One-year Patient Survival Rates Research Articles

Early conversion to belatacept-based immunosuppression regimen promotes improved long-term renal graft function in kidney transplant recipients

BackgroundBelatacept has been demonstrated as an effective alternative immunosuppressant in kidney transplant recipients. This study focuses on outcomes of early and late conversion to Belatacept-based immunosuppression after kidney transplant. Materials and methodsThis retrospective analysis of a prospectively collected database included all adult kidney transplants patients at SUNY Upstate Medical Hospital from 1 January 2014 to 30 December 2022. Early conversion was defined as all conversions done at <6 months after kidney transplantation, and late conversion to belatacept was defined as conversion at >6 months after kidney transplantation. ResultsOut of 61 patients included in this study, 33 patients (54%) were in the early conversion group, and 28 patients (46%) were in the late conversion group. The mean eGFR in the early conversion group was 26.73 ± 16.26 ml/min/1.73 m2 before conversion to belatacept, which improved to 45.3 ± 21.01 ml/min/1.73 m2 at one-year post-conversion (p = 0.0006). Furthermore, eGFR changes in the late conversion group were insignificant, with 46.30 ± 15.65 ml/min/1.73 m2 before conversion to belatacept, and 44.76 ± 22.91 ml/min/1.73 m2 after one year of follow-up (p = 0.72). All four biopsy-proven allograft rejections in the early conversion group were acute T-cell-mediated rejections (ATMR). In the late conversion group, out of three biopsy-proven rejections, one was chronic antibody-mediated rejection (CAMR), one was ATMR, and one was mixed ATMR/CAMR. All four patients with ATMR rejection received mycophenolic acid (MPA) as part of their immunosuppressive regimen, and none received tacrolimus. The one-year post-conversion allograft survival rate in early and late conversion groups was 100%. However, the one-year post-conversion patient survival rate was 90.9% in the early conversion group and 100% in the late conversion group (P = 0.11). ConclusionsEarly post-transplant conversion to belatacept can improve the eGFR more meaningful when compared to late conversion. Patients who receive belatacept and MPA rather than tacrolimus may have increased rates of T-cell-mediated rejection.

Utilization of Segmental Grafts Is Associated With Higher Transplant Rates in Pediatric Patients

IntroductionIn July 2017, a policy to increase the use of segmental grafts (SGs) was implemented at our institution. The aim was to compare changes in waitlist activity after implementation of this policy. MethodsA single-center, retrospective study. Pediatric patients on the liver waiting list between January 2015 and December 2019 were screened. Patients were classified as receiving a liver transplant (LT) before (Period 1) or after (Period 2) policy changes. Primary end points were transplant rates and time to transplant. ResultsSixty five first LT performed on 65 patients were included. Twenty nine LT were performed during Period 1 and 36 during Period 2. More than half (55%) of LT in Period 2 were SG, compared to 10.3% in Period 1 (P < 0.001). Forty nine and 56 pediatric candidates on the waiting list accounted for 38.78 and 24.48 person-years during Period 1 and Period 2, respectively. Transplant rates per 100 person-years on the waiting list increased from 85.09 during Period 1 to 187.87 in Period 2 (Rate ratio: 2.20; P < 0.001). Median time to receive a LT decreased from 229 d in Period 1 to 75 d during Period 2 (P = 0.013). One-year patient survival rates were 96.6% in Period 1 and 95.7% in Period 2. One-year graft survival rates were 89.7% and 88% in Period 1 and Period 2, respectively. ConclusionsA policy to increase the use of SG was associated with significantly higher transplant rates and lower waiting times. Implementation of this policy can be done successfully with no observed negative impact on patient and graft survival.

The state of cancer care in Russia: one-year survival rate of patients with malignant neoplasms and first-year mortality rate for cancer of any site. (Population study at the federal district level)

Наиболее объективным критерием оценки деятельности онкологической службы является показатель выживаемости, исчисленный по международным стандартам на базе данных тщательно выверенного Популяционного ракового регистра. Уровень стандартизованных показателей заболеваемости населения злокачественными новообразованиями (ЗНО) в России и Северо-Западном федеральном округе Российской Федерации (СЗФО РФ) различаются на 4,26% (в пределах статистической погрешности, что позволяет нам перевести итоги нашего исследования на всю Россию. Население СЗФО РФ в 2022 году составило 13,9 млн. человек, что соответствует населению Белоруссии, Латвии и Литвы вместе взятых. Впервые в России на материале базы данных популяционного регистра (БД ПРР) СЗФО РФ исчислены показатели однолетней и пятилетней выживаемости по всем трехзначным рубрикам МКБ-10 плюс 13 сгруппированным рубрикам, как это принято в отчетах (форма №7) для анализа динамики заболеваемости и смертности населения от ЗНО. Цель исследования: на обширном выверенном материале БД ПРР СЗФО РФ представить анализ деятельности онкологической службы региона на основе расчета динамики показателей наблюдаемой выживаемости больных 71 локализации опухолей. Материалы и методы. Материалом явилась БД ПРР СЗФО РФ объемом более 1 млн. 150 тыс. наблюдений, использована методология расчета показателей выживаемости по программе Eurocare. Полученные результаты. Проведенное сравнение уровней показателей однолетней выживаемости больных ЗНО за два периода наблюдения (1995-1999 и 2015-2019) выявило рост однолетней наблюдаемой выживаемости с 63,8 до 71,0, т.е. на 11,29%, соответственно снижение одногодичной летальности по региону составило с 36,2 до 29,0%. Наибольшие успехи достигнуты (прирост однолетней выживаемости более 25%) для ЗНО печени (С22), тонкого кишечника (С17), желчного пузыря (С23, 24), рото- и гортаноглотки (С10, 12, 13). Более 10% прирост однолетней выживаемости пришелся на ЗНО языка (С01, 02), пищевода (С15), предстательной железы (С61), плаценты (С58) и ободочной кишки (С18). При среднем показателе (С00-96) – 11,29%. По многим локализациям ЗНО, выявлены более скромные успехи. По ведущим локализациям опухолей прирост этого показателя составил для рака желудка +5,5; рака легкого +2,7; рака прямой кишки +4,7; меланомы кожи +3,8; рака шейки матки +2,5. Однолетняя выживаемость больных раком тела матки и раком поджелудочной железы остались без изменений, по ряду локализаций (С51, С81-96, С60, С07-08, С00 и С70-72) отмечено снижение показателя от -2 до -9%. Пятилетняя наблюдаемая выживаемость возросла с 42,9% в 1995-1999г. до 47,1% в 2010-2014 году или на 9,8%. Относительная однолетняя выживаемость была на 1-2% выше, пятилетняя кумулятивная относительная выживаемость на 5-7% выше. Прирост показателя пятилетней выживаемости больных ЗНО произошел по многим локализациям опухолей и системным новообразованиям лимфатической и кроветворной ткани, но в существенно меньших объемах по сравнению с однолетней выживаемостью. По 20 локализациям пятилетняя выживаемость больных ЗНО уменьшилась, в первую очередь по опухолям головного мозга, поджелудочной железы, пищевода, желудка, легких и некоторых других. Заключение и выводы. Проведенное популяционное исследование показало улучшение проводимых мероприятий противораковой борьбы, существенный рост показателя однолетней выживаемости и рост показателя пятилетней выживаемости. К проценту прироста-убыли показателя надо относиться критически с учетом её реальной величины на исходном уровне. По ряду локализаций уже ранее были достигнуты высокие уровни выживаемости больных, в связи с чем величина прироста показателя может быть скромной. Это в первую очередь относится к новообразованиям щитовидной железы, мочевого пузыря, яичка, меланомы кожи, глаза, тела матки, губы, системных новообразований лимфатической кроветворной ткани.

The Addition of Hypomethylating Agents to Low-Intensity Induction Chemotherapy Does Not Improve Outcomes in Elderly Acute Myeloid Leukemia Patients: A Single-Center Retrospective Study

Background and Objectives: This study aimed to evaluate whether the addition of hypomethylating agents (HMA) to low-intensity chemotherapy can enhance the clinical efficacy of induction treatment for elderly acute myeloid leukemia (AML) patients who are unsuitable for standard induction therapy. Materials and Methods: This study retrospectively analyzed 117 patients over 60 years old who were initially diagnosed with AML and received low-intensity induction treatment in the Department of Hematology in Anhui provincial hospital from January 2015 to December 2020. Twenty-three patients were excluded, and the remaining 94 patients were divided into two groups according to the selection of induction regimens. Results: Forty-four patients received HMA combined with low-intensity chemotherapy, and the other 50 patients received only low-intensity induction chemotherapy. Forty-three patients (45.7%) obtained complete remission (CR) after the initial induction treatment. The CR rate in the HMA plus low-intensity chemotherapy group was 34.1% (15/44), and in the single low-intensity chemotherapy group was 56.0% (28/50) (p = 0.04). The 30 days cumulative early death rates were 9.1% (95% CI: 3.5-22.4%) in the HMA plus low-intensity chemotherapy group and 6.0% (95% CI: 2.0-17.5%) in the single low-intensity chemotherapy group, respectively (p = 0.59), and the one-year cumulative relapse rates were 21.1% (95% Cl: 9.8-41.9%) and 33.3% (95% Cl: 20.3-51.5%), respectively (p = 0.80). The one-year overall survival (OS) rates for patients in the HMA plus low-intensity chemotherapy group and the single low-intensity chemotherapy group were 37.3% (95% Cl: 23.1-51.5%) and 55.4% (95% Cl: 40.5-67.9%), respectively (p = 0.098), and the one-year event-free survival (EFS) rates were 8.5% (95% Cl: 2.2-20.6%) and 20.6% (95% Cl: 9.1-35.3%), respectively (p = 0.058). Conclusions: This study showed that the addition of HMA to low-intensity induction chemotherapy does not improve prognosis in elderly AML patients who are unsuitable for standard induction chemotherapy.

Current morbimortality and one-year survival after pneumonectomy for infectious diseases

ObjectiveIdentify the one-year survival rate and major complications in patients submitted to pneumonectomy for infectious disease. MethodsRetrospective data from all cases of infectious disease pneumonectomy over the past 10 years were collected from two reference centers. The authors analyzed: patient demographics, etiology, laterality, bronchial stump treatment, presence of previous pulmonary resection, postoperative complications in the first 30 days, the treatment used in pleural complications, and one-year survival rate. Results56 procedures were performed. The average age was 44 years, with female predominance (55%). 29 cases were operated on the left side (51%) and the most frequent etiology was post-tuberculosis (51.8%). The overall incidence of complications was 28.6% and the most common was empyema (19.2%). Among empyema cases, 36.3% required pleurostomy, 27.3% required pleuroscopy and 36.3% underwent thoracoplasty for treatment. Bronchial stump fistula was observed in 10.7% of cases. From all cases, 16.1% were completion pneumonectomies and 62.5% of these had some complication, a significantly higher incidence than patients without previous surgery (p = 0.0187). 30-day in-hospital mortality was (7.1%) with 52 cases (92.9%) and 1-year survival. The causes of death were massive postoperative bleeding (1 case) and sepsis (3 cases). ConclusionsPneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. While morbidity is often significant, once the perioperative risk has passed, the one-year survival rate can be very satisfying in selected patients with benign disease.

Cardiopulmonary Exercise Test Could Predict Mortality in Patients with Interstitial Lung Disease

<h3>Research Objectives</h3> To identify the mortality predictors from cardiopulmonary exercise test in a group of Asian patients with interstitial lung disease. <h3>Design</h3> A prospective observational study followed up for 32 months. <h3>Setting</h3> A referral medical center. <h3>Participants</h3> A total of 106 patients with definite diagnosis of interstitial lung disease confirmed by high-resolution computed tomography were enrolled in our study. <h3>Interventions</h3> This is a prospective observational study without any special intervention. All participants received the cardiopulmonary exercise test. <h3>Main Outcome Measures</h3> Mortality. <h3>Results</h3> Six variables from cardiopulmonary exercise test, namely peak oxygen consumption, oxygen pulse, peak end-tidal partial pressure of carbon dioxide, heart rate recovery 1 minute after cardiopulmonary exercise test, minute ventilation to carbon dioxide output slope and functional aerobic impairment, were identified to be significant predictors of mortality. We created a summed score, representing the number of variables beyond the cutoff values. The one-year survival rate of patients scored 6 in this summed score were only 25%, in contrast to 97.96% for patients scored 0-5. <h3>Conclusions</h3> If a cardiopulmonary exercise test is available for patients with interstitial lung disease, the summed score created in this study can provide a useful tool to screen these patients for their prognosis. Additional study recruiting more participants is required before the results to be used in clinical settings. <h3>Author(s) Disclosures</h3> All authors of this study declares no conflicts of interest.

The state of cancer care in Russia: cancer of the small intestine (C17). Survival of patients, median survival, survival of patients according to tumor localization, histological pattern and stage of the disease (Population study at the federal district level). Part II

Background. Small intestine cancer is extremely rare cancer worldwide with an incidence of less than 1.0 per 100,000 population. In 2020, 1,711 cases of small intestine cancer were recorded in Russia, including 781 cases among the male population, and 930 among the female population. It should be noted that in Russia, despite the decrease in the total number of new cancer cases associated with the coronavirus epidemic, the number of patients with small intestine cancer increased by 4.14 % from 2019 to 2020. In the Northwestern Federal district of the Russian Federation, 216 patients with newly diagnosed small intestine cancer were registered in 2020, (29 more patients than in the previous year). The purpose of the study was to analyze the efficiency of small intestine cancer care provision based on of the database of the population cancer Registry (db pcr) of the Northwestern Federal district of the Russian Federation, with an assessment of one- and five-year survival rates. Material and methods. To calculate the survival rates for patients with small intestine cancer, we selected 1922 patients from the database of the pcr of the Northwestern Federal district of the Russian Federation, for the period from 2000 to 2018. Standard methods for calculating survival rates according to the eurocare program were used. Results. The one-year survival rate of small intestine cancer patients increased from 50.0 % to 61.1 % from 2000 to 2018, and the five-year survival rate remained almost unchanged. The relative one-year survival rate of patients was 2.0 % higher. The five-year survival rate for five-year cohorts indicates defects in staging of small intestine cancer rather than an improvement in patient care; although this rate increased from 31.5 to 32.9 %. The histological detail of small intestine cancer according to the icd-10 was investigated. Conclusion. The study confirmed the high mortality rates and modest survival benefits in survival rates in patients with small intestine cancer. Defects in the distribution of patients by disease stages were revealed. The most common histological types of small intestine cancer with calculations of patient survival were identified.

Short-term outcome of kidney transplantation from deceased donors with nephrolithiasis.

Shortage of kidney allografts is a major barrier to end-stage renal disease patients receiving kidney transplantation, and it is necessary to enlarge the donor pool and find better ways of using available allografts. The global incidence of nephrolithiasis is increasing, nephrolithiasis affects approximately 10% of adults worldwide, and it also affects the kidney donors. However, there is little information about the use of cadaveric kidney allografts with nephrolithiasis. This study aims to evaluate the safety and outcome of kidney transplantation with allografts from the deceased donors with nephrolithiasis. A total of 520 deceased donors who was at least 10 years old, and 945 adult recipients with single kidney transplantation at the Department of Kidney Transplantation, the Second Xiangya Hospital from 2016 to 2020 were included in this study. The donors were divided into 2 groups according to nephrolithiasis diagnoses: The donors with nephrolithiasis (D + ) and the donors without nephrolithiasis (D - ). The recipients were assigned into 3 groups according to their donors and the allografts they received: The allografts from donors without nephrolithiasis (D - K - ), the allografts without nephrolithiasis from donors with nephrolithiasis (D + K - ), and the allografts with nephrolithiasis (D + K + ). The demographic and clinical data of enrolled subjects were retrospectively analyzed. The allograft discard ratio between different donors were analyzed. The one-year survival of allografts and recipients, as well as the allograft function and the complications of kidney transplantation were compared. Fifty out of 520 donors had nephrolithiasis, and the nephrolithiasis incidence was 9.6%. We recovered 1 040 kidneys, and total discard rate was 4.4% (46/1 040). The D + group had a rate of 7% discard. The donors with kidney discard accounted for 12% in the D + group, and this was higher than that of donors in the D - group (5.1%, P <0.05). The total incidence of delayed graft function (DGF) was 7.5%, and there were no significant differences in the incidence of DGF in recipients among the D - K - , D + K - , and D + K + group (7.5% vs 6.5% vs 8.2%, P> 0.05). During the one-year follow-up, 8 allografts lost function and 19 recipients died with a functional allograft. Recipients in the D - K - , D + K - ,and D + K + groups also had no significant difference between a one-year allograft and patient survival rate ( P >0.05). However, recipients in the D + K + group had a higher level of serum creatinine [(139.2±62.46) μmol/L vs (117.19±51.22) μmol/L, P <0.05] and lower estimated glomerular filtration rate [eGFR; (56.67±23.31) mL/(min·1.73 m -2 ) vs (66.86±21.90) mL/(min·1.73 m -2 ), P <0.05] compared with recipients in the D - K - group at 12 months after transplantation. During the first year after transplantation, 4 recipients developed urolithiasis, and recipients who received allografts from the D + group donors had a higher incidence of urolithiasis than those who received allografts from the D - group donors (2.2% vs 0.2%, P <0.05). There were no significant differences in the incidence of urinary tract infections and ureteral strictures at 1 year between recipients of D + and D - donors (both P >0.05). The cadaveric kidney allografts with nephrolithiasis could be safely used for transplantation, and the short-term outcome is acceptable. However, nephrolithiasis in donors may increase the rate of kidney discard, disturb the short-term function of allografts, and increase the risk of urolithiasis in recipients. Further research with a long-term study is needed to verify the long-term outcome of kidney transplantation using cadaveric kidney allografts with nephrolithiasis.

The role of post-operative glutamine serum level and one-year survival rate of stage III of colorectal cancer patients: a single center study

Introduction: Colorectal cancer (CRC) occurs, accounting for 11.5% of all patients with cancer in Indonesia. The less the spread of cancer, the higher the life expectancy of patients with cancer. Glutamine is involved in tumor cell proliferation and growth. This study aims to verify the correlation of serum glutamine levels with the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia. Method: A quantitative analytic-observational longitudinal study (Cohort) was conducted from May 1st, 2020, to September 30th, 2021. Inclusion criteria were the CRC patients with stage III and could be followed up for one year. Exclusion criteria were the CRC patients who had other systemic problems. The patient’s blood glutamine levels were taken three months postoperatively measured by Glutamine Assay kit (Colorimetric) ab197011 and evaluated clinically for one year. Glutamine levels in the blood are low if they are less than 52 ng/µL. The parameters assessed were glutamine serum level and survival rate of colorectal cancer patients. Statistical analysis using the Chi-square test and the Kaplan Meier method was employed to obtain the survival curve. Analysis to compare survival rate with glutamine levels used the Cox regression model. Results: A one-year survival rate in patients with stadium III colorectal cancer was 95.5% at post-operative glutamine levels of ≥ 52 ng/µL and 65.4% at post-operative glutamine levels of &lt; 52 ng/µL. The mean progressive free survival rate was 11.818 months (95%CI=11.470-12.166) at post-operative glutamine levels of ≥ 52 ng/µL and 10.038 months (95%CI=8.913-11.164) at post-operative glutamine levels of &lt; 52 ng/µL. The overall free survival rate was 11.955 months (95%CI=11.868-12.042) at post-operative glutamine levels of ≥ 52 ng/µL and 10.885 months (95% CI=10.128-11.641) at post-operative glutamine levels of &lt; 52 ng/µL. Patients with glutamine levels of &lt;52 ng/µL were 8.959 times more probable to die than patients with post-operative glutamine levels of ≥ 52 ng/µL. Conclusion: This study shows a significant relationship between serum glutamine levels and the one-year survival rate of patients with stadium III colorectal cancer at Dr. Moewardi Hospital, Surakarta, Indonesia.

Application of PET/CT in Preoperative Evaluation and Diagnosis of Gastric Cancer.

The aim study to study the significance of pet clinical examination image technology for early gastric mucosal adenocarcinoma, improve the accuracy and accuracy of image examination results of gastric cancer, and provide important reference significance and value for early treatment. Study methods, we used the experimental method of clinical medicine to obtain some reference data through the intervention of different image examinations on experimental patients of different groups and stages, These data show that the use of PET-CT imaging can improve the one-year survival rate of patients and reduce the one-year recurrence rate. Lymphatic metastasis rate and hematogenous metastasis rate, so as to highlight the advantages of PET-CT imaging.

A Systematic Review on Overall Survival and Disease-Free Survival Following Total Pelvic Exenteration.

Backgrounds:Total Pelvic Exenteration (TPE) is a radical operation for malignancies in which all of the organs inside the pelvic cavity, including the female reproductive organs, the lower urinary tract, and a part of the rectosigmoid are removed. In this study, we aimed to conduct a systematic review to assess the overall survival (OS) and disease-free survival (DFS) following TPE.Methods:This systematic review is composed of a comprehensive review of PubMed and Scopus databases with various related keywords to synthesis the overall survival and disease-free survival following TPE. The Synthesis Without Meta-analysis guideline was used to summarize the results. Results:We included the results of 39 primary studies and the results revealed that one-year OS of gynecological cancer in patients who have undergone TPE ranged from 50.0% to 72.0% and the 5-years OS ranged from 6.0% to 64.6%. The one-year survival rate of colorectal cancer patients was reported to be over 80% in almost all studies. The 3-year survival rate of patients varied from 25% to 75% and the lowest 5-year survival rate was 8% and the highest survival rate was 92%. To synthesis the disease-free survival rate in colorectal cancer, ten studies were included and one-year recurrence rate was 9.1% and the one-year DFS was reported as 61.0%. Three-year recurrence rate study was 20.4% and 3 and 5-year DFS ranged from 22.0% to 78.0%. Conclusions:The results suggested that DFS in primary advanced cancers is higher than locally recurrence tumors. This review showed that patient overall survival and disease-free survival rates have increased over time, especially at high volume centers that are more experienced and possibly better equipped. Therefore, it can be suggested that the attitude towards PE as a palliative surgery can be turned into curative surgery.

ПЕРВЫЕ 100 ТРАНСПЛАНТАЦИЙ ПОЧКИ ОТ РОДСТВЕННОГО ДОНОРА: ОПЫТ ЦЕНТРА ЭКСТРЕННОЙ МЕДИЦИНСКОЙ ПОМОЩИ

Topicality. The advances achieved in the field of transplantation make it possible to make this type of renaltherapy routine and define it as the “gold standard” in the treatment of patients with chronic renal failurewith the best indicators in comparison with other methods of substitution therapy. At the present stage,transplantologists are faced with achieving 95% graft survival within 5 years. Currently, the graft survival ratein the first year has significantly increased to 93.4% with LT from cadaveric donors and 97.2% from living22 Вестник экстренной медицины, 2021, том 14, № 4donors. An improvement in this indicator is possible due to the improvement of immunosuppression protocolsand the prevention of surgical complications.Aim. To analyze the results of the first 100 kidney transplants from related donors at the Republican ResearchCenter of Emergency Medicine.Material and methods. The work included 100 patients who underwent kidney transplantation from a livingdonor at the Republican Research Center of Emergency Medicine from March 2018 to January 2021.Results. Immediate graft function was noted in 84 (84%) cases, and DGF - in 16 (16%). SPT took place mainlyin the presence of multiple vessels of the donor kidney (35.5%) compared with a single renal artery and vein(12.1%), which was influenced by the average duration of warm ischemia - 80.26 ± 38.35 minutes with multiplearteries and 50.44 ± 14.44 with a single renal artery and vein (p = 0.001). In 3 (3%) cases, there was an acutecellular rejection of the graft, which was successfully treated with pulse therapy with methylprednisolone, in1 (1%) - hyperacute rejection, which resulted in the removal of the graft. Urological complications in the formof ureteral stenosis were observed in 2 (2%) cases and ureteral necrosis with anastomotic insufficiency - in1 (1%). Urological complications were mainly observed with ureteral-vesical anastomosis without stenting(50%) than with stenting (4.5%), RR = 21.5 (95% CI = 3.84 - 117.57) (p˂0.001) . Graft artery thrombosis wasdetected in 1 (1%) case, vein thrombosis of the transplanted kidney and external iliac vein was detected in 1(1%) case, bleeding was noted in 8 (8%) cases. In 13 (13%) recipients, purulent-infectious processes wereobserved, of which in 9 (9.3%) cases, wound infection developed. Two recipients (2%) underwent renal graftnephrectomy. In our short-term study, the one-year survival rate for patients with LT was 93% and the graftsurvival rate was 91%.Conclusions. Delayed graft function often develops with a long stay of the recipient on hemodialysis, as well asan increase in the time of thermal ischemia, which is influenced by the number of vessels in the donor kidneyand is an important prognostic factor for the development of acute rejection. Due to postoperative hemodialysisdue to the development of delayed graft function, the risk of developing vascular complications increases.The risk of developing urological complications is high with the imposition of a ureteral-vesical anastomosiswithout stenting. Hyperacute rejection and the development of a purulent infection leading to arrosive arterialbleeding may result from the loss of a kidney transplant. The cause of the death of the recipient in the first yearafter KT is mainly: pulmonary embolism, infection and sepsis as a result of immunosuppression, hypovolemicshock and acute ischemic stroke.

Non-Hodgkin Lymphoma Mortality in the Elderly Population By Race, Gender, and Region in the United States

Background: Over the past decades, non-Hodgkin lymphoma (NHL) patients have significant improvement in the 5-year relative survival rate. In elderly NHL patients, comorbidities play a major role in mortality. Studies have shown that lower survival rates are multifactorial and strongly associated with certain races, gender, socioeconomic status, and availability of rituximab. Therefore, we aim to assess the differences in causes of mortality among races and genders. To better understand environmental contributions to one-year survival rate in NHL patients state-wise in the US, we examined the mortality-to-incidence rate (MIR) in senior NHL patients characterized by race, gender, and American health ranking (AHR) index.Methods: This is a retrospective study using the Centers for Disease Control and Prevention database from 2008 to 2017. Patients ≥65 years with non-Hodgkin lymphoma were included. AHR assesses the nation's health on a state-by-state basis to determine state health rankings with a composite index of health measures. AHR consists of five weighted core measures (four groups of health determinants and one health outcome): (1). Behaviors including excessive drinking, obesity, smoking, (2). Community and environment including air pollution, poverty, infectious disease, violent crime, (3). Policy including immunization, public health funding, uninsured rate, (4). Clinical care including primary care physicians, mental health providers, preventable hospitalizations, and (5). Outcomes including cancer deaths, cardiovascular deaths, diabetes, disparity in mental status. A ten-year (2008-2017) average of all-determinants value from AHR were reported and MIR, a parameter that can serve as a proxy for survival, was compared between US states. We analyzed the association between NHL mortality and state health disparities using linear regression. Multiple-cause-of-death data is based on death certificates for US residents. Each death certificate contains a single underlying cause of death, up to twenty additional multiple causes, and demographic data. We analyzed the multiple cause age-adjusted mortality rate in White males and females versus African American males and females. All data were analyzed using R version 4.0.5, with p-values <0.05 in two-sided t-tests to indicate statistical significance.Results: In this 10-year analysis, the mean age-adjusted mortality rate (AAMR) in Whites, African Americans, and all populations were 38.2, 21.4, and 36.7 per 1,000,000 population, respectively. Among all 50 states, Idaho had the highest AAMR for all populations (42.7/1,000,000) and Whites (43.1/1,000,000); Minnesota had the highest AAMR for African Americans (29/1,000,000). District of Columbia had the lowest AAMR for all populations (26.4/1,000,000); New Mexico had the lowest AAMR for Whites (30.6/1,000,000) and New York had the lowest AAMR for African Americans (Table 1). Our results demonstrated that elderly NHL patients in states with better health all-determinants index had significantly lower MIR in all populations (R 2=0.2654, p <0.001, Figure 1). The three lowest MIR states in the US were Florida (0.319), Connecticut (0.348), and New York (0.348) (Figure 2). Whites were more likely to have underlying comorbidities than African Americans, especially ischemic heart disease (Male: OR 87.16, 95% CI 74.23-102.34; Female: 26.10, 95% CI 22.01-30.94), congestive heart failure (Male: OR 53.31, 95% CI 45.35-62.66; Female: OR 25.98, 95% CI 22.25-30.34), and chronic obstructive pulmonary disease (Male: OR 54.55, 95% CI 45.27-65.73; Female: OR 45.98, 95% CI 36.48-57.95) (Table 2,3).Conclusions: States of better health index in terms of all determinants had lower MIR for elderly NHL patients in the US. Factors contributing to the difference in MIR possibly include variations in socioeconomic status, insurance coverage, and healthcare access. Our results highlight the need to focus on secondary prevention to decrease morbidities and health disparities in NHL patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation.

BackgroundInfections remain a major cause of morbidity and mortality in kidney transplant (KT) recipients. This study was performed to identify the overall prevalence of early infections, prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after KT, one-year postoperative mortality in patients with early infections and risk factors for CRKP infections.MethodsWe conducted a retrospective study of all patients who received KT in our hospital between January 2017 and December 2019. We evaluated the demographic, clinical, infection characteristics and the one-year postoperative outcomes.ResultsAmong the 419 patients who received KT between January 2017 and December 2019, 150 patients had at least one infection within 90 days after KT. The total prevalence of early infections was 36.1% (150/415), the prevalence of early CRKP infections was 10.4% (43/415), and the one-year postoperative mortality was 15.3% (23/150) in patients with early infections. The risk factors independently related to one-year postoperative mortality were mechanical ventilation (MV) > 48 h (Odds ratio (OR)= 13.879, 95%Confidence interval (CI): 2.265~85.035; P=0.004) and CRKP infection (OR=6.751, 95% CI: 1.051~43.369; P =0.044). MV> 48 h was independently related to CRKP infection (OR=3.719, 95% CI: 1.024~13.504; P=0.046). Kaplan-Meier survival curves showed that the one-year survival rate of patients infected with CRKP in the early postoperative stage was significantly lower than that of uninfected patients.ConclusionsIn general, the prevalence of early infections after KT is high, and CRKP infection is closely correlated with poor prognosis. The effective prevention and treatment of CRKP infection is an important way to improve the one-year survival rate after KT.

Outcome of urgent desensitization in sensitized heart transplant recipients

Sensitization, the presence of preformed anti-human antibody in recipients, restricts access to ABO-compatible donors in heart transplant. Desensitization therapy works by reducing preformed antibodies to increase the chances of a negative crossmatch or permit safe transplantation across positive crossmatch. There is no consensus regarding the desensitization protocol in cardiac patients, and the outcome of desensitization remains under debate. Twenty-five consecutive sensitized heart transplant recipients received perioperative desensitization in our institution from 2012 to 2019. One-year patient survival and graft rejection rate were analyzed and compared between sensitized recipients and non-sensitized recipients. Within the first year after transplant, patient survival in sensitized recipients was 76%. Infection was the major cause of death. The cumulative incidence of rejection was 8% for antibody-mediated rejection and 16% for acute cellular rejection. No significant difference in 1-year survival or rejection rate could be demonstrated between sensitized and nonsensitized recipients. Acceptable early outcomes in patient survival and graft rejection could be anticipated in sensitized heart transplant recipients under a perioperative algorithm using complement-dependent cytotoxicity crossmatch- or panel-reactive antibody-directed urgent immunomodulation strategies, while infection remains the major concern.

Sequential Treatment of Biliary Atresia With Kasai Hepatoportoenterostomy and Liver Transplantation: Benefits, Risks, and Outcome in 393 Children.

Introduction: Surgical treatment of biliary atresia (BA) is still based on sequential strategy with Kasai hepatoportoenterostomy (KP) followed by liver transplantation (LT), in case of complicated secondary biliary cirrhosis. Concerns have been expressed regarding the risks of LT related to previous KP, suggesting primary LT as an exclusive treatment of BA.Methods: Single-center retrospective analysis including 393 pediatric patients who underwent LT for BA from 1993 to 2018, categorized into two groups: with (KP) or without (NoKP) previous KP. Pre-LT clinical condition was estimated considering age at LT, time on waiting list, pediatric end-stage liver disease score (PELD), and presence of portal vein hypoplasia. Post-LT outcome was evaluated considering patient and graft survival rates, and need for early reoperation due to abdominal or graft-related complications (<45 days after LT).Results: Two-hundred ninety-six patients (75.3%) were categorized in the KP group, and 97 (24.7%) in the NoKP group. Median age at LT was 1.14 years in the KP group and 0.85 years in the NoKP group (p < 0.0001). PELD score was significantly less severe in KP patients (p < 0.05). One-year patient survival rates were 96.9 and 96.8% in the KP and NoKP groups, respectively (p = 0.43), and the corresponding graft survival was 92.5 and 94.8% (p = 0.97). The need for early reoperation was more frequent in the KP group (29.8%) vs. NoKP group (12.4%, p = 0.01). The rate of bowel perforation was non-significantly higher in the KP group (8.1%) vs. NoKP group (3.1%, p = 0.11).Conclusions: The sequential strategy including KP and LT allowed performing LT in patients with significant older age and better clinical conditions, when compared to those transplanted without previous KP. Patient and graft survivals were not impacted by previous KP. Although previous KP was associated with an increased rate of post-LT surgical complications, bowel perforation and bleeding did not occur significantly more frequently. Such results support the current strategy based on sequential treatment.

Efficiency and Toxicity of Ruxolitinib as a Salvage Treatment for Steroid-Refractory Chronic Graft-Versus-Host Disease.

Graft-versus-host disease (GVHD), especially steroid-refractory GVHD, remains a life-threatening complication after hematopoietic stem cell transplantation (HSCT). The effect of the JAK1/2 kinase inhibitor ruxolitinib on treating steroid-refractory acute GVHD has been verified by the REACH1/2 study; however, its safety and efficacy in patients with steroid-refractory chronic GVHD (SR-cGVHD) remain unclear. In this retrospective study, 70 patients received ruxolitinib as a salvage therapy for SR-cGVHD. Twenty-four weeks after ruxolitinib treatment, the overall response rate (ORR) was 74.3% (52/70), including 34 patients who achieved complete remission (CR) and 18 who achieved partial remission (PR). The main adverse event was cytopenia, which occurred in 51.4% (36/70) of patients. After ruxolitinib treatment, the percentage of CD4 cells increased from 18.20% to 23.22% (P<0.001), while the percentages of NK (CD16+CD56+) cells and regulatory T cells (CD4+CD127 ± CD25+) decreased (P<0.001, P<0.001). Among the B cell subsets, the proportion of total B cells approximately tripled from 3.69% to 11.16% (P<0.001). Moreover, we observed a significant increase in IL-10 levels after ruxolitinib treatment (P=0.025) and a remarkable decrease in levels of suppression of tumorigenicity 2 (ST2) from 229.90 ng/ml to 72.65 ng/ml. The median follow-up after the initiation of ruxolitinib treatment was 401 (6-1076) days. The estimated one-year overall survival rate of the whole group was 66.0% (54.4–77.6%, 95% CI), and the one-year overall survival rate of patients with mild and moderate cGVHD was 69.6% (57.4–81.8%, 95% CI), which was better than that of patients with severe cGVHD (31.3%, 0.0–66.2%, 95% CI) (P=0.002). Patients who achieved a CR and PR achieved better survival outcomes (84.5%, 73.9–95.1%, 95% CI) than those who showed NR to ruxolitinib treatments (16.7%, 0–34.3%, 95% CI) (P<0.001). At the final follow-up, cGVHD relapse occurred in six patients after they reduced or continued their ruxolitinib doses. Collectively, our results suggest that ruxolitinib is potentially a safe and effective treatment for SR-cGVHD.

Occurrence and prediction on post-contrast acute kidney injury following endovascular interventions

Objective: To investigate the incidence, risk factors and prognosis of post-contrast acute kidney injury (PC-AKI) and to evaluate the usefulness of serum cystatin C (sCysC) and serum creatinine (sCr) for the prediction of PC-AKI after endovascular interventions. Methods: The clinical data of 404 patients who underwent endovascular procedures from August 2014 to October 2018 in the Sixth People's Hospital South Campus, Shanghai Jiao Tong University were retrospectively analyzed. All patients received 0.9% sodium chloride through an angiographic catheter during the procedure. Patients with an estimated GFR (eGFR)<60 ml/(min·1.73m2) received a continuous intravenous hydration with isotonic saline from 6 hours before to 12 hours after an endovascular procedure. The level of sCr, eGFR and sCysC were measured at 1-2 days pre-procedure and at 48, 72 h, and 7 days post-procedure. Univariate and multivariate logistic regression analyses were used to identify risk factors of PC-AKI. A receiver operator characteristic (ROC) curve was used to evaluate the usefulness of various factors for the prediction of PC-AKI. Kaplan-Meier method was used for survival analysis. Results: Thirteen patients (3.2%) developed PC-AKI. All patients were divided into PC-AKI group and no PC-AKI group for statistical comparison. Wilcoxon signed rank sum test revealed that sCr levels at 7 days post-procedure [63.0 (56.0, 74.0) μmol/L] were significantly lower than pre-procedure sCr levels [65.6 (56.2, 77.0) μmol/L] in patients without PC-AKI (P<0.05). Meanwhile, eGFR levels were significantly higher at 72 h [114.9 (96.3, 135.0) ml/(min·1.73m2)] and 7 days [116.7 (98.5, 139.9) ml/(min·1.73m2)] post-procedure than eGFR levels before endovascular procedures [112.3 (94.1, 133.5) ml/(min·1.73m2)] in patients without PC-AKI (P<0.05). However, there was an increase in sCysC at 48 h [0.9 (0.8, 1.1) mg/L] after endovascular procedures than pre-operative sCysC [0.9 (0.8, 1.1) mg/L] in patients without PC-AKI (P<0.05). SCr, sCysC, levels were significantly increased at 48 h [108.0 (95.3, 125.0) μmol/L, 1.5 (1.2, 2.0) mg/L] and 72 h [123.4 (91.3, 143.0) μmol/L, 1.6 (1.1, 2.0) mg/L] post-procedure than SCr, sCysC, levels before endovascular procedures [81.6 (63.1, 111.0) μmol/L, 1.1 (1.0,1.7) mg/L] and eGFR levels were significantly decreased at 48 h [55.8 (48.9, 77.6) ml/(min·1.73m2)] and 72 h [52.7 (47.7, 63.9) ml/(min·1.73m2)] after endovascular procedures than eGFR levels before exposure to CM [88.8 (65.6, 100.7) ml/(min·1.73m2)] in patients with PC-AKI (P<0.05). SCr, sCysC and eGFR in PC-AKI group tended to levels before an endovascular procedure within 7 days. The receiver operator characteristic curve (ROC) analysis showed that preoperative sCysC and sCr levels had high discriminatory power for evaluating the risk of PC-AKI after an endovascular procedure. ROC analysis showed that sCysC before endovascular procedures was useful to predict the risk of PC-AKI with a satisfactory sensitivity of 69.2% (9/13), specificity of 77.5% (300/387), positive predictive value (PPV) of 9.3% (9/96) and negative predictive value (NPV) of 98.7% (300/304). The incidence of PC-AKI was low in patients with a pre-procedure sCysC<1.09 mg/L. The sCr was predictive of PC-AKI with a satisfactory sensitivity of 69.2% (9/13), specificity of 76.7% (300/391), PPV of 9.0% (9/100) and NPV of 98.7% (300/304). The incidence of PC-AKI was low in patients with a pre-procedure sCr<77.6 μmol/L. Results of univariate analysis and multiple logistic regression analysis indicated that sCysC before endovascular procedures was an risk factor for PC-AKI (OR=13.917, 95%CI:1.666-116.237, P=0.015). The one-year, three-year and five-year survival rate for patients diagnosed with PC-AKI was 50%, 30% and 30% respectively. The median survival time was 6 (0-26) months. Conclusions: The sCysC before endovascular procedures is an independent risk factor of PC-AKI. SCysC and SCr before an endovascular procedure with a cut-off value of 1.09 mg/L and 77.6 μmol/L may help to rule out patients at lower risk of PC-AKI.

Detection of DKK-1 gene methylation in exfoliated cells of cervical squamous cell carcinoma and its relationship with high risk HPV infection.

To detect the methylation of Dickkopf-associated protein 1 (DKK-1) gene promoter in cervical exfoliated cells and to study its clinical significance in cervical squamous cell carcinoma (CSCC) and its relationship with high-risk HPV infection. Methylation-specific PCR (MSP) was utilized to detect the methylation of DKK-1 gene promoter in cervical exfoliated cells from 40 patients with CSCC and 40 patients with chronic cervicitis in the Affiliated Hospital of Inner Mongolia Medical University. The methylation rate of DKK-1 gene promoter in different clinicopathological factors and its relationship with high-risk HPV infection was compared, and different detection methods were compared. The degree of methylation of DKK-1 gene promoter in CSCC group was significantly higher than that in cervicitis group (P < 0.05). In CSCC group, the degree of methylation was significantly different in high-risk HPV infection, histological differentiation, tumor size, lymph node metastasis and the International Federation of Gynecology and Obstetrics (FIGO) staging (all P < 0.05). The degree of methylation is not related to the type of high-risk HPV infection (P > 0.05). The one-year survival rate of CSCC patients with high-risk HPV positive and DKK-1 gene promoter methylation is relatively low, only 74.1%. The sensitivity, specificity and accuracy of DKK-1 gene methylation combined with high-risk HPV detection were 96.7%, 78.0% and 85.0%, respectively. Methylation of DKK-1 gene promoter in cervical exfoliated cells of patients with CSCC is related to high-risk HPV infection and different clinicopathological factors, but the degree of methylation of DKK-1 gene is not related to the type of high-risk HPV infection. It may become an indicator different from HPV typing detection, which may play a shunt role in suggesting whether further invasive cervical examination is needed and reduce cervical invasive examination and overtreatment. It may be related to the survival rate of patients, which can be used to estimate the development and prognosis of CSCC and may play a good role in early warning in follow-up monitoring of CSCC after treatment. DKK1 gene methylation combined with HPV detection can improve the sensitivity, specificity and accuracy of diagnosis, which may improve the detection rate of early CSCC and make up for the deficiency of HPV and TCT detection. That may become a non-invasive screening method for CSCC.

Predicting the risk of tumor progression in patients with early stages of adenocarcinoma and squamous cell lung carcinoma based on laboratory parameters

Non-small cell carcinoma (NSCLC) prevails in the structure of the incidence of lung cancer. In patients with I stage NSCLC, only 60-70% overcome the 5-year survival barrier, and at II stage it decreases to 35-40%. The reason for such a high mortality rate is almost always a relapse of the disease. The main histological forms of NSCLC - adenocarcinoma (AC) and squamous cell carcinoma (SCLC) - differ in the course, protocols and effectiveness of the treatment. Comparative survival data for AK and PCLC are controversial, and reliable biomarkers for determining the risk of tumor progression are lacking. In thus study we have investigated the possibility of using laboratory parameters characterizing the level of some blood proteins involved in carcinogenesis in patients with early stages of AC and SCLC to determine the risk of disease progression. We retrospectively analyzed the duration of the relapse-free period after surgical treatment for one year in 1250 patients (816 with stages I and II of adenocarcinoma, G1-3 and 434 with early stages of SCLC, G1-3). In 81 patients with AC and 36 - with SCLC (stages I-II, G1-3) the level of CYFRA 21-1 and SCC by electrochemiluminescent method, chemokines CXCL5, CXCL8, TPA, pyruvate kinase M2, HIF-1α and hyaluronic acid by enzyme immunoassay, receptors CXCR1, CXCR2, CD44v6 by flow cytometry were determined. Using the Kaplan-Meier graphical analysis, groups of low (stage I G1-2 + stage II G1) and high (stage I G3 + stage II G2-3) risk of tumor progression were identified. In the case of the one-year survival rate of patients with AC was higher than with SCLC. In patients with AC and a high risk of tumor recurrence, compared with a low one, the level of CYFRA 21-1, the mean intensity of fluorescence (MFI) of the CXCR1 receptor in granulocytes, and the relative content of the CXCR2 receptor in lymphocytes were higher. In the case of rapid progression of SCLC in patients, the relative content of the CXCR2 receptor in lymphocytes, the proportion of monocytes equipped with the CD44v6 receptor, and the SCC level were higher than with slow progression. Regression equations, including combinations of the above parameters (threshold value for AC - 0,512, for SCLC - 0,409, sensitivity - 91,9% and 90,0%, specificity - 90,0% and 87,5%, respectively), allow to predict the probability of tumor recurrence.