Risk Factor For Graft Failure Research Articles

Risk factors for graft failure after penetrating keratoplasty.

The objective of our study was to define principal risk factors for graft failure in patients who underwent penetrating keratoplasty (PK).Retrospective data obtained from a cohort of 895 penetrating keratoplasties performed between 2001 and 2006 were analysed. Recipient related factors, graft characteristics, and surgical technique were assessed in a univariate analysis and with a multivariate proportional hazard model to detect principal risk factors for definitive graft failure.Multivariate analysis showed clear significance for diagnosis and number of previous grafts and border line significance for the oldest donor age group. Patients with keratoconus had the best 10-year survival estimate (95%), followed by endothelial and stromal dystrophies (both 55%), infectious leukomas (49%), trauma (33%) and chemical burns (14%). Primary PK grafts had a survival rate of 81%, second grafts of 33% and third or more grafts of 16%. Overall 10-year survival estimate based on univariate analysis was found to be 65%.In conclusion, we found that primary diagnosis and previous graft failures in the recipient are the most important risk factors of graft failure after a PK.

Risk Factors for Early Graft Failure and Death After Kidney Transplantation in Recipients Older Than 70 Years

IntroductionAlthough kidney transplantation carries a survival benefit compared with dialysis, mortality, especially the first year after transplantation, is high in recipients older than 70. The aim of this study was to evaluate early death and graft failure, and to determine the risk factors associated with these events in this specific population.MethodsAll patients older than 70 years who received a kidney transplant between January 2000 and December 2014 in the North-West of France were included (n = 171). Baseline characteristics and outcomes after transplantation were studied. Kaplan-Meier analysis was performed to assess patient and graft survival, and Cox regression analysis to evaluate risk factors for graft failure and patient death.ResultsThe mean recipient age was 73.3 ± 2.5 years. Death-censored graft survival at 1, 3, and 5 years were 82.6%, 78.7%, and 75.4%, respectively. Patient survival at 1, 3, and 5 years was 90.1%, 82.5%, and 68.1%, respectively. One year after transplantation, 17 patients (9.9%) were dead, mainly from infectious (58.5%) or cardiovascular disease (29.4%). According to the Cox multivariate analysis, the independent risk factors for death or graft failure during the first year were arrhythmia (odds ratio [OR] 2.26; 95% confidence interval [CI] 1.08–4.8), left-ventricular ejection fraction (LVEF) under 56% (OR 2.38; 95% CI 1.18–4.83), human leucocyte antigen (HLA) antibodies (OR 2.1; 95% CI 1.04–4.2), deceased donor from cardiovascular cause (OR 5.18; 95% CI 1.22–6.3), and acute rejection (OR 2.77; 95% CI 1.2–6.3).ConclusionIn kidney transplant recipients older than 70 years, cardiac evaluation and immunosuppression optimization seem to be crucial to improve short-term patient and graft survival.

Update on Failure Analysis of Implants in ACL Surgery: Technical Failure or Fate?

Reasons for failure of anterior cruciate ligament (ACL) reconstructions are manifold and require a multifactorial explanatory approach. In addition to technical failures, many modifiable and non-modifiable risk factors for a new ACL injury have to be considered. Technical failures primarily include non-anatomical tibial and femoral tunnel position. In comparison to the transtibial drilling technique, the tibial tunnel-independent technique results in a more anatomical position of the femoral tunnel and should therefore be preferred. One can differentiate between non-modifiable and modifiable risk factors. At the same time, the combination of more than one risk factor increases the risk of injury significantly. Non-modifiable risk factors include genetic predisposition, female sex, young age and ligament hyperlaxity. Young age at the time of the first injury is the most important risk factor for graft failure. Modifiable risk factors include high body mass index (BMI), deficits in jump landing mechanics, a steep posterior tibial slope and narrow intercondylar notch width. Neuromuscular training or additional surgical procedures modify these risk factors and reduce the probability of further injuries. A high tibial osteotomy (HTO) is the surgical procedure of choice for a reduction in the posterior tibial slope and anterior tibial translation. In case of a tibial slope over 12°, this procedure should be considered. In revision anterior cruciate ligament reconstructions with remaining anterolateral rotatory instability, additional lateral extraarticular tenodesis should be taken into account. This is also recommended for patients participating in pivoting sports, having concomitant hyperlaxity or additional injury of peripheral structures with insufficiency of the ACL. In addition, the surface of the pitch can be modified and thus influence the risk of an ACL injury. In summary, a substantiated failure analysis is required to initiate specific and individualised therapy - not only in the case of ACL rerupture. These factors should already be considered in risk assessment during patient information.

Indications and visual outcome following penetrating keratoplasty at tertiary health-care institution

Context: Success rate after keratoplasty is dependent on recipients' anterior segment status and donors' corneal parameters. Aims: The aim of this study is to investigate indications and visual outcome. Settings and Design: Prospective interventional. Patients and Methods: The present study recruited 30 eyes and donor cornea graded by slit -lamp microscope. Patients followed up at 3, 6, 12, and 18 months for visual acuity (VA) and graft survival. Quality of life (QOL) was evaluated by the Visual Analog Scale. Primary outcome measures were VA and graft clarity and secondary outcome was QOL. Statistical significance considered at or Statistical Analysis: SPSS software version 20. Results: Mean age of 55.5 (±17.06 standard deviation) years ranging from 17 to 86 was enrolled. Optical keratoplasty executed in 23 (76.66%) and therapeutic in 7 (23.33%) eyes. Pseudophakic bullous keratopathy (PBK) was diagnosed in 33.33%, recalcitrant corneal ulcer in 23.33%, corneal opacities in 20%, and previous graft failures in 20%. Grade A corneas transplanted in 93.2% of eyes. Phi and Cramer's V test showed 0.404 each between variables for vascularization and graft survival. Wilcoxon test for QOL showed P and Z values of 0.001 and − 3.247. Conclusions: PBK was the most common indication with satisfactory vision as well for recalcitrant corneal ulcers with statistical significant QOL. Vascularisation was the high risk factor for graft failure. PBK and keratoconus showed 100% survival rates at 12 and 18 months. At 18 months, graft survival rate was 60% and 93%, respectively, in patients with and without vascularization.

The Predictive Effects of Clinical Hematological Changes on Saphenous Graft Patency after Coronary Artery Surgery.

ObjectivesTo investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery.MethodsA total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft.ResultsIn logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001).ConclusionIncreased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.

Long-term results of fresh osteochondral allografts and realignment osteotomy for cartilage repair in the knee.

The aim of this study was to report the outcome of femoral condylar fresh osteochondral allografts (FOCA) with concomitant realignment osteotomy with a focus on graft survivorship, complications, reoperation, and function. We identified 60 patients (16 women, 44 men) who underwent unipolar femoral condylar FOCA with concomitant realignment between 1972 and 2012. The mean age of the patients was 28.9 years (10 to 62) and the mean follow-up was 11.4 years (2 to 35). Failure was defined as conversion to total knee arthroplasty, revision allograft, or graft removal. Clinical outcome was evaluated using the modified Hospital for Special Surgery (mHSS) score. A total of 14 grafts (23.3%) failed at a mean of 8.6 years (1.4 to 20.1). Graft survivorship was 87.3% (95% confidence interval (CI) 79.0 to 96.6), 85.0% (95% CI 75.8 to 95.3), 74.8% (95% CI 62.2 to 90.0), 65.2% (95% CI 49.9 to 85.2), and 59.8% (95% CI 43.5 to 82.1) at five, ten, 15, 20, and 25 years, respectively. A total of 23 patients (38.3%) developed complications, and 26 (43.3%) had a further operation. Persistent postoperative malalignment occurred more frequently in failed grafts (28.6% vs 4.3%; p = 0.023), and was a risk factor for graft failure (hazard ratio 6.55; 95% CI 1.61 27.71; p = 0.009). The mean mHSS score improved from 74.1 (40 to 91) preoperatively to 89.0 (66 to 100) at final follow-up (p < 0.001). Femoral condylar FOCA with concomitant realignment osteotomy provides excellent long-term graft survival and reliable functional improvement. Persistent malalignment may increase the risk for graft failure.

Graft failure in allogeneic hematopoietic stem cell trans-plantation

With the progress of medical technology, the development of new drugs and the improvement of the therapeutic effect of graft-versus host disease in the last two decades, the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) have been greatly improved. However, graft failure is still a rare but serious complication of allo-HSCT. HLA incompatibility, virus infection, elderly donor, uncontrolled primary disease, damage of bone marrow hematopoietic microenvironment, ABO blood group incompatibility, T cell depletion, reduced intensity conditioning, and low nucleated cell number are all risk factors for graft failure. In recent years, with the implementation of HLA haplo-identical hematopoietic stem cell transplantation, the role of donor-specific antibodies in graft failure has attracted attention increasingly. This article reviews the recent studies involving the mechanism, risk factors and prevention measures of graft failure in allo-HSCT.

Warm ischemic time as a critical risk factor of graft failure from donors after cardiac death: A single‐center experience over three decades in the Kidney Donor Profile Index/Kidney Donor Risk Index era in Japan

To evaluate the prognostic value of the warm ischemic time and the validity of the Kidney Donor Profile Index/Kidney Donor Risk Index for predicting the survival of donors after cardiac death grafts. We retrospectively assessed 315 kidneys retrieved from donors after cardiac death at Fujita Health University Hospital, Toyoake, Aichi, Japan. The Kidney Donor Profile Index/Kidney Donor Risk Index was calculated and the grafts were enrolled. The median follow-up period was 11.9years. The Kidney Donor Profile Index had a markedly asymmetric distribution (median 94%), and the Kidney Donor Risk Index had high index rates (0.79-2.94, median 1.70). The overall 5-, 10- and 15-year graft survival rates were 67.5%, 52.1% and 38.9%, respectively. The Kidney Donor Profile Index correlated with graft survival. The 5-, 10- and 15-year graft survival rates for the Kidney Donor Profile Index <1.2 were 87.7%, 73.5% and 59.2%; those for the Kidney Donor Risk Index >2.0 were 55.0%, 34.7% and 22.1%, respectively. A Cox multivariate analysis identified the Kidney Donor Risk Index (hazard ratio 2.06, 95% confidence interval 1.48-2.86, P<0.0001) and warm ischemic time (hazard ratio 1.21, 95% confidence interval 1.09-1.34, P=0.0010) as independent risk factors for graft loss. The addition of warm ischemic time >30min had a significant effect, as measured by the C-index (0.708-0.731, P=0.032), improving the net reclassification improvement score (0.256, P=0.0039) and integrated discrimination improvement score (0.042, P=0.0022). The Kidney Donor Profile Index/Kidney Donor Risk Index is a good prognostic tool for determining the outcomes of donors after cardiac death grafts. However, the warm ischemic time should also be included in the allocation system for donors after cardiac death grafts.

Partial meniscectomy adversely affects return-to-sport outcome after anatomical double-bundle anterior cruciate ligament reconstruction.

The purposes of this study were to determine whether the partial meniscectomy combined with ACL reconstruction affect the postoperative return-to-sport and to identify if partial meniscectomy has an influence on the graft failure following an anatomical double-bundle ACL reconstruction case. A retrospective cohort study including 426 primary double bundle ACL reconstruction cases. There were 206 males and 220 females, median age of 28.4years, median BMI of 23.0, median preinjury Tegner score of 7.0 and median follow-up period after surgery of 24.0months. Patients with less than 12months of follow-up, revision surgery, multi-ligaments injury, previous contralateral knee ligaments injury and postoperative infection cases were excluded. Furthermore, patients who had meniscal repair were excluded in order to compare the outcomes between patients who had intact menisci and those who underwent partial meniscectomy. There were 227 patients with intact menisci (group A) and 199 patients with partial meniscectomy (group B). The median age was younger and the preoperative Tegner score was higher in group A. The patients in group B were subcategorized as the site of partial meniscectomy, including medial (group C), lateral (group D) and bicompartmental (group E) meniscectomy. There were 74, 94, and 31 patients in group C, D, and E, respectively. Return-to-sport (running and sport phase) and graft failure were included in our primary outcomes, and functional outcome as Lysholm knee scores was included in secondary outcome. The rate of return to running phase and sport phase were 91% (387/426) and 76% (303/399), the mean time taken to return to running and sport phase were 5.7months and 11.1months, respectively. There was significant difference in the returning to sport phase between group A and B (p=0.01), and between group A and D/E subgroups (p=0.007). There were fourteen graft failures (3.5%) in total. In addition, 9 and 5 graft failures in group A and B, respectively. Of the 5 graft failures in group B, 2 and 3 graft failures in group C and D, respectively. There was no significant difference of the graft failure ratio among the groups. Our study demonstrates that partial meniscectomy has an adverse effect on the return to sport phase following the anatomical double-bundle ACL reconstruction. Therefore, greater postoperative care would be needed to return to sport with partial meniscectomy in ACL reconstruction cases. On the contrary, partial meniscectomy is not considered to be the risk factor for graft failure at short-term follow-up. Case-control study, Level III.

Sequential Saphenous Vein Coronary Bypass Grafting.

The enormous majority of previous reports focused on evaluating the safety and efficacy of sequential saphenous vein (SV) coronary bypass grafting; however, no reports to date have revealed concern regarding the impacts of the number of distal anastomoses of sequential SV grafting on graft patency after coronary artery bypass grafting (CABG). This single-center retrospective study aimed to evaluate the impacts of three versus two distal anastomoses per single SV conduit on SV graft patency after off-pump CABG, and to determine the independent risk factors for sequential SV graft failure.From January 2011 to December 2014, 1320 eligible patients were assigned to either a triple group (three distal anastomoses of sequential SV grafting, n = 758) or a double group (two distal anastomoses of sequential SV grafting, n = 562). The primary endpoint was over a 2-year follow-up SV graft failure after off-pump CABG.The triple and double group received a similar total patency rate of sequential SV conduits (86.5% versus 87.1%, P = 0.757). The number of distal anastomoses of sequential SV grafting (three versus two) was not a predictive factor for the follow-up graft failure of sequential SV conduits (HR = 0.91, 95% CI: 0.66-2.29, P = 0.137). Moreover, the two groups received a similar follow-up survival freedom from repeat revascularization (χ2 = 1.881, log-rank P = 0.170).Three versus two distal anastomoses per single SV conduit received a similar SV graft patency. The number of distal anastomoses of sequential SV grafting was not an independent risk factor for graft failure.

Successful engraftment after cord blood transplantation from an HLA‐homozygous donor (homo‐to‐hetero cord blood transplantation) in a primary myelofibrosis patient with broad HLA antibodies

Donor-specific human leukocyte antigen (HLA) antibodies are a significant risk factor for graft failure in cord blood transplantation (CBT). Although there are several treatments to decrease HLA antibodies, such as platelet transfusion, plasma exchange, rituximab, and bortezomib, their effectiveness has not been established. We herein report the case of a primary myelofibrosis (PMF) patient with broad HLA antibodies who underwent CBT from an HLA-homozygous donor in which the alleles were matched only in the host-versus-graft direction (homo-to-hetero CBT). The cord blood was killer cell immunoglobulin-like receptor (KIR) ligand matched. She received a reduced-intensity conditioning regimen. We used tacrolimus and mycophenolate mofetil as prophylaxis against graft-versus-host disease (GVHD). The neutrophils engrafted on Day 31. A chimerism analysis with fluorescence in situ hybridization of peripheral blood cells showed 99.9% donor type on Day 33. She developed only mild acute skin GVHD and chronic skin GVHD. This case indicates the usefulness of homo-to-hetero CBT in a patient with broad HLA antibodies with a strong mean fluorescence intensity, which is a significant risk factor for graft failure. Further studies are necessary to determine the risk of GVHD and to elucidate the association between KIR ligand incompatibility and graft failure in homo-to-hetero CBT.

Evaluation of the Effect of Regional Anaesthesia on Microvascular Free Flaps.

Multiple factors influence the success of microvascular free flap surgeries. Anaesthesia is an important factor to maximise the success rate of microvascular free flaps both by controlling haemodynamics and improving the perfusion of free vascularised tissue. The debate on the usefulness of regional and general anaesthesia for free tissue transfer is ongoing. This retrospective study was conducted to evaluate the effects of regional anaesthesia and other perioperative factors on outcomes of microvascular free flaps. This retrospective observational study was conducted on 165 patients undergoing microvascular free flap surgeries between January 2014 and December 2015 after obtaining approval from the Institutional Ethics Committee (Nizams Institute Ethics Committee, Nizams Institute of Medical Sciences, India). Perioperative variables analysed included the type of surgery, indication, ASA physical status, type of anaesthesia, perioperative haemodynamics, fluids used, duration of surgery, re-explorations, blood transfusion and duration of hospital stay. The primary outcome measure was to assess the effect of regional anaesthesia on the success of free flap. Multivariate analysis identified the type of anaesthesia and preoperative haemodynamics as independent risk factors for predicting the failure of flap with an odds ratio of 0.208 and 7.469, respectively. A subgroup analysis of 55 acute trauma patients revealed preoperative haemodynamic instability as an individual independent risk factor for graft failure with an odds ratio of 11.90. The results of this study emphasise the importance of the choice of anaesthesia and preoperative optimisation in improving the success of free flap surgeries.

Moderately Long-Term Safety and Efficacy of Repeat Penetrating Keratoplasty.

To investigate the moderately long-term safety and efficacy of repeat penetrating keratoplasty (PK) for treatment of a failed PK graft. Retrospective consecutive clinical case series. Of 992 consecutive cases that underwent PK at Baptist Eye Institute, Kyoto, Japan, between April 1998 and September 2013, 96 cases that underwent repeat PK with more than 3 years postoperatively follow-up were retrospectively reviewed. Surgical outcomes including donor graft survival rate, best spectacle-corrected visual acuity, endothelial cell density, and complications afeter repeat PK were assessed. At 1, 3, and 5 years after repeat PK, the donor graft survival rate was 91%, 75%, and 64%, respectively, and the mean endothelial cell density in those survived grafts was 1778, 1207, and 989 cells/mm, respectively. Best spectacle-corrected visual acuity over 20/200 and 20/40 was achieved in 71% and 27% of the patients, respectively, at 1 year postoperatively, in 59% and 31% of the patients, respectively, at 3 years postoperatively, and in 53% and 29% of the patients, respectively, at 5 years postoperatively. The most common complication for repeat PK was the need for additional glaucoma surgery [n = 11 patients (11.5%)]. Cox proportional hazard regression analyses revealed that previous glaucoma surgery and a rejection episode were high risk factors for graft failure in repeat PK [hazard ratio (HR) = 6.7; 95% confidence interval (CI), 2.1-21.2 and HR = 5.6; 95% CI, 1.8-18.0, respectively]. Repeat PK provided relatively safe and effective moderately long-term surgical outcomes.

One-Year Blood Glucose Level is the Best Metabolic Marker for the Prediction of Late Pancreas Graft Failure

Aim The goal of this study was to explore whether donor and recipient’s characteristics, and one-year biological parameters could have a predictive value for the diagnosis of late pancreas graft failure. Methods 354 type 1 diabetic patients underwent pancreas transplantation between 2000 and 2015. Pancreas graft failure was defined as return to oral antidiabetics, permanent insulin-dependence. Recipient and donor characteristics were analyzed at the time of transplantation to determine potential risk factors for late graft dysfunction (after one year). Biological parameters such as HbA1c, fasting blood glucose, C-peptide, insulin, amylase, lipase, OGTT, Matsuda index, Beta score, HOMA IR and HOMA B, were analyzed one year after transplantation. Results 280 SPK, 38 PTA and 36 PAK were performed in 139 men and 215 women, with a mean age of 40 years. Median follow-up was 6 years. Patient survival was 96% at 1 year, 93% at 3 years and 87.5% at 5 years, whithout any significant difference between the three pancreas categories. Cardio-vascular diseases were the first cause of late recipient death. 111 patients experienced graft failure, 50 of them after the first year of transplantation. Pancreas survival was 80.5%, 70.7% and 67.5%, respectively at 1, 3 and 5 years, without any difference between the three categories. After the first year post-transplantation, death with a functioning graft occurred in 35.5% of patients with graft dysfunction. Donor death from cardiovascular cause was the only risk factor for late graft failure (OR 1,82 [1.05; 3.75], p=0,0345). One-year fasting blood glucose was the best predictive marker for a future graft dysfunction, especially when this value was over 5,4 mmol/l (OR 3.44 [1.80; 6.58] p=0.0002). 2-hour OGTT glucose level was also a risk factor for graft failure (OR 1.19 [1.04; 1.37] p=0,0109) while high Beta score (OR 0.62 [0.41; 0.94] p=0.0231) and high values of HOMA-B (OR 0.996 [0.992; 0.999] p=0,0483) were protective factors. Multivariate analysis identified a value of fasting blood glucose over 5.4 mmol/l (OR 4.24 [1.28; 14.04] p=0.0180) as the only significant risk factor. Graft survival was significantly different between patients with one-year blood glucose over or below 5.5 mmol/l: 85.2 vs 94.5% at 3 years and 72.3% vs 91.5% at 5 years (p<0,05), respectively. Conclusion Donor death from cardiovascular cause was the single risk factor for late graft failure among all donor and recipient’s base-line data. One-year fasting blood glucose level was the most significant biochemical parameter among patients at risk for graft failure, especially when the value was over 5,4 mmol/l. Two-hour OGTT glucose level, Beta score and HOMA B performed one year after transplantation are additional useful tools for identification of patients at risk. Whether medical intervention (i.e. GLP-1 analogue) among patients with still “normal glucose metabolism” could improve long-term graft survival requires prospective evaluation.

Anterior Cruciate Ligament Reconstruction in Young Females: Patellar versus Hamstring Tendon Autografts

Objectives:Female athletes are two to eight times more likely to suffer a primary ACL tear than males. Although ACL reconstruction can successfully return many athletes to their pre-injury sports, re-injury to the ipsilateral or contralateral knee can occur in over 20% of young athletes. Both female sex and younger age have been shown to be risk factors for graft failure. The optimal graft choice for this high-risk population of young female athletes remains unknown and poorly studied. We compared the clinical outcomes in young female patients who underwent ACL reconstruction at our institution using bone-patellar tendon-bone (BTB) and quadrupled hamstring (HS) autografts.Methods:Female patients aged 15-25 who underwent primary ACL reconstruction at our institution between January 2012 and May 2015 using either BTB or HS autograft were included in our review. Patients were further sub-divided into 2 age groups, 15-20 and 20-25. Patients with a prior history of ACL injury to either knee, or those with multiligament injury were excluded. Graft choice and fixation method were documented from a review of operative records. Medical records were reviewed to document the occurrence of chondral, meniscal or ligamentous injury to the ipsilateral or contralateral knee in the first two years following ACL reconstruction. Comparisons were made using the chi-square test with statistical significance set at p < 0.05.Results:A total of 256 females were included in our review with 175 in the BTB group and 81 in the HS group. There was no difference between the groups with regards to average age or time to follow-up. The majority of patients in both groups, 80% of the BTB group and 77.8% of the HS group, were between the ages of 15-20. Interference screw fixation was used in all BTB cases and 63.0% of HS cases. In the remainder of HS cases, femoral suspension and tibial screw (27.2%), and femoral cross-pins and tibial screw (9.9%) were used. In our series, 22.2% of hamstring grafts were augmented with allograft due to inadequate size. Overall, graft re-tear occurred in 6.9% of BTB patients and 12.3% of HS patients [p=0.16]. Contralateral ACL tear occurred in 7.4% of BTB patients and 6.2% of HS patients [p=0.72]. Sub-group analysis showed that 75% of BTB and 100% of HS graft re-tears occurred in females aged 15-20. Within this group, there was a significantly lower rate of graft re-tears in the BTB group (6.4%) when compared to the HS group (15.9%) [p=0.04]. Allograft augmentation was used in four of the ten HS grafts that re-tore. The risk of failure with hamstring augmentation with allograft (4/18, 22.2%) was higher than that of hamstring autograft alone (6/63, 9.5%), but this difference was not significant [p=0.18].Conclusion:The results of our study indicate that BTB autograft led to fewer graft re-tears compared to HS autograft following ACL reconstruction in female patients aged 15-20. However, this difference was not observed in females aged 20-25. Thus, further investigation regarding optimal graft choice is warranted in this age group.

Long-term prognosis of BK virus-associated nephropathy in kidney transplant recipients

BackgroundThe long-term prognosis of BK virus-associated nephropathy (BKVAN) in kidney transplant recipients (KTRs) is uncertain. We evaluated the long-term prognosis in KTRs with BKVAN and the clinical significance of BKVAN on post-transplant clinical outcome.MethodsWe retrospectively analyzed the medical records of 582 patients who underwent kidney transplant (KT) between 2001 and 2014. We divided the patients into a BKVAN group (15 patients) diagnosed by allograft biopsy and a control group (356 patients).ResultsThe incidence of BKVAN was 4.0%, and the mean follow-up duration was 93.1 ± 52.3 months. Median time from KT to BKVAN diagnosis was 5.9 months (interquartile range [IQR], 4.4–8.7). In the BKVAN group, 9 (60.0%) KTRs with combined acute rejection progressed to graft failure, and the median time from BKVAN diagnosis to graft failure was 36.2 months (IQR, 9.7–65.5). Death-censored graft survival rate and patient survival rate in the BKVAN group were significantly lower than those in the control group. BKVAN and rejection were independent risk factors for graft failure. In the subgroup analysis, death-censored graft survival rate of KTRs with BKVAN with acute rejection was significantly worst in comparison with similar patients without BKVAN regardless of acute rejection (P < 0.001).ConclusionThe long-term prognosis of BKVAN with acute rejection was very poor because of graft failure caused by inadequate treatment for acute rejection considering BKVAN. Therefore, we should carefully monitor the allograft status of KTRs through regular surveillance tests after treatment for BKVAN with acute rejection.

Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction.

To analyze the contribution of increased lateral (LTPS) and medial tibial slopes (MTPS) as independent risk factors of graft failure following anterior cruciate ligament (ACL) reconstruction. Fifty-seven patients with graft failure after ACL reconstruction who underwent revision surgery between 2009 and 2014 were enrolled and matched to a control group of 69 patients with primary anatomic successful ACL reconstruction. Patients were matched based on age, sex, date of primary surgery and graft type. LTPS and MTPS were measured on MRI in a blinded fashion. Tibial and femoral tunnel positions were determined on CT scans. Independent t test was used to compare the MTPS and LTPS between subgroups. Risks of graft failure associated with an increasing MTPS and LTPS were analyzed using binary logistic analysis. The means of LTPS (7.3°) and MTPS (6.7°) in the graft failure group were found to be significantly greater than in the control group (4.6° and 4.1°, respectively; p = < 0.001). Non-anatomic and anatomic tunnel positions were found in 42 cases (73.7%) and 15 cases (26.3%), respectively. There were no significant differences in MTPS or LTPS between patients with anatomic and non-anatomic tunnel positions within the graft failure group. An increase of the MTPS of 1° was associated with an 1.24 times increased likelihood of exhibiting graft failure [95% CI 1.07-1.43] (p = 0.003) and an increase of the LTPS of 1° was associated with an 1.17 times increased likelihood of exhibiting graft failure [95% CI 1.04-1.31] (p = 0.009). The increased risk was most evident in patients with a lateral tibial posterior slope of ≥ 10°. Increased LTPS and MTPS are independent risk factors for graft failure following ACL reconstruction regardless whether tunnel position is anatomic or non-anatomic. This information may be helpful to clinicians when considering slope correction in selected revision ACL reconstruction procedures.

Five-Year Graft Survival of Descemet Membrane Endothelial Keratoplasty (EK) versus Descemet Stripping EK and the Effect of Donor Sex Matching

To determine whether the reduced risk of immunologic rejection with Descemet membrane endothelial keratoplasty (DMEK) results in a 5-year survival advantage relative to Descemet stripping endothelial keratoplasty (DSEK) and to determine whether matching the donor and recipient sex affects the rejection episode and graft survival rates. Retrospective cohort study. Patients with Fuchs' endothelial corneal dystrophy treated with DSEK or DMEK. This study reviewed 2017 consecutive cases (1312 DSEK and 705 DMEK) performed by 13 surgeons between 2003 and 2012 and included the surgeons' first cases. Survival rates were calculated by Kaplan-Meier analysis. Immunologic rejection episodes, graft failure or replacement for any reason, and endothelial cell loss. The 5-year rejection episode rate was lower with DMEK (2.6% vs. 7.9% with DSEK, relative risk, 0.29; 95% confidence interval, 0.16-0.53) despite early reduction of topical corticosteroids in 25% of the DMEK cases. African Americans (n= 46) had a higher risk of rejection episodes than other races (relative risk, 4.4; 95% confidence interval, 2.0-9.6). The cumulative 5-year survival rate was 93% with DSEK and DMEK (P= 0.86). Forty-four DMEK and 69 DSEK grafts failed or were replaced within 5 years, but only 1 DMEK and 4 DSEK failures followed a rejection episode. Rejection episodes increased endothelial cell loss (P= 0.004) but were not a significant risk factor for graft failure within 5 years (P= 0.90). The mean 5-year endothelial cell loss was similar between DMEK (48%±19%) and DSEK (47%±19%) (P= 0.22). Graft rejection episode and survival rates were not significantly influenced by whether the sex of the donor matched that of the recipient (rejection episodes: P= 0.07 for female recipients and P= 0.33 for male recipients; graft survival: P=0.67 for female recipients and P= 0.17 for male recipients). Five-year graft survival was similar between DMEK and DSEK. Although DMEK had a significantly lower risk of immunologic rejection, rejection episodes rarely resulted in graft failure within 5 years with either procedure. Sex matching the donor and recipient provided no survival advantage with DSEK or DMEK.

Clinical Outcomes of Kidney Transplantation in Patients With Biopsy-Proven Glomerulonephritis

BackgroundThe clinical outcomes after kidney transplantation (KT) according to the types of glomerulonephritis (GN) as the cause of end-stage renal disease (ESRD) are various, but there are not many studies on this. MethodsAmong 1,253 patients who had KT between November 1982 and January 2017, 183 recipients with biopsy-proven GN as the primary cause of ESRD were enrolled. We analyzed the incidence of recurrent GN and the factors associated with recurrence and graft and patient survivals. ResultsThe types of GN were 95 IgA nephropathy, 47 focal segmental glomerulosclerosis, 14 membranous proliferative GN, 9 membranous GN, 8 lupus nephritis, 6 rapid progressive GN, and 4 Alport syndrome. The mean follow-up duration was 103 ± 81.7 months. Recurrence was reported in 36 patients, of which 20 grafts failed due to recurrence. The age of patients with GN recurrence was significantly younger than that of patients without GN recurrence (P = .030). The graft failure rate of KT recipients with recurrent GN was significantly higher than that of the recipients without recurrent GN (55.6% vs 18.4%, P < .001). In multivariate analysis, recurrence of primary GN, the number of HLA mismatches at AB, delayed graft function, and acute rejection were independent risk factors for graft failure. ConclusionRecurrent GN remains a significant cause of graft loss in KT recipients. Surveillance of GN recurrence in the KT recipients with biopsy-proven GN can reduce allograft dysfunction.

Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: analysis of 120 patients

The aim of this study was to identify the risk factors associated with sinus membrane perforation and the effect of sinus membrane perforation and other risk factors on graft success and postoperative sinusitis. Sinus membrane perforation, graft failure, and postoperative sinusitis were tested for an association with age, sex, operator experience, side of the operation, residual bone height, presence of septa, presence of a mucous retention cyst, and smoking (χ2 test). Logistic regression analysis was used to model the odds ratio (OR) with corresponding risk factors. One hundred and twenty patients were included in this study. A total of 22 (18.3%) perforations occurred. A residual bone height of 3–6mm (OR 6.808, P=0.002) and presence of septa (OR 4.023, P=0.025) were identified as significant risk factors. Twenty-eight (23.3%) sinus grafts were classified as failed. Membrane perforation (OR 16.819, P<0.005) and residual bone height of 3–6mm (OR 5.363, P=0.01) were identified as significant risk factors for graft failure. None of the risk factors investigated in this study was significantly associated with postoperative sinusitis. These results suggest that the presence of septa and a residual bone height of 3–6mm are associated with an increased risk of sinus membrane perforation, and that sinus membrane perforation has a negative effect on graft success.