Background: In several countries, patients with end-stage renal disease who are ineligible for dialysis are considered urgency priority (UP) for kidney transplantation (KT) through distinct allocation rules. There are scarce published data on clinical features and outcomes after KT of these patients.
Methods: We retrospectively reviewed and compared demographic and clinical pretransplant characteristics and outcomes after KT of all patients transplanted under UP allocation in a single Brazilian transplant center from January 10 to March 16 (n = 74) and 1: 1 patients transplanted under standard allocation in the same period (n = 74). A propensity score (PS) matching analysis was performed to evaluate risk factors for death-censored graft loss.
Results: UP KT group presented higher percentage of women (58.1 vs. 33.8%, p = 0.005), higher class I (22.2 ± 32.9 vs. 13.1 ± 25.3%, p = 0.027) and class II panel reactive antibodies (11.5 ± 24 vs. 5.2 ± 19.1%, p = 0.002), higher HLA mismatches (4.9 ± 0.9 vs. 3.7 ± 1.2, p < 0.001), higher percentage of retransplants (27 vs. 4.1%, p < 0.001), and spent longer time on dialysis off the waiting list (WL; 54.5 ± 52.5 vs. 31.2 ± 29.0 months, p = 0.03). After transplantation, UP KT patients presented longer hospital stay (29.3 ± 35.7 vs. 18.5 ± 19.5 days, p = 0.003) and inferior death-censored graft survival at 3 years (82 vs. 95.8%, log rank = 0.016), with 33.3% of graft losses due to vascular thrombosis. In PS-matched multivariable analysis, UP status hazard ratios (HR 4.791, 95% CI 1.052-21.722, p = 0.042) and donor age (HR 1.071, 95% CI 1.003-1.145, p = 0.041) were independent risk factors for death-censored graft loss.
Conclusion: Patients transplanted under UP status remained a longer time on dialysis off the WL, suggesting that long-term dialysis led to exhaustion of accesses. After transplantation, outcomes are inferior and UP status was a risk factor for graft loss. These results point to the need for local policies to encourage and monitor the early referral to KT.
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http://dx.doi.org/10.1159/000497120 | DOI Listing |
Ann Intern Med
January 2025
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System; Department of Population Health Sciences, Duke University School of Medicine; and Durham Evidence Synthesis Program, Durham Veterans Affairs Health Care System, Durham, North Carolina (J.M.G.).
Background: Postdischarge contacts (PDCs) after hospitalization are common practice, but their effectiveness in reducing use of acute care after discharge remains unclear.
Purpose: To assess the effects of PDC on 30-day emergency department (ED) visits, 30-day hospital readmissions, and patient satisfaction.
Data Sources: MEDLINE, Embase, and CINAHL searched from 2012 to 25 May 2023.
Adv Sci (Weinh)
January 2025
Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver Disease, West China Hospital, Sichuan University, Chengdu, 610041, China.
Skeletal muscle atrophy (sarcopenia) is a serious complication of liver cirrhosis, and chronic muscle inflammation plays a pivotal role in its pathologenesis. However, the detailed mechanism through which injured liver tissues mediate skeletal muscle inflammatory injury remains elusive. Here, it is reported that injured hepatocytes might secrete mtDNA-enriched extracellular vesicles (EVs) to trigger skeletal muscle inflammation by activating the cGAS-STING pathway.
View Article and Find Full Text PDFEur J Endocrinol
January 2025
Department of Internal Medicine IV, LMU University Hospital, LMU Munich, 80336 Munich, Germany.
Objective: The effects of sex hormones remain largely unexplored in pheochromocytomas and paragangliomas (PPGLs) and gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Methods: We evaluated the effects of estradiol, progesterone, Dehydroepiandrosterone sulfate (DHEAS), and testosterone on human patient-derived PPGL/GEP-NET primary culture cell viability (n = 38/n = 12), performed next-generation sequencing and immunohistochemical hormone receptor analysis in patient-derived PPGL tumor tissues (n = 36).
Results: In PPGLs, estradiol and progesterone (1 µm) demonstrated overall significant antitumor effects with the strongest efficacy in PPGLs with NF1 (cluster 2) pathogenic variants.
Acta Orthop
January 2025
Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
Background And Purpose: Vascularized fibular grafting following tumor resection is an essential treatment option in limb salvage surgery. We aimed to evaluate: (I) bone healing, (II) complications and reoperations, (III) limb salvage, and (IV) survival.
Methods: We present a retrospective evaluation of a national cohort comprising 27 patients.
Blood Transfus
January 2025
Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Institute of Cancer and Hematological Diseases, Hospital Clínic Universitari de Barcelona, Barcelona, Spain.
Background: Chronic graft-vs-host disease (cGvHD) is a severe immune-mediated complication that affects patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Oral manifestations of cGvHD, such as ulcers and mucosal inflammation, significantly impair quality of life and often require long-term treatment. Existing therapies provide limited relief, prompting the exploration of new approaches, including the use of autologous platelet lysate (PL) gel for its regenerative properties.
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