Cumulative Incidence Of Outcomes Research Articles

#1750 Burden and excess risk of adverse outcomes in patients with type 1 diabetes utilizing KDIGO classification: a national cohort study

Abstract Background and Aims Our investigation was motivated by the underutilization of the “Kidney Disease Improving Global Outcomes” (KDIGO) classification in evaluating the burden and impact of renal and cardiovascular (CV) adverse outcomes in individuals with type 1 diabetes mellitus (T1DM). Focusing on T1DM patients from the Swedish National Diabetes Register, our study aimed to clarify three key aspects: 1) the distribution of various KDIGO categories across the cohort, 2) the incidence of adverse renal and cardiovascular events, including mortality, for each KDIGO category, and 3) the association of baseline KDIGO category and future excess risk for five major outcomes described below. Method The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2009 equation at baseline and during follow-up. In accordance with KDIGO 2012 guidelines, participants were classified based on their baseline albuminuria and creatinine into G1 to G5 eGFR and A1 to A3 albuminuria categories. Renal outcomes of interest for incidence analysis included: acute kidney injury, 40% eGFR decline from baseline, kidney failure, renal death, and a composite outcome named “MAKE” comprising either of the above renal outcomes. The CV outcomes were coronary heart disease (incorporating acute myocardial infarction and unstable angina), stroke and CV death, the composite outcome “MACE” that included either of the above CV outcomes and heart failure. Additionally, incidence of all-cause mortality was analysed. The cumulative incidence of outcomes was assessed using Kaplan-Meier Survival curves, and incidence rate was calculated per 1000 person-years (py). Cox proportional hazards regression models of risk in the KDIGO strata were employed to examine the association between baseline KDIGO category and the risk of the following five major outcomes: 40% decline, KF, MAKE, MACE and all-cause mortality. Hazard ratios (HR) and 95% confidence intervals were determined. Cox-regression analyses were conducted twice: initially using as reference the conventional KDIGO low-risk categories “combined G1A1 + G2A1” and then using “only G1A1” to specifically evaluate if G2A1 is associated with excess risk. Results Among 39 067 included patients, mean follow-up was 9.1 years (350 000 person-years). The prevalence of chronic kidney disease, defined as eGFR <60 ml/min/1.73 m2 and/or albuminuria, was 18.5% of whom 8.1% were normoalbuminuric. As seen in the figure below, a progressive increase in incidence and adjusted HR for all outcomes was found with advancing eGFR and albuminuria categories, even in individuals with eGFR ≥60 ml/min/1.73 m2. Interestingly, repeat analysis using G1A1 alone as reference revealed significantly elevated risk for all major outcomes even in G2A1 (10% of the entire cohort), conventionally perceived as low risk. Conclusion A progressively increasing burden of adverse cardiorenal outcomes including mortality was observed with advancing KDIGO categories in T1DM population. Even in subjects with preserved eGFR and normoalbuminuria, we identified an elevated risk for all major outcomes, indicating that early screening and implementation of preventive strategies may be beneficial in improving prognosis of this population.

Long-term risk of myocarditis in patients with inflammatory bowel disease: a nationwide cohort study in Sweden.

Despite a suggested link between inflammatory bowel disease (IBD) and myocarditis, the association has not been well-established. This study aimed to investigate the long-term risk of myocarditis in patients with IBD. This nationwide cohort involved all patients with biopsy-confirmed IBD in Sweden (1969-2017) (n=83,264, Crohn's disease [CD, n=24,738], ulcerative colitis [UC, n=46,409], and IBD-unclassified [IBD-U, n=12,117]), general population reference individuals (n=391,344), and IBD-free full siblings (n=96,149), and followed until 2019. Primary outcome was incident myocarditis and secondary outcome was severe myocarditis (complicated with heart failure, death, or readmission). Flexible parametric survival models were used to estimate adjusted hazard ratios (aHR) and cumulative incidence of outcomes, along with 95% confidence intervals (CIs). During a median follow-up of 12 years, there were 256 myocarditis cases in IBD patients (incidence rate [IR]=22.6/100,000 person-years) and 710 in reference individuals (IR=12.9), with an aHR of 1.55 (95%CI: 1.33 to 1.81). The increased risk persisted through 20 years after IBD diagnosis, corresponding to one extra myocarditis case in 735 IBD patients until then. This increased risk was observed in CD (aHR=1.48 [1.11 to 1.97]) and UC (aHR=1.58 [1.30 to 1.93]). IBD was also associated with severe myocarditis (IR: 10.1 vs. 3.5; aHR=2.44 [1.89 to 3.15]), irrespective of IBD subtypes (CD: aHR=2.39 [1.43 to 4.01], UC: aHR=2.82 [1.99 to 4.00], and IBD-U: aHR=3.14 [1.55 to 6.33]). Sibling comparison analyses yielded similar results. Patients with IBD had an increased risk of myocarditis, especially severe myocarditis, for ≥20 years after diagnosis, but absolute risks were low.

PD06-03 BLADDER OUTLET PROCEDURES WITHOUT AUGMENTATION CYSTOPLASTY: EXTENDED LONG-TERM OUTCOMES AND RISKS ASSOCIATED WITH PREOPERATIVE BLADDER COMPLIANCE

You have accessJournal of UrologyCME1 Apr 2023PD06-03 BLADDER OUTLET PROCEDURES WITHOUT AUGMENTATION CYSTOPLASTY: EXTENDED LONG-TERM OUTCOMES AND RISKS ASSOCIATED WITH PREOPERATIVE BLADDER COMPLIANCE Alexandra Carolan, Shane Batie, Yvonne Chan, Micah Jacobs, and Bruce Schlomer Alexandra CarolanAlexandra Carolan More articles by this author , Shane BatieShane Batie More articles by this author , Yvonne ChanYvonne Chan More articles by this author , Micah JacobsMicah Jacobs More articles by this author , and Bruce SchlomerBruce Schlomer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A bladder outlet procedure (BOP) without augmentation cystoplasty (AC) for incontinence due to neurogenic bladder (NGB) is associated with risk of upper tract changes, chronic kidney disease (CKD), and need for additional surgeries. A cohort of patients who underwent BOP without AC from 2000-2013 was previously reported. From 2014 to present, BOP without AC has been used selectively. Here, we present extended outcomes, hypothesizing that BOP without AC in patients with high preoperative compliance (≥20 mL/cm H2O) is associated with fewer adverse outcomes. METHODS: A retrospective chart review was performed and longitudinal dataset created. Cumulative incidence of outcomes up to 15 years were calculated. The association of preoperative bladder compliance with adverse outcomes was studied by log-rank test. RESULTS: 120 patients underwent BOP without AC from 2000-2020 at a median age of 7.5 years (Interquartile range (IQR) 5.8-11.5), with a median follow up of 10.1 years (IQR 7.1-13.3). Table 1 displays the 1, 5, 10, and 15 year cumulative incidences of outcomes. At 15 years, the cumulative incidence of AC was 42% and CKD was 48%. The most common indications for AC were small bladder capacity (25/37 patients, 76%), elevated detrusor pressure (24/37, 73%), incontinence (20/37, 61%), and new or worsening renal scarring (8/37, 24%). Of 87 patients with preoperative urodynamics available, a preoperative bladder compliance ≥ 20 mL/cm H2O (32/87, 37%) was associated with a lower incidence of subsequent AC and abnormal DMSA (Figure 1). CONCLUSIONS: BOP without AC carries a significant risk of adverse outcomes including additional surgeries, upper tract changes, and CKD when used non-selectively. Patients with a preoperative bladder compliance ≥20 mL/cm H2O may have a lower risk of adverse outcomes. These results support the selective use of BOP without AC in NGB patients with large, compliant bladders but long-term monitoring is needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e156 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Carolan More articles by this author Shane Batie More articles by this author Yvonne Chan More articles by this author Micah Jacobs More articles by this author Bruce Schlomer More articles by this author Expand All Advertisement PDF downloadLoading ...

Hepatic hydrothorax is not associated with increased complications or poor survival after liver transplantation

ABSTRACT Background Hepatic hydrothorax (HH) is associated with a poor prognosis. Liver transplant (LT) is the best treatment modality. We aim to assess post-LT morbidity and mortality in patients with cirrhosis and HH. Research design and methods Adult patients with cirrhosis, who underwent LT at our institution from 2015 to 2020, were retrospectively reviewed. Baseline data was obtained at the time of LT. Patients were followed from baseline until the last follow-up or death. Censoring occurred at the time of the last follow-up or death, whichever occurred earlier. Cumulative incidence of outcomes was determined by the Kaplan–Meier method. Short-term post-operative complications were compared between both groups as well. Results 428 patients had a LT, of which 72 (16.8%) had HH. Most of the baseline characteristics were similar between patients with and without HH; however, patients in the HH group had a higher proportion of pre-operative history of ascites and hepatic encephalopathy. Pre-operative HH was not significantly associated with post-LT mortality (Hazard ratio 1.12, 95% confidence interval 0.54-2.32; P-value 0.76). Patients had similar short-term post-operative complications between both groups. Conclusions LT is an excellent therapeutic option for patients with cirrhosis and HH, with excellent long-term survival without increased morbidity.

S519 Impact of COVID-19 on Motility Practices: New Onset Gastrointestinal and Autonomic Dysfunction After COVID-19 and the Effects of Vaccination in a Nationwide Cohort Study

S519 Impact of COVID-19 on Motility Practices: New Onset Gastrointestinal and Autonomic Dysfunction After COVID-19 and the Effects of Vaccination in a Nationwide Cohort Study

Editor's Choice – External Applicability of the COMPASS and VOYAGER-PAD Trials on Patients with Symptomatic Lower Extremity Artery Disease in France: The COPART Registry

The aim of this study was to examine the external applicability of the COMPASS and the VOYAGER-PAD trials in patients with lower extremity artery disease (LEAD) in the real world. This was a multicentre retrospective analysis of prospectively collected COPART data, a French multicentre registry of patients hospitalised for symptomatic LEAD. The proportion of patients eligible for the combination of rivaroxaban 2.5 mg twice daily plus aspirin based on either COMPASS or VOYAGER-PAD criteria is reported. The one year cumulative incidence of outcomes between eligible and non-eligible patients, as well as eligible patients vs. control arms of the COMPASS (LEAD patient subgroup) and the VOYAGER-PAD trials were compared. Analyses were performed using Cox models. Of 2 259 evaluable patients, only 679 (30.1%) were eligible for a low dose rivaroxaban plus aspirin regimen. Others were not eligible because of the need for anticoagulant (48.5% and 38.9% of patients meeting COMPASS and VOYAGER-PAD exclusion criteria, respectively) or dual antiplatelet therapy use (15.7% and 16.5%, respectively), high bleeding risk (14.4% and 11.6%, respectively), malignancy (26.1% and 21.0%, respectively), history of ischaemic/haemorrhagic stroke (21.1% and 19.8%, respectively), and severe renal failure (13.2% and 10.5%, respectively). COMPASS and VOYAGER-PAD eligible and ineligible patients were at higher risk of ischaemic events than participants in these trials. The one year cumulative incidences were 6.0% (95% CI 4.3 - 8.1) in the COMPASS eligible subset vs. 3.5% (95% CI 2.9 - 4.3) in the COMPASS control arm for major adverse cardiovascular events, and 27.9% (95% CI 19.9 - 38.3) in the VOYAGER-PAD eligible subset vs. 6.0% (95% CI 5.3 - 6.9) in the VOYAGER-PAD control arm for major adverse limb events. Many patients hospitalised for symptomatic LEAD in France are not eligible for the low dose rivaroxaban plus aspirin combination. In turn, those eligible may potentially have greater absolute benefit because of higher risk than those enrolled in the trials.

Liver stiffness regression after sustained virological response by direct-acting antivirals reduces the risk of outcomes

The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30–6.95), p = 0.010], baseline albumin < 3.5 mg/dL [HR = 4.49 (1.95–10.34), p < 0.001] and baseline unfavorable Baveno-VI [HR = 4.72 (1.32–16.83), p = 0.017] were independently associated and LSM regression ≥ 20% after SVR had a trend to reduce the risk of LRC or death [HR = 0.45 (0.21–1.02), p = 0.058]. The use of simple parameters before DAAs and repetition of LSM post-SVR can identify patients with different risks for severe outcome after HCV eradication.

Sex Differences in Extrahepatic Outcomes After Antiviral Treatment for Hepatitis C.

Despite recognized differences in the rates of cardiovascular and renal disease between men and women in the general population, studies of the downstream effects of antiviral treatment for hepatitis C (HCV) have not investigated differences in outcomes based on sex. We analyzed sex differences in risk of acute coronary syndrome (ACS), end-stage renal disease (ESRD), and ischemic stroke by treatment and response in a large US-based multisite cohort of HCV patients. Observation started at the HCV diagnosis date (untreated) or last antiviral treatment start (treated). Treatment selection bias was addressed using an inverse probability-weighting approach. We estimated the effect of treatment on the cumulative incidence of outcomes using the Fine-Gray method (subdistribution hazard ratios [sHR] and 95% confidence intervals [95% CI]). Death was a competing risk. Roughly 40% of 15,295 HCV patients were women. After controlling for other risk factors, sustained virological response (SVR) (interferon-based [IFN] or direct-acting antiviral [DAA]) significantly reduced risk of all outcomes, particularly among female patients. Female patients who achieved SVR after IFN-based treatment had significantly lower risk of ACS compared with male patients with SVR from either treatment type (sHR 0.45 [95% CI 0.35-0.59] vs 0.81 [95% CI 0.69-0.96, for DAA SVR] and sHR 0.72 [95% 0.62, 0.85, for IFN SVR]). Successful treatment seemed to be most protective against ESRD; female patients who achieved SVR were at 66%-68% lower risk than untreated patients (sHR 0.32 [95% CI 0.17-0.60 for DAA SVR] and 0.34 [95% CI 0.20-0.58 for IFN SVR]), whereas men were at 38%-42% lower risk (sHR 0.62 [95% CI 0.46-0.85 for DAA SVR] and 0.58 [95% CI 0.43-0.76 for IFN SVR]). IFN treatment failure significantly increased risk of all outcomes by 50%-100% among female patients. Compared with no treatment, female patients who experienced IFN treatment failure were at 63% increased risk of ACS (sHR 1.63 [95% CI 1.35-1.96]), almost twice the risk of ESRD (sHR 1.95 [95% CI 1.43-2.66]) and 51% increased risk of stroke (sHR 1.49 [95%CI 1.11-2.00]). SVR reduced the risk of extrahepatic complications, particularly in females. The significantly increased risk associated with IFN TF in women-a subset who represented roughly 10% of that group-underscores the importance of prioritizing these patients for DAA treatment irrespective of the fibrosis stage.

Application of a Medicare claims-based model predicting left ventricular ejection fraction subtype to investigate the epidemiology of heart failure in the US Medicare program

Abstract Introduction Administrative claims do not contain ejection fraction (EF) information for heart failure (HF) patients. To address this limitation, we recently developed a claims-based model to classify HF patients into reduced EF (rEF) or preserved EF (pEF) using 35 predictors. Purpose To report distribution of key patient characteristics and rates of HF decompensation and mortality in model-identified rEF and pEF patients from nationwide Medicare claims (2012–2016) and compare with estimates from the literature. Methods We identified HF patients ≥65 years from US Medicare claims using recorded diagnosis after ≥6 months of continuous enrollment. The date of HF diagnosis was the cohort entry date. The 6-month baseline period prior to the cohort entry date was used to identify predictors and apply the claims-based model to distinguish rEF and pEF. Patients were followed for the composite outcome of time to first HF decompensation (HF hospitalization or outpatient IV diuretic treatment) or all-cause mortality. Descriptive statistics were used to summarize baseline patient characteristics. Cumulative incidence estimates along with 95% confidence intervals (CI) were calculated for the composite endpoint as well as all-cause and cause-specific mortality (derived from National Death Index linkage) using the Kaplan-Meier method. Results A total of 3,134,414 HF patients with an average age of 79 years were identified, of which 200,950 (6.4%) were classified as rEF. Among those classified as rEF, men comprised a larger proportion (68% vs 41%), the average age was lower (76 vs 79 years), and history of myocardial infarction was more frequent (32% vs 13%) compared to pEF. One-year cumulative incidence (95% CI) of the composite endpoint was 42.6% (42.4–42.8%) for rEF and 36.9% (36.7–37.0%) for pEF. One-year all-cause mortality incidence was similar between the groups (27.4% [27.2–27.6%] for rEF and 26.4% [26.3–26.4%] for pEF), however, cardiovascular mortality was higher for rEF (16.7% [16.5–16.8%] vs 12.3% [12.2–12.3%]), whereas non-cardiovascular mortality was higher for pEF (12.9% [12.7–13.1%] vs 16.0% (16.0–16.1%) (Figure 1). These results were in line with estimates from other well-established cardiovascular cohorts including the Get With The Guidelines-HF cohort and the Olmstead County HF epidemiology cohort. Conclusion We replicated well-documented differences in key patient characteristics and endpoints between rEF and pEF in these populations identified based on application of a claims-based model. Our results support use of this model for identifying cohorts of rEF and pEF to conduct subtype specific investigations of treatment outcomes. However, a notably lower proportion of patients were identified as having rEF compared to previous reports indicating low sensitivity of this approach for rEF and suggesting that model-based classification may not be useful in tracking subtype specific incidence or prevalence of HF using Medicare claims. Cumulative incidence of outcomes in HF Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novartis Inc.

Single Stage Permanent Implant Reconstruction Has Better Outcome Than Tissue Expander/Implant in Patients Treated with Postmastectomy Radiation

To identify which type of implant based reconstruction has the most favorable outcome in the setting of post mastectomy radiation (PMRT). We conducted a retrospective cohort study of 1179 breast cancer patients who underwent a total of 1729 mastectomies of which 76% (1329) underwent implant based reconstruction; 56% (739) involved tissue expander/implant (TE/I) exchange and 44% (590) were single-stage permanent implants (PI); 23% (400) had autologous tissue reconstruction (ATR), all treated at one institution from 1997-2014. Of the total breasts undergoing mastectomy, 29% (507) received PMRT and 71% (1222) did not. Median prescribed PMRT dose to the chest wall was 50 Gy (range 45-50.4 Gy); of which 61% (311) received a chest wall boost (10-16 Gy). Forty percent (495) of mastectomies were performed prophylactically in an uninvolved breast. Primary outcome was defined as implant removal (IR) due to complications requiring surgical intervention, with or without re-reconstruction. The association of clinical and pathologic parameters with IR was evaluated using logistic regression models, and the cumulative incidence of outcome was estimated using the Kaplan-Meier method. The median follow-up was 64 months. In patients who received PMRT, the 5 -year risk of IR was 33.8% vs 16.4% for TE/I and PI; respectively (P = 0.0007). Similarly, patients with TE/I had a higher risk for IR with failed implant replacement compared to patients with PI (18.6% vs 9.3%; respectively; P = 0.0098); as well as a higher 5 yr predicted IR with successful re-reconstruction (18.7%, vs 7.8%; respectively; P = 0.025). In the absence of PMRT, 5-year predicted incidence of IR did not differ between TE/I and PI (13.9% vs 8.4%; respectively; P = 0.074). Neither did the 5-yr IR with failed implant replacement (3.9% vs 2.3% respectively; P = 0.31); nor 5-yr IR with successful re-reconstruction (10.4% vs 6.3%; respectively; P = 0.14). The 5-yr complication rate among patients with ATR was not significantly different with and without PMRT (18.2% vs 16.6%; respectively; P = 0.97). The 5- yr complication rate was not significantly different between irradiated ATR and irradiated single stage (PI) (18.2% vs 16.4%; respectively; P = 0.99); while this was significantly lower compared to irradiated TE/I (18.2% vs 33.8%; respectively; P = 0.015). In multivariate analysis, PMRT, tissue expander/implant (TE/I) reconstruction and active smoking were significant predictors for implant removal (Odds Ratio [OR] = 7.2, P < 0.001; OR = 5.8, P = 0.001 and OR = 3.5, P = 0.02; respectively). Neoadjuvant chemotherapy, surgery related parameters as reconstruction timing, and implant size were not predictive of IR. These data suggest that in the setting of PMRT, two stage tissue expander/implant (TE/I) has significantly higher rate of implant removal compared to Single Stage PI and ATR. PI could be considered a preferable alternative to TE/I when PMRT is indicated.

Commentary to “Cumulative incidence of outcomes and urologic procedures after augmentation cystoplasty”

[13] Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int 2012;109:1280e93. [14] Snodgrass WT, Elmore J, Adams R. Bladder neck sling and appendicovesicostomy without augmentation for neurogenic incontinence in children. J Urol 2007;177:1510e4. [15] Schlomer BJ, Saperston K, Baskin L. National trends in augmentation cystoplasties in the 2000s and factors associated with patient outcomes. J Urol. [Epub 2013 Apr 30]. [16] Begg CB, Riedel ER, Bach PB, Kattan MW, Schrag D, Warren JL, et al. Variations in morbidity after radical prostatectomy. N Engl J Med 2002;346:1138e44. [17] Benoit RM, Naslund MJ, Cohen JK. Complications after radical retropubic prostatectomy in the medicare population. Urology 2000;56:116e20. [18] Mongelluzzo J, Mohamad Z, Ten Have TR, Shah SS. Corticosteroids and mortality in children with bacterial meningitis. JAMA 2008;299:2048e55. [19] DeFoor W, Tackett L, Minevich E, Wacksman J, Sheldon C. Risk factors for spontaneous bladder perforation after augmentation cystoplasty. Urology 2003;62:737e41. [20] Obermayr F, Szavay P, Schaefer J, Fuchs J. Outcome of augmentation cystoplasty and bladder substitution in a pediatric age group. Eur J Pediatr Surg 2011;21:116e9. [21] Barroso U, Jednak R, Fleming P, Barthold JS, Gonzalez R. Bladder calculi in children who perform clean intermittent catheterization. BJU Int 2000;85:879e84. [22] Hensle TW, Bingham J, Lam J, Shabsigh A. Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol. BJU Int 2004;93:585e7. [23] Palmer LS, Franco I, Kogan SJ, Reda E, Gill B, Levitt SB. Urolithiasis in children following augmentation cystoplasty. J Urol 1993;150:726e9. [24] Austin JC. Long-term risks of bladder augmentation in pediatric patients. Curr Opin Urol 2008;18:408e12. [25] Zerr DM, Garrison MM, Allpress AL, Heath J, Christakis DA. Infection control policies and hospital-associated infections among surgical patients: variability and associations in a multicenter pediatric setting. Pediatrics 2005;115:e387e92.

Long-term outcomes of community-acquired versus hospital-acquired acute kidney injury: a retrospective analysis

To compare long-term outcomes in CA-AKI to HA-AKI. The hypothesis was that renal and patient survival would be better in CA-AKI than in HA-AKI. Retrospective cohort analysis of patients hospitalized from 2004 to 2005, in Upstate New York Veterans Affairs hospitals. The groups: CA-AKI (n = 560), HA-AKI (n = 158), or No AKI (NA) (n = 2,320). Risk, injury, failure, loss, and end-stage kidney (RIFLE) criterion was used to define AKI. doubling of serum creatinine, endstage renal disease (ESRD), death, and a composite of the three. de novo chronic kidney disease (CKD), recovery of renal function, and re-admission rate. The cumulative incidence of outcomes was determined over a period of 3 years after discharge. CA-AKI was 3.5 times as prevalent as HA-AKI. In comparison to patients with HA-AKI, those with CA-AKI had better estimated glomerular filtration rate (71.3 vs. 61.1 mL/min/1.73 m(2), p < 0.001) and lower prevalence of CKD (42.3 vs. 51.9%, p = 0.03) at baseline. More patients with CA-AKI than HA-AKI met RIFLE failure criterion (43.8 vs. 29.1%, p < 0.001). By 3 years, no differences were found for the individual primary and secondary outcomes tested (all p > 0.05). CA-AKI was found to be considerably more common than HA-AKI and had similar long-term consequences.

Superior Survival after Autologous vs. Allogeneic Hematopoietic Stem Cell Transplantation (HCT) for Diffuse Large B-Cell Lymphoma (DLBCL) Not Explained by Differences in Chemosensitivity.

No randomized trials have compared autologous HCT (autoHCT) to allogeneic HCT (alloHCT) for DLBCL. We analyzed the outcomes of 916 patients (pts) (837 autoHCT and 79 alloHCT) ages 18–60yrs after a first autoHCT or HLA-identical sibling alloHCT for DLBCL between 1995 and 2003 reported to the CIBMTR. Pts receiving T-cell depleted allografts or reduced-intensity conditioning were excluded. There were significant baseline differences between the groups in disease stage, B symptoms, extranodal disease and marrow involvement. AlloHCT pts were significantly more likely to have >3 chemo regimens prior to HCT (53 vs 40%), and resistant induction failure or relapse (39 vs 16%). At 1yr, treatment-related mortality (TRM) was higher after alloHCT (41%, 95% CI, 30–52%) than after autoHCT (11%, 95% CI, 9–14%, p<0.001), but risks of relapse/progression were similar (30%, 95% CI, 21–41%) and (33%, 95% CI, 29–36%, p=0.69), respectively. Cumulative incidence of outcomes and univariate probabilities of progression free (PFS) and overall survival (OS) at 5 yrs are summarized in table 1. In multivariate analysis, allo and autoHCT had differential early and late effects on outcomes. In the first 12 mo after transplant, alloHCT was associated with higher TRM (RR 4.76, 95% CI, 3.14–7.22, p<0.001), treatment failure (RR 2.08, 95% CI, 1.56–2.77, p<0.001) and mortality (RR 2.78, 95% CI, 2.06–3.77, p<0.001) but similar risk of progression (RR 1.14, 95% CI, 0.75–1.74, p=0.54) compared to autoHCT. Among pts surviving 12 mo post-transplant, no significant difference was observed between autoHCT and alloHCT for TRM, progression, PFS, or OS. Covariates that increased the risks of TRM and OS were older age (51–60 years), KPS <90%, chemoresistance at transplant, and earlier transplant yr (before 2001 vs later). Older age and chemoresistance were also associated with progression and lower PFS. There were no significant interactions between graft type and other prognostic variables; in particular, relative risk of outcomes with allo vs autoHCT were similar for patients with chemosensitive and chemoresistant disease. In summary, myeloablative alloHCT increased risks of early TRM and mortaliy without an effect on progression (compared to autoHCT). Transplant type did not affect outcomes after 12 months post-transplant. AutoHCT was associated with superior survival (fig 1), and the difference was not explained by differences in chemosensitivity at the time of transplant.AutoHCTAlloHCTOutcomes(95%CI)(95%CI)AGVHD @ day 100N/A42 (31–53)CGVHD @ 5yrsN/A27 (18–38)TRM @ 5yrs18 (15–20)45 (34–57)Relapse/progression @ 5yrs39 (36–43)33 (23–44)PFS @ 5yrs43 (40–46)26 (18–37)OS @ 5yrs49 (46–53)27 (18–27) [Display omitted]