and 15 (65%) of them received grafts. RESULTS: The 23 patients included 4 female and 19 male patients of age range 10 to 80 years. Eighteen (78%) of them needed ECMO before TpVAD implantation. Twelve (67%) were implanted with a TpVAD double bridge to HTx. The demand for MCS among patients with acute hemodynamic collapse has led to major improvements in the existing systems such as ECMO with double bridge to TpVAD. CONCLUSION: We used ECMO as a rescue procedure for acute hemodynamic deterioration. However, during ECMO support, left ventricular afterload increased. If prolonged support is required, TpVAD might be required: 15 (65%) of patients supported by ECMO with TpVAD needed to a wait a suitable donor. We recommend the application of ECMO for short-term support (within 1 week), and TpVAD as a bridge for medium- or long-term support.
Subject(s)
Extracorporeal Membrane Oxygenation , Heart Failure/therapy , Heart Transplantation , Heart-Assist Devices , Tissue Donors/supply & distribution , Adult , Aged , Aged, 80 and over , Child , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/mortality , Female , Heart Failure/mortality , Heart Failure/physiopathology , Heart Failure/surgery , Heart Transplantation/adverse effects , Heart Transplantation/mortality , Heart-Assist Devices/adverse effects , Hemodynamics , Humans , Male , Middle Aged , Prosthesis Design , Taiwan , Time Factors , Treatment Outcome , Ventricular Function, Left , Waiting Lists , Young AdultABSTRACT
UNLABELLED: Cardiac allograft vasculopathy (CAV) remains one of the leading causes of late graft failure and death. Cyclosporine microemulsion Neoral (CsA) had been used in heart transplantation (HTx) recipients. Meanwhile, Everolimus (EVL; Certican, Norvatis Pharmaceuticals; Basel, Switzerland) or mycophenolate mofetil (MMF) have been combined with CsA for maintenance treatment. We compared atherosclerosis in HTx patients showing CAV by intravascular ultrasound (IVUS) in two groups: the CE who received CsA, EVL, and steroid versus the CM group, who received CsA, MMF, and steroid. MATERIALS AND METHODS: We explored IVUS parameters such as plaque thickness (PT), lumen circumference (LC), media adventitial circumference, lumen diameter (LD), and media adventitial diameter to characterize the atherosclerosis among CE versus CM groups. RESULTS: In this study, both the CE and CM groups showed increased plaque thickening in the first year posttransplantation (P < .05). However, MMF significantly reduced LC and LD (P < .05) Upon multivariate linear regression analysis, the CE group seemed to show less effect on the maximal difference in PT between 2 and 12 months after adjusting for age at transplantation and gender (P < .05). There was no acute clinical adverse event of CAV reported in either both group during the follow-up. The atherosclerosis of CAV revealed by LC, LDmax, and LDmin was significantly less among patients treated with CE than CM. CONCLUSION: These results suggested that everolimus-treated patients showed benefits compared with MMF-treated subjects as extrapolated from these IVUS data.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/prevention & control , Heart Transplantation/adverse effects , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/analogs & derivatives , Sirolimus/analogs & derivatives , Ultrasonography, Interventional , Adult , Aged , Coronary Artery Disease/etiology , Cyclosporine/therapeutic use , Drug Therapy, Combination , Everolimus , Female , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Mycophenolic Acid/therapeutic use , Predictive Value of Tests , Risk Assessment , Risk Factors , Sirolimus/therapeutic use , Steroids/therapeutic use , Taiwan , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: On-treatment monitoring of serum hepatitis B virus (HBV) DNA to guide treatment strategy for patients on entecavir has received little attention. AIM: To investigate the predictive value of on-treatment HBV DNA levels for responses to entecavir. METHODS: This was a retrospective cohort study among nucleos(t)ide analogue-naïve HBV-infected patients on entecavir with a minimum follow-up of 2 years. Maintained virological suppression was defined as undetectable HBV DNA (<20 IU/mL) until the last visit. Genotypic drug resistance was screened by using the INNO-LiPA DR assay. RESULTS: A total of 440 chronic hepatitis B patients (160 HBeAg-positive) followed for 34 ± 9 months were included. The cumulative probability of maintained virological suppression at year 1, 2 and 3 were 76.5%, 83.0% and 88.3% respectively. On multivariate analysis, lower baseline HBV DNA, undetectable HBV DNA at month 12 and negative HBeAg were the independent predictors of maintained virological suppression. M12 responders (who had undetectable HBV DNA at month 12) had higher probability of maintained virological suppression at 3 years (99.1%) as compared to non responders (57.5%; P < 0.001). The cumulative probability of HBeAg-seroconversion at year 1, 2 and 3 were 19.0%, 27.2% and 33.5% respectively. M12 responders had higher probability of HBeAg-seroconversion at 3 years (43.2%) than the non responders (19.0%; P = 0.003). M12 responders had lower probability of drug resistance at 3 years (0%) than the non responders (2.6%; P = 0.004). CONCLUSION: Month 12 HBV DNA responses could predict the probability of maintained virological suppression, HBeAg-seroconversion and risk of drug resistance among patients on entecavir treatment at 3 years.
Subject(s)
Antiviral Agents/therapeutic use , DNA, Viral/blood , Guanine/analogs & derivatives , Hepatitis B e Antigens/blood , Hepatitis B virus/genetics , Hepatitis B, Chronic/drug therapy , Adult , Cohort Studies , Drug Resistance, Viral/drug effects , Drug Resistance, Viral/immunology , Female , Follow-Up Studies , Guanine/therapeutic use , Hepatitis B, Chronic/immunology , Hepatitis B, Chronic/virology , Humans , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Retrospective Studies , Time FactorsABSTRACT
Posttransplant new-onset diabetes mellitus (NODM) is an important complication among patients receiving immunosuppressants. It has a considerable impact on chronic allograft dysfunction. Calcineurin inhibitors have been implicated in the development of posttransplant NODM. Since high-risk candidates also undergo transplantation, prevention and control of posttransplant NODM is important. A 3-year postmarketing surveillance study is currently underway in Taiwan to evaluate the incidence and risk factors leading to development of NODM among de novo and maintenance solid-organ transplant patients receiving cyclosporine (CsA)-based immunosuppressive therapy. Concomitant therapy consisted of basiliximab, mycophenolate mofetil or enteric-coated mycophenolate sodium, and corticosteroids. Diabetes was diagnosed according to the American Diabetes Association criteria. This 6-month protocol-defined interim analysis included 101 patients (84 de novo, 17 maintenance) who received renal (n = 77), liver (n = 13), or heart (n = 11) transplantation. At the end of 6 months, 8/101 (7.92%) patients experienced NODM. The mean time to NODM was 3.05 months. No significant difference was observed between NODM and non-NODM patients for risk factors: age, body mass index, blood pressure, gender, high-density lipoproteins/triglycerides hdl/tg, and anti-hepatitis C virus. The composite endpoint of biopsy-proven acute rejection, graft loss, or death was reached in four patients, with a mean time to event of 3.81 months. Infections were noted in 34 subjects but, no malignancies. Among 389 adverse events reported in 91 patients (90.1%), the majority were of mild to moderate severity. Two deaths were reported: heart transplant recipients with acute rejection and cytomegalovirus meningitis with respiratory failure. Long-term enrollment with follow-up evaluation of these NODM patients up to 3 years will help evaluate the NODM incidence rates and exact graft survival and overall survival rates of CsA-treated transplant patients in Taiwan.
Subject(s)
Cyclosporine/adverse effects , Diabetes Mellitus/chemically induced , Immunosuppressive Agents/adverse effects , Organ Transplantation , Product Surveillance, Postmarketing , Adult , Cyclosporine/therapeutic use , Diabetes Mellitus/epidemiology , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Taiwan/epidemiologyABSTRACT
According to the Australian and New Zealand Dialysis and Transplantation (ANZDATA) 2010 Annual Report, cancer is surpassing cardiovascular diseases as the leading cause of posttransplantation death. Skin cancer and posttransplantation lymphoproliferative disorder (PTLD) are 2 cancers in Western countries. However, urothelial cancer happens much more frequently among Chinese people. We reviewed our experience in Congress of the Asian Society of Transplantation (CAST) 2005, including 10 urothelial cancers, among 620 renal transplant recipients. In this report, we have presented our updated data. From July 1981 to May 2011, we performed 770 renal transplantations followed by graft and native kidney sonography annually even among asymptomatic cases using the protocol described in CAST 2005. During this period, 35 urothelial tumors were detected, ie, 25 new cases were identified in 6 years. These 35 cases included 7 cases with bilateral upper tract involvement and 5 of them with bladder tumors. Seven patients had bladder cancer alone. In 19 patients, 22 ureteral cancers included 1 that grew from the graft ureter, 17 (77.3%) patients showed hydronephrosis by sonography. We performed 13 bilateral nephroureterectomies; 2 were known to have bilateral upper tract cancer. Four of the other 11 were found to have insidious tumors. In contrast, 2 of the 15 initial unilateral nephroureterectomy patients underwent a subsequent contralateral nephroureterectomy due to a tumor. The pattern of urethral cancer in renal transplant recipients is thoroughly different, including female predominance, and a higher incidence of upper tract involvement. We emphasize the necessity of routine periodic sonographic survey even among asymptomatic patients for early detection of a urothelial tumor.
Subject(s)
Kidney Neoplasms/complications , Kidney Transplantation/adverse effects , Ureteral Neoplasms/complications , Urinary Bladder Neoplasms/complications , Female , Humans , MaleABSTRACT
BACKGROUND: Obesity, in the either kidney donor or the recipient, has been related to worse graft function. The aim of this study was to compare long-term graft outcomes of living-related kidney recipients regarding the donor-to-recipient body mass index (BMI) ratio. METHODS: From November 2002 to November 2010, 62 consecutive living-related kidney transplantations were performed at our center. Donor and recipient BMIs were categorized by Taiwan's national standard using dividing values of 18.5, 24, and 27 kg/m(2) to divide subjects into donor-to-recipient BMI categories. These with the same BMI category as their donors were defined as the same-BMI group (group 0); recipients with a lower BMI category than their donors were defined as the large-to-small group (group 1); and those with a higher BMI category than their donors were defined as the small-to-large group (group 2). Baseline parameters and posttransplantation follow-up data were analyzed according to this grouping. RESULTS: Of the 57 recipients followed regularly at our hospital (mean follow-up 48.9 months), 21 (36.8.1%) were in group 0; 26 (45.6%) in group 1, and 10 (17.6%) in group 2. The baseline parameters were similar among these groups. The overall graft survival rates were 81.0% in group 0, 76.9% in group 1, and 90.0% in group 2. The rejection-free graft survival rates were 81.0%, 65.4%, and 90.0%, respectively. By Kaplan-Meier analysis, group 1 showed worse rejection-free graft survival than group 0 or group 2 (log-rank P = .046). CONCLUSIONS: Living-related recipients of kidneys from donors with a higher BMI showed lower long-term graft survival, which might suggest that petite recipients may need time to compensate adequate blood flow for the relative large graft, thus carrying a higher chance of rejection and worse graft outcomes.