A Prospective Study of Predicting Prognosis and Recurrence of Thyroid Cancer Via New Biomarkers, Urinary Exosomal Thyroglobulin and Galectin-3

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   National Taiwan University Hospital
Not yet recruiting

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Incidence, Risk Factors, and Outcomes of Clostridium difficile Infections in Kidney Transplant Recipients

Background Kidney transplant recipients (KTR) may be at increased risk for Clostridium difficile infections (CDI) but risk factors and outcomes in this population have not been well studied. Methods An observational cohort study was conducted to determine the incidence, risk factors, and outcomes of CDI in KTR. A total of 1,816 KTR transplanted between 2000 and 2013 at Toronto General Hospital were included. Sixty-eight patients developed CDI. Controls were selected at a 4:1 ratio using risk-set sampling and risk factors were explored using conditional logistic regression models. The impact of CDI on graft outcomes was evaluated using Cox proportional hazards models. Results The incidence rate of CDI was 0.64 cases/100 person-years. Independent predictors of CDI included antibiotic use (OR 2.88 [95%CI: 1.35, 6.15]), increased duration of hospitalization posttransplant (OR 1.04 [95%CI: 1.02, 1.06]), receiving a deceased donor kidney (OR 2.98 [95%CI: 1.47, 6.05]), and a history of biopsy-proven acute rejection (OR 5.82 [95%CI: 2.22, 15.26]). In the Cox proportional hazards model, CDI was found to be an independent risk factor for the subsequent development of biopsy-proven acute rejection (HR 2.18 [95% CI: 1.34, 3.55]). Conclusions Our results confirm that transplant-specific factors place KTR at a higher risk for CDI. CDI may increase the risk of adverse outcomes such as biopsy-proven acute rejection. These findings emphasize the importance of preventive strategies to reduce the morbidity associated with CDI in KTR. Address correspondence to: S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto General Hospital, University Health Network, 585 University Avenue, 11-PMB-129, Toronto, Ontario, Canada M5G 2N2. Email: joseph.kim@uhn.ca. Office: 416-340-3228. Fax: 416-340-4701 AUTHORSHIP Research design: G. Li, Trac, Husain, Famure, Y. Li, Kim Writing the paper: G. Li, Trac, Husain, Famure, Kim Performance of the research: G. Li, Trac, Husain, Famure, Kim Contributed analytic tools: G. Li, Trac, Y. Li, Kim Participated in data analysis: G. Li, Trac, Husain, Famure, Y. Li, Kim DISCLOSURE The authors have no conflicts of interest to disclose as it relates to this work. FUNDING No external funding was acquired to support this research. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Reduced access to liver transplantation in women: role of height, MELD exception scores and renal function underestimation

Background Sex-based disparities in liver transplantation (LT) are incompletely understood. We assessed the role of height, MELD, MELD-Na and exception points in the disparate access to LT. Methods Adults waitlisted for LT at Organ Procurement and Transplantation Network (OPTN) between 2002 and 2013 were included. Covariates associated with likelihood of LT were analyzed by Cox proportional model. In a separate cohort of waitlisted adults with glomerular filtration rate (GFR) measurement by iothalamate clearance (n=611), we determined the number of creatinine-derived MELD points in men vs women, across all ranges of GFR. The impact of correcting the MELD score deficit in women on LT was modeled. Results Among 90,720 OPTN registrants, women had higher mortality than men (4 years after listing: 22% vs 18%, p

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Long-term outcomes of ABO-incompatible pediatric living donor liver transplantation

Background ABO-incompatible (ABOi) living donor liver transplantation (LDLT) have been performed to compensate for donor shortage. To date, few studies have reported detailed B cell desensitization protocols and long-term outcomes of ABOi pediatric LDLT. Methods Twenty-nine pediatric ABOi LDLT recipients were retrospectively analyzed. We compared the clinical outcomes between ABOi (n = 29) and non-ABOi (n = 131) pediatric LDLT recipients. Furthermore, we evaluated the safety and efficacy of our rituximab-based regimen for ABOi pediatric LDLT (2 ≤ age

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Meeting Report of the 13th Congress of the International Society of Vascularized Composite Allotransplantation

The International Society of Vascularized Composite Allotransplantation (ISVCA) held its 13th congress "Defining Success" in October 2017 in Salzburg, Austria. A total of 122 delegates from 22 countries representing 5 continents attended the conference. The theme strived to provide pathways to accomplish best possible outcomes in this unique and multifaceted field of transplantation. 'Ignite talks', a new feature introduced for the first time at the Salzburg meeting served as key elements for productive discussions on both congress days. The "ignitors" had been selected as experts from Europe, the Americas and Asia in VCA and neighbouring disciplines and provided a global perspective of their topic. Posttransplant treatment regimens, including the most burdensome side effects of immunosuppressants in addition to novel and future therapeutic options were discussed in depth. An additional ethics symposium summarized and advanced topics that had been discussed during the first international workshop on bioethical challenges in reconstructive transplantation held earlier in 2017. Correspondence Annemarie Weissenbacher, MD, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Old Road, Oxford, OX3 7LE, United Kingdom. Tel.: +447481147692. E-mail: annemarie.weissenbacher@nds.ox.ac.uk Authorship AW: local organising chair and chair of the SPC for the ISVCA congress, wrote the meeting report; LC, EM, PP, GB, PJF, VG, CK, JK, LSL, GV, SS: SPC members, participated in editing the meeting report Disclosure The authors declare no conflicts of interest. The authors have no funding to disclose. Funding No funding received. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Pancreas Transplantation from pediatric donors: a single center experience

Background Pancreas allografts from pediatric donors are considered less suitable due to the increased risk of surgical complications and reduced islet cell mass that may compromise function. Methods All pancreatic transplants, procured from donors 60kg. Analysis of patient and graft survival was done between the groups, and subsequently between the pediatric cohort and the adult-donor control group. Results Sixty-three pediatric-donor pancreas transplants were performed. The mean donor age and weight were of 12.10±4.13 years and 47.8±21.3kg. Excellent metabolic control was achieved in 59 (93.65%) patients at the time of discharge and at a mean 5 year follow up, with the average hemoglobin A1c of 5.30 ±0.61% and blood glucose level of 102.75±20.70 mg/dL in those with a functioning graft. Nine graft losses were registered, of which one (1.6%) was due to arterial thrombosis. Eight (12.7%) patients experienced rejection. Overall graft survival and patient survival were of 85.7% and 92.1%, respectively, at a median follow up of 37.07 months (min 0.19 – max 119.57). No differences amongst the 3 groups were identified. Long term patient and allograft survival was comparable to that of the adult-donor pancreatic transplants. Conclusion Pediatric-donor pancreas demonstrated excellent short-term outcomes with no surgical complications and promising long-term outcomes despite the smaller islet mass. Pancreata from pediatric donors should not be marginalized and can offset worsening organ shortage. Corresponding Author: Mario Spaggiari, MD, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Clinical Sciences Building, Suite 522, Chicago, Illinois 60612. Telephone: 312-996-6771. Fax: 312-413-3483. mspaggia@uic.edu Authorship: Mario Spaggiari participated in study design, statistical analysis, and writing. The author declares no conflict of interest. Caterina Di Bella participated in study design, statistical analysis, and writing. The author declares no conflict of interest. Pierpaolo Di Cocco participated in study design, statistical analysis and writing. The author declares no conflict of interest. Maya Campara participated in writing and critical review. The author declares no conflict of interest. Kelly Galen participated in writing and critical review. The author declares no conflict of interest Federico Gheza participated in data analysis and critical review. The author declares no conflict of interest. Jose Oberholzer participated in critical review and study design. The author declares no conflict of interest. Enrico Benedetti participated in critical review and study design. The author declares no conflict of interest. Ivo G. Tzvetanov participated in critical review and study design. The author declares no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Tofacitinib halts progression of graft dysfunction in a rat model of mixed cellular and humoral rejection

Background The progression from acute to chronic antibody-mediated rejection in kidney transplant recipients is usually not prevented by current therapeutic options. Here, we investigated whether the use of tofacinitib, a Janus kinase 3 inhibitor, was capable of preventing the progression of allograft dysfunction in a Fisher-to-Lewis rat model of kidney transplantation. Methods Rats were treated from the third week after transplantation in order to allow the development of rejection. Treatment was based on cyclosporin A, rapamycin or tofacitinib. Renal function was assessed at 1, 4, 8 and 12 weeks after transplantation while rat survival, histological lesions and infiltrating lymphocytes were analyzed at 12 weeks. Results Tofacitinib prolonged graft survival, preserved tubular and glomerular structures and reduced humoral damage characterized by C4d deposition. Tofacitinib was able to reduce donor-specific antibodies. In addition, T and NK cell graft infiltration was reduced in tofacitinib treated rats. Although rapamycin treated rats also showed prolonged graft survival, glomerular structures were more affected. Moreover, only tofacitinib treatment reduced the presence of T, B and NK cells in splenic parenchyma. Conclusions Tofacitinib is able to reduce the immune response generated in a rat model of kidney graft rejection, providing prolonged graft and recipient survival, better graft function and less histological lesions. CORRESPONDING AUTHOR Fritz Diekmann, MD, Hospital Clínic de Barcelona, Department of Nephrology and Renal Transplantation, Villarroel 170 (Escala 12 – Planta 5). E-08036 Barcelona, Spain. Tel.: +34-932275444. Fax: +34-934546033. fdiekman@clinic.ub.es Authorship Jordi Rovira: participated in research design, performance of research, data analysis and writing of the paper. María J Ramírez-Bajo: participated in data analysis, performance of research. Elisenda Banon-Maneus: participated in data analysis, performance of research. Marta Lazo-Rodríguez: participated in data analysis, performance of research. Daniel Moya-Rull: participated in data analysis, performance of research. Natalia Hierro-Garcia: participated in data analysis, performance of research. Valeria Tubita: participated in data analysis, performance of research. Gastón J Piñeiro: participated in data analysis, performance of research. Ignacio Revuelta: participated in data analysis, performance of research. Pedro Ventura-Aguiar: participated in data analysis, performance of research. David Cucchiari: participated in data analysis, critical revision of the manuscript for important intellectual content. Federico Oppenheimer: critical revision of the manuscript for important intellectual content. Mercè Brunet: participated in data analysis, critical revision of the manuscript for important intellectual content. Josep M Campistol: critical revision of the manuscript for important intellectual content. Fritz Diekmann: participated in research design, data analysis and writing of the paper. Disclosure The authors declare no conflicts of interest. Funding This study has been funded by the project PI11/01112 and Redes Tematicas De Investigacion Cooperativa En Salud, REDINREN (RD12/0021/0028 and RD16/0009/0023) both co-funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) "Una manera de hacer Europa". CERCA Programme/Generalitat de Catalunya. This work was developed at the Centre de Recerca Biomèdica Cellex, Barcelona, Spain. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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