Risk Factor For Survival In Patients Research Articles

Risk of COVID-19 infection in patients with NSCLC receiving EGFR-TKI targeted therapy during the first wave in China.

We examined the factors influencing hospitalization and prognosis among patients with non-small cell lung cancer receiving epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) targeted therapy during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. In total, 267 patients diagnosed with NSCLC who were receiving treatment with third-generation EGFR-TKIs were included in our retrospective study. Data on patients' demographics, clinical characteristics, and survival were collected and analyzed. Over a mean follow-up of 18 months, 80.5% (215/267) of the patients contracted COVID-19, and 12.6% (27/215) of these patients were hospitalized for COVID-19 treatment. Vaccinated patients, those with body mass index (BMI) ≥22.3 kg/m2, and those with no comorbidities had lower rates of infection and hospitalization than unvaccinated patients, those with BMI <22.3 kg/m2, and those with comorbidities, respectively. Continued NSCLC treatment in patients with COVID-19 was identified as a risk factor for patient survival. NSCLC treatment can be continued for patients who received COVID-19 vaccines, those with higher BMI, and those without comorbidities during the COVID-19 epidemic, but treatment interruption might be required for patients during the active phase of infection.

A novel liver-function-indicators-based prognosis signature for patients with hepatocellular carcinoma treated with anti-programmed cell death-1 therapy

BackgroundThe liver function reserve has a significant impact on the therapeutic effects of anti-programmed cell death-1 (PD-1) for hepatocellular carcinoma (HCC). This study aimed to comprehensively evaluate the ability of liver-function-based indicators to predict prognosis and construct a novel prognostic score for HCC patients with anti-PD-1 immunotherapy.MethodsBetween July 2018 and January 2020, patients diagnosed with HCC who received anti-PD-1 treatment were screened for inclusion in the study. The valuable prognostic liver-function-based indicators were selected using Cox proportional hazards regression analysis to build a novel liver-function-indicators-based signature (LFIS). Concordance index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and Kaplan–Meier survival curves were utilized to access the predictive performance of LFIS.ResultsA total of 434 HCC patients who received anti-PD-1 treatment were included in the study. The LFIS, based on alkaline phosphatase-to-albumin ratio index, Child–Pugh score, platelet-albumin score, aspartate aminotransferase-to-lymphocyte ratio index, and gamma-glutamyl transpeptidase-to-lymphocyte ratio index, was constructed and identified as an independent risk factor for patient survival. The C-index of LFIS for overall survival (OS) was 0.692, which was higher than the other single liver-function-based indicator. The AUC of LFIS at 6-, 12-, 18-, and 24-month were 0.74, 0.714, 0.747, and 0.865 for OS, respectively. Patients in the higher-risk LFIS group were associated with both worse OS and PFS. An online and easy-to-use calculator was further constructed for better application of the LFIS signature.ConclusionThe LFIS score had an excellent prognosis prediction ability superior to every single liver-function-based indicator for anti-PD-1 treatment in HCC patients. It is a reliable, easy-to-use tool to stratify risk for OS and PFS in HCC patients who received anti-PD-1 treatment.

#2771 Peritoneal dialysis after kidney graft loss … and now, what?

Abstract Background and Aims The evolution of peritoneal dialysis (PD) as renal replacement therapy (RRT) after graft loss is not well defined. Method Retrospective analysis of the Andalusian Renal Registry of patients who received their first kidney transplant (KT) in Andalusia (Spain) and returned to dialysis between 1978-2023. Patients who lost follow-up and those who underwent preemptive re-KT were excluded of the study. We compared clinical characteristics and evolution between those who started hemodialysis (HD) and peritoneal dialysis (PD) after graft loss. Secondly, we analyzed technique and patient survival in those who started PD post-KT versus patients on PD as their first renal replacement therapy (RRT) We performed multivariate analysis for PD technique and patient survival risk factors using Cox regression. Results During this period, we followed 11868 KT recipients in Andalusia. Of these, 3148 (26.52%) lost the graft: 2768 started HD and 298 PD. 82 patients underwent preemptive re-KT. Patients who returned to DP were younger (p &amp;lt; 0.001) and glomerulonephritis as cause of chronic kidney disease (CKD) was more frequent (p = 0.019). The pre-KT RRT was HD in 96.3% of patients starting HD post-KT and PD in 48.3% of patients who returned to PD after KT (p &amp;lt; 0.001). Survival of patients in the HD group was lower than those who started PD (p = 0.026). In the multivariate analysis, older age when dialysis restarted, male sex and diabetes were risk factors for patient death and not the type of dialysis. When comparing only the post-KT PD group (n = 298) versus patients on PD as their first RRT (n = 5312), patients on the first group were younger (57.1 vs. 41.9; p &amp;lt; 0.001) and time on PD was longer (24.4 vs. 19 months; p &amp;lt; 0.001). The causes of PD drop-out also varied between groups (p &amp;lt; 0.001). During this period, 269 post-KT PD patients left the technique mainly due to re-KT (34.3%) and in the PD group as the first RRT, there were 4919 technique drop-outs, mainly due to transfer to HD (35.3%) and death (30%). The percentage of peritonitis was higher in the post-KT PD group, although without significant differences (post-KT PD 27.9% vs. PD as first RRT 23.25%; p = 0.061). Survival of the DP technique in post-KT PD group was 78.2% at 1 year and 38.5% at 5 years, and 77.7% and 42.1% respectively in the DP group as the first DP RRT (p = 0.059). In the multivariate analysis, patient age and diabetes as a cause of CKD, behaved as risk factors for patient survival. Conclusion Almost half of the patients starting PD after KT had been on PD prior to transplantation. They tend to have more peritonitis although survival of the technique and complications were very similar to those observed in patients on PD as first RRT.

#2454 Meeting guideline goals at hemodialysis patients impact their survival?

Abstract Background and Aims The Institute of Medicine (IOM) defines clinical practice guidelines as "statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options". First publication of Clinical Guidelines by the National Kidney Foundation (NKF), addressing good clinical practice in hemodialysis, was published in 1998. The aim of the present study was to investigate the influence of adherence to current guidelines of Mineral and Bone Disorders, Anemia and Adequacy of Dialysis, on their survival in patients undergoing hemodialysis. Method This is a single center retrospective study of 113 chronic hemodialysis patients (79 males and 34 females), with median age 70 years (56, 78), median duration on hemodialysis 52 months (21, 95). Based on whether or not they met the KDIGO guidelines’ targets for anemia, bone disease, dialysis adequacy, and the targets of all three guidelines during the last three years, patients were divided in two groups: group A with the patients who met the goals of the guidelines and group B with the patients who did not meet the goals. Clinical and biochemical parameters were compared among the groups of patients as well as hemodialysis adequacy (Kt/V). The survival analysis of the patients was calculated by Kaplan-Meier, while the possible effect of any parameter on survival was also evaluated with Cox-Regression. Results There was significant difference between the two groups in age, phosphorous (P), PTH, Kt/V, URR and Alb. There was no significant difference between the two groups in sex, duration of HD, Hemoglobin (Hg), Calcium (Ca++), Hypertension and Diabetes (Table). In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, p=0.044). There was no significant difference between the two groups when we compare the adherence to guidelines for MBD (p=0.507) and anemia (p=0.394). There was no statistical difference when we compare the achievement of targets of all three guidelines (p=0.796). We identified as an independent risk factor for patient survival the serum albumin (p&amp;lt;0.001). Patient survival was better with higher dialysis dose and adequate serum albumin level. Conclusion Clinical guidelines are useful tools for good clinical practice for hemodialysis patients. Adherence to clinical guidelines regarding dialysis adequacy is an independent risk factor for better survival of patients undergoing hemodialysis.

Renal Transplant in Elderly End-Stage Renal Disease Patients: Impact of Comorbidities and Posttransplant Adverse Events on Outcomes.

Elderly renal transplant continues to be debated because of age-related factors affecting transplant success and long-term prognosis. We investigated the effects ofrecipient age and predictors of renal transplant outcomes in elderly renal transplant recipients. We retrospectively analyzed 506 patients who had a first renal transplant between January 2010 and December 2020; there were 165 recipients aged ≥60 years (elderly) and 341 recipients aged <60 years (young).We collected recipient, donor, and transplant characteristics and assessed 1-, 3-, and 5-year overall patient and death-censored graft survival and risk factors influencing outcomes ofrenal transplant in elderly recipients. Elderly recipients showed significantly lower 1-, 3-, and 5-year patient survival rates (96.3%, 89.8%, 80.9%) than young recipients (98.8%, 98.5%, 97.8%; P < .001). However, death-censored graft survival rates were not significantly different (P = .459) between elderly (96.3%, 94.3%, 93.2%) and young recipients (97.7%, 97.0%, 93.9%). Advanced recipient age was identified as an independent risk factor for patient survival, irrespective of donor age. In elderly recipients, male gender (hazard ratio 2.013; 95% CI, 1.110-3.649), pretransplant cardiovascular disease (hazard ratio 1.774; 95% CI, 1.030-3.553), and posttransplant chestinfection (hazard ratio 2.421; 95% CI, 1.439-4.076) were significant predictors of inferior patient survival. Proteinuria at 1 month (hazard ratio 1.006; 95% CI, 1.000-1.011) and low estimated glomerular filtration rate at 3 months (hazard ratio 0.943; 95% CI, 0.899-0.988) posttransplant were early predictors of worse death-censored graft survival. Elderly renaltransplantrecipients showed promising 5-year patient and death-censored graft survival, exceeding 80%, despite higher mortality risk compared with young recipients. Optimizing outcomes of elderly renal transplant necessitates a multifaceted approach encompassing meticulous pretransplant cardiovascular disease assessment, rigorous posttransplant chest infection prevention and management, and proactive monitoring for early posttransplant kidney dysfunction, to permit timely intervention.

Low-dose radiotherapy promotes the formation of tertiary lymphoid structures in lung adenocarcinoma.

A tertiary lymphoid structure (TLS) refers to an organized infiltration of immune cells that is linked to a positive prognosis and improved response to immunotherapy. However, methods that promote TLS formation are limited and challenging to implement in clinical settings. In this study, we aimed to promote the formation and maturation of TLSs in lung adenocarcinoma (LUAD) by combining low-dose radiotherapy (LDRT) with immunotherapy. Tissue sections from 198 patients who had undergone surgery were examined. Risk factors for patient survival were assessed, and the relationship between TLSs and five-year survival was analyzed. The Kras-LSL-G12D spontaneous lung cancer mouse model was used to screen the optimal irradiation dose (0/1/2 Gy whole lung irradiation) for promoting TLS formation. LDRT combined with anti-PD-1 was used to promote the formation and maturation of TLSs. TLS+, TLSHigh, TLS+GC+ and CD8High within TLS+ were associated with a favorable prognosis. LDRT increased the formation of early TLSs in the Kras-LSL-G12D lung cancer mouse model. In addition, LDRT combined with anti-PD-1 treatment can significantly improve the maturity of TLSs in mouse LUAD, resulting in greater antitumor effects. This antitumor effect was strongly associated with the number of CD8+ T cells within the TLSs. We successfully applied LDRT combined with PD-1 inhibitor therapy for the first time, which increased both the quantity and maturity of TLSs in lung cancer. This approach achieved a promising antitumor effect.

Correlation Between NLR Combined with PLR Score and Prognosis of Hepatocellular Carcinoma After Liver Transplantation.

This investigation evaluated the prognostic significance of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and introduced a combined NLR-PLR score to evaluate the correlation between NLR-PLR score and hepatocellular carcinoma (HCC) recurrence. We enrolled 110 patients who underwent orthotopic liver transplantation (LT) for HCC. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were assessed, and appropriate cut-off values were established. The NLR-PLR score ranged from 0 to 2 as follows: score of 2, high NLR (≥3.37) and high PLR (≥105.96); score of 1, either high NLR or high PLR; score of 0, neither high NLR nor high PLR. The median overall survival (OS) of patients with NLR-PLR score of 0, 1 and 2 was 27, 26.5, and 6 months, respectively. The median OS of patients with NLR-PLR score of 2 was shorter than those with 0 (P < 0.001) and 1 (P < 0.001). The median disease-free survival (DFS) time of patients with NLR-PLR score of 0, 1 and 2 was 24.5, 24, and 6 months, The median DFS of patients with NLR-PLR score of 2 was shorter than those with 0 (P = 0.001) and 1 (P = 0.015). Multivariate analysis showed that NLR-PLR score was an independent risk factor for prognosis and survival. NLR, PLR and NLR-PLR score can predict the long-term survival of patients, and NLR-PLR score, having more predictive value than NLR and PLR alone is an independent risk factor for patient survival. more predictive value than NLR and PLR alone.

Positive TIGIT and VISTA Expression Predict Worse Prognosis in Cervical Cancer Patients Treated with (Chemo)Radiotherapy

Immune checkpoint inhibitors combined with (chemo)radiotherapy could be an attractive treatment strategy for patients with cervical cancer (CC), but the expression of some immune checkpoint proteins in cervical cancer and their impact on patient survival remains largely unknown. Here, we investigated the predictive value of T cell immunoreceptor with Ig and ITIM domain (TIGIT), V-domain Ig suppressor of T cell activation (VISTA), and lymphocyte-activation gene-3 (LAG-3) expression in pathological tissues of CC patients treated with (chemo)radiotherapy. We enrolled 175 CC patients who received (chemo)radiotherapy and collected their pre-treatment tumor tissue sections for the immunohistochemical stain of TIGIT, VISTA, and LAG-3. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS) after (chemo)radiotherapy. Univariate and multivariate COX proportional hazards regression models were employed to analyze potential risk factors for patient survival. Kaplan-Meier survival analyses showed that the PFS and OS of patients with positive expression of TIGIT and VISTA were significantly shorter than those patients with negative expression of the proteins (all p<0.05). However, we did not reach the same conclusion in the analysis of LAG-3 (both p>0.05). Univariate COX regression analysis showed that the positive expression of TIGIT and VISTA are related to poor PFS and OS (both HR>1.0 and p<0.05). Multivariate COX regression analysis showed that TIGIT positive and VISTA positive patients have shorter PFS and OS (both HR>1.0 and p<0.05). There is no significant correlation between LAG-3 expression and PFS or OS in these CC patients treated with (chemo)radiotherapy. We revealed that positive TIGIT and VISTA expression could predict worse prognosis in cervical cancer patients treated with (chemo)radiotherapy, which may help to refine the treatment strategies of combining immune checkpoint inhibitors and radiotherapy.

Clinicopathological characteristics and outcomes of lupus nephritis patients with scanty immune depositions in kidneybiopsies.

The clinicopathological features, outcomes, and pathogenesis of lupus nephritis with scanty immune deposits in the kidney biopsy remain unclear. Four hundred ninety-eight biopsy-proven lupus nephritis patients were included, and clinical and pathological data were collected. The primary endpoint was mortality, while the secondary endpoint was doubling baseline serum creatinine or end-stage renal disease. Associations between scanty immune deposits lupus nephritis and adverse outcomes were analyzed by Cox regression models. Among 498 lupus nephritis patients, 81 were diagnosed withscanty immune deposits. Patients with scanty immune deposits had significantly higher serum albumin and serum complement C4 than those with immune complex deposits. The proportion of anti-neutrophil cytoplasmic antibodies was similar between the two groups. In addition, patients with scanty immune deposits showed less proliferativefeatures at kidney biopsy and lower activity index score, accompanied by milder mesangial cell and matrix hyperplasia, endothelial cell hyperplasia, nuclear fragmentation, and glomerular leukocyte infiltration. Patients in this group also had a milder degree of foot process fusion. Overall, renal survival and patient survival showed no significant difference between the two groups. 24-h proteinuria and chronicity index were significantrisk factors for renal survival, and 24-h proteinuria and positive anti-neutrophil cytoplasmic antibodies were risk factors for patient survival in scanty immune deposits lupus nephritis patients. Compared with other lupus nephritis patients, scanty immune deposits lupus nephritis patients had significantly lower activity features on kidney biopsy, but have similar outcomes. Positive anti-neutrophil cytoplasmic antibodies may be a risk factor for patient survival in scanty immune deposits lupus nephritis patients.

#4934 HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY WITH CISPLATIN INCREASES THE RISK OF ACUTE KIDNEY INJURY COMPARED TO CONVENTIONAL INTRAPERITONEAL CISPLATIN

Abstract Background and Aims Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin is increasingly used for the treatment of ovarian and peritoneal cancer. Acute kidney injury (AKI) is a frequent complication after cisplatin containing HIPEC therapy. The aim of this study was to compare the incidence and severity of AKI and renal survival after HIPEC compared to repeated cycles of conventional high-dose intraperitoneal cisplatin in patients with ovarian and malignant peritoneal cancer. Method We conducted a retrospective study that included patients with ovarian cancer that received repeated cycles of high-dose intraperitoneal cisplatin and patients with ovarian and primary malignant peritoneal cancer that received HIPEC with cisplatin in our center between August 2006 and September 2022. Demographic and perioperative data were compared between both groups. We compared the incidence of AKI defined as a rise in serum creatinine by ≥ 0.3 mg/dL within 48 hours (KDIGO criteria), the severity of AKI defined as stages I, II and III using the KDIGO staging, the rate of kidney function recovery and need for renal replacement therapy in both groups. We performed logistic regression analysis to identify independent risk factors for experiencing AKI and conducted survival analyses and multivariate Cox regression analyses to detect independent risk factors for patient survival. Results The study included 39 patients; 20 received 76 cycles of conventional intraperitoneal cisplatin, and 19 patients (13 with ovarian cancer and 6 with primary peritoneal cancer) received HIPEC. Patients who received HIPEC were older (63.4±20 years vs 56±8 years, p = 0.002) and received a lower dose of cisplatin both in absolute values (109.2±41.1 mg vs 159.2±15.2 mg, p&amp;lt;0.001) and adjusted by body surface area (63.4±19.9 mg/m2 vs 96.8±9.2 mg/m2, p&amp;lt;0.001). AKI was significantly more frequent in patients receiving HIPEC (42.1% vs 15.8%, p = 0.012), and was more severe after HIPEC with AKIN-I, AKIN-II and AKIN-III in 50% vs 83%, 12.5% vs 16.7% and 37.5% vs 0% respectively, p = 0.042. Recovery from AKI was more frequent in patients receiving conventional intraperitoneal cisplatin (100% vs 50%, p = 0.014) and 1 patient in the HIPEC group progressed to end stage kidney disease. In the multivariate logistic regression analysis, after adjusting for age, baseline serum creatinine and cisplatin dose, treatment with HIPEC compared to conventional high-dose intraperitoneal cisplatin remained a significant risk factor for developing AKI (OR 1550, CI 95% 19-128070). Conclusion Cisplatin-based HIPEC therapy is associated with an increased risk of severe AKI compared to conventional high-dose intraperitoneal cisplatin regimens, despite the use of prophylactic measures. Hyperthermic perfusion of the abdomen might be an important contributing factor in HIPEC-induced renal injury. To reduce the incidence of AKI and its associated morbidity after HIPEC, early implementation of preventive measures with adequate fluid management and closer monitoring of hemodynamic parameters and kidney function tests should be taken into consideration.

Preoperative hemoglobin levels, extended resections and the body mass index influence survival after pancreaticoduodenectomy

The negative influence of perioperative transfusion of packed red blood cells on the prognosis of various malignancies is the focus of recent research interest. The development of a propensity score for the prediction of perioperative transfusion of packed red blood cells (pRBCs) and the identification of independent risk factors for survival, that can either be known prior to or during surgery in patients undergoing pancreaticoduodenectomy for pancreatic head cancer are the two objectives of this study. Logistic regression analyses and Cox regression modeling were used to identify independent risk factors for perioperative transfusion of pRBCs and to determine individual risk factors for patient survival. A total of 101 adult patients who underwent surgery between 01/01/2016 and 12/31/2020 were investigated in a single-center retrospective analysis. Preoperative hemoglobin levels (OR: 0.472, 95%-CI: 0.312-0.663, p < 0.001) and extended resections (OR: 4.720, 95%-CI: 1.819-13.296, p = 0.001) were identified as independent risk factors for perioperative transfusion of pRBCs, enabling the prediction of pRBC transfusion with high sensitivity and specificity (AUROC: 0.790). The logit of the derived propensity model for the transfusion of pRBCs (HR: 9.231, 95%CI: 3.083-28.118, p < 0.001) and preoperative Body Mass Index (BMI) (HR, 0.925; 95%-CI: 0.870-0.981, p = 0.008) were independent risk factors for survival. Low preoperative hemoglobin levels, low BMI values, and extended resections are significant risk factors for survival that can be known and thus potentially be influenced prior to or during surgery. Patient blood management programs and prehabilitation programs should strive to increase preoperative hemoglobin levels and improve preoperative malnutrition.

Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation.

To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment. A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups. The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both). Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.

Characterization of Epithelial-Mesenchymal Transition Identifies a Gene Signature for Predicting Clinical Outcomes and Therapeutic Responses in Bladder Cancer.

The complex etiological variables and high heterogeneity of bladder cancer (BC) make prognostic prediction challenging. We aimed to develop a robust and promising gene signature using advanced machine learning methods for predicting the prognosis and therapy responses of BC patients. The single-sample gene set enrichment analysis (ssGSEA) algorithm and univariable Cox regression were used to identify the primary risk hallmark among the various cancer hallmarks. Machine learning methods were then combined with survival and differential gene expression analyses to construct a novel prognostic signature, which would be validated in two additional independent cohorts. Moreover, relationships between this signature and therapy responses were also identified. Functional enrichment analysis and immune cell estimation were also conducted to provide insights into the potential mechanisms of BC. Epithelial-mesenchymal transition (EMT) was identified as the primary risk factor for the survival of BC patients (HR=1.43, 95% CI: 1.26-1.63). A novel EMT-related gene signature was constructed and validated in three independent cohorts, showing stable and accurate performance in predicting clinical outcomes. Furthermore, high-risk patients had poor prognoses and multivariable Cox regression analysis revealed this to be an independent risk factor for patient survival. CD8+ T cells, Tregs, and M2 macrophages were found abundantly in the tumor microenvironment of high-risk patients. Moreover, it was anticipated that high-risk patients would be more sensitive to chemotherapeutic drugs, while low-risk patients would benefit more from immunotherapy. We successfully identified and validated a novel EMT-related gene signature for predicting clinical outcomes and therapy responses in BC patients, which may be useful in clinical practice for risk stratification and individualized treatment.

Liver Transplantation in Sexagenarian Patients Using Grafts From Uncontrolled Circulatory Death Versus Grafts From Brain Death Donation

An increased number of older recipients underwent liver transplantation in recent years, and consequently needing to obtain more liver grafts. In order to increase this pool, in 2006, we initiated the use of livers from uncontrolled circulatory death (uDCD). We analyzed the use of uDCD livers in sexagenarian recipients and their effect on overall survival. A retrospective and comparative study was performed among 4 groups according to recipient age (less or greater than 60 years) and donor type (donor brain death [DBD] or uDCD): Group A: DBD livers in recipients aged <60 years (n=169); Group B: uDCD livers in recipients aged <60 years (n=36); Group C: DBD livers in recipients aged >60 years (n=96); and Group D: uDCD livers in recipients aged >60 years(n=39). Intraoperative transfusion, biliary complications, primary non-function, acute rejection, chronic renal dysfunction, retransplantation, and mortality during follow-up (cardiovascular diseases in 3 patients, hepatitis C virus recurrence in 4 patients, and de novo malignancies in 3 patients) were significantly higher, and 5-year patient and graft survival was significantly lower in sexagenarian recipients. Bilirubin and packed red blood cells transfusion were risk factors for patient survival, whereas hepatocelular carcinoma, creatinine, and packed red blood cells transfusion were risk factors for patient survival. Recipient age (<60 years) was confirmed as protective factor for patient and graft survival, whereas the use of uDCD was not a risk factor for patient or graft survival. Use of a uDCD liver did not demonstrate as a risk factor for patient and graft survival, and recipient age (<60 years) was a protective factor for patient and graft survival.

Long-Term Kidney Prognosis and Pathological Characteristics of Late-Onset Lupus Nephritis.

BackgroundArguments still exist on prognosis of late-onset SLE, especially their kidney function. The purpose of this study was to investigate long-term kidney outcomes in patients with late-onset lupus nephritis (LN).MethodsA retrospective long-term cohort study was conducted in adult Chinese patients with LN. The patients were divided into late- (>50 years) and early-onset (<50 years) LN groups. The baseline characteristics, especially the kidney pathological characteristics, were compared. The cohort was followed-up for kidney outcome defined as doubling of serum creatinine or ESRD. Cox regression analysis was used to examine the association between late onset LN and its outcomes.ResultsA total of 1,264 patients were recruited, who were assigned to late-onset LN with 102 patients and early-onset LN with 1,162 patients. The late-onset LN group showed a worse baseline kidney function and more chronic pathological lesions than the early-onset LN group. During a follow-up time of 55 (3, 207) months, 114 (13.1%) deaths occurred, 107 (12.2%) had doubling of creatinine, and 80 (9.1%) developed end-stage kidney disease. The 5- and 10-year survival rates of the late-onset LN group were 67.6 and 50.5%, respectively, which were much worse than those of the early-onset LN group (89.8 and 84.6%, respectively). However, no significant difference was found on kidney survival (log-rank chi-square = 3.55, p = 0.06). Cox regression analysis showed that late-onset LN was an independent risk factor for patient survival (hazard ratio = 3.03, 95% CI (1.39, 6.58), p = 0.005). Increased baseline serum creatinine was an independent risk factor for kidney survival of patients with late-onset LN.ConclusionsPatients with late-onset LN had milder active lesions but severer chronic lesions in kidney pathology. They have poorer overall outcome but relatively favorable kidney outcome.Trial RegistrationClinicalTrials.gov Identifier: NCT03001973, 22 December 2016 retrospectively registered.

Kidney transplant outcomes in elderly recipients with controlled donation after circulatory death or donation after brain death donors: a registry cohort study.

The number of kidney transplant (KT) procedures with controlled donation after circulatory death (cDCD) donors has exponentially increased in Spain in recent years, with a parallel increase in donor and recipient acceptance criteria. The outcomes of cDCD-KT have been reported to be comparable to those of KT with donation after brain death (DBD) donors. However, studies in elderly recipients have yielded contradictory results. We performed a registry analysis of 852 KT recipients aged ≥65years (575 in the DBD-KT group, 277 in the cDCD-KT group) in Catalonia, Spain. Clinical outcomes and survival were compared between DBD-KT and cDCD-KT recipients. The donor and recipient ages were similar between the two groups (71.5±8.7years for donors, 70.8±4.1years for recipients). Delayed graft function (DGF) was more frequent among cDCD-KT recipients, without a difference in the rate of primary nonfunction. The 3-year patient and death-censored graft survival rates were similar between DBD-KT and cDCD-KT recipients (78.8% vs. 76.4% and 90.3% vs. 86.6%, respectively). In multivariable analysis, previous cardiovascular disease and DGF were independent risk factors for patient death. The type of donation (cDCD vs. DBD) was not an independent risk factor for patient survival or graft loss. cDCD-KT and DBD-KT provide comparable patient and graft survival in elderly recipients.

Derivation and Clinical Validation of a Redox-Driven Prognostic Signature for Colorectal Cancer.

Colorectal cancer (CRC), a seriously threat that endangers public health, has a striking tendency to relapse and metastasize. Redox-related signaling pathways have recently been extensively studied in cancers. However, the study and potential role of redox in CRC remain unelucidated. We developed and validated a risk model for prognosis and recurrence prediction in CRC patients via identifying gene signatures driven by redox-related signaling pathways. The redox-driven prognostic signature (RDPS) was demonstrated to be an independent risk factor for patient survival (including OS and RFS) in four public cohorts and one clinical in-house cohort. Additionally, there was an intimate association between the risk score and tumor immune infiltration, with higher risk score accompanied with less immune cell infiltration. In this study, we used redox-related factors as an entry point, which may provide a broader perspective for prognosis prediction in CRC and have the potential to provide more promising evidence for immunotherapy.

Pre-and Post-Transplant Serum Lactate Dehydrogenase Levels as a Predictive Marker for Patient Survival and Engraftment in Allogeneic Hematopoietic Stem Cell Transplant Recipients.

The discovery of biomarkers to predict the development of complications associated with hematopoietic stem cell transplantation (HSCT) offers a potential avenue for the early identification and treatment of these life-threatening consequences. Serum lactate dehydrogenase (sLDH) has been identified as a potential biomarker for determining the outcome of allogenic HSCT (allo-HSCT). A retrospective study was performed using data collected from 204 allo-HSCT recipient patients to examine the predictive value of sLDH levels pre- and post-allo-HSCT on patient survival, graft-versus-host-disease (GVHD) incidence, and time to platelet/white blood cells (WBC) engraftment. Our findings show that neither pre- (p= 0.61) nor post-transplantation (p= 0.55) sLDH levels were associated with GVHD incidence. However, elevated sLDH levels pre- and post-transplantation (≥ 386 and ≥ 409 IU/mL, respectively) were found to be adverse risk factors for patient survival (p= 0.16, p= 0.20, respectively). Furthermore, a median sLDH level ≥ 400 IU/mL from day +5 to day +15 post-transplantation had a significant positive association with enhanced time to platelet and white blood cell (WBC) engraftment, compared to patients with sLDH levels < 400 IU/mL (p< 0.001). Our data suggests that high sLDH levels pre- and post-allo-HSCT could be considered a predictor of poor patient survival. Furthermore, high levels of sLDH days 5-15 post-allo-HSCT could be associated with improved time to platelet and WBC engraftment; however, this appears to come at the cost of increased mortality risk.

Liver transplantation for hepatocellular carcinoma using grafts from uncontrolled circulatory death donation

Controversy exists regarding whether the rate of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplantation (OLT) differs when using livers from donation after controlled circulatory death (DCD) versus livers from donation after brain death (DBD). The aim of this cohort study was to analyze rates of HCC recurrence, patient survival, and graft survival after OLT for HCC, comparing recipients of DBD livers (n = 103) with recipients of uncontrolled DCD livers (uDCD; n = 41). No significant differences in tumor size, tumor number, serum alpha-fetoprotein, proportion of patients within Milan criteria, or pre-OLT bridging therapies were identified between groups, although the waitlist period was significantly shorter in the uDCD group (p = 0.040). HCC recurrence was similar between groups. Patient survival was similar between groups, but graft survival was lower in the uDCD group. Multivariate analysis identified recipient age (p = 0.031), pre-OLT bridging therapy (p = 0.024), and HCC recurrence (p = 0.048) as independent risk factors for patient survival and pre-OLT transarterial chemoembolization (p = 0.045) as the single risk factor for HCC recurrence. In conclusion, similar patient survival and lower graft survival were observed in the uDCD group. However, the use of uDCD livers appears to be justified due to a shorter waitlist time, and lower waitlist dropout and HCC recurrence rates.

Application of competing risk model in the prognostic prediction study of patients with follicular thyroid carcinoma.

Follicular thyroid carcinoma (FTC) is an indolent carcinoma. The cumulative incidence of death from patients with FTC and the nomogram built based on the competing risks model have not been described. The data from patients diagnosed with primary FTC were identified and extracted from the surveillance, epidemiology, and end results (SEER) program (1988-2015). The cumulative incidence function was utilized to calculate the likelihood of death resulting from thyroid cancer and other causes, respectively. Gray's test was used to examine the difference in the cumulative incidence of death between the groups. A tenfold cross-validation was applied to assess the discrimination and calibration of the model. A total of 9210 patients diagnosed with primary FTC were included. The median follow-up time was 92months (1-347months). The 5-year, 10-year, and 20-year probabilities of death from FTC were 2.84%, 5.23%, and 8.61%, respectively. The age at diagnosis, sex, tumor size, pathological subtypes, tumor extension, lymph node involvement, as well as surgical and radiotherapy methods used, were related to the cumulative incidence of death. Multivariate analysis identified several risk factors for patient survival. The model behaved well in terms of performance. A nomogram based on the model allowed the prediction of the probability of death among patients with FTC. The prognosis of FTC is excellent. The likelihood of death caused by thyroid cancer increases with age. Male sex, tumors larger than 4cm, invasion, extrathyroidal extension, lymph node involvement, and distant metastases increase the risk of dying of thyroid carcinoma. The nomogram constructed on the basis of the model is potentially useful for both clinicians and patients.