Long-term durability of sustained virologic response for hepatitis C virus infection in solid organ transplant recipients receiving direct-acting antivirals.

Data are limited regarding the long-term durability of sustained virologic response (SVR) in solid organ transplant recipients who achieve SVR12 with direct-acting antivirals (DAAs) for hepatitis C virus (HCV). We reported the virologic outcomes in 42 recipients who received DAAs for acute or chronic HCV infection after heart, liver, and kidney transplantation. After achieving SVR12, all recipients received HCV RNA surveys at SVR24, and biannually until the last visit. If HCV viremia was detected during the follow-up period, direct sequencing and phylogenetic analysis were performed to confirm late relapse or reinfection. Sixteen (38.1%), 11 (26.2%), and 15 (35.7%) patients underwent heart, liver and, kidney transplantation. Thirty-eight (90.5%) received sofosbuvir (SOF)-based DAAs. No recipients had late relapse or reinfection after a median (range) of post-SVR12 follow-up 4.0 (1.0-6.0) years. We demonstrate that the durability of SVR in solid organ transplant recipients is excellent once SVR12 is achieved with DAAs.

Sofosbuvir-based Interferon-Free Direct Acting Antiviral Regimens for Heart Transplant Recipients With Chronic Hepatitis C Virus Infection.

We assessed the effectiveness and safety of sofosbuvir (SOF) combined with ledipasvir (LDV) or daclatasvir (DCV) in 12 heart transplant recipients with chronic hepatitis C virus (HCV). The sustained virologic response (SVR12) rate was 100% [95% confidence interval [CI]: 75.8%-100%]. All patients tolerated treatment well without interruption, death, or serious adverse events.

An observational study of extracorporeal CPR for in-hospital cardiac arrest secondary to myocardial infarction.

OBJECTIVE: To determine the effects of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with in-hospital cardiac arrest (IHCA) due to acute myocardial infarction (AMI). METHODS: IHCA patients due to AMI undergoing CPR between 1 January 2006 and 1 July 2010 were analysed retrospectively. We compared the survival outcome of 43 patients who received ECPR with that of 23 patients who underwent conventional CPR. RESULTS: The survival rate was 34.9% for patients who received ECPR and 21.8% for those who received conventional CPR (p=0.4). Increased survival rates to hospital discharge were seen in patients with ST segment elevation (p<0.01), or had initial rhythm of ventricular tachycardia/ventricular fibrillation (VT/VF) during resuscitation (p=0.031). CONCLUSIONS: ECPR may improve survival in cardiac arrest patients who have a ST segment elevation or initial rhythm of VT/VF myocardial infarction.

Long-term prognosis in ethnic Chinese patients with unprotected left main coronary artery disease.

OBJECTIVE: The aim of this study was to investigate the long-term outcome of unprotected left main coronary artery disease (LMCA) with different therapeutic modalities in Chinese patients. BACKGROUND: Coronary artery bypass graft (CABG) has been considered standard therapy for patients with LMCA disease. Percutaneous coronary intervention (PCI) has recently been alternative choice for unprotected LMCA. Nevertheless, the effects on the long-term outcome of unprotected LMCA by the above-mentioned management in Chinese remains unknown. METHODS: Patients with unprotected LMCA were enrolled at National Taiwan University Hospital from January 1996 to June 2006. Survival outcomes were obtained by the Bureau of National Health Insurance and clinical results were obtained by chart record review and telephone interview. RESULTS: A total of 620 patients with a mean age of 67 +/- 10 years were enrolled and followed up for 1,587 +/- 1,136 days. Of these, 136 were treated with medical therapy, 336 with CABG and 148 with PCI. Clinical outcome of patients receiving medical therapy was the worst. There was no significant difference between the PCI and CABG group in the risk of cardiovascular death. Cox regression analysis showed that cardiovascular mortality was significantly associated with age (P < 0.001), diabetes mellitus (P = 0.004), LVEF (P = 0.001). In high-risk left ventricular dysfunction, the elderly and renal insufficiency patients, the long-term survival was statistically significantly better in the CABG group. CONCLUSION: For Chinese patients with unprotected left main coronary artery disease, a significant higher risk of cardiovascular death was noted in the medical therapy group. Overall the long-term cardiovascular survival was similar in LMCA patients treated with either PCI or CABG, but CABG provided better survival outcome in high-risk subgroup patients.

Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.

BACKGROUND: Extracorporeal life-support as an adjunct to cardiac resuscitation has shown encouraging outcomes in patients with cardiac arrest. However, there is little evidence about the benefit of the procedure compared with conventional cardiopulmonary resuscitation (CPR), especially when continued for more than 10 min. We aimed to assess whether extracorporeal CPR was better than conventional CPR for patients with in-hospital cardiac arrest of cardiac origin. METHODS: We did a 3-year prospective observational study on the use of extracorporeal life-support for patients aged 18-75 years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min compared with patients receiving conventional CPR. A matching process based on propensity-score was done to equalise potential prognostic factors in both groups, and to formulate a balanced 1:1 matched cohort study. The primary endpoint was survival to hospital discharge, and analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00173615. FINDINGS: Of the 975 patients with in-hospital cardiac arrest events who underwent CPR for longer than 10 min, 113 were enrolled in the conventional CPR group and 59 were enrolled in the extracorporeal CPR group. Unmatched patients who underwent extracorporeal CPR had a higher survival rate to discharge (log-rank p<0.0001) and a better 1-year survival than those who received conventional CPR (log rank p=0.007). Between the propensity-score matched groups, there was still a significant difference in survival to discharge (hazard ratio [HR] 0.51, 95% CI 0.35-0.74, p<0.0001), 30-day survival (HR 0.47, 95% CI 0.28-0.77, p=0.003), and 1-year survival (HR 0.53, 95% CI 0.33-0.83, p=0.006) favouring extracorporeal CPR over conventional CPR. INTERPRETATION: Extracorporeal CPR had a short-term and long-term survival benefit over conventional CPR in patients with in-hospital cardiac arrest of cardiac origin.