Risk Factor For Survival In Patients Research Articles

High Hepatic leukemia factor expression indicates a favorable survival in glioma patients.

Hepatic leukemia factor (HLF) is an oncogenic transcript factor, but its role in gliomas is unclear.With the open-access data from the Cancer Genome Atlatls (TCGA), HLF expression was compared between normal and glioma tissues and its correlation to patient survival, age, gender, race, and tumor grade was analyzed. Multivariate Cox regression was adopted to explore the independent risk factors for patient survival. Survivals between high and low HLF expression, and high and low model predicted risk subgroups were compared. 1, 2, 3, and 5-year patient survival were predicted with the Cox regression model. Gene set enrichment analysis (GSEA) was performed to predict the potential function of HLF.Expression and clinical data of 5 normal brain samples and 655 glioma samples were obtained from TCGA. HLF expression was downregulated in gliomas than normal brain tissue (P = .007), and negatively related to patient age and advancing tumor grade (P < .001). HLF was a protective factor for patient survival (OR = 0.81, 95%CI 0.67–0.99, P = .035). Patients’ survivals were poorer in low HLF expression subgroups and the Cox regression model predicted high-risk subgroups (P < .001). The accuracy of the model in predicting 1, 2, 3, and 5-year patient survival was 0.864, 0.895, 0.907, and 0.893, respectively. GSEA revealed HLF mainly took part in regulating tumor cell metabolism and cell cycle.HLF was downregulated in gliomas than normal tissue, negatively related to patient age and tumor grade, and was an independent protective factor for glioma patients.

Idiopathic membranous nephropathy in older patients: Clinical features and outcomes

BackgroundVarious factors can affect renal and patient outcome in idiopathic membranous nephropathy (iMN). We aimed to identify predictors of renal and patient survival in patients with iMN, with a special focus on outcomes among older patients.MethodsWe retrieved data on 1,776 patients (mean age 53.0 ± 14.7 years; 1,075 [60.5%] males) diagnosed with iMN from the Korean GlomeruloNEphritis sTudy (KoGNET), a database compiled from 18 centers in Korea.ResultsThe cohort included 428 (24.1%) patients over 65 years old. Compared to younger patients, this group had lower hemoglobin and serum albumin levels, a higher incidence of nephrotic-range proteinuria, and higher prevalences of hypertension and diabetes. At last follow-up, complete or partial remission rates were not significantly different between the older and younger groups. Older age (HR: 0.98, 95%CI: 0.97–0.99), elevated hemoglobin (HR: 0.82, 95%CI: 0.72–0.93), high serum albumin (HR: 0.66, 95%CI: 0.44–0.99), and a high estimated glomerular filtration rate (HR: 0.96, 95%CI: 0.95–0.97) at biopsy were good predictors of renal outcomes. Significant risk factors for patient survival were older age (HR: 1.04, 95%CI: 1.01–1.10) and hypertension at biopsy (HR: 2.76, 95%CI: 1.30–5.90).ConclusionsOlder patients with iMN had favorable renal outcomes, but poor patient survival, compared to younger patients. Prognostic information on outcomes in this study might be helpful for optimizing the management of patients with iMN.

APopulation Study to Identify Candidates for Cytoreductive Nephrectomy in Patients with Metastatic Sarcomatoid Renal Cell Carcinoma from the Surveillance, Epidemiology, and End Results (SEER) Database.

BackgroundThis population study aimed to identify suitable candidates for cytoreductive nephrectomy in patients with metastatic sarcomatoid renal cell carcinoma (RCC) from the US Surveillance, Epidemiology, and End Results (SEER) database.Material/MethodsDemographic and clinical data from 1,229 patients with metastatic sarcomatoid RCC were retrieved from the SEER database. Patients were divided into the cytoreductive nephrectomy group (n=937) and the no surgery group (n=292). Multivariate Cox regression analysis identified factors associated with overall survival (OS) and propensity score matching identified factors that significantly impacted the OS. Survival of propensity score-matched subgroups of patients with metastatic sarcomatoid RCC treated by cytoreductive nephrectomy or no surgery was determined by the Kaplan–Meier method and compared by the log-rank test.ResultsOf the 1,229 patients with metastatic sarcomatoid RCC retrieved from the SEER database, age, tumor size, T stage, and N stage were independent risk factors for patient survival. There were no significant differences in age, N stage, and tumor size between the cytoreductive nephrectomy-treated and non-surgically treated T stage cases following propensity score matching. OS benefits were found in cases with stage T1 (12 months increase), T2 (7.5 months increase), T3a (2 months increase), and T4 (3 months increase), but not in the T3b or T3c subgroups treated by cytoreductive nephrectomy, compared with patients with no surgical treatment.ConclusionsData from the SEER database showed that cytoreductive nephrectomy improved OS in patients with T1 and T2 metastatic sarcomatoid RCC with a significant long-term survival benefit of >6 months.

P0411PREDICTORS OF RENAL AND PATIENT OUTCOME IN PATIENTS WITH IDIOPATHIC MEMBRANOUS NEPHROPATHY: FROM KOGNET DATA

Abstract Background and Aims Idiopathic membranous nephropathy (iMN) is a leading cause of nephrotic syndrome and one of the major causes of end-stage renal disease (ESRD). Various factors can affect renal and patient outcome in patients with iMN. In this study, we analyzed the predictors of renal and patient survival in patients with iMN. Method We analyzed 1,776 patients diagnosed with iMN in Korean GlomeruloNEphritis STudy (KoGNET), a retrospective database of patients with renal biopsy from 1979 to 2018 from 18 centers in Korea. Student t-test for continuous variables and Chi-square test for categorical variables were performed for analyses. Cox proportional hazard regression was used to determine risk factors affecting renal and patient survival. Results The mean age of patients was 53.0 ± 14.7 years old and 1,075 (60.5%) were male. At the time of renal biopsy, 755 (46.0%) and 266 (16.2%) had hypertension and diabetes, respectively. Serum albumin level was 2.7 ± 0.8 g/dL and 871 (49.0%) had nephrotic range of proteinuria. When analyzed by dividing over 65 and under, the hemoglobin and serum albumin level were lower, more patients showed nephrotic ranged proteinuria, and higher prevalence of comorbidities such as hypertension, diabetes, coronary heart disease and cerebrovascular disease in the group over 65 than in the group under 65. Median duration of follow-up was 88.0 (38.0 – 115.1) months. Complete or partial remission rates were 48.5%, 63.8%, and 68.0% at 6 months, 12months after biopsy, and last follow-up, respectively. In Cox proportional hazard regression, high hemoglobin [HR 0.66 (0.47 – 0.93), p=0.017], high serum albumin level [HR 0.41 (0.18 – 0.94), p=0.034], and high estimated GFR by CKD-EPI equation [HR 0.94 (0.91 – 0.96), p&amp;lt;0.001] at biopsy were good predictors for renal outcome, whereas presence of cerebrovascular disease at biopsy [HR 6.45 (1.16 – 35.71), p=0.033] were poor prognostic factors for ESRD. Age 65 and older [HR 3.26 (1.53 – 6.95), p=0.002] and presence of hypertension at biopsy [HR 2.45 (1.09 – 5.54), p=0.031] were significant risk factors for patient survival in multivariate Cox proportional regression analysis. Conclusion High hemoglobin and serum albumin, and good renal function at biopsy were good predictors for renal survival. Older age and hypertension at biopsy were poor prognostic factors for patient survival in iMN patients. Prognostic information of outcomes in this study might be helpful to optimize management in iMN patients.

Too Fat for Transplant? The Impact of Recipient BMI on Pancreas Transplant Outcomes.

In many transplant centers, a recipient body mass index (BMI) >30 kg/m2 would be considered a contraindication for pancreas transplantation. This study aims to investigate the impact of recipient BMI on graft outcomes after pancreas transplantation. Retrospective data on all UK solid organ pancreas transplants from 1994 to 2016 were obtained from the National Health Service Blood and Transplant UK Transplant Registry, n = 2618. Cases missing BMI data were excluded, resulting in a final cohort of n = 1452. Graft and patient survival analysis were conducted using Kaplan-Meier plots and Cox regression models. The mean recipient BMI was 24.8 kg/m2 (±2.4). There were 507 overweight (BMI 25-29.9) and 146 obese (>30) recipients receiving pancreas transplants. Univariate analysis showed no statistically significant difference between overweight BMI categories compared with normal BMI (18.5-24.9 kg/m2). Multivariate analysis revealed increasing recipient BMI had a significant impact on graft survival (P = 0.03, hazard ratio 1.04, 95% confidence interval, 1.00-1.08). Receiver operating characteristic curve analyses revealed no value of BMI that provided both specific and sensitive discrimination between death and survival of both grafts or patients. Recipients on dialysis with a BMI >30 kg/m2 had a statistically significant decrease in both graft (P = 0.002) and patient survival (P = 0.015). Analysis of available UK Pancreas data has shown recipient BMI is an independent risk factor for patient survival after transplantation. However, we have been unable to define a specific cutoff value above which patients have poorer outcomes. Obese patients on hemodialysis had the poorest graft survival, and preemptive transplantation may be beneficial in this cohort.

Clinicopathologic characteristics and outcomes of lupus nephritis with positive antineutrophil cytoplasmic antibody

Aims The aim was to determine whether anti-neutrophil cytoplasmic antibody (ANCA)-positive serology in patients with lupus nephritis (LN) is associated with different clinicopathologic features and outcomes. Methods In our retrospective analysis, 283 patients were enrolled between 2013 and 2018. Thirty-six patients were ANCA-positive, and this group was compared with the remaining 247 patients who were confirmed as ANCA-negative at the time of biopsy. Results ANCA-positive LN patients exhibited higher anti-dsDNA antibody titers and serum creatinine levels and lower serum hemoglobin concentrations than ANCA-negative LN patients. On pathological evaluation, segmental endocapillary hypercellularity observed by light microscopy was significantly more common in the ANCA-positive group. This feature was not significantly different in the treatment group, but the response to treatment was significantly different, as was remission (76.1% vs 69.4%, p < 0.001), between the ANCA-negative and ANCA-positive groups. During follow-up, the times to renal replacement therapy (RRT) and death were significantly different between the two unmatched groups (chi-square test, p = 0.041). Multivariate Cox analysis revealed that neurological disorders, ANCA positivity, and the chronicity index (CI) remained independent risk factors for patient survival. Pulmonary infection was the main cause of death and was most often due to fungal infection. Conclusion ANCA-positive LN patients typically exhibited higher anti-dsDNA antibody titers, lower serum hemoglobin concentrations and worse renal function than ANCA-negative LN patients. Fungal infection was the main cause of death. We observed that ANCA positivity was an independent risk factor for patient survival.

Prognosis of Split Liver Transplantation Compared with Whole Liver Transplantation in Adult Patients: Single-center Results under the Korean MELD Score-based Allocation Policy.

BackgroundSplit liver transplantation (SLT) has been occasionally performed in Korea. This study compared the incidence and prognosis of SLT with whole liver transplantation (WLT) in adult patients.MethodsBetween June 2016 and November 2019, 242 adult patients underwent a total of 256 deceased donor liver transplantation operations. SLT was performed in 7 patients (2.9%).ResultsThe mean age of SLT donors was 29.7 ± 7.4 years, and the mean age of recipients was 55.7 ± 10.6 years, with the latter having a mean model for end-stage liver disease score of 34.6 ± 3.1. Mean split right liver graft weight was 1,228.6 ± 149.7 g and mean graft-recipient weight ratio was 1.97 ± 0.39. Of the seven SLT recipients, Korean Network for Organ Sharing (KONOS) status was one in status 1, one in status 2 and five in status 3. The graft (P = 0.72) and patient (P = 0.84) survival rates were comparable in the SLT and WLT groups. Following propensity score matching, graft (P = 0.61) and patient (P = 0.91) survival rates remained comparable in the two groups. Univariate analysis showed that pretransplant ventilator support and renal replacement therapy were significantly associated with patient survival, whereas KONOS status category and primary liver diseases were not. Multivariate analysis showed that pretransplant ventilator support was an independent risk factor for patient survival.ConclusionSurvival outcomes were similar in adult SLT and WLT recipients, probably due to selection of high-quality grafts and low-risk recipients. Prudent selection of donors and adult recipients for SLT may expand the liver graft pool for pediatric patients without affecting outcomes in adults undergoing SLT.

Expression of Dual-Specificity Phosphatase 2 (DUSP2) in Patients with Serous Ovarian Carcinoma and in SKOV3 and OVCAR3 Cells In Vitro.

BackgroundOvarian cancer commonly presents at a late stage and is associated with poor prognosis. The most common histological subtype is serous ovarian carcinoma. Dual-specificity phosphatase 2 (DUSP2) is a protein phosphatase and substrate for mitogen-activated protein kinases (MAPKs) with increased expression levels in malignancy. This study aimed to evaluate the expression of DUSP2 in tumor tissues from patients with serous ovarian carcinoma and the association with tumor grade, stage, and patient survival and to investigate the effects of DUSP2 expression in SKOV3 and OVCAR3 cells in vitro.Material/MethodsTumor tissue and adjacent normal ovarian tissue from 127 patients with histologically confirmed serous ovarian carcinoma underwent quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry to measure DUSP2 mRNA and protein expression, respectively. Tumor grade, stage, and clinicopathological data underwent correlation analysis with DUSP2 expression, and survival data were assessed with Kaplan-Meier and Cox regression analysis. The effects of DUSP2 expression on the proliferation and migration of SKOV3 and OVCAR3 cells were evaluated.ResultsImmunohistochemistry showed that DUSP2 was down-regulated in serous ovarian carcinoma tissues compared with adjacent ovarian tissues, and was significantly correlated with tumor stage. Survival analysis showed that DUSP2 expression was an independent risk factor for patient survival. DUSP2 expression in SKOV3 and OVCAR3 cells in vitro suppressed cell proliferation and migration.ConclusionsDown-regulation of DUSP2 expression in serous ovarian carcinoma was an independent risk factor for patient survival, and its expression in SKOV3 and OVCAR3 cells inhibited cell proliferation and migration in vitro.

Prediction of the Outcome for Patients with Glioblastoma with lncRNA Expression Profiles

Background Progress in gene sequencing has paved the way for precise outcome prediction of the heterogeneous disease of glioblastoma. The aim was to assess the potential of utilizing the lncRNA expression profile for predicting glioblastoma patient survival. Materials and Methods Clinical and lncRNA expression data were downloaded from the public database of the cancer genome atlas. Differentially expressed lncRNAs between glioblastoma and normal brain tissue were screened by bioinformatics analysis. The samples were randomly separated into the training and testing sets. Univariate Cox regression, least absolute shrinkage, selection operator regression, and multivariate Cox regression were performed to develop the prediction model with the training set, which was presented as a forest plot. The performance of the model was validated by discrimination and calibration analysis in both the training and testing sets. Patient survival between model-predicted low- and high-risk subgroups was compared in both the training and testing sets. Results One thousand two hundred and fifty-five differentially expressed lncRNAs between glioblastoma and normal brain tissues were screened. After univariate Cox regression and the least absolute shrinkage and selection operator regression, a 12 lncRNA constituted prediction model was developed by multivariate Cox regression. Of the 12 lncRNAs, 4 lncRNAs were independent risk factors for patient survival. The areas under the receiver operating characteristic curves of the model for predicting 0.5-, 1-, 1.5-, and 2-year patient survival was 0.788, 0.824, 0.874, and 0.886, respectively in the training set and 0.723, 0.84, 0.816, and 0.773 in the testing set. The calibration curves of the prediction model fitted well. Significant survival disparity was observed between the model dichotomized low- and high-risk subgroups in both the training and testing set. Conclusions LncRNA expression signature can predict glioblastoma patient survival, promising lncRNA-based survival prediction.

Prediction of Three-Year Mortality After Deceased Donor Kidney Transplantation in Adults with Pre-Transplant Donor and Recipient Variables.

BackgroundPrognostic models for 3-year mortality after kidney transplantation based on pre-transplant donor and recipient variables may avoid futility and thus improve donor organ allocation.Material/MethodsThere were 1546 consecutive deceased-donor kidney transplants in adults (January 1, 2000 to December 31, 2012) used to identify pre-transplant donor and recipient variables with significant independent influence on long-term survival (Cox regression modelling). Detected factors were used to develop a prognostic model for 3-year mortality in 1289 patients with follow-up of >3 years (multivariable logistic regression). The sensitivity and specificity of this model’s prognostic ability was assessed with the area under the receiver operating characteristic curve (AUROC).ResultsHighly immunized recipients [hazard ratio (HR: 2.579, 95% CI: 1.272–4.631], high urgency recipients (HR: 3.062, 95% CI: 1.294–6.082), recipients with diabetic nephropathy (HR: 3.471, 95% CI: 2.476–4.751), as well as 0, 1, or 2 HLA DR mismatches (HR: 1.349, 95% CI: 1.160–1.569) were independent and significant risk factors for patient survival. Younger recipient age ≤42.1 years (HR: 0.137, 95% CI: 0.090–0.203), recipient age 42.2–52.8 years (HR: 0.374, 95% CI: 0.278–0.498), recipient age 52.9–62.8 years (HR: 0.553, 95% CI: 0.421–0.723), short cold ischemic times ≤11.8 hours (HR: 0.602, 95% CI: 0.438–0.814) and cold ischemic times 11.9–15.3 hours (HR: 0.736, 95% CI: 0.557–0.962) reduced this risk independently and significantly. The AUROC of the derived model for 3-year post-transplant mortality with these variables was 0.748 (95% CI: 0.689–0.788).ConclusionsOlder, highly immunized or high urgency transplant candidates with anticipated longer cold ischemic times, who were transplanted with the indication of diabetic nephropathy should receive donor organs with no HLA DR mismatches to improve their mortality risk.

Vitamin D as a risk factor for patient survival after kidney transplantation: A prospective observational cohort study.

Short-term survival after kidney transplantation is excellent, but long-term survival remains low and is equivalent to non-end-stage renal disease patients with many invasive malignancies. The aim of the study was to explore vitamin D status in the early phase after transplantation as a prognostic marker for long-term graft and patient survival. All first-time kidney transplant recipients between October 2007 and October 2012 in Norway were included. Vitamin D was measured 10weeks post-transplant. Information on graft failure and death was obtained from the Norwegian Renal Registry. Seven hundred and sixty-two first-time kidney transplant recipients were included, with a median age of 57years and a median follow-up of 82months. In the follow-up period, there were 172 graft failures (23%) and 118 deaths (15%). Eighty-six percent of the transplant recipients with sufficient vitamin D levels were alive with a well-functioning graft after 5years using Kaplan-Meier survival estimates, compared with 79% and 76% of the patients with vitamin D deficiency and insufficiency, respectively (P=0.006). In a nation-wide cohort of 762 first-time kidney transplant recipients, long-term graft and patient survival were better in recipients with vitamin D sufficiency 10weeks post-transplant compared with those with vitamin D deficiency and insufficiency.

The Association of obesity with vascular complications after liver transplantation

BackgroundBecause of the growing number of obese patients undergoing liver transplantation (LT), it is important to investigate the impact of obesity on post-transplant outcomes. Vascular complications are rare, but serious causes of morbidity and mortality after LT. It is not known if pre-transplant obesity is associated with an increased incidence of post-LT vascular complications.MethodsMedline, Embase, and Cochrane Library databases were searched in September 2017. The primary outcome was the impact of obesity on the vascular complication rate in adult LT recipients. Survival and biliary complications rates were also analyzed. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare pooled data between groups with a body mass index (BMI) ≥ 30 kg/m2 and < 30 kg/m2.ResultsSix retrospective cohort studies with a total of 987 patients with a BMI ≥ 30 kg/m2 (high BMI group) and 2911 patients with a BMI < 3 0 kg/m2 (control group) were included in the analysis. All studies had Newcastle-Ottawa Scale scores ≥4. The vascular complication rates were similar between the high BMI group and control group (RR = 1.13, 95% CI: 0.87–1.47, P = 0.27), as were the patient survival, graft survival, and biliary complication rates. In subgroup analysis, there was no difference in the vascular complication rates between BMI ≥ 35 vs. BMI < 25 kg/m2; BMI 30–35 vs. BMI 18–25 kg/m2; BMI ≥ 30 vs. BMI 18–25 kg/m2; and BMI ≥ 35 vs. BMI < 35 kg/m2. No difference was found in subgroup analysis when BMI was adjusted for ascites. However, recipients whose primary disease was alcoholic liver disease, those with a BMI ≥ 30 kg/m2 had higher incidence of vascular complications than those with a BMI < 30 kg/m2 (RR = 1.55, 95% CI: 1.07–2.25, P = 0.02) .ConclusionsBMI does not affect incidence of vascular complications after LT. High pre-transplant BMI is not a risk factor for patient survival and biliary complications after LT.

Urgent-Start Peritoneal Dialysis as a Bridge to Definitive Chronic Renal Replacement Therapy: Short- and Long-Term Outcomes.

Background: The peritoneal dialysis (PD) urgent-start pathway, without typical 2-week break-in period, was meant for late-referral patients able and prone to join PD-first program, with its main advantages such as: keeping the vascular system intact, preserving their residual renal function and retaining life-style flexibility. We compared the short- and long-term outcomes of consecutive 35 patients after urgent- and 94 patients after the planned start of PD as the first choice.Methods: The study included all incident end-stage renal disease patients starting PD program between January 2005 and December 2015, classified into two groups: those with urgent (unplanned) and those with elective (planned) start. Urgent PD was initiated as an overnight automatic procedure (APD) with dwell volume gradually increased, and after 2–3 weeks, target PD method was established.Results: The mean time between catheter implantation and PD start was 3.5 ± 2.3 in urgent and 16.2 ± 1.7 days in planned-start groups (p < 0.00001). 51% of the patients in the urgent-start group required PD during first 48 h after catheter insertion. Mean follow-up of 17.6 ± 11.09 months (median: 19.0) was in the urgent-start group and 28.6 ± 26.6 months (median: 19.5) in the planned-start group. The early mechanical complications were observed more often in the urgent-start group (29 vs. 4%, p = 0.00005). The only significant predictors of early mechanical complications were serum albumin (p = 0.02) and time between the catheter insertion and PD start. The first year patient survival and technique survival censored for death and kidney transplantation were not significantly different between groups. In Cox proportional analysis the independent risk factors for patient survival as well as for method and patient survival appeared Charlson Comorbidity Index CCI (HR 1.4; p = 0.01 and 1.24; p = 0.02) and time from catheter implantation to PD start with HR 5.11; p = 0.03 and 4.29; p = 0.04 for <2 days, while time >14 days lost its predictive value (p = 0.07).Conclusion: Peritoneal dialysis may be a feasible and safe alternative to HD in patients who need to start dialysis urgently without established dialysis access, with an acceptable complications rates, as well as patient and technique survival.

Post-transplant lymphoproliferative disease may be an adverse risk factor for patient survival but not graft loss in kidney transplant recipients

Better prognostication of graft and patient outcomes among kidney transplant recipients with post-transplant lymphoproliferative disease (PTLD) in the rituximab era is needed to inform treatment decisions. Therefore, we sought to estimate the excess risks of death and graft loss in kidney transplant recipients with PTLD, and to determine risk factors for death. Using the ANZDATA registry, the risks of mortality and graft loss among recipients with and without PTLD were estimated using survival analysis. A group of 367 patients with PTLD (69% male, 85% white, mean age 43 years) were matched 1 to 4 to 1468 controls (69% male, 88% white, mean age 43 years), and followed for a mean of 16 years. Recipients with PTLD experienced poorer 10-year patient survival (41%, 95% confidence intervals 36-47%) than controls (65%, 63-68%). Excess mortality occurred in the first 2 years post-transplant (hazard ratio 8.5, 6.7-11), but not thereafter (1.0, 0.76-1.3). Cerebral lymphoma (2.0, 1.3-3.1), bone marrow disease (2.0, 1.2-3.3) and year of diagnosis prior to 2000 (2.2, 1.4-3.5; after 2000 reference) were risk factors of death. PTLD did not confer an excess risk of graft loss (1.08, 0.69-1.70). Thus, PTLD is a risk factor for death, particularly in the first two years after diagnosis. Cerebral or bone marrow diseases were associated with increased mortality risk, but overall survival in the rituximab era (post 2000) has improved.

The safety and effect of transhepatic hilar approach for the treatment of bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma

Objective: To compare the efficiency between the transhepatic hilar approach and conventional approach for the surgical treatment of Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma. Methods: There were 42 consecutive patients with hilar cholangiocarcinoma of Bismuth type Ⅲ and Ⅳ who underwent surgical treatment at Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2008 to December 2013.The transhepatic hilar approach was used in 19 patients and conventional approach was performed in 23 patients.There were no differences in clinical parameters between the two groups(all P>0.05). The t-test was used to analyze the measurement data, and the χ(2) test was used to analyze the count data.Kaplan-Meier analysis was used to analyze the survival period.Multivariate COX regression analysis was used to analyze the prognosis factors. Results: Among the 19 patients who underwent transhepatic hilar approach, 3 patients changed the operative planning after reevaluated by exposing the hepatic hilus.The intraoperative blood was 300(250-400)ml in the transhepatic hilar approach group, which was significantly less than the conventional approach group, 800(450-1 300)ml(t=4.276, P=0.00 1), meanwhile, the R0 resection rate was significantly higher in the transhepatic hilar approach group than in the conventional approach group(89.4% vs. 52.2; χ(2)=6.773, P=0.009) and the 3-year and 5-year cumulative survival rate was better in the transhepatic hilar approach group than in the conventional approach group(63.2% vs. 47.8%, 26.3% vs. 0; χ(2)=66.363, 127.185, P=0.000). On univariate analysis, transhepatic hilar approach, intraoperative blood loss, intraoperative blood transfusion, R0 resection and lymph node metastasis were significant risk factors for patient survival(all P<0.05). On multivariate analysis, use of transhepatic hilar approach, intraoperative blood loss, R0 resection and lymph node metastasis were significant independent risk factors for patient survival(all P<0.05). Conclusion: The transhepatic hilar approach is the preferred technique for surgical treatment for hilar cholangiocarcinoma because it can improve accuracy of surgical planning, safety of operation, R0 resection rate and survival rate compared with the conventional approach.

The long-term outcomes of hepatitis C virus core antigen-positive Japanese renal allograft recipients.

The impact of hepatitis C virus (HCV) infections on patient long-term survival after renal transplants is unclear. To clarify the long-term outcomes of Japanese renal allograft recipients with HCV infections, we studied the cases of 187 patients (118 males and 69 females; 155 living donor cases, and 32 deceased donor cases; median follow-up period: 250months) who underwent an initial renal transplant at Kanazawa Medical University from 1974 onwards. In this cohort, 35 patients (18.7%) were HCV core antigen (Ag)-positive, and 13 of them (37.1%) died (due to liver cirrhosis (4 cases), hepatocellular carcinoma (1 case), fibrosing cholestatic hepatitis due to HCV (1 case), and infections complicated with chronic hepatitis (6 cases)). However, only 14 of the 145 (9.7%) recipients died in the HCV-Ag/HCV antibody (Ab)-negative group. The Kaplan-Meier life table method indicated that the HCV-infected group exhibited significantly lower patient and death-censored allograft survival rates (log-rank test; patient survival: Chi-square: 11.2, p = 0.004; graft survival: Chi-square: 25.7, p < 0.001). The survival rate of the HCV-Ag-positive recipients decreased rapidly at 240 months after the renal transplant procedure. In addition, a Cox proportional hazards model indicated that positivity for the HCV-Ag was the most important independent risk factor for post-renal transplant survival and allograft function [survival: hazard ratio (HR) 3.93 (1.54-10.03), p = 0.004; graft function: HR 2.09 (1.14-3.81), p = 0.016]. HCV infection is a harmful risk factor for patient survival (especially at ≥20years post-renal transplant) and renal allograft function in allograft recipients.

Renal vasculitis presenting with acute kidney injury.

Renal failure secondary to ANCA-associated vasculitis represents a clinical and therapeutic challenge. In this study, we aimed to assess the treatment response rates and long-term outcomes of vasculitis patients presenting with renal failure. This retrospective study included 151 patients with renal vasculitis from three hospitals who underwent a renal biopsy between 1997 and 2014. Patients with renal failure which required dialysis at the onset were compared to those presenting with more preserved renal function. The primary end point was treatment response and patient surivival. Patients with severe renal involvement had a lower response to treatment compared to those having preserved renal function (26.6 versus 93.4%; p < 0.001). Dialysis-dependent patients who received plasmapheresis in addition to immune suppressants associated a higher rate of renal recovery (41.6 versus 12.5%; p = 0.05). A higher incidence of severe infections was observed among patients with severe renal involvement (38.4 versus 18.1%, p = 0.01). The mortality rate was significantly higher among vasculitis patients presenting with renal failure (53.8 versus 22.2%, p = 0.001). Global survival at 1 and 5years was 60 and 47% in patients requiring dialysis compared with 90 and 80% among those with more preserved renal function (p < 0.001). After multivariate adjustment, the need for dialysis remained as an independent predictor of death (HR 2.5; 95% CI 1.1-5.7; p = 0.03). The presence of severe renal dysfunction represents an independent risk factor for patient survival in renal vasculitis. Patients requiring dialysis associate a lower response rate to immunosuppressive therapy and a higher incidence of severe infections.

Prognostic Influence of Internal Mammary Node Drainage in Patients with Early-stage Breast Cancer.

The management of internal mammary nodes (IMNs) during multidisciplinary treatment of breast cancer has been debated for the last four decades without unequivocal conclusion. We retrospectively reviewed patients with breast cancer who underwent sentinel lymph node biopsy at our center from 2008 until 2012. IMN drainage was assessed as a potential risk factor for local and distant disease recurrence. We identified 712 patients, with incidence of drainage to IMNs of 18.4%. No detrimental effect of the pattern of drainage to IMNs was found after a median follow-up of 58 months. A similar outcome was observed when drainage to IMNs was evaluated as a risk factor for patient survival. The potential risk factors for drainage to IMNs during sentinel lymph node biopsy were younger age (p=0.002) and tumor location in lower-outer, lower-inner, and upper-inner versus upper-outer quadrant (p<0.0001). The drainage to IMNs is unlikely to have a detrimental effect on patient outcome.

InFRank: a ranking-based identification of influential genes in biological networks.

Capturing the predominant driver genes is critical in the analysis of high-throughput experimental data; however, existing methods scarcely include the unique characters of biological networks. Herein we introduced a ranking-based computational framework (inFRank) to rank the proteins by their influence. Using inFRank, we identified the top 20 influential genes in hepatocellular carcinoma (HCC). Network analysis revealed a prominent community composed of 7 influential genes. Intriguingly, five genes among the community were critical for mitotic spindle assembly checkpoint (SAC), suggesting that dysregulation of SAC could be a distinct feature of HCC and targeting SAC-associated genes might be a promising therapeutic strategy. Cox regression analysis revealed that CDC20 exerted as an independent risk factor for patient survival, indicating that CDC20 could be a novel biomarker for HCC prognosis. inFRank was then used for pan-cancer study, and all of the most influential genes in 18 cancers were achieved. We identified altogether 19 genes that were important in multiple cancers, and observed that cancers originating from the same organ or function-related organs tended to share more influential genes. Collectively, our results demonstrated that the inFRank was a powerful approach for deep interpretation of high-throughput data and better understanding of complex diseases.

First 1500 Kidney Transplants at the Institute of Nephrology and Urology in Uruguay: Analysis of the Results

BackgroundThe Institute of Nephrology and Urology (INU) has performed 75% of kidney transplantations (KT) in Uruguay during its 35 years of activity, with 90.6% from cadaveric donors. We investigated the risk factors (RF) for delayed graft function (DGF) and patient and graft survival (SV). MethodsWe analyzed retrospectively the characteristics and evolution of 1500 KT performed by INU until December 2014. The incidence of DGF and RF for patient and graft SV were analyzed in 4 eras, according to the year that KT was performed. ResultsThe number of KT per year has progressively increased until reaching 40 KT per million population in 2006, with a decrease of the living donor KT (LDKT) rate. The age of the donors (D) and recipients (R) as well as the time on dialysis (TOD) have progressively increased over the different eras. Five hundred twenty-five R (35%) presented with DGF. The RF for DGF were the age of the R and the D, the TOD, the DDKT, and the warm ischemia time (WIT). In the DDKT group, the cold ischemia time and “died of stroke” were added factors. The death-censored graft SV at 1, 5, 10, and 15 years were 90%, 76%, 62%, and 49%, respectively. They improved as from era I, the patient SV being 92%, 83%, and 75% at 1, 5, and 10 years, in era I; 98%, 93%, and 86% in era II; 98%, 92%, and 83% in era III; and 95% and 90% at 1 and 5 years in era IV (P < .001). The graft SV over the same periods was 76%, 58%, and 40% in era I; 88%, 68%, and 52% in era II; 93%, 81%, and 70% in era III; and 93% and 85% at 1 and 5 years in era IV (P < .0001). The RF for patient SV were diabetes mellitus, era I, lower albuminemia, older age or TOD, and DGF. For kidney SV, the era, the age of the R, TOD, DGF, and D older than 60 years were RF associated with a worse evolution. In DDKT, the RF for the graft SV were the era, younger age of the R, and DGF. The group with the worst graft SV was the one made up of children and adolescents. ConclusionsOur results relating to patient and graft SV are acceptable and comparable to those mentioned on large records such as the OPNT/SRTR and the Collaborative Transplant Study. This has been the case, even though we have transplanted increasingly aged patients, with increasingly aged donors, or donors with associated pathology. The risk factors that we found both for DGF and SV have also been pointed out by other authors. The validity of some findings has the limitation of being from a retrospective analysis; hence, they should be corroborated by a prospective study.