bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of a Venous Catheter as a Stent for Treatment of Acquired Punctal and Canalicular Stenosis
Authors: Meduri Alessandro , Inferrera Leandro , Tumminello Giuseppe , Frisina Rino , Forlini Matteo , Kaufman Stephen , Aragona Pasquale
Published: July 2019

Purpose:

The aim of this study was to describe a simple technique to insert a venous catheter as a stent for the treatment of acquired punctal and canalicular stenosis.

Methods:

We performed this technique using a central venous catheter as a stent for the treatment of acquired punctal and canalicular stenosis.

Results:

The results show the easy availability of the material used for the intervention, its easy execution, and the low costs of materials. The goal of this technique is to have a lacrimal dot dilated and canalicular duct easy to irrigate.

Conclusion:

The use of a venous catheter as a stent for treatment of acquired punctal and canalicular stenosis seems to be simple, safe, repeatable, and noninvasive.
Computerized Tomography Radiomics Features Analysis for Evaluation of Perihematomal Edema in Basal Ganglia Hemorrhage
Authors: Yao Xiang , Liao Lishang , Han Yuxiao , Wei Ting , Wu Hai , Wang Yiying , Li Yanfei , Zhang Xinyuan , Ren Ke
Published: July 2019

To evaluate the edema area around basal ganglia hemorrhage by the application of computerized tomography (CT)-based radiomics as a prognostic factor and improve the diagnosis efficacy, a total of 120 patients with basal ganglia hemorrhage were analyzed retrospectively. The texture analysis software Mazda 3.3 was used to preprocess the CT images and manually sketch the region of interest to extract the texture features. The extracted texture features were selected by Fisher coefficient, POE+ACC and mutual information. The texture discriminant analysis uses the B11 module in the Mazda 3.3 software. The data were randomly divided into a training dataset (67%) and test dataset (33%). To further study the texture features, the training dataset can be divided into groups according to the median of GCS score, NIHSS score, and maximum diameter of hematoma. Random forest model, support vector machine model, and neural network model were built. AUC of the receiver operating characteristics curve was used to assess the performance of models with test dataset. Among all texture post-processing methods, the lowest error rate was 2.22% for the POE+ACC/nonlinear discriminant. For the maximum diameter of hematoma, GCS score, and NIHSS score group, the lowest error rate were 26.66%, 23.33%, and 30.00%, respectively. The values of AUCs were 0.87, 0.81, and 0.76, for random forest model, support vector machine model, and neural network model in the test dataset, respectively. Radiomic method with proper model may have a potential role in predicting the edema area around basal ganglia hemorrhage. It can be used as a secondary group in the diagnosis of edema area around basal ganglia hemorrhage.
Comparison of Three-Dimensional Surface Imaging Systems Using Landmark Analysis
Authors: Liberton Denise K. , Mishra Rashmi , Beach Margaret , Raznahan Armin , Gahl William A. , Manoli Irini , Lee Janice S.
Published: July 2019

Numerous 3d imaging systems are now available commercially for the capture of facial shape data via landmarking or surface shape comparisons but it is not known whether these systems produce data of comparable quality. This study investigates the error associated with landmark coordinate data collected on facial surface images taken using three 3d imaging systems: the 3dMDface system (3dMD, Atlanta, GA), the Planmeca ProFace system (Planmeca, Roselle, IL), and the Vectra H1 handheld system (Canfield Scientific, Parsippany, NJ). This was a retrospective study involving 3d imaging data that used geometric morphometric analysis to assess overall shape differences as well as landmark-specific differences among the systems. Ten individuals evaluated at the NIDCR dental clinic on various protocols were imaged on all 3 systems. The subject pool consisted of syndromic and unaffected subjects, as disease status was irrelevant to the question of reproducibility and variability. Variation in landmark placement across systems was assessed by ANOVA, covariance matrix, and summary statistics. No overall shape or size differences were found among the systems. However, there was some landmark-specific variation and the 3dMD and Vectra systems were generally more similar to each other than either was to the Planmeca system. The data acquired by these 3 systems are comparable, although landmarks on the eyes and ears are noisy and most different among systems.
Olfactory Fossa and New Angle Measurements: Lateral Lamella-Cribriform Plate Angle
Authors: Asal Neşe , Bayar Muluk Nuray , Inal Mikail , Şahan Mehmet Hamdi , Doğan Adil , Arikan Osman Kürşat
Published: July 2019

Objectives:

The authors investigated the olfactory fossa (OF) in patients with unilateral nasal septal deviation (NSD) and presented the lateral lamella-cribriform plate angle (LLCPA).

Methods:

Paranasal sinus computed tomography images of 300 adult subjects with unilateral NSD (111 males, 189 females) were evaluated retrospectively. Septal deviation angle (SDA), Keros Classification, OF depth and width, LLCPA; and orbital plate and cribriform plate (OPCP) distance were measured.

Results:

The OF depth values (ipsilateral, contralateral) were found as Keros III >Keros II >Keros I (P
adjusted <0.0175). The OF width values (ipsilateral) were detected as Keros I >Keros II and Keros I >Keros III (P
adjusted <0.0175). In patients with higher SDA values, ipsilateral OF depth values decreased (P <0.05). The LLCPA and OPCP values were higher in Keros I and lower in Keros III (P <0.05).

Conclusion:

In patients with lower LLCPA and OPCP, endoscopic sinus surgery will be more dangerous for trauma to lateral lamella and intracranial penetration.
Safety and Feasibility of Laparoscopic Pelvic Exenteration for Locally Advanced or Recurrent Colorectal Cancer
Authors: Ichihara Momoko , Uemura Mamoru , Ikeda Masataka , Miyake Masakazu , Kato Takeshi , Hamakawa Takuya , Maeda Sakae , Hama Naoki , Nishikawa Kazuhiro , Miyamoto Atsushi , Miyazaki Michihiko , Hirao Motohiro , Sekimoto Mitsugu
Published: July 2019

Purpose:

Pelvic exenteration (PE) for locally advanced or recurrent colorectal cancer is often used to secure negative resection margins. The aim of this study was to evaluate the feasibility of laparoscopic PE.

Materials and Methods:

The clinical records of 24 patients (9, open; 15, laparoscopic) who underwent total or posterior PE for locally advanced or recurrent colorectal cancer between July 2012 and April 2016 at Osaka National Hospital were retrospectively reviewed. Operative factors were compared between the 2 groups.

Results:

The R0 resection rate was 100% in the laparoscopic group and 89% in the open group. The operative time and the incidence of postoperative complications were not significantly different between the 2 groups. The laparoscopic group showed less intraoperative blood loss (P=0.019), a lower C-reactive protein elevation on postoperative day 7 (P=0.025), and a shorter postoperative hospital stay (P=0.0009).

Conclusions:

Laparoscopic PE is a safe and feasible procedure to reduce postoperative stress.
Moving On: How Many Women Opt for Surgery After Pessary Use for Prolapse?
Authors: Patnam Radhika , Sripad Abhishek A. , Dengler Erin , Geller Elizabeth J. , Wu Jennifer M.
Published: July 2019

Objective

Our primary objective was to evaluate the proportion of women who underwent surgery after successful pessary fitting for pelvic organ prolapse (POP). Our secondary objectives were to assess when surgery occurs and to evaluate factors associated with choosing surgery as compared to continuing with a pessary.

Methods

Our study population included women successfully fitted with a pessary for POP 1/1/12 and 12/31/16. We excluded non–English-speaking women and those who used pessary only as a bridge until surgery. We evaluated events occurring after a successful fitting, including whether women (1) continued pessary use, (2) underwent surgery, or (3) discontinued pessary without surgery. Our primary outcome was the proportion of women who opted for surgery after a successful pessary fitting for POP. We also assessed the median time to surgery and compared women who underwent surgery with those who continued with a pessary to assess variables associated with surgery.

Results

Of the 444 women with POP who were successfully fitted with a pessary and met inclusion criteria, 137 (31%) ultimately underwent surgery. The median time to surgery was 10 months (interquartile range, 4–18), with 59% having surgery within 1 year, and 89% within 2 years. In a logistic regression analysis controlling for age in decades, advanced POP stage, and Charlson Comorbidity Index, younger age remained significantly associated with surgery (odds ratio, 0.77, 95% confidence interval, 0.62–0.95; P = 0.02).

Conclusions

Among women successfully fitted with a pessary for POP, one third ultimately underwent surgery, with approximately 60% of these women undergoing surgery within the first year and 90% within 2 years.
Antimotility agents for the treatment of acute noninfectious diarrhea in critically ill patients: A practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Bugaev Nikolay , Bhattacharya Bishwajit , Chiu William C. , Como John J. , Cripps Michael W. , Ferrada Paula , Gelbard Rondi B. , Gondek Stephen , Kasotakis George , Kim Dennis , Mentzer Caleb , Robinson Bryce R. H. , Salcedo Edgardo S. , Yeh D. Dante
Published: July 2019

BACKGROUND

Acute noninfectious diarrhea is a common phenomenon in intensive care unit patients. Multiple treatments are suggested but the most effective management is unknown. A working group of the Eastern Association for the Surgery of Trauma, aimed to evaluate the effectiveness of loperamide, diphenoxylate/atropine, and elemental diet on acute noninfectious diarrhea in critically ill adults and to develop recommendations applicable to daily clinical practice.

METHODS

The literature search identified 11 randomized controlled trials (RCT) appropriate for inclusion. The Grading of Recommendations Assessment, Development, and Evaluation methodology was applied to evaluate the effect of loperamide, diphenoxylate/atropine, and elemental diet on the resolution of noninfectious diarrhea in critically ill adults based on selected outcomes: improvement in clinical diarrhea, fecal frequency, time to the diarrhea resolution, and hospital length of stay.

RESULTS

The level of evidence was assessed as very low. Analyses of 10 RCTs showed that loperamide facilitates resolution of diarrhea. Diphenoxylate/atropine was evaluated in three RCTs and was as effective as loperamide and more effective than placebo. No studies evaluating elemental diet as an intervention in patients with diarrhea were found.

CONCLUSION

Loperamide and diphenoxylate/atropine are conditionally recommended to be used in critically ill patients with acute noninfectious diarrhea.

LEVEL OF EVIDENCE

Systematic Review/Guidelines, level III.
Presbyphagia Versus Dysphagia
Authors: Barrera Marissa A. , O'Connor Wells Barbara
Published: July 2019

The purpose of this article is to describe normal, age-related changes in the swallowing mechanism, clinically referred to as “presbyphagia.” The authors compare presbyphagia in the oral, pharyngeal, and esophageal phases of the swallow to abnormal, or impaired swallowing, termed “dysphagia.” This article focuses on how older persons with Parkinson disease and multiple sclerosis frequently have dysphagia symptoms, such as food residue, delayed swallow trigger, penetration, and/or aspiration, superimposed over presbyphagia. Information on the psychosocial and emotional impacts of dysphagia on persons with Parkinson disease and/or multiple sclerosis, along with common treatment approaches to alleviate swallowing difficulties, has also been discussed.
The Effects of an IL-21 Receptor Antagonist on the Alloimmune Response in a Humanized Mouse Skin Transplant Model
Authors: de Leur Kitty , Luk Franka , van den Bosch Thierry P.P. , Dieterich Marjolein , van der Laan Luc J.W. , Hendriks Rudi W. , Clahsen-van Groningen Marian C. , Issa Fadi , Baan Carla C. , Hoogduijn Martin J.
Published: July 2019

Background.

Interleukin 21 (IL-21) is involved in regulating the expansion and effector function of a broad range of leukocytes, including T cells and B cells. In transplantation, the exact role of IL-21 in the process of allograft rejection is unknown. To further explore this, the aim of this study is to test the effect of an IL-21 receptor (IL-21R) blocking antibody on the early phase of allograft rejection in a humanized skin transplantation model in mice reconstituted with human T and B cells.

Methods.

Immunodeficient Balb/c IL2rγ−/−Rag2−/− mice were transplanted with human skin followed by adoptive transfer of human allogeneic splenocytes. Control animals were treated with a phosphate buffered saline vehicle while the other group was treated with a humanized anti-IL-21R antibody (αIL-21R).

Results.

In the phosphate buffered saline-treated animals, human skin allografts were infiltrated with lymphocytes and developed a thickened epidermis with increased expression of the inflammatory markers Keratin 17 (Ker17) and Ki67. In mice treated with αIL-21R, these signs of allograft reactivity were significantly reduced. Concordantly, STAT3 phosphorylation was inhibited in this group. Of note, treatment with αIL-21R attenuated the process of T and B cell reconstitution after adoptive cellular transfer.

Conclusions.

These findings demonstrate that blockade of IL-21 signaling can delay allograft rejection in a humanized skin transplantation model.
Education Strategies in Dialysis Centers Associated With Increased Transplant Wait-listing Rates
Authors: Waterman Amy D. , Peipert John D. , Xiao Huiling , Goalby Christina J. , Kawakita Satoru , Cui Yujie , Lentine Krista L.
Published: July 2019

Background.

Transplant education in dialysis centers can increase access to kidney transplant; however, dialysis center transplant barriers are common, and limited research identifies the most effective transplant education approaches.

Methods.

We surveyed transplant educators in 1694 US dialysis centers about their transplant knowledge, use of 12 education practices, and 8 identified education barriers. Transplant wait-listing rates were calculated using US Renal Data System data.

Results.

Fifty-two percent of educators orally recommended transplant to patients, 31% had in-center transplant discussions with patients, 17% distributed print educational resources, and 3% used intensive education approaches. Distribution of print education (incident rate ratio: 1.021.151.30) and using >1 intensive education practice (1.001.111.23) within dialysis centers were associated with increased wait-listing rates. Several dialysis center characteristics were associated with reduced odds of using education strategies leading to increased wait-listing. Centers with greater percentages of uninsured patients (odds ratio [OR]: 0.960.970.99), in rural locations (OR: 0.660.790.95), with for-profit ownership (OR: 0.640.770.91), and with more patients older than 65 years (OR: 0.050.110.23) had lower odds of recommending transplant, while centers with a higher patient-to-staff ratio were more likely to do so (OR: 1.011.031.04). Language barriers (OR: 0.480.640.86) and having competing work priorities (OR: 0.400.530.70) reduced the odds of distributing print education. Providers with greater transplant knowledge were more likely to use >1 intensive educational strategy (OR: 1.011.271.60) while providers who reported competing work priorities (OR: 0.510.660.84) and poor communication with transplant centers (OR: 0.580.760.98) were less likely to do so.

Conclusions.

Educators should prioritize transplant education strategies shown to be associated with increasing wait-listing rates.
Is Preoperative Preparation Time a Barrier to Small Children Being Ready for Kidney Transplantation?
Authors: Feltran Luciana S. , Cunha Miriam F.M. , Perentel Simone M.R. de Melo , Hamamoto Fernando , Camargo Maria Fernanda C. , Komi Shirlei , Leão Jovelino Q.S. , Koch-Nogueira Paulo Cesar
Published: July 2019

Background.

Small children are less frequently transplanted when compared with older. The objective of the present study was to compare the preparation time for transplantation in children of different weights and to identify factors associated with a delay in the workup of small children.

Methods.

We report on a retrospective cohort comprising all children referred for renal transplantation (RTx) workup between 2009 and 2017. The main outcome was transplantation workup time, defined as the time elapsed between the first consultation and when the child became ready for the surgery.

Results.

A total of 389 children (63.5% males) were selected, with a median weight of 18 kg (interquartile range, 11–32). Patients were categorized into 2 groups: group A (study group): ≤15 kg (n = 165) and group B (control group): >15 kg (n = 224). The probability of being ready for RTx was comparable between groups A and B. The cumulative incidence rate difference between groups is −0.05 (95% confidence interval, −0.03 to 0.02). The median time for RTx workup was 5.4 (2.4–9.4) in group A and 4.3 (2.2–9.0) months in group B (P = 0.451). Moreover, the presence of urinary tract malformation was associated with the need for longer transplantation workup time (P < 0.001).

Conclusions.

In children >7 kg, the workup time for transplantation is not related to body weight. In a specialized center, children weighing 7–15 kg became ready within the same timeframe as children weighing >15 kg, despite the smaller children had greater difficulty being nourished, dialyzed, and a greater need for surgical correction of the urinary tract pretransplant.
Association Between Living Kidney Donor Postdonation Hypertension and Recipient Graft Failure
Authors: Holscher Courtenay M. , Ishaque Tanveen , Haugen Christine E. , Jackson Kyle R. , Garonzik Wang Jacqueline M. , Yu Yifan , Al Ammary Fawaz , Segev Dorry L. , Massie Allan B.
Published: July 2019

Background.

Recipients of kidneys from living donors who subsequently develop end-stage renal disease (ESRD) also have higher graft failure, suggesting the 2 donor kidneys share risk factors that could inform recipient outcomes. Given that donor ESRD is rare, an earlier and more common postdonation outcome could serve as a surrogate to individualize counseling and management for recipients. Hypertension is a frequent event before donor ESRD; thus, early postdonation hypertension might indicate higher risk of graft failure.

Methods.

We studied Scientific Registry of Transplant Recipients data to quantify the association between early postdonation hypertension and recipient graft failure using propensity score-weighted Cox proportional hazards regression. We also examined the association between postdonation systolic blood pressure and graft failure.

Results.

Of 37 901 recipients, 2.4% had a donor who developed hypertension within 2 years postdonation. Controlling for donor and recipient characteristics, recipients whose donors developed hypertension had no higher risk for graft failure (adjusted hazard ratio [aHR] 1.03, 95% confidence interval [CI] 0.85-1.25, P = 0.72). This was consistent among subgroups of recipients at higher risk for adverse outcomes due to hyperfiltration: African American recipients (aHR 1.10, 95% CI 0.70-1.73, P = 0.68) and those with ESRD caused by hypertension (aHR 1.10, 95% CI 0.65-1.85, P = 0.73) or diabetes (aHR 0.80, 95% CI 0.56-1.13, P = 0.20). However, graft failure was associated with postdonation systolic blood pressure (per 10 mm Hg, aHR 1.05, 95% CI 1.03-1.08, P < 0.001).

Conclusions.

Although postdonation systolic blood pressure is associated with graft failure, the reported diagnosis of hypertension as determined by the requirement for blood pressure treatment early postdonation did not portend a higher risk of recipient graft failure in the same way as eventual postdonation ESRD.
Oligonucleotide-based Preconditioning of DCD Cardiac Donors and Its Impact on Cardiac Viability
Authors: Kearns Mark J. , Miller Sally D. , Kong Hyejin J. , Sirounis Demetrios , Cheung Anson , Bashir Jamil , Seidman Michael A. , Boyd John H.
Published: July 2019

Background.

While clinical donation after circulatory death (DCD) cardiac transplantation is being implemented with increasing frequency to address the supply/demand mismatch of donor grafts, no research to date has examined a strategy of donor preconditioning to optimize the viability of DCD hearts for transplantation. In our rat model of the DCD protocol, we investigate the impact of pretreating donors with phosphorothioate-linked cytosine and guanine rich oligodeoxynucleotides (CpG ODN) and their effects on cardiac function, injury, and a novel left ventricular (LV) mRNA biomarker panel.

Methods.

DCD rats were subjected to a withdrawal protocol, followed by 20 minutes of warm acirculatory standoff, representing a group of severely injured hearts as previously demonstrated. Beating heart controls and DCD rats were pretreated with vehicle or stimulatory CpG ODN (beating heart control and DCD stimulated with CpG ODN, BST and DST). Hearts were harvested for ex situ heart perfusion (ESHP), where LV function, histochemical injury, and differences in gene expression were characterized between groups.

Results.

Donor pretreatment with CpG ODN doubled the number of functional DCD hearts at ESHP. Pretreatment was associated with improved systolic and diastolic LV function, a reduction in histological injury, and markedly reduced elaboration of cardiac troponin-I in coronary effluent during ESHP. Pretreatment was also associated with a reduction in mRNA biomarkers associated with myocardial injury.

Conclusions.

A single dose of CpG ODN was associated with reduced biomarkers of cardiac injury and a 100% increase in cardiac viability in this rodent model of marginal DCD cardiac donation.
Geographic Disparities in Access to Simultaneous Pancreas and Kidney Transplant in the Pre- and Post-Pancreas Allocation System Eras
Authors: Concepcion Beatrice P. , Feurer Irene D. , Rega Scott A. , Niederhaus Silke , Odorico Jon , Forbes Rachel C.
Published: July 2019

Background.

The 2014 pancreas allocation system (PAS) intended to decrease geographic variability in listing practices for simultaneous pancreas and kidney (SPK) transplant and define eligibility criteria for those with type 2 diabetes mellitus (T2DM). Our primary aims were to evaluate geographic disparities in access to SPK and assess T2DM SPK listings in the pre- and post-PAS eras.

Methods.

Adult listings for SPK and kidney transplant (pre-PAS, January 2010 to October 29, 2014; post-PAS, October 30, 2014, to June 2, 2017) were identified in the Scientific Registry of Transplant Recipients. Multivariable logistic regression models tested associations of geography and/or diabetes mellitus type on the likelihood of SPK versus kidney transplant listing pre- and post-PAS. Competing risk models tested the likelihood of SPK transplantation within 2 years of listing for SPK.

Results.

Among 41 205 listings (27 393 pre-PAS; 24 439 T2DM), univariate analysis showed reduced percentages for SPK post-PAS (22.1%–20.8%; P = 0.003). After adjusting for patient and center characteristics, geographic disparities declined slightly but persisted post-PAS (era by region interaction P < 0.001). The era by type of diabetes mellitus interaction effect was statistically significant (P = 0.039), reflecting that the proportions of SPK listings for T2DM increased in the post-PAS era (3.4%–3.9%; univariate P = 0.038), while those for type 1 diabetes mellitus remained statistically stable (47.9%–48.4%; univariate P = 0.571). Among people listed for SPK, geographic disparities in the cumulative incidence of transplantation within 2 years declined and the overall likelihood of transplantation increased in the post-PAS era (both P < 0.001).

Conclusions.

Geographic disparities in access to SPK declined slightly but persisted post-PAS. With new allocation change proposals and elimination of listing criteria for T2DM, further monitoring is warranted.
A 3-month, Multicenter, Randomized, Open-label Study to Evaluate the Impact on Wound Healing of the Early (vs Delayed) Introduction of Everolimus in De Novo Kidney Transplant Recipients, With a Follow-up Evaluation at 12 Months After Transplant (NEVERWOUND Study)
Authors: Manzia Tommaso Maria , Carmellini Mario , Todeschini Paola , Secchi Antonio , Sandrini Silvio , Minetti Enrico , Furian Lucrezia , Spagnoletti Gionata , Pisani Francesco , Piredda Gian Benedetto , Cappelli Gianni , Tisone GIuseppe
Published: July 2019

Background.

The risk of wound healing complications (WHCs) and the early use of mammalian target of rapamycin inhibitors after kidney transplantation (KT) have not been fully addressed.

Methods.

The NEVERWOUND study is a 3-month, multicenter, randomized, open-label study designed to evaluate whether a delayed (ie, 28 ± 4 d posttransplant) immunosuppression regimen based on everolimus (EVR) reduces the risk of WHC versus EVR started immediately after KT. Secondary endpoints were treatment failure (biopsy-proven acute rejection, graft loss, or death), delayed graft function, patient and graft survival rates, and renal function.

Results.

Overall, 394 KT recipients were randomized to receive immediate (N = 197) or delayed (N = 197) EVR after KT. At 3 months, WHC-free rates in the immediate EVR versus delayed EVR arm, considering the worst- and best-case scenario approach, were 0.68 (95% confidence interval [CI], 0.62-0.75) versus 0.62 (95% CI, 0.55-0.68) (log-rank P = 0.56) and 0.70 (95% CI, 0.64-0.77) versus 0.72 (95% CI, 0.65-0.78) (log-rank P = 0.77), respectively. The 3- and 12-month treatment failure rates, delayed graft function and renal function, and patient and graft survival were not different between the arms.

Conclusions.

The early introduction of EVR after KT did not increase the risk of WHC, showing good efficacy and safety profile.
Incidence, Predictors, and Impact on Survival of Long-term Cardiovascular Events After Liver Transplantation
Authors: Sastre Lydia , García Raquel , Gándara Julián-Gonzalo , Ruiz Pablo , Lombardo Julissa , Colmenero Jordi , Navasa Miquel , Crespo Gonzalo
Published: July 2019

Background:

Information on the risk factors, particularly kidney function, and impact of long-term cardiovascular events (CVE) after liver transplantation (LT) remains scarce.

Methods:

This is a retrospective, single-center study that included consecutive LT recipients between 2007 and 2017. The incidence of CVE, their risk factors, and their impact on patient survival were investigated.

Results:

We included 627 LT recipients. The incidence of CVE was 8% and 20% at 12 and 60 months after LT, respectively. The independent risk factors of long-term (beyond 12 mo) CVE were age at LT (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.01-1.07), male gender (HR, 2.48; 95% CI, 1.21-5.05), history of pre-LT cardiovascular disease (HR, 2.19; 95% CI, 1.2-3.98), and immunosuppression with cyclosporine A (HR, 1.93; 95% CI, 1.14-3.3). In patients with pre-LT cardiovascular disease, creatinine levels 12 months after LT significantly impacted the risk of long-term CVE. Long-term CVE (HR, 2.12; 95% CI, 1.24-3.61), hepatitis C as the etiology of liver disease (HR, 2.18; 95% CI, 1.29-3.67), cytomegalovirus infection (HR, 1.89; 95% CI, 1.08-3.3), and donor age (HR, 1.02; 95% CI, 1.01-1.04) were independent factors associated with post-LT patient death.

Conclusions:

Age, male gender, cardiovascular disease before LT, and cyclosporine A were associated with the risk of long-term CVE. The impact of serum creatinine was restricted to patients with pre-LT cardiovascular disease. In these patients, preservation of kidney function early after LT may lessen the incidence of CVE, which are an independent predictor of post-LT death.
New Evidence Supporting Increased Use of Split Liver Transplantation
Authors: Perkins James D. , Dick Andre A. , Healey Patrick J. , Montenovo Martin I. , Biggins Scott W. , Sibulesky Lena , Reyes Jorge D.
Published: July 2019

Background.

Young children and small-statured candidates are dying on liver candidate waitlists. The Organ Procurement and Transplantation Network and United Network for Organ Sharing have proposed a split liver (SL) variance encouraging transplant programs to split more livers to aid these smaller statured candidates.

Methods.

We evaluated the US experience of splitting donor livers during 2002–2016. The results of our analysis provide new evidence to support this variance.

Results.

During 2002–2016, SL grafts from 935 donors were transplanted into 1870 recipients. Controlling for recipient factors and using time period and program identification as random variables, a multivariable mixed Cox proportional hazards model for graft failure revealed that donor aged 3–10 years had a relative risk (RR) of 3.94 (2.86–5.44), and donor aged >30 years had a RR of 1.94 (1.59–2.35) for graft failure. Donor-to-recipient body surface area ratio <0.90 had a RR of 1.40 (1.13–1.75). Programs with experience transplanting <23 SLs had a RR of 1.43 (1.21–1.75). The same program transplanting both split segments had a RR of 1.38 (1.20–1.59).

Conclusions.

Splitting protocols based on these findings could improve graft survival after SL transplantation, which would encourage programs to opt into splitting more livers. The new protocols may consider donor age restrictions, necessary program experience, donor with body surface area appropriate for recipient, and improved logistical factors to share segments between transplant programs. The result would likely be a drastic reduction in liver waitlist deaths for young children and small-statured candidates.
Implementing a Ureteric Magnetic Stent in the Kidney Transplant Setting: Report of 100 Consecutive Cases
Authors: Capocasale Enzo , Cremaschi Elena , Valle Raffaele Dalla , Ferretti Stefania , Pellegrino Carlo , Iaria Maurizio , Puliatti Carmelo
Published: July 2019

Background.

Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease. The double-J-stent has been used to prevent urological complications (UCs), but it requires cystoscopy extraction. The novel magnetic black star (MBS) stent provided with a customized retrieval device (9 or 15 Fr) has been developed to spare cystoscopy. Scope of the paper is to analyze MBS in 100 consecutive KTs.

Methods.

We report a retrospective analysis of 100 consecutive KT performed between April 2015 and September 2018 using MBS (4.8 Fr, 15 cm) to protect Lich-Gregoir ureteroneocystotomy. MBS was removed 4 weeks after KT by either the 9 Fr (61 cases) or the 15 Fr (39 cases) retrieval device.

Results.

Intraoperative MBS insertion was straightforward in all cases, and its extraction was carried out in the outpatient setting in 93 patients. Extraction time was <30 seconds in 45 out of 61 patients (73.8%) and in 38 out of 39 patients (97.4%) using the 9 Fr and the 15 Fr retrieval device, respectively. In 15 patients, MBS removal took between 30 seconds and 3 minutes. Only 2 cases required extraction by cystoscopy. We observed 2 UC (ureteric leak and stenosis), 8 urinary tract infections, and 9 stent-related symptoms. 7 patients experienced distressing pain according to Visual Analog Scale for Pain.

Conclusions.

In our cohort, MBS appeared to be safe and cost-effective. We advocate its routine implementation in KT because of an easy and comfortable extraction in the outpatient setting even by nondedicated staff, without detrimental impact on UC and urinary tract infection rates.
Do Social Determinants Define “Too Sick” to Transplant in Patients With End-stage Liver Disease?
Authors: Bababekov Yanik J. , Hung Ya-Ching , Chang David C. , Rickert Charles G. , Adler Joel T. , Bethea Emily , Pomfret Elizabeth A. , Pomposelli James J. , Yeh Heidi
Published: July 2019

Background.

Delisting for being “too sick” to be transplanted is subjective. Previous work has demonstrated that the mortality of patients delisted for “too sick” is unexpectedly low. Transplant centers use their best clinical judgment for determining “too sick,” but it is unclear how social determinants influence decisions to delist for “too sick.” We hypothesized that social determinants and Donor Service Area (DSA) characteristics may be associated with determination of “too sick” to transplant.

Methods.

Data were obtained from the Scientific Registry of Transplant Recipients for adults listed and removed from the liver transplant waitlist from 2002 to 2017. Patients were included if delisted for “too sick.” Our primary outcome was Model for End-Stage Liver Disease (MELD) score at waitlist removal for “too sick.” Regression assessed the association between social determinants and MELD at removal for “too sick.”

Results.

We included 5250 delisted for “too sick” at 127 centers, in 53 DSAs, over 16 years. The mean MELD at delisting for “too sick” was 25.8 (SD ± 11.2). On adjusted analysis, social determinants including age, race, sex, and education predicted the MELD at delisting for “too sick” (P < 0.05).

Conclusions.

There is variation in delisting MELD for “too sick” score across DSA and time. While social determinants at the patient and system level are associated with delisting practices, the interplay of these variables warrants additional research. In addition, center outcome reports should include waitlist removal rate for “too sick” and waitlist death ratios, so waitlist management practice at individual centers can be monitored.
Metformin Attenuates Cyclosporine A-induced Renal Fibrosis in Rats
Authors: Lin Can-Xiang , Li Yan , Liang Shi , Tao Jun , Zhang Li-Sui , Su Yang-Fan , Huang Yun-Xi , Zhao Zong-Kai , Liu Shan-Ying , Zheng Jun-Meng
Published: July 2019

Background.

The aim of the present study was to investigate the therapeutic potential of metformin in preventing cyclosporine A (CsA)-induced nephrotoxicity.

Methods.

Three groups of adult male Sprague-Dawley rats were treated with vehicle, CsA, and CsA + metformin for 4 weeks following 1 week on low sodium diet, respectively. At the end of treatment, all animals were euthanized, and the samples of kidney, urine, and blood were collected for functional, morphological, and molecular biological evaluation.

Results.

Metformin effectively prevented CsA-induced renal dysfunction with increased creatinine clearance rate and reduced blood urea nitrogen and serum creatinine, as well as less proteinuria in comparison to the CsA group. Morphologically, metformin ameliorated CsA-induced renal fibrosis and tissue collapse in the areas of arteries, glomeruli, and proximal tubules. We further demonstrated that the antifibrotic effects of metformin in kidneys treated with CsA were associated with decreased phosphorylation of extracellular signal-regulated kinase1/2 (ERK1/2).

Conclusions.

In conclusion, our study revealed new therapeutic potential of metformin to attenuate calcineurin inhibitor-induced renal fibrosis, which was closely related to the suppression of MEK/ERK1/2 pathway.
Long-term Seroprotection of Varicella-zoster Immunization in Pediatric Liver Transplant Recipients
Authors: Verolet Charlotte M. , Pittet Laure F. , Wildhaber Barbara E. , McLin Valérie A. , Rodriguez Maria , Grillet Stéphane , Siegrist Claire-Anne , Posfay-Barbe Klara M.
Published: July 2019

Background.

Chickenpox is a highly contagious vaccine-preventable disease that can lead to severe complications, especially in immunocompromised patients. Varicella-zoster virus (VZV) vaccine appears to be safe and immunogenic in pediatric solid organ transplant recipients, but there are few data on the long-term vaccine-induced seroprotection.

Methods.

In this prospective interventional study, we offered 2 doses of VZV vaccine to all eligible and nonseroprotected children seen 1 year after liver transplant. Vaccine responses were measured 1 month later and yearly thereafter. Vaccine safety was closely monitored. A supplementary dose was administered if protective levels were not reached/maintained.

Results.

Among 121 enrolled patients, 49 were vaccinated and followed during 5.5 years (interquartile range, 3.7-8.0). Their seroconversion rate reached 100% (97.5% confidence interval [CI], 92.7-100). Low VZV-antibody concentration (≤400 UI/L) after the first 1–2 dose/s was associated with the need for a supplementary dose (odds ratio, 15.0; 95% CI, 3.4-67.0, P = 0.001) and was given to 31% (15/47) of children at 1.1 year (interquartile range, 0.9-3.9). Although antibody concentrations declined during follow-up, 96% (95% CI, 86.0-99.5) of patients maintained protective antibody concentrations at a median of 5.5 years after vaccination. One breakthrough disease was identified.

Conclusions.

VZV immunization of pediatric solid organ transplant recipients confers sustained seroprotection.
Plasmacytoid Dendritic Cell–driven Induction of Treg Is Strain Specific and Correlates With Spontaneous Acceptance of Kidney Allografts
Authors: Oh Nicholas A. , O’Shea Thomas , Ndishabandi Dorothy K. , Yuan Qing , Hong Shuahuan , Gans Jared , Ge Jifu , Gibney Sean , Chase Catharine , Yang Chao , Rosales Ivy , Shinoda Kazunobu , Drew Benjamin , Kojima Lisa , Russell Paul S. , Madsen Joren C. , Colvin Robert B. , Alessandrini Alessandro
Published: July 2019

Background.

DBA/2J kidney allografts, but not heart allografts, are spontaneously accepted indefinitely in C57BL/6 (B6) mice, through regulatory tolerance mechanism dependent on Foxp3+ cells. In contrast, B6 kidneys are rejected within a week in DBA/2J recipients. We hypothesized that the tolerogenic difference of the kidneys might be due to differences in number or function of plasmacytoid dendritic cells (pDCs), because these cells are potent inducers of Foxp3+ cells.

Methods.

pDCs from murine bone marrow, native kidneys, and spontaneously accepted kidney allografts were analyzed using flow cytometry and immunohistochemical staining. Naive T cells were cocultured with pDCs in specific strain combinations and analyzed for FoxP3 induction and functionality. MEK/ERK and NFκB inhibitors were used to assess the regulatory T-cell induction pathways. pDCs and T-cell cultures were adoptively transferred before heterotopic heart transplantation to assess allograft survival.

Results.

DBA/2J pDCs were more potent in inducing Foxp3+ in B6 T cells than the reverse combination, correlating with survival of the kidney allografts. Foxp3 induction by pDCs in vitro was dependent on pDC viability, immaturity, and class II MHC mismatch and blocked by MEK/ERK and NFκB inhibition. pDC-induced Foxp3+ T cells suppressed proliferation of B6 T cells in vitro, and adoptive transfer into B6 recipients 2 weeks before heterotopic DBA/2J heart transplantation resulted in prolonged allograft survival.

Conclusions.

These data suggest that pDC-induced regulatory T cells are dependent on downstream signaling effects and on strain-dependent, MHC class II disparity with naive T cells, which may explain organ- and strain-specific differences in spontaneous tolerance.
First European Case of Simultaneous Liver and Pancreas Transplantation as Treatment of Wolcott-Rallison Syndrome in a Small Child
Authors: Nordström Johan , Lundgren Markus , Jorns Carl , Fischler Björn , Arnell Henrik , Dlugosz Rafal , Sandberg John , Wennberg Lars , Nowak Greg
Published: July 2019

Background.

The concept of organ transplantation as treatment for complex genetic conditions, including Wolcott-Rallison syndrome (WRS), continues to show promise. Liver transplantation is essential for survival of patients with WRS, and pancreas transplantation cures their type I diabetes mellitus.

Methods.

The recipient, a 3-year-old girl weighing 14 kg at the time of transplantation, suffered from major complications of WRS, including repetitive liver failure episodes and poorly controlled diabetes. The patient underwent a nonacute, combined, simultaneous liver and pancreas transplantation from a pediatric donor without using the en bloc technique.

Results.

Well-preserved graft functions at 2-year follow-up with normal liver and pancreas function.

Conclusions.

This is the first case report of simultaneous liver and pancreas transplantation as treatment of WRS in a small child in Europe. Two-year follow-up demonstrates that organ transplantation can halt life-threating recurrent liver failure episodes and cure type 1 diabetes.
Kidney After Liver Transplantation Matched-pair Analysis: Are Kidneys Allocated to Appropriate Patients to Maximize Their Survival?
Authors: Eerhart Michael J. , Reyes José A. , Leverson Glen E. , Danobeitia Juan S. , Blanton Casi L. , Zitur Laura J. , Chlebeck Peter J. , Fernandez Luis A.
Published: July 2019

Background.

Kidney after liver transplantation (KALT) is the best therapeutic option for patients with end-stage renal disease after orthotopic liver transplantation (OLT). New allocation policies prioritize kidneys to patients in renal failure within the first year following OLT. There is little data on how kidney quality, measured by kidney donor profile index (KDPI), impacts KALT survival outcomes.

Methods.

The United Network for Organ Sharing database was queried for adult KALT recipients from 1988 to 2015 and compared to their paired kidney transplant alone (KTA) recipients. Seven hundred forty-five pairs were stratified into 3 KDPI subgroups and compared patient survival, graft survival, and death-censored graft survival among matched-paired recipients.

Results.

Overall, KTA recipients had superior patient and graft survival compared with the KALT group. KTA patient survival was superior for all 3 KDPI subgroups analysis. KTA graft survival was superior compared with KALT recipients of KDPI 21%–85% kidneys. Inferior graft half-life was observed in KALT versus KTA recipients with KDPI 21%–85% and >85%.

Conclusions.

From a utilitarian perspective, it is important that kidneys are allocated to recipients that are able to maximize their benefit from the full life of the organ. In KTA recipients, graft quality correlates directly to graft survival. However, in KALT patients receiving the matched-pair kidneys of the KTA recipients, patient mortality, rather than kidney quality, dictates graft survival significantly. As allocation practices continue developing, utilization of expanded criteria kidneys that better match anticipated patient and graft survival should be strongly considered to maximize the benefits of limited resources for the greatest number of patients.
Impact of a Mobile Health Intervention on Long-term Nonadherence After Lung Transplantation: Follow-up After a Randomized Controlled Trial
Authors: Geramita Emily M. , DeVito Dabbs Annette J. , DiMartini Andrea F. , Pilewski Joseph M. , Switzer Galen E. , Posluszny Donna M. , Myaskovsky Larissa , Dew Mary Amanda
Published: July 2019

Background.

In a randomized controlled trial, lung transplant recipients (LTRs) using a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), showed better adherence to the medical regimen than LTRs receiving usual care during the first year posttransplant. We examined whether these effects were maintained beyond the end of the trial and evaluated other potential risk factors for long-term nonadherence.

Methods.

Adherence in 8 areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Pocket PATH and usual care groups’ nonadherence rates were compared; multivariable regression analyses then examined and controlled for other patient characteristics’ associations with nonadherence.

Results.

One hundred five LTRs (75% of survivors) were assessed (M = 3.9 years posttransplant, SD = 0.8). Nonadherence rates in the past month were 23%–81% for self-care and lifestyle requirements (diet, exercise, blood pressure monitoring, spirometry), 13%–23% for immunosuppressants and other medications, and 4% for tobacco use, with 31% clinic appointment nonadherence in the past year. In multivariable analysis, the Pocket PATH group showed lower risk of nonadherence to lifestyle requirements (diet/exercise) than the usual care group (P < 0.05). Younger age and factors during the first year posttransplant (acute graft rejection, chronically elevated anxiety, less time rehospitalized, nonadherence at the final randomized controlled trial assessment) were each associated with nonadherence in at least 1 area at follow-up (P < 0.05).

Conclusions.

Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other risk factors for long-term nonadherence. Future work should explore strategies to facilitate sustained effects of mobile health interventions.
Ileostomy After Intestinal Transplantation: The First in Depth Report on Techniques, Complications, and Outcomes
Authors: Dumronggittigule Wethit , Venick Robert S. , Dubray B. John , Cheng Elaine C. , Duffy John P. , Marcus Elizabeth A. , Busuttil Ronald W. , Farmer Douglas G.
Published: July 2019

Background.

Temporary ileostomy during intestinal transplantation (ITx) is the standard technique for allograft monitoring. A detailed analysis of the ITx ileostomy has never been reported.

Methods.

A retrospective review of a single-center ITx database was performed. The analysis was divided into ileostomy formation and takedown episodes.

Results.

One hundred thirty-five grafts underwent ileostomy formation, and 79 underwent ileostomy takedown. Median age at ITx was 7.7 years and weight was 23 kg. Allograft types were intestine (22%), liver/intestine (55%), multivisceral (16%), and modified multivisceral (7%). Sixty-four percent had 1-stage ITx, whereas 36% required 2-staged ITx. Final ileostomy types were end (20%), loop (10%), distal blowhole (59%), and proximal blowhole (11%). Ileostomy formation: Thirty-one grafts had complications (23%), including prolapse (26%), ischemia (16%), and parastomal hernia (19%). Twelve required surgical revision. There were no significant differences in graft type, ileostomy type, survival, and ileostomy takedown rate between grafts with and without complications. Colon inclusive grafts had higher complication rates (P = 0.002). Ileostomy takedown: Ileostomy takedown occurred at a median of 422 days post-ITx. Twenty-five complications occurred after 22 takedowns (28%), including small bowel obstruction (27%) and abscess (18%). Fifteen grafts required surgical correction. Recipients with complications had longer hospital stay (17 versus 9 d; P = 0.001) than those without complications. Graft type, ileostomy type, and survival were not different.

Conclusions.

The first of its kind analysis of the surgical ileostomy after ITx reveals that most recipients can undergo successful ileostomy formation/takedown, complication rates are significant but within an acceptable range, and complications do not affect survival. This study demonstrates that the routine use of transplant ostomies remains an acceptable practice after ITx. However, true analysis of risk and benefit will require a randomized control trial.
Age-related Hearing Loss and Dementia
Authors: Chern Alexander , Golub Justin S.
Published: July 2019

Dementia is a devastating disease and global health challenge that is highly prevalent worldwide. A growing body of research has shown an independent association between age-related hearing loss (ARHL) and dementia, identifying ARHL as a compelling potential target in preventive strategies for dementia. However, a causal linkage between ARHL and dementia needs to be investigated before making definitive clinical guidelines and treatment recommendations regarding ARHL as a modifiable risk factor. In this review, we discuss the association between ARHL and dementia, the importance of addressing this finding, as well as common mechanisms (eg, microvascular disease) and causal mechanisms (eg, depletion of cognitive reserve and social isolation) that may explain the nature of this relationship. Future directions for research are also highlighted, including randomized controlled trials, developing high-resolution microvascular imaging, and further refining audiometric testing.