Department Of Transplantation Research Articles

2037. A Novel Strategy of Antimicrobial Stewardship in Shanghai: Preliminary Practice with Integration of Three Surveillance Networks

BackgroundThe bacterial resistance surveillance networks, antimicrobial clinical use surveillance networks and provincial hospital-acquired infection (HAI) surveillance have been well established in China. They aim to inform the current situation of bacterial resistance, antimicrobial use and HAI, and to guide the rational use of antimicrobials. However, these three networks presently are running separately. To increase the data value in antimicrobial stewardship (AMS)practice, those three surveillance networks are integrated in ShanghaiMethodsThe Committee of Rational Use of Antimicrobials and AMS of Shanghai Municipal Health Commission, consisting of health administrators, clinical physicians and microbiologists, clinical pharmacologists and infection control experts, was formed in 2017. The oversight committee developed a comprehensive AMS score index mainly based on the surveillance data of the three networks to evaluate the AMS requirements in the hospitals. The AMS score index consists of 3 surveillance network indexes: resistance weight index; antimicrobial weight index and HAI weight index; each of the indexes is further divided into two parts, namely the surveillance quality score and data-related score. For example, the data-related score in the resistance index is calculated for the prevalence of 6 most important MDR/XDR bacteria (CRKP, CRAB, CRPA, ESBL, MRSA, VRE). A multi-disciplinary AMS team was convened to provide expert on-site visit of the hospitals and offered AMS support in the form of practical guidance and advice.ResultsAMS score and detailed score such as the prevalence of CRKP were ranked among 50 hospitals within the networks. These scores will support the AMS team to find out the main drivers of resistance/antibiotic use and thereby support appropriate interventions during the on-site visit. For example, a hospital visited which had a high consumption of carbapenems (ranked third in Shanghai) and also had a high percentage of carbapenems used in the department of liver transplantation. The advice of the on-site visit team was to encourage a more diverse group of antibiotics so as to spare carbapenems.ConclusionInvolvement of the multi-disciplinary team and integration of surveillance networks are very helpful in AMS practice.Disclosures All authors: No reported disclosures.

Infection profile in children and adolescents with bone marrow failures treated with allogeneic hematopoietic stem cell transplantation.

The objective of the study was to analyze the profile of infections in children with BMF following alloHCT. Data of 169 consecutive children with inherited and acquired BMF treated with alloHCT between 2012 and 2017 in Polish pediatric transplant departments were analyzed in registry-based retrospective study, with respect to the type of infection, and clinical outcome. At least 1 infection was diagnosed in 107/169 patients (60.4%). In total, 182 infections were diagnosed. The most common were VI (96; 52.7%), followed by BI (71; 39.0%), and FI (15; 8.2%), P<.001. The most common etiological factors of VI were as follows: CMV (38.5%), EBV (22.9%), and BK virus (24%); while of BI were as follows: Staphylococcus spp. (17; 23.9%), Enterococcus faecium (10; 14.1%), and Klebsiella pneumoniae (9; 12.7%). No difference was found between the occurrence of infections with respect to donor type, graft source, and conditioning type. GvHD had no impact on the incidence of VI, BI, and FI. Fifteen FI were diagnosed in 12 patients, of which 14 FI were diagnosed in children transplanted for FA. Of total 107 children, 9 died (8.4%), of which 4 (3.7%) due to infections: bacterial sepsis (2) and invasive FI (2). Infections in children with BMF following alloHCT remain an important cause of morbidity. Children with FA had high incidence of FI. In our analysis, aGvHD had no impact on the occurrence on infections, although the study was not strong enough to prove such a difference.

Editorial introductions

Editorial introductions

Efficacy of short term valganciclovir in a standard-dose for cytomegalovirus prophylaxis in living donor kidney transplantation: a single-center report

Immunosuppressive drugs predispose the kidney transplant recipient to reactivation of сytomegalovirus (CMV) infections. Prophylaxis given to these patients is very important for the prevention of opportunistic CMV infections.&#x0D; The objective of this study was to evaluate the short term and standard-dose valganciclovir prophylaxis for CMV infections in living donor kidney transplantation.&#x0D; Methods. This study is retrospective one. Between April 2014 and April 2019 100 patients after living donor kidney transplantation with results CMV PCR-DNA and prophylactic treatment were studied retrospectively at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey.&#x0D; Results.The mean age was 38.3±15.6 years. 68 (68%) patients were males and 32 (32%) patients were females. All patients were treated with 900 mg daily and 90 days valganciclovir prophylaxis. Mean follow-up was 29.1±15 months. There were not detected CMV infections during the follow-up period.&#x0D; Conclusions: Short term and standard-dosevalganciclovir prophylaxis appears to be successful prevention CMV infections in living donor kidney transplantation.

USE OF PERIPHERALLY INSERTED CENTRAL CATHETER IS INTEGRAL TO SUPPORTIVE CARE IN HEMATOPOIETIC STEM CELLS TRANSPLANTATION – A SINGLE CENTRE STUDY

Background: Peripherally inserted central catheters (PICCs) are commonly being used in haematological diseases for&nbsp;treatment and now are being used even in haemopoietic stem cells transplantation. The present study was planned with an&nbsp;objective to study the complications, safety and efficacy of PICCs in haemopoietic stem cell transplantation for&nbsp;haematological diseases. Methods: A prospective cohort study was conducted in stem cell transplantation department of our&nbsp;tertiary care cancer hospital for a period of two and half years as per the proforma. All patients with hematological cancer who&nbsp;were undergoing stem cell transplantation were enrolled and were followed up until catheter removal or patient death. The&nbsp;basic information was recorded at the time of PICC insertion, weekly care, and removal after the transplantation. The data&nbsp;were analyzed to study the aims and objectives of the study. Results: Seventy two PICCs were inserted over a period of two&nbsp;and half years for a total of 8048 catheter-days (mean of 111.77 +/_ 66.55 days i.e 3.7 months, range: 9 to 269 days). Out of&nbsp;these 72 PICCs, 11 (15.27%) PICCs had complications and all of them were removed at the rate of 1.35/1000 PICC-days.&nbsp;Catheter related blood stream infection (CRBSI) was higher in allogenic transplant group (16%) than in autologous group&nbsp;(2.5%) while thrombosis was present in allogenic group only. Mortality due to non-PICC complications was higher in&nbsp;allogenic transplant (40%) than in the autologous group (7.5%). Conclusion: PICCs plays an integral part to supportive care in&nbsp;hematopoietic stem cell transplantation for hematological cancers.

Use of double J stent in kidney transplantation: a single-center cohort report

Kidney transplantation is the treatment of choice for end-stage kidney disease.The double J stent is commonly used in kidney transplantation.The incidence of urologic complications varies between 0.22 % and 30 %. Ureteral strictures and urinary leakage are the most common urological complications after kidney transplantation. Use of the double J stent can decrease urological complications after kidney transplantation. However, the double J stent can increase urinary tract infections, suprapubic pain and urinary incontinence.&#x0D; This study aimed to evaluate the outcomes of the use of double J stent in kidney transplantation.&#x0D; Methods. Between April 2014 and April 2019 130 patients with the use of double J stent were studied retrospectively at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey. In these patients, demographic features, clinical features and urologic complications were evaluated.&#x0D; Results. The mean age of the patients was 38.3 ± 15.6 years. 84 (67 %) patients were males and 46 (33 %) were females. Mean follow-up was 29.1 ± 15 months. Mean double J stent removal time was 31.3 ± 2.2 days. During follow-up, there were no ureteral strictures and urinary leakage. Urinary infections were diagnosed in 5 (3.8 %) patients.&#x0D; Conclusions. Use of double J stent appears to be successful to prevent the urological complications in kidney transplantation.

A Preoperative Educational Time-Out is Associated with Improved Resident Goal Setting and Strengthens Educational Experiences

The purpose of this study was to assess the impact of a preoperative Educational Time-Out (ETO) with structured postoperative feedback on resident preoperative goal-setting and the educational experience of a clinical rotation. A preoperative ETO was developed during which trainees and faculty jointly identified an operative goal and discussed the trainee's operative autonomy. Postoperative feedback with a smartphone application was encouraged. From November 2016 to October 2017, the intervention was piloted with 1 surgical service. Outcomes included ETO completion rate, goal setting rate, and subjects' perception of the impact of the ETO on identification of performance deficits, trainee autonomy, and receipt of feedback. Data were analyzed using descriptive statistics. This study was performed in an institutional hospital setting. Third-year general surgery residents and surgical faculty in the Department of Hepatobiliary Surgery and Liver Transplantation at Vanderbilt University Medical Center took part in the intervention. Seven residents and 7 attending surgeons participated in this study. Residents performed a median of 15 procurements during an average of 6.5 weeks each on service. The ETO completion rate was 83%. Resident-reported preoperative goal setting increased after the intervention (from 36% to 78%, p = 0.015). Subjects reported a positive impact of the intervention, with high resident agreement that the ETO helped identify deficits (82% median agreement), increased autonomy (82% median agreement), and increased receipt of feedback (84% median agreement). Residents and attendings agreed that the educational experience was stronger due to the ETO (median 81% and 77%, respectively). The ETO intervention improved rates of resident preoperative goal setting and strengthened perceived educational experiences. Resident participants also reported improvements in autonomy and rates of postoperative feedback. Broader implementation of this brief preoperative pause is an easy way to emphasize procedural education in the operating room.

Practice of allogeneic hematopoietic stem cell transplantation for infantile autosomal recessive osteopetrosis

Generalized osteopetrosis is a rare hereditary disease characterized by impairment of skeleton bones formation, bone marrow dysfunction, neurologic deficiency and blindness. The main treatment for osteopetrosis is an allogeneic hematopoietic stem cell transplantation (allo-HSCT). To review and analyze experience of Department of bone marrow transplantation of RDKB (BMT RDKB) of allo-HSCT for patients with autosomal recessive generalized osteopetrosis; to evaluate tolerability and efficacy of the conditioning regiment administered. Between 2010 to 2018 years, 7 patients (2-male, 5-female) with autosomal recessive generalized osteopetrosis underwent allo-HSCT in tDepartment of bone marrow transplantation of RDKB. Median age at the moment of HSCT was 5,5 years (1–11 years). Before the transplantation myeloablative conditioning regimen was used: treosulfan, fludarabine and melphalan for 5 patients, treosulfan, fludarabine and thiotepa for 1 patient and treosulfan with fludarabine for 1 patient. In case of unrelated allo-HSCT antithymocyte globulin was added to the conditioning regimen. Bone marrow from matched (HLA- 10/10) unrelated donor was used for 4 patients, peripheral blood stem cells from matched unrelated donor was used for 1 patient, two grafts of unrelated umbilical cord blood (HLA 8/10 and 9/10) for 1 patient and peripheral blood stem cells from matched (HLA 10/10) from related donor – for 1 patient. For “graft-versus-host” disease (GVHD) prophylaxis either cyclosporine A/tacrolimus and methotrexate/ mofetil mycophenolate was used. White blood cell recovery had been achieved for 6 from 7 patients on +13 to +22 day (median +17 day). Quick autoreconstitution of hemopoesis was observed for the recipient of umbilical cord blood who got one myeloablative drug. The following early post transplantation complications were registered: oropharyngeal mucositis up to II degree in 6 patients, neutropenic enterocolitis up to II degree in 4 patients, up to III degree in 3 patients, sepsis in 3 patients. The GVHD symptoms occurred in 2 cases: skin form of II degree in one patient and skin form of II degree and intestinal form of IV degree in another patient. One patient with neurodegenerative form of osteopetrosis died with increase of hypertensive-hydrocephalus syndrome, cerebral edema with downward cerebellar herniation. During 5-6 months after allo-HSCT the 5 successfully transplanted patients experienced poor graft function but then reduction of extramedullary hemopoesis occurred and full engraftment was achieved. Hypercalcemia was reported in 2–5 months after allo-HSCT and was treated by administration of bisphosphonates. Visual impairment persisted after allo-HSCT. After 4–6 months after transplantation axis skeleton growth occurred for all 5 successfully transplanted patients, skull deformation reduced and no new zones of nerve’s compression were observed. No patients had any developmental delays after the treatment. Allo-HSCT is an effective systemic treatment of autosomal recessive generalized osteopetrosis. However because serious neurodegenerative condition cannot be reversed by allo-HSCT, such treatment may not be recommended for patients with heavy CNS impairment. Myeloablative conditioning regimen with two alkylating agents provides allogeneic reconstitution of hemopoesis. In post transplantation period, measures for hypercalcemia control are necessary. Early diagnostic of autosomal recessive generalized osteopetrosis can help to evaluate feasibility of allo-HSCT and to start treatment on time thus provide chance for long-term rehabilitation and prevention of serious disability. The study was approved by the Independent Ethics Committee of Russian Children's Clinical Hospital.

PF430 EARLY POST‐TRANSPLANTATION ANEMIA IS ASSOCIATED WITH MORTALITY OR GRAFT FAILURE IN LIVER TRANSPLANTED ADULTS

Background:Post liver transplantation anemia (PLTA) in adults is a very common finding, but its characteristics and long‐term effect on major patients’ outcomes is still to be elucidated.Aims:To evaluate PLTA incidence, characteristics and predictors at 6 months (early PLTA) and 2 years (late PLTA) post liver transplantation. In addition, PLTA impact on various long‐term outcomes, including mortality, graft failure or mortality, malignancy and cardiovascular outcomes was assessed.Methods:This is a single center retrospective cohort study using prospectively collected data from a transplantation department registry. Liver transplantations of adult patients between the years 2007–2015 were identified and patients’ medical records evaluated. We assessed PLTA incidence, characteristics and predictors at different time points and evaluated whether PLTA is associated with 4 outcomes: (1) mortality, (2) the composite of mortality or graft failure, (3) major adverse cardiovascular events and (4) malignancy during a follow up of 3 years (available for all patients), as well as during the maximal individual follow‐up for each patient. Characteristics of patients who developed PLTA were compared in a univariate and multivariate analyses in order to find predictors for PLTA. Kaplan‐Meier survival analysis, using the log‐rank test, was used to compare time‐to‐event outcomes. Effect of different variables including PLTA on long term outcomes were evaluated through a univariate and multivariate analysis. Logistic regression was used to calculate univariate and multivariate odds ratios.Results:150 liver transplantations were included in the analysis. There was a 79% prevalence of anemia pre‐transplantation, whereas early and late PLTA were evident in 58% and 40% of patients, respectively. Pre‐transplantation anemia was associated with early PLTA and early PLTA was predictive of late PLTA. PLTA was normocytic, with increased RDW and increased in percentages of hypochromic RBCs. Chronic kidney disease was present in a quarter of patients with anemia. At a follow‐up of 3 years, patients with early PLTA or anemia at 1‐year post transplantation had a higher mortality rate compared with patients with normal hemoglobin level (12.79% vs. 3.17%, P = 0.0442 and 12.86% vs. 2.9%, P = 0.0552, respectively). In a multivariable analysis, existence of early PLTA (odds ratio [OR] 3.838, 95% CI 1.114–13.226) remained significantly associated with mortality or graft failure at 3 years of follow‐up. At a longer follow‐up (mean 5.5 ± 2.5 years) patients with anemia 1 year post transplantation had a higher mortality rate (p = 0.0323) and a higher rate of mortality or graft failure (p = 0.0249, Figure 1) according to survival analysis. Late PLTA was not significantly associated with worse long‐term outcomes.Summary/Conclusion:Early and late PLTA are prevalent among liver transplanted patients. Early PLTA is associated with long‐term mortality or graft failure.image

The impact of systematic review of status 7 patients on the kidney transplant waitlist

BackgroundIncreased morbidity and mortality are well documented in Status 7(inactive list) patients. Delays in transplantation secondary to prolonged periods on inactive status also negatively impacts transplant outcomes. We developed an effective system to reduce the proportion of status 7 patients on our kidney transplant waitlist. This can easily be reproduced by other transplant centers since concerns about Status 7 list size are commonplace.MethodsMeetings of a dedicated status 7 focus group were undertaken biweekly beginning in April 2016, each lasting for 1 hour or less. The group was led by a transplant physician and comprised of members from all disciplines of the kidney transplant department. Individual patient barriers to activation were systematically evaluated and action plans were developed to overcome those. The formal meetings were supplemented by updates to an electronic database accessible to all members of the team.ResultsIn the first 2 years of the program, we were able to activate and eventually transplant 18% of the formerly inactive patients. Forty percent of all inactive patients were removed from the waitlist due to one or more unsurmountable barriers. The median time patients stayed inactive on the waitlist was shortened from 1344 days at the start of this initiative to 581 days at the end.ConclusionThis strategy of systematic reevaluation of status 7 patients resulted in successful disposition of a substantial number of inactive patients. Further, waitlist time was reduced and transplantation expedited for the appropriate individuals. This approach could easily be adapted by other transplant centers with minimum utilization of resources.

Liver Transplant for Metastatic Neuroendocrine Tumors: A Single-Center Experience in Hungary

Unresectable liver metastases of gastroenteropancreatic neuroendocrine tumors are an accepted indication for liver transplant. Patients undergoing liver transplant because of neuroendocrine tumor liver metastases have similar long-term survival compared with hepatocellular carcinoma; however, recurrence rates are reported to be higher. MethodsWe performed a retrospective analysis of medical records of patients who received transplants for neuroendocrine tumor liver metastases in the Department of Transplantation and Surgery of Semmelweis University between January 1995 and August 2018. The median follow-up period was 33 months. ResultsTen liver transplants have been performed because of neuroendocrine tumor liver metastases during the observed period. Recurrence occurred in 5 cases, and 3 patients died. Estimated 1- and 5-year patient survival rates after transplant were 89% and 71%, respectively. Estimated 1- and 5-year recurrence-free rates were 80% and 43%, respectively. Every patient whose primary tumor was of pancreatic origin or those recipients who had Ki67 index values in the explanted liver higher than 5% had disease recurrence. ConclusionPatient survival and recurrence rates after liver transplant were comparable with the results reported by other centers. In line with previous findings, primary pancreatic neuroendocrine tumors and higher Ki67 index values in the explanted livers were both associated with higher recurrence rates. We believe that an international registry would be helpful to better understand factors leading to tumor recurrence in these cases.

Oncological Screening of Kidney Transplant Patients: The Role of Ultrasound Examination

IntroductionImmunosuppressive therapy used after organ transplantation represents a considerable oncological risk. Abdominal ultrasound examinations play an essential role in the oncological screening of organ transplant patients. Our aim was to study the effectiveness of the ultrasound screening protocol currently used in our clinic. MethodsReports of screening abdominal ultrasound examinations of kidney transplant recipients were processed at the Department of Transplantation and Surgery of Semmelweis University from January 2012 to December 2015. ResultsIn 1478 studies, 14 patients were diagnosed with a malignant tumor, 11 of which were formed in the native shrunken kidney. The mean age for tumor diagnosis was 55.6 ± 12.6 years, and 80% of the patients diagnosed with tumor were male. On average, 7.5 ± 4.6 years passed between the transplantation and recognition of the tumor. All of the kidney tumors were diagnosed at an early stage: histologic examination of removed kidneys showed 73% pT1a- and 17% pT1b-stage tumors. ConclusionIn our study, early stage shrunken kidney cancers were outstandingly the most common post-transplant malignancies found by ultrasound screening. Annual ultrasound examinations as part of our current screening protocol allowed the detection of tumors at an early stage in kidney transplant recipients.

Living donor liver transplantation in hepatocellular carcinoma: A single-center experiences

Aim: Hepatocellular carcinoma (HCC) is the most common primary solid tumor of the liver. Hepatitis B virus (HBV) infections, Hepatitis C virus (HCV) infections and at alcoholism can be seen. The aim of this study was to evaluate living donor liver transplantation in hepatocellular carcinoma.Methods: This is a retrospective cohort study. Between April 2014 and December 2017 at Medipol University Medical Faculty Hospital Organ Transplantation Department, 38 patients in living donor liver transplantation for HCC were evaluated.Results: The mean patient age was 58.0 (9.9) (20–74) years; 31 (81.6%) of the 38 were male. The mean MELD score was 14.2 (8–32). Outside Milan criteria (P=0.003), poorly differentiated and cholangiocarcinoma tumor component (P=0.003) appears to be worse in living donor liver transplantation in hepatocellular carcinoma.Conclusions: In this study, outside Milan criteria, poorly differentiated and cholangiocarcinoma tumor component appears to be worse in living donor liver transplantation in hepatocellular carcinoma.

Surgical correction of the chronic liver purulent-septic lesions

Purpose of the study. The purpose of the study is to improve the results of surgical treatment of patients with purulent-septic lesion of the liver substantiating the indication for resection method use.&#x0D; Material and methods. The work is based on a comparative analysis of the results of examination and treatment of 64 patients aged 10 to 81 years old, with chronic liver abscesses in the department of surgery and liver transplantation during the 1995–2016 periods.&#x0D; According to the tasks of the study patients are divided into two groups. In 30 (46,8%) patients (the study group), various types of anatomical resection of the liver with a purulent lesion were performed without its dissection during the operation; in 34 (53,2%) patients (group of comparison) they performed the disclosure, sanation, drainage of purulent cavity. The majority of patients with chronic liver abscesses treated the abscess with a puncture or drainage method under the control of ultrasound in other medical institutions of Ukraine.&#x0D; Results. The results of diagnosis and treatment of 64 patients for chronic liver abscesses from 1995 to 2016 are analyzed. In the study group, the patients performed anatomical resection of the liver, in the comparison group – standard surgical interventions – the disclosure and drainage of the abscess of the liver. The duration of antibiotic therapy after surgery in the comparison group is significantly higher than in the study group, respectively, 22 ± 3,4 and 5,75 ± 1,6 days; p &lt; 0,001. Second-line antibacterial drugs after draining operations were used more often (p &lt; 0,001) than after resection interventions, respectively, in 94,1 and 6,6% of cases. The duration of treatment of patients in the hospital after surgery in the study group was less than in the comparison group, according to 15,1 ± 0,7 and 27,3 ± 3,05 days; total 25,9 ± 1,4 and 45,7 ± 3,45 days (p &lt; 0,001). After drainage operations, drainages from the abdominal cavity were removed later than after resection interventions, respectively, 17,1 ± 2,8 and 6,35 ± 1,1 days (p &lt; 0,001), through.&#x0D; Conclusion. Resection for chronic purulentseptic lesions of the liver is the priority methods of surgical treatment. The analysis of the obtained results allows us to conclude that resection technologies contribute to the rapid normalization of physical and social rehabilitation of patients with septic liver damage.

Transarterial Chemoembolization (TACE) with Lipiodol� in HCC PatientsTechnical, clinical and imagistic aspects

Hepatocellurar carcinoma (HCC) is the most frequent primary hepatic tumor, the vast majority of patients have less than a 12 month survival rate. The aim of this study was to evaluate the efficacy of TACE in patients with HCC, based on a case series and literature review. The study included 12 consecutive patients with HCC who underwent surgical treatment (resection, liver transplantation � resection) at the Department of Transplantation and Surgery, Semmelweis University, Budapest, during 2009-2015. All the patients received at least one TACE session. Patients with BCLC B-stage who benefit from TACE and another alternative therapy (eg, RFA) may be associated with or exhibit tumor stagnation, or tumor necrosis in most cases. In C BCLC stages, desperate cases - the two patients to whom TACE was the last therapeutic attitude, despite the predicted prognosis, TACE assured the prolongation of life and increased life quality. In the majority of patients in this study, stage A BCLC, chemoembolization was a therapeutic attitude that allowed subsequent liver transplantation (when it was not feasible initially due to tumor size) or liver resection in apparently inoperable cases. The arterial chemotherapy is the unanimously accepted indication in patients with stage B, BCLC. The data presented encourages us to opt for TACE with the intention of destaging BCLC and giving an operability character to the hepatic tumors (resection � hepatic transplantation). In stage C BCLC, TACE can be a last attempt to improve the quality of life and to control tumor progression.

PROSTATIC HYPERPLASIA (BPH);

Objectives: To determine the efficacy of tamsulosin with and without tolterodine in patients having benign prostatic hyperplasia (BPH) with irritative (overactive bladder) symptoms. Study Design: Randomized clinical trial. Setting: Department of Urology and Kidney Transplantation, Sheikh Zayed Hospital Lahore. Period: Six months from July to Dec 2017. Patients and Methods: Sixty patients of BPH had irritative (overactive bladder) &amp; obstructive presentation were recruited. Patients were categorized in two groups and were compared for efficacy according to international prostatic symptom scoring while the data analyzed in SPSS 16. Results: Patients with BPH having irritative (overactive bladder) symptoms, after receiving Tamsulosin with Tolterodine, 76.60% (23/30) of patients reported symptomatic improvement whereas only 40.00 % (12/30) of subjects improved with tamsulosine only. Rate of improvement was observed to be higher in individuals with tamsulosine with tolterodine (Group B) than group A (includes tamsulosin only) with statistical significance) chi-square = 8.297; p=0.004). Conclusion: Efficacy of tamsulosin with tolterodine is higher than tamsulosin alone in subjects with BPH had irritative (overactive bladder) &amp; obstructive symptoms.

Healthcare Analytics Is the Future

Background Medical data has long been generated and shared. Today, not only do healthcare analytics assist us in understanding past performance, but is also used to obtain insight into what may occur in the future. Healthcare analytics has become essential, achievable, and unavoidable. The Blood and Marrow Transplant (BMT) department at one Comprehensive Cancer Center has firsthand experience with a variety of healthcare software and informatics programs. In 2015, a team from the organization reported the process of choosing the best match for BMT informatics software. At present, the BMT department has set out to use a new hospital software program, Software M, which helps hospitals use patient-oriented data to manage, measure and monitor quality, patient safety, financial and clinical outcomes. [1] The BMT data managers (DM), along with the BMT Program Manager, have taken advantage of this software's quality performance aspect to improve their CIBMTR data accuracy rate. Method Internal assessments (IA) were completed and audited by the DM for validity and quality of registry data. After auditing the IA forms, the DM entered monthly IA through Software M. In the past, calculating results proved laborious. Now, calculating the accuracy rate of CIBMTR data has become much more efficient. Using the software has improved DM efficiency and leaves less room for data entry error. To enhance output of the report, the DM provided a variety of IA forms to a healthcare analyst at the hospital. According to CIBMTR criteria, the DM distinguished which IA form fields were critical fields versus random fields. Data could now be displayed through a variety of visual representations, the DM reviewed the output requirements with the analyst. Results Identified output resulted in the following: Total number (No.) of questions (QNS) correct; total No. of QNS answered; percent success overall; total No. of critical QNS answered; total No. of correct critical QNS; percentage success of critical QNS; total No. of non-critical QNS correct; total No. of non-critical QNS answered; percentage success of non-critical QNS. In addition, a graph with the overall, critical, and random percentages is displayed. After the use of Software M, the analysis of the accuracy rate has become significantly more precise and descriptive. CONCLUSION Healthcare analytics is making data more accessible than ever. Over the past four years, the BMT department has made advances with state-of-the-art technology. Trends of the data accuracy rates of IA can be viewed at a glance and if need be, corrected in a more timely manner, improving overall outcomes and allowing for a thorough training for staff. With CIBMTR and FACT standards becoming increasingly stringent, better strategies for timely data analysis are key.

Analysis of donor-associated factors in unrelated transplantations of hematopoietic stem cells in children with non-malignant diseases

The choice of the optimal donor in the absence of an HLA-compatible relative, as well as the analysis of the risks of hematopoietic stem cell transplantation (HSCT), is extremely important, especially in patients with non-cancerous diseases. The article analyzes 99 allogeneic HSCTs from unrelated donors in the bone marrow transplantation department of the Russian Children’s Clinical Hospital. The analysis included patients with acquired and congenital forms of non-malignant diseases. The choice of an optimal unrelated donor in the absence of a compatible relative donor, as well as an analysis of the risks of treatment, requires studying the factors that influence the outcome of treatment in this group of patients. It was shown that the level of 2-year overall survival (OS) was 74 % (standard deviation ± 4.7 %). At the same time, clinical manifestations of the acute graft versus host disease of grade I–IV were recorded in 67 % (n = 66) of patients, and severe forms of grade III–IV in 13 % (n = 13) of children. Chronic graft versus host disease (chGVHD) was observed in 29 % (n = 29) patients. When studying the factors associated with the donor, it was found that the differences in the HLA system have a negative effect on the incidence of chGVHD; in a (9/10) HLA-incompatible donor, it was 29 % higher (p = 0.019). Increasing the age of the donor for every 10 years consistently reduces the OS by 9–11 % (p = 0.117), however, the OS with a donor over 46 years old was 100 % (n = 7). No effect on the agents with respect to the following factors with respect to the recipient was found: by sex, blood group, serostatus for cytomegalovirus (CMV). It was noted that the combination of CMV-positive serostatus of the donor and the negative status of the recipient increases the risk of transplant rejection up to 50 % in comparison with other variants of CMV serostatus (p = 0.001). In general, the possibility of performing HSCT from an unrelated donor for patients with non-malignant diseases and possible ways of selecting the optimal donor was noted. Conflict of interest. The authors declare no conflict of interest.Funding. The study was performed without external funding.

History of Infection Prior to Hematopoietic Stem Cell Transplant in the Recipient as a Risk Factor to Develop Acute Graft versus Host Disease

Background: Acute graft-versus-host disease (aGVHD) is the most frequent and severe complication after allogeneic hematopoietic stem cell transplantation (HSCT). Objective: To determine if a history of prior infection in the allogeneic HSTC recipient is a risk factor to develop aGVHD. Methods: A retrospective cohort study based on data collected from the Department of Hematopoietic Stem Cell Transplantation at the Instituto Nacional de Pediatría (INP) from January 1998 to December 2016 was performed to identify if prior infection was a predictive risk factor for aGVHD. Results: 27 patients developed aGVHD (36.4%). Median time to aGVHD presentation was 82 days (9 to 273 days). Most patients developed grade III aGVHD. Following the multivariate analysis peripheral blood > bone marrow (OR 12.3; p 8.3 × 106/kg (OR 7.1; p = 0.05), peripheral blood (OR: 11.4; p Conclusions: Either bacterial infection or CMV infection in the recipient was significant risk factor within the aGVHD recipients; it is important to consider these factors for patients that are going to receive an allogeneic HSCT.

Frequencies of Common Infectious Organisms Causing Chronic Diarrhea in Renal Transplant Patients.

Gastrointestinal complications are common in kidney transplant patients, with the most frequent being diarrhea (60%). Chronic diarrhea affects the patient's quality of life, causes fatigue and weight loss and malabsorption, increases the number of hospitalizations, increases serum creatinine levels, and causes alterations in immunosuppressive drug levels. Diarrhea is also associated with an increased risk of graft failure and death. In this study, we aimed to determine the frequencies of common infectious organisms causing chronic diarrhea in renal transplant patients. Our study included 124 renal transplant patients who presented with chronic diarrhea over a 6-month period at the Sindh Institute of Urology and Transplantation Department tertiary care hospital (Karachi, Pakistan). Stool analysis was performed in all transplant recipients. Upper and lower gastrointestinal endoscopy was also performed in patients with chronic diarrhea, and biopsy specimens underwent histopathologic evaluations. Of 124 renal transplant recipients, 29 were female (23.4%) and 95 were male (76.6%). Giardia was the most common organism found (n = 37 patients; 29.8%) followed by Cryptosporidium (n = 36; 29.0%), Entameba histolytica (n = 29; 23.4%), tuberculosis (n = 14; 11.3%), and sprue (n =8; 6.5%). The mean duration since renal transplant was 78.5 ± 63.37 months. Although not statistically significant, the frequency of diarrhea was higher in patients who had transplant procedures ≥ 2 years previously. Chronic diarrhea is prevalent in renal transplant patients irrespective of age, sex, and duration since transplant. Giardiasis and Cryptosporidium species infections are important causes of chronic diarrhea, but other causative factors need to be further studied, including comorbid conditions and immunosuppressive agents.