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1.
Cancer ; 125(6): 933-942, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30624768

RESUMO

BACKGROUND: Transplant recipients have an elevated risk of cancer because of immunosuppressive medications used to prevent organ rejection, but to the authors' knowledge no study to date has comprehensively examined associations between transplantation status and mortality after a cancer diagnosis. METHODS: The authors assessed cases in the US general population (N=7,147,476) for 16 different cancer types as ascertained from 11 cancer registries. The presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplantation registry (1987-2014). Cox models were used to examine the association between transplantation status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage. RESULTS: For the majority of cancers, cancer-specific mortality was higher in transplant recipients compared with other patients with cancer. The increase was particularly pronounced for melanoma (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [95% CI], 2.18-3.00) and cancers of the breast (aHR, 1.88; 95% CI, 1.61-2.19), bladder (aHR, 1.85; 95% CI, 1.58-2.17), and colorectum (aHR, 1.77; 95% CI, 1.60-1.96), but it also was increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung as well as diffuse large B-cell lymphoma (aHR range, 1.21-1.47). Associations remained significant after adjustment for first-course cancer treatment and generally were stronger among patients with local-stage cancers for whom potentially curative treatment was provided, including patients with melanoma (aHR, 3.82; 95% CI, 2.94-4.97) and cancers of the colorectum (aHR, 2.77; 95% CI, 2.07-3.70), breast (aHR, 2.08; 95% CI, 1.50-2.88), and prostate (aHR, 1.60; 95% CI, 1.12-2.29), despite the lack of an association for prostate cancer overall. CONCLUSIONS: For multiple cancer types, transplant recipients with cancer appear to have an elevated risk of dying of their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.


Assuntos
Neoplasias/diagnóstico , Neoplasias/mortalidade , Transplantados/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Modelos de Riscos Proporcionais , Sistema de Registros , Análise de Sobrevida , Estados Unidos/epidemiologia
2.
Transplant Rev (Orlando) ; 33(2): 87-98, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30551846

RESUMO

Despite improvements in graft survival, solid organ transplantation is still associated with considerable infection induced morbidity and mortality. If we were able to show that serious infection risk was associated with excessive suppression of immune capacity, we would be justified in "personalizing" the extent of immunosuppression by carefully monitored reduction to see if we can improve immune compromize without increasing the risk of rejection. Reliable biomarkers are needed to identify this patients at an increased risk of infection. This review focuses on the currently available evidence in solid organ transplant recipients for immune non-pathogen specific biomarkers to predict severe infections with the susceptibility to particular pathogens according to the component of the immune system that is suppressed. This review is categorized into immune biomarkers representative of the humoral, cellular, phagocytic, natural killer cell and complement system. Biomarkers humoral and cellular systems of the that have demonstrated an association with infections include immunoglobulins, lymphocyte number, lymphocyte subsets, intracellular concentrations of adenosine triphosphate in stimulated CD4+ cells and soluble CD30. Biomarkers of the innate immune system that have demonstrated an association with infections include natural killer cell numbers, complement and mannose binding lectin. Emerging evidence shows that quantification of viral nucleic acid (such as Epstein Barr Virus) can act as a biomarker to predict all-cause infections. Studies that show the most promise are those in which several immune biomarkers are assessed in combination. Ongoing research is required to validate non-pathogen specific immune biomarkers in multi-centre studies using standardized study designs.


Assuntos
Trifosfato de Adenosina/imunologia , Linfócitos T CD4-Positivos/imunologia , Rejeição de Enxerto/imunologia , Células Matadoras Naturais/imunologia , Transplante de Órgãos/efeitos adversos , Biomarcadores/análise , Feminino , Humanos , Hospedeiro Imunocomprometido , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Masculino , Transplante de Órgãos/métodos , Transplante de Órgãos/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Medição de Risco , Análise de Sobrevida , Imunologia de Transplantes/fisiologia , Resultado do Tratamento
3.
Transplant Proc ; 50(10): 3025-3035, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577162

RESUMO

BACKGROUND: Transplantation of organs from living donors helps to decrease the organ shortage and shortens waiting times. Living donor (LD) transplantation is also generally associated with better outcomes. Unfortunately, there has been no comprehensive analysis and comparison of all types of solid-organ transplantation from living donors since the inception of the United Network for Organ Sharing (UNOS). METHODS: Using the UNOS/Organ Procurement and Transplantation Network (OPTN) database, all LD transplants from October 1, 1987, to December 31, 2015, were studied with univariate and multivariate analyses. RESULTS: A total of 140,090 organs were transplanted from LDs, accounting for 21% of all transplants in the United States. Over 95% were kidney; 4% were liver; and <1% intestine, lung, and pancreas LDs. Only LD kidney transplant patient and graft survival rates were significantly higher compared deceased donor transplants over the period of analysis. The best long-term LD transplant results were achieved in pediatric liver recipients. Significantly more women than men donated organs and significantly more men than women received solid-organ transplants. A regional disparity was observed for LD kidney as well as for LD liver transplants. Despite improvements in outcomes and increased use of nonbiologic donors, the number of LD transplants in the United States has declined. This decline was greater in children than adults and was noted for all types of organ transplants. CONCLUSION: Further efforts are needed to educate the public, health professionals, and transplant candidates on the advantages of living vs deceased donor organ transplantation. Compared with other countries, LD transplantation has yet to reach its full potential in the United States.


Assuntos
Doadores Vivos/provisão & distribução , Doadores Vivos/estatística & dados numéricos , Transplante de Órgãos/estatística & dados numéricos , Adulto , Criança , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Sistema de Registros , Taxa de Sobrevida , Obtenção de Tecidos e Órgãos , Estados Unidos
4.
Transplant Proc ; 50(10): 3783-3788, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577270

RESUMO

Pulmonary complications following solid organ transplantation are common and often infectious in nature. Articles describing noninfectious pulmonary complications overwhelmingly rely on clinical and radiographic data. There are a limited number of studies with companion histology delineating the clinical diagnoses of pulmonary complications. This contrasts with blood and bone marrow transplantations. Using a retrospective cohort approach, the current study aimed to assess antemortem and postmortem pulmonary findings in solid organ transplantation recipients. Medical records and autopsy materials from 92 solid organ transplantation recipients were reviewed. Pulmonary complications were identified in 70 patients (76%). For patients with pulmonary complications at autopsy the mean survival posttransplantation was 3.48 years as compared to 7.29 years for patients without pulmonary complications at autopsy (P = .01). Twenty-eight infectious complications (fungal pneumonia, n = 20; cytomegalovirus pneumonia, n = 7; bacterial pneumonia, n = 1) and 113 noninfectious pulmonary complications were identified. The most common noninfectious findings were diffuse alveolar damage (n = 32), organizing pneumonia (n = 31), and pulmonary thromboemboli (n = 26). Disseminated infections and respiratory failure were the most common immediate causes of death (n = 24 and n = 23, respectively). Most noninfectious complications were not diagnosed antemortem.


Assuntos
Pneumopatias/epidemiologia , Pneumopatias/etiologia , Transplante de Órgãos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Autopsia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Estudos Retrospectivos
5.
J Crit Care ; 48: 42-47, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30172032

RESUMO

PURPOSE: We sought to build prediction models for organ transplantation and recipient survival using both biomarkers and clinical information. MATERIALS AND METHODS: We abstracted clinical variables from a previous randomized trial (n = 556) of donor management. In a subset of donors (n = 97), we measured two candidate biomarkers in plasma at enrollment and just prior to explantation. RESULTS: Secretory leukocyte protease inhibitor (SLPI) was significant for predicting liver transplantation (C-statistic 0.65 (0.53, 0.78)). SLPI also significantly improved the predictive performance of a clinical model for liver transplantation (integrated discrimination improvement (IDI): 0.090 (0.009, 0.210)). For other organs, clinical variables alone had strong predictive ability (C-statistic >0.80). Recipient 3-years survival was 80.0% (71.9%, 87.0%). Donor IL-6 was significantly associated with recipient 3-years survival (adjusted Hazard Ratio (95%CI): 1.26(1.08, 1.48), P = .004). Neither clinical variables nor biomarkers showed strong predictive ability for 3-year recipient survival. CONCLUSIONS: Plasma biomarkers in neurologically deceased donors were associated with organ use. SLPI enhanced prediction within a liver transplantation model, whereas IL-6 before transplantation was significantly associated with recipient 3-year survival. Clinicaltrials.gov: NCT00987714.


Assuntos
Morte Encefálica/imunologia , Interleucina-6/sangue , Transplante de Órgãos/mortalidade , Inibidor Secretado de Peptidases Leucocitárias/sangue , Obtenção de Tecidos e Órgãos/métodos , Adulto , Biomarcadores/sangue , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Humanos , Masculino , Pessoa de Meia-Idade
6.
Infect Dis Poverty ; 7(1): 82, 2018 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30107857

RESUMO

BACKGROUND: Rabies, for which the mortality rate is almost 100%, is a zoonotic viral disease that can be transmitted via solid organs or tissue allotransplantation. Dozens of deaths from rabies via solid organs or tissues allotransplantation (ROTA) have been documented during the last decades. In 2015 and 2016, two cases of rabies virus transmission via solid organs or tissue allotransplantation were reported in China, which further underscore the risk and importance of this special type of rabies for organ transplant recipients. MAIN TEXT: From 1978 to 2017, at least 13 cases of ROTA, causing dozens of deaths, have been reported worldwide, whether in the high-risk or low-risk countries of rabies. The reported incubation period of ROTA ranges from 11 days to more than 17 months, while the historical incubation period of rabies is generally considered to range from ~ 1 week to several years. The pathogenesis of ROTA is not clear, but the use of post-exposure prophylaxis (PEP) can play a protective role in the transplant recipients. We also summarize reports about ROTA in China, combined with the actual situation regarding work on rabies surveillance and elimination, and suggest countermeasures for the prevention and control of ROTA in the future. CONCLUSIONS: Understanding the significance of ROTA, screening the suspected organs, assessing the risk and protecting the related population will be effective way to prevent and control further occurrence of ROTA.


Assuntos
Transplante de Órgãos/efeitos adversos , Profilaxia Pós-Exposição/organização & administração , Vacinas Antirrábicas/administração & dosagem , Vírus da Raiva/patogenicidade , Raiva/prevenção & controle , Transplante de Tecidos/efeitos adversos , China/epidemiologia , Feminino , Humanos , Masculino , Transplante de Órgãos/mortalidade , Raiva/epidemiologia , Raiva/mortalidade , Raiva/virologia , Vírus da Raiva/imunologia , Análise de Sobrevida , Transplante de Tecidos/mortalidade , Transplante Homólogo , Vacinação
7.
Arq Bras Cir Dig ; 31(2): e1364, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29972392

RESUMO

BACKGROUND: The best site for splenic implant was not defined, mainly evaluating the functionality of the implant. AIM: To evaluate the effects of autogenous splenic implantation on the subcutaneous tissue in the survival of splenectomized rats. METHOD: Twenty-one randomly assigned rats were studied in three groups (n=7): group 1 - manipulation of the abdominal cavity and preservation of the spleen; group 2 - total splenectomy; group 3 - splenectomy and implant of the tissue removed in the subcutaneous. The animals were followed for 90 days postoperatively. RESULTS: There was a higher mortality in groups 2 (p=0.0072) and 3 (p=0.0172) in relation to group 1. There was no difference between groups 2 and 3 (p=0.9817). CONCLUSION: The splenic implant in the subcutaneous is ineffective in the survival of rats submitted to splenectomy.


Assuntos
Baço/transplante , Tela Subcutânea/cirurgia , Animais , Masculino , Transplante de Órgãos/mortalidade , Distribuição Aleatória , Ratos Wistar , Esplenectomia , Taxa de Sobrevida
8.
Pharmacol Res ; 134: 61-67, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29890253

RESUMO

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection diagnosed in immunocompromized patients. After solid organ transplantation, early infection has decreased as a result of effective prophylaxis, but late infections and even outbreaks caused by interpatient transmission of pneumocystis by air are present in the SOT community. Different risk factors for PJP have been described and several indications for PJP prophylaxis have to be considered by clinicians in patients even years after transplantation. Diagnosis of PJP is confirmed by microscopy and immunofluorescence staining of bronchial fluid but PCR as well as serum ß-D-Glucan analysis have become increasingly valuable diagnostic tools. Treatment of choice is Trimethoprim/sulfamethoxazole and early treatment improves prognosis. However, mortality of PJP in solid organ transplant patients is still high and many aspects including the optimal management of immunosuppression during PJP treatment require further investigations.


Assuntos
Antifúngicos/administração & dosagem , Infecções Oportunistas/tratamento farmacológico , Transplante de Órgãos/efeitos adversos , Pneumocystis carinii/efeitos dos fármacos , Pneumonia por Pneumocystis/tratamento farmacológico , Antifúngicos/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/mortalidade , Transplante de Órgãos/mortalidade , Pneumocystis carinii/imunologia , Pneumocystis carinii/patogenicidade , Pneumonia por Pneumocystis/imunologia , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/mortalidade , Guias de Prática Clínica como Assunto , Fatores de Risco , Resultado do Tratamento
10.
Exp Clin Transplant ; 16 Suppl 1(Suppl 1): 171-175, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29528021

RESUMO

OBJECTIVES: Acinetobacter baumannii, depending on the immune status of the host, may result in one of the most serious hospital infections. Infections involving A. baumannii infection have been recently rising. However, little is known about the clinical features of A. baumannii infection in solid-organ transplant recipients. We aimed to share our clinical experiences with A. baumannii infection in our transplant recipients. MATERIALS AND METHODS: Between 2011 and 2017, 41 solid-organ transplant patients developed A. baumannii infection at Baskent University Hospital. Medical records were reviewed, and patient demographics, microbiology results, and overall outcome data were noted. RESULTS: Of 41 solid-organ transplant patients with A. baumannii infection, 29 were male and 12 were female patients with mean age of 47.15 ± 13.24 years. Our infection rate with A. baumannii infection was 6.1%. The most common sites of infection were deep tracheal aspirate (48.8%)and bloodstream (36.6%). Onset of infection 1 year posttransplant was identified in 58.5% of recipients. Risk factors included presence of invasive procedures (56.1%) and administration of high-dose corticosteroids for rejection 1 year before infection (68.3%). Thirty-day mortality rate was 41.5% (17/41 patients) and was not associated with the infection site, microbiological cure, clinical cure, and drug resistance in our study group. CONCLUSIONS: Acinetobacter baumannii is an important cause of hospital-acquired infection and mortality worldwide. A major problem with A. baumannii infection is delayed initiation of appropriate antibiotic treatment and the rising numbers of extensively drug-resistant organisms. Predicting the potential risk factors, especially in the already at-risk solid-organ transplant population, has an important role in patient outcomes.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/patogenicidade , Infecções Oportunistas/microbiologia , Transplante de Órgãos/efeitos adversos , Transplantados , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/imunologia , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/efeitos dos fármacos , Adulto , Farmacorresistência Bacteriana Múltipla , Feminino , Hospitais Universitários , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Infecções Oportunistas/mortalidade , Transplante de Órgãos/mortalidade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Turquia
11.
Ann Transplant ; 23: 98-104, 2018 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-29402878

RESUMO

BACKGROUND Patients undergoing re-transplantation often receive high doses of immunosuppression, which may lead to an immunocompromised status of the recipient. This study investigates the outcomes after intestine/multivisceral re-transplantation. MATERIAL AND METHODS Clinical outcomes of 23 patients undergoing 24 re-transplantations at a single intestine transplant center were reviewed. Bone marrow suppression was used as a surrogate marker of immunocompromised status, and was defined as platelet count <50 k/mm3 and absolute lymphocyte count <200/mm³. RESULTS All re-transplants except one were liver inclusive. Fifteen of 23 patients died at a median time of 12 months (range 0.2-75) after re-transplantation. Of the 15 deaths, nine (60%) resulted from complications associated with a compromised host immune status: graft versus host disease (GVHD) affecting bone marrow (three cases), persistent viral infection (three cases), post-transplant lymphoproliferative disorder (PTLD (one case), metastatic cancer (one case), multi-drug resistant polymicrobial sepsis (one case). Four deaths (27%) resulted from severe rejection. Non-survivors were more likely to have received alemtuzumab, and had higher incidence of bone marrow suppression. In addition to immunocompromised status and rejection, the use of alemtuzumab was associated with mortality after intestinal/multivisceral re-transplantation. CONCLUSIONS High mortality was associated with intestine/multivisceral re-transplantation. To improve clinical outcomes of intestine and multivisceral transplantation, it is important to allow reconstitution of host immunity. Longer interval between the two transplantations, and strategies such as allograft specific immunosuppression, may spare the host from the devastating effects of potent immunosuppression currently used.


Assuntos
Rejeição de Enxerto/prevenção & controle , Doença Enxerto-Hospedeiro/prevenção & controle , Imunossupressão , Imunossupressores/uso terapêutico , Intestino Delgado/transplante , Transplante de Órgãos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/mortalidade , Doença Enxerto-Hospedeiro/mortalidade , Humanos , Hospedeiro Imunocomprometido , Lactente , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Reoperação , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Surg Today ; 48(6): 618-624, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29380136

RESUMO

PURPOSE: In Japan, there have been no national surveys on the incidence of de novo malignancy after solid organ transplantation, which is one of the leading causes of death in transplant recipients. METHODS: A questionnaire was distributed to institutions that perform solid organ transplantation in Japan, and clinical information was collected from patients who underwent transplantation between 2001 and 2010 and who exhibited de novo malignancies. RESULTS: Nine thousand two hundred ten solid organ transplants (kidney, 49.9%; liver, 45.9%; heart, 0.9%; lung, 1.2%; pancreas, 1.9%; small intestine, 0.2%) were performed. Four hundred seventy-nine (5.2%) cases of de novo malignancy were identified. The transplanted organs of the patients included the kidney (n = 479, 54.8%), liver (n = 186, 38.8%), heart (n = 5, 0.1%), lung (n = 18, 3.8%), pancreas (n = 9, 1.9%), and small intestine (n = 1, 0.02%). The most common malignancies were post-transplant lymphoproliferative disorder (n = 87) and cancers of the kidney (n = 43), stomach (n = 41), large intestine (n = 41), and lung (n = 36). CONCLUSIONS: This is the first national survey of the incidence of de novo malignancy in Japan. Further study is required to identify the risk of de novo malignancy in organ transplant recipients in comparison to the general population, namely the standardized incidence ratio.


Assuntos
Neoplasias/epidemiologia , Transplante de Órgãos , Complicações Pós-Operatórias/epidemiologia , Causas de Morte , Feminino , Humanos , Imunossupressores/efeitos adversos , Incidência , Neoplasias Intestinais/epidemiologia , Japão/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Pulmonares/epidemiologia , Transtornos Linfoproliferativos/epidemiologia , Masculino , Transplante de Órgãos/mortalidade , Transplante de Órgãos/estatística & dados numéricos , Risco , Neoplasias Gástricas/epidemiologia , Inquéritos e Questionários , Fatores de Tempo
13.
Transplantation ; 102(3): 378-386, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29135830

RESUMO

Short-term outcomes of solid organ transplantation have improved dramatically over the past several decades; however, long-term survival has remained static over the same period, and chronic rejection remains a major cause of graft failure. The importance of donor, or "passenger," lymphocytes to the induction of tolerance to allografts was recognized in the 1990s, but their precise contribution to graft acceptance or rejection has not been elucidated. Recently, specialized populations of tissue-resident lymphocytes in nonlymphoid organs have been described. These lymphocytes include tissue-resident memory T cells, regulatory T cells, γδ T cells, invariant natural killer T cells, and innate lymphoid cells. These cells reside in commonly transplanted solid organs, including the liver, kidneys, heart, and lung; however, their contribution to graft acceptance or rejection has not been examined in detail. Similarly, it is unclear whether tissue-resident cells derived from the pool of recipient-derived lymphocytes play a specific role in transplantation biology. This review summarizes the evidence for the roles of tissue-resident lymphocytes in transplant immunology, focussing on their features, functions, and relevance for solid organ transplantation, with specific reference to liver, kidney, heart, and lung transplantation.


Assuntos
Linfócitos/imunologia , Transplante de Órgãos/mortalidade , Rejeição de Enxerto , Humanos , Memória Imunológica , Linfócitos T/imunologia
14.
Am J Transplant ; 18(2): 492-503, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28992380

RESUMO

Organ shortage continues to challenge the field of transplantation. One potential group of donors are those who have been transplant recipients themselves, or Organ Donation After Transplant (ODAT) donors. We conducted a retrospective cohort study to describe ODAT donors and to compare outcomes of ODAT grafts versus conventional grafts. From October 1, 1987 to June 30, 2015, 517 former recipients successfully donated 803 organs for transplant. Former kidney recipients generally survived a median of approximately 4 years before becoming an ODAT donor whereas liver, lung, and heart recipients generally survived less than a month prior to donation. In the period June 1, 2005 to December 31, 2014, liver grafts from ODAT donors had a significantly higher risk of graft failure compared to non-ODAT liver transplants (P = .008). Kidney grafts donated by ODAT donors whose initial transplant occurred >1 year prior were associated with significantly increased graft failure (P = .012). Despite increased risk of graft failure amongst certain ODAT grafts, 5-year survival was still high. ODAT donors should be considered another form of expanded criteria donor under these circumstances.


Assuntos
Sobrevivência de Enxerto , Doadores Vivos , Transplante de Órgãos/mortalidade , Complicações Pós-Operatórias , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adolescente , Adulto , Feminino , Seguimentos , Rejeição de Enxerto , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Reoperação , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Obtenção de Tecidos e Órgãos/métodos , Adulto Jovem
15.
Perit Dial Int ; 38(1): 37-43, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29162679

RESUMO

BACKGROUND: End-stage renal disease is a well-known complication after solid-organ transplantation, mostly as a result of calcineurin-inhibitor therapy. Among recipients of solid-organ transplants other than kidneys, peritoneal dialysis (PD) has been considered an accessory technique as an increased risk of infectious complications has been reported. The aim of our study was to evaluate the outcome of patients with a liver, heart, or lung transplant who underwent PD for replacement therapy. METHODS: This was a retrospective, monocentric study. Every adult patient starting PD between January 1, 2001, and December 31, 2016, at our center was included. The history of previous solid-organ transplantation was determined. For the statistical analysis, we considered 2 groups of patients: 1 group having a history of transplantation of an organ other than the kidney (lung, heart, liver), and 1 group that was starting dialysis without any prior history of organ transplantation. Patients who had previously undergone kidney transplantation were excluded. The events of interest were the first peritonitis episode, death, and PD failure, defined as transfer to hemodialysis. RESULTS: A total of 383 patients started PD during this period, 13 of whom had a history of organ transplantation. We found no significant difference between the solid-organ transplantation patients and those without a history of transplantation in terms of the occurrence of peritonitis (HR [hazard ratio] 0.91 [0.37 - 2.22]), death (HR 0.83 [0.26 - 2.63]), and PD failure (HR 1.01 [0.32 - 3.22]). CONCLUSION: Peritoneal dialysis appears to be an effective replacement therapy for patients with a previous history of solid-organ transplantation.


Assuntos
Falência Renal Crônica/terapia , Transplante de Órgãos/efeitos adversos , Diálise Peritoneal/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Peritonite/epidemiologia , Peritonite/etiologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 43(9): 617-621, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28858185

RESUMO

STUDY DESIGN: Retrospective database review. OBJECTIVE: To characterize the outcomes of solid organ transplant (SOT) patients after one- or two-level lumbar fusion surgery. SUMMARY OF BACKGROUND DATA: Over the past decade advances in SOT patients have improved graft survival. As such, this patient population is increasingly eligible for elective surgery such as lumbar fusion procedures to improve mobility and quality of life. However, the outcomes of spine surgery in this population are not well defined. METHODS: Data from the full 100% Medicare sample between 2005 and 2014 were used for the study. Patients were included if they had an elective one- or two-level lumbar spine fusion and previous history of renal, heart, liver, or lung SOT patients during this period. SOT patients were compared to non-SOT patients with respect to baseline characteristics, 90-day medical complications, 1-year rate of revision surgery, and 1-year mortality. RESULTS: There were 961 patients in the transplant cohort and 258,342 in the non-SOT cohort. Seventy-seven percent of the SOT patients had prior renal transplant. SOT patients had a longer length of stay (P < 0.001), and a higher 30-day readmission rate compared to non-SOT patients (P =  < 0.001). In addition, SOT patients experienced a 23.8% rate of 90-day postoperative major medical complications and 3.0%, 1-year mortality, significantly larger than respective rates in the control population (P < 0.001). One-year infection, revision surgery rates, and wound dehiscence were not significantly different between the two cohorts. CONCLUSION: Spine surgery is associated with significant medical complications and 1-year mortality in the SOT population. Although there may be a substantial benefit from lumbar fusion in the SOT population, judicious patient selection is of paramount importance. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Transplante de Órgãos/mortalidade , Complicações Pós-Operatórias/mortalidade , Fusão Vertebral/mortalidade , Transplantados , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/tendências , Readmissão do Paciente/tendências , Complicações Pós-Operatórias/etiologia , Reoperação/tendências , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/tendências
17.
BMJ Open ; 8(12): e024502, 2018 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-30598488

RESUMO

INTRODUCTION: In the past decades, short-term results after solid organ transplantation have markedly improved. Disappointingly, this has not been accompanied by parallel improvements in long-term outcomes after transplantation. To improve graft and recipient outcomes, identification of potentially modifiable risk factors and development of biomarkers are required. We provide the rationale and design of a large prospective cohort study of solid organ transplant recipients (TransplantLines). METHODS AND ANALYSIS: TransplantLines is designed as a single-centre, prospective cohort study and biobank including all different types of solid organ transplant recipients as well as living organ donors. Data will be collected from transplant candidates before transplantation, during transplantation, at 3 months, 6 months, 1 year, 2 years and 5 years, and subsequently every 5 years after transplantation. Data from living organ donors will be collected before donation, during donation, at 3 months, 1 year and 5 years after donation, and subsequently every 5 years. The primary outcomes are mortality and graft failure. The secondary outcomes will be cause-specific mortality, cause-specific graft failure and rejection. The tertiary outcomes will be other health problems, including diabetes, obesity, hypertension, hypercholesterolaemia and cardiovascular disease, and disturbances that relate to quality of life, that is, physical and psychological functioning, including quality of sleep, and neurological problems such as tremor and polyneuropathy. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the relevant local ethics committee. The TransplantLines cohort study is designed to deliver pioneering insights into transplantation and donation outcomes. The study design allows comprehensive data collection on perioperative care, nutrition, social and psychological functioning, and biochemical parameters. This may provide a rationale for future intervention strategies to more individualised, patient-centred transplant care and individualisation of treatment. TRIAL REGISTRATION NUMBER: NCT03272841.


Assuntos
Doadores Vivos/estatística & dados numéricos , Transplante de Órgãos/mortalidade , Transplante de Órgãos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Sobrevivência de Enxerto , Humanos , Países Baixos , Estudos Observacionais como Assunto , Estudos Prospectivos , Projetos de Pesquisa , Fatores de Tempo , Bancos de Tecidos , Obtenção de Tecidos e Órgãos
18.
Am Surg ; 84(12): 1894-1899, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30606345

RESUMO

The objective of the study is to evaluate the impact of the Affordable Care Act (ACA) on accessibility to solid organ transplant and outcomes. Data source registry: United Network of Organ Sharing database. Patients aged ≥18 years listed for kidney, liver, heart, and lung transplant between years 2010 and 2016 were classified by insurance and status of Medicaid adoption under ACA to evaluate insurance distribution. Between 2010 and 2016, states that adopted Medicaid had 2 to 4 per cent point increase in the proportion of patients listed with Medicaid across all organs. One-year waiting list survival of Medicaid patients was better in the ACA era. States that expanded Medicaid under the ACA had a significant increase in the proportion of patients listed with Medicaid and better one-year waiting list survival.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Transplante de Órgãos/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Listas de Espera/mortalidade , Bases de Dados Factuais/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Humanos , Transplante de Órgãos/mortalidade , Transplante de Órgãos/normas , Avaliação de Resultados da Assistência ao Paciente , Sistema de Registros/estatística & dados numéricos , Análise de Sobrevida , Estados Unidos/epidemiologia
19.
Clin Transplant ; 31(11)2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28881060

RESUMO

The number of nonrenal solid-organ transplants increased substantially in the last few decades. Many of these patients develop renal failure and receive kidney transplantation. The aim of this study was to evaluate patient and kidney allograft survival in primary, repeat, and kidney-after-nonrenal organ transplantation using national data reported to United Network for Organ Sharing (UNOS) from January 2000 through December 2014. Survival time for each patient was stratified into the following: Group A (comparison group)-recipients of primary kidney transplant (178 947 patients), Group B-recipients of repeat kidney transplant (17 819 patients), and Group C-recipients of kidney transplant performed after either a liver, heart, or lung transplant (2365 patients). We compared survivals using log-rank test. Compared to primary or repeat kidney transplant, patient and renal allograft survival was significantly lower in those with previous nonrenal organ transplant. Renal allograft and patient survival after liver, heart, or lung transplants are comparable. Death was the main cause of graft loss in patients who had prior nonrenal organ transplant.


Assuntos
Bases de Dados Factuais , Rejeição de Enxerto/mortalidade , Falência Renal Crônica/cirurgia , Transplante de Rim/mortalidade , Transplante de Órgãos/mortalidade , Complicações Pós-Operatórias/mortalidade , Adulto , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Testes de Função Renal , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/efeitos adversos , Prognóstico , Sistema de Registros , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
20.
Dig Dis Sci ; 62(11): 2966-2976, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28918445

RESUMO

Pre-emptive transplantation is a well-established practice for certain types of end-organ failure such as in the use of kidney transplantation. For irreversible intestinal failure, total parenteral nutrition (TPN) remains the gold standard, due to the suboptimal long-term results of intestinal transplantation. As such, the only role for pre-emptive transplantation, if at all, will be for patients identified to be at high risk of complications and mortality while on definitive long-term TPN. In these patients, the timing of early listing and transplantation could become life-saving, taking into account that mortality on the waiting list is still the highest for intestinal candidates. The development of simulation models or pre-transplant scoring systems could help in selecting patients based on potential outcome on TPN or with transplantation, and recent reports from high-volume centers identify few underlying pathologic conditions and some TPN complications as at higher risk of increased morbidity and mortality. A pre-emptive transplant could be used as a rehabilitative procedure in a well-selected case-by-case scenario, among TPN patients at risk of liver failure, repeated central line infections, mesenteric infarction, short bowel syndrome (SBS) <50 cm or with end stoma, congenital mucosal disease, desmoid tumors: These conditions must be carefully evaluated, not to underestimate the clinical stage nor to over-estimate the impact of a temporary situation. At the present time, diseases with a variable and unpredictable course, such as intestinal dysmotility disorders, or quality of life and financial issues are still far from being considered as indications for a pre-emptive transplant.


Assuntos
Enteropatias/cirurgia , Intestinos/transplante , Transplante de Órgãos/métodos , Cirurgiões , Tomada de Decisão Clínica , Comorbidade , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Custos de Cuidados de Saúde , Humanos , Enteropatias/diagnóstico , Enteropatias/economia , Enteropatias/mortalidade , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/economia , Transplante de Órgãos/mortalidade , Nutrição Parenteral Total/efeitos adversos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Tempo para o Tratamento , Resultado do Tratamento , Listas de Espera
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