Objectives: The effect of allograft ischaemic time (AIT) on postoperative events after lung transplantation remains unclear. This study aims to assess the feasibility of extending the duration of AIT.
Methods: The United Network for Organ Sharing database was queried for adult lung transplantation from 4 May 2005 to 30 June 2020. Patients were divided as per AIT into standard ischaemic time (<6 h) and prolonged ischaemic time (≥6 h) groups using propensity score matching and evaluated on a continuous scale using restricted cubic splines. The primary outcome was overall 1-year and 5-year survival.
Results: Among 11 438 propensity-matched recipients, standard ischaemic time and prolonged ischaemic time showed no differences in overall 1-year (P = 0.29) or 5-year (P = 0.29) survival. Prolonged ischaemic time independently predicted early postoperative ventilator support for >48 h (OR = 1.33, 95% CI 1.22-1.44), dialysis (OR = 1.55, 95% CI 1.30-1.84), primary graft dysfunction (PGD; OR = 1.28, 95% CI 1.09-1.50), acute rejection (OR = 1.42, 95% CI 1.24-1.62), and interestingly, decreased 5-year bronchiolitis obliterans syndrome (HR = 0.91, 95% CI 0.85-0.97). In relative risk curves, 1-year mortality, prolonged ventilation, dialysis and PGD steadily increased per hour as AIT extended. The risk of acute rejection and 5-year bronchiolitis obliterans syndrome also showed significant changes between 5 and 8 h of AIT. In contrast, 5-year mortality remained constant despite rising AIT.
Conclusions: Prolonged AIT worsened early outcomes such as PGD, but improved bronchiolitis obliterans syndrome freedom at later time points. Despite this, both short- and long-term survival were similar between prolonged ischaemic time and standard ischaemic time patients. Dynamic risk changes in post-transplant events should be noted for prolonged ischaemia lung use.
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http://dx.doi.org/10.1093/ejcts/ezae425 | DOI Listing |
Introduction Parenteral heparin is widely used as bridging therapy while optimising oral anticoagulation(OAC). Newer Direct-Acting OACs(DOACs) attain therapeutic effect very quickly. We report the use of dabigatran as bridging therapy during warfarin optimization for cardioembolic stroke in two patients who opted to receive warfarin for long-term anticoagulation for secondary stroke prevention.
View Article and Find Full Text PDFCardiol Ther
December 2024
Internal Medicine Medical Affairs, Pfizer Japan Inc, 3-22-7 Yoyogi, Shibuya-Ku, Tokyo, 151-8589, Japan.
Introduction: Very elderly patients with nonvalvular atrial fibrillation (NVAF) are at high risk for both ischemic and hemorrhagic events. This study aimed to understand the characteristics and real-world treatment of very elderly patients with NVAF in Japan.
Methods: We conducted a retrospective analysis of electronic health records and claims data from acute care hospitals for very elderly patients with NVAF with medical records available on or after their 80th birthday.
Zhonghua Yu Fang Yi Xue Za Zhi
December 2024
Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing100020, China.
This study aimed to analyze the clinical characteristics and prognosis of Takayasu's arteritis (TA) with carotid artery occlusion in children. This study collected clinical data and follow-up information on the first diagnosis and treatment of c-TA combined with carotid artery occlusion in pediatric patients at the Children's Hospital affiliated with the Capital Institute of Pediatrics and Inner Mongolia Medical University Affiliated Hospital from 2013 to 2023. This study included four female patients with a mean age of (13.
View Article and Find Full Text PDFAm J Cardiol
December 2024
Jinan Hospital, 63-1 Lishan Road, Jinan City 250013.
Individual cerebral small vessel disease (SVD) markers independently predict poor prognosis following stroke. However, the impact of a single SVD, especially cumulative SVD burden on outcomes in acute ischemic stroke (AIS) after intravenous thrombolysis remains unclear. This work evaluated the occurrence of small vessel disease (SVD) in AIS patients who were treated with intravenous thrombolytic therapy by using multimodal MRI imaging.
View Article and Find Full Text PDFJ Ethnopharmacol
December 2024
Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China; Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China; Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China. Electronic address:
Ethnopharmacological Relevance: Delayed tissue-type plasminogen activator (t-PA) thrombolysis, which has a restrictive therapeutic time window within 4.5 h following ischemic stroke (IS), increases the risk of hemorrhagic transformation (HT) and subsequent neurotoxicity. Studies have shown that the NLRP3 inflammasome activation reversely regulated by the PGC-1α leads to microglial polarization and pyroptosis to cause damage to nerve cells and the blood-brain barrier.
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