Modest minds for big scientific disciplines

These findings were confirmed using a more recent LT population closer to the current standard of care (LT after the year 2000).
an increasing number of PSC patients, particularly women, are being transplanted in European countries with better graft outcome in female recipients. learn more Other variables impacting outcome include donor and recipient age, CC, non-DBD donor and reduced graft size.
an increasing number of PSC patients, particularly women, are being transplanted in European countries with better graft outcome in female recipients. Other variables impacting outcome include donor and recipient age, CC, non-DBD donor and reduced graft size.
From population studies, solid organ transplant recipients are at increased risk of mortality from RT-PCR confirmed COVID-19 infection. The risk factors associated with infection acquisition and mortality in transplant recipients using serological data have not been reported.
From 1725 maintenance transplant recipients, 855 consecutive patients were screened for SARS-CoV-2 antibodies. Serological screening utilized assays to detect both the N protein and receptor binding domain antibodies. Thirty-three of 855 (3.9%) of the screened patients had prior infection confirmed with RT-PCR. Twenty-one additional patients from our 1725 maintenance cohort with RT-PCR confirmed infection were included in our analysis.
Eighty-nine of 855 (10.4%) patients tested positive for SARS-CoV-2 antibodies. Fifty-nine of 89 (66.3%) cases were patients newly identified as exposed, while 30/89 (33.7%) seropositive patients had previous infection confirmed by RT-PCR. A diagnosis of SARS-CoV-2 (RT-PCR or Ab+) was associated with ion of immunosuppression regimen on outcomes.
The risk of COVID-19 infection in transplant recipients (TRs) is unknown. Patients on dialysis may be exposed to greater risk of infection due to an inability to isolate. Consideration of these competing risks is important before restarting suspended transplant programs. This study compared outcomes in kidney and kidney/pancreas TRs with those on the waiting list, following admission with COVID-19 in a high-prevalence region.
Audit data from all 6 London transplant centers were amalgamated. Demographic and laboratory data were collected and outcomes included mortality, intensive care (ITU) admission, and ventilation. Adult patients who had undergone a kidney or kidney/pancreas transplant, and those active on the transplant waiting list at the start of the pandemic were included.
One hundred twenty-one TRs and 52 waiting list patients (WL) were admitted to hospital with COVID-19. Thirty-six TR died (30%), while 14 WL patients died (27% P = 0.71). There was no difference in rates of admission to ITU or ventilation. Twenty-four percent of TR required renal replacement therapy, and 12% lost their grafts. Lymphocyte nadir and D-dimer peak showed no difference in those who did and did not die. No other comorbidities or demographic factors were associated with mortality, except for age (odds ratio of 4.3 [95% CI 1.8-10.2] for mortality if aged over 60 y) in TR.
TRs and waiting list patients have similar mortality rates after hospital admission with COVID-19. Mortality was higher in older TRs. These data should inform decisions about transplantation in the COVID era.
TRs and waiting list patients have similar mortality rates after hospital admission with COVID-19. Mortality was higher in older TRs. These data should inform decisions about transplantation in the COVID era.
Intrahepatic cholangiocarcinoma (iCCA) is a contraindication to liver transplantation (LT) in most centers worldwide. Therefore, only a few such cases have been performed in each individual center and the need for a systematic review and meta-analysis to cumulatively pool these results is apparent.
A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA statement (end-of-search date May 29, 2020). Meta-analyses of proportions were conducted to pool the overall survival (OS), recurrence-free survival (RFS), and overall recurrence rates using the random-effects model. Meta-regression was utilized to examine cirrhosis and incidental diagnosis as confounders on OS and RFS.
Eighteen studies comprising 355 patients and a registry study of 385 patients were included. The pooled 1-, 3-, and 5-year OS rates were 75% (95%CI 64%-84%), 56% (95%CI 46%-67%), and 42% (95%CI 29%-55%), respectively. The pooled 1-, 3-, and 5-year RFS rates were 70% (95%CI 63%-75%), 49% (95%CI 41%-57%), and 38% (95%CI 27%-50%), respectively. Cirrhosis was positively associated with RFS, while incidental diagnosis was not. Neither cirrhosis nor incidental diagnosis were associated with OS. The pooled overall recurrence rate was 43% (95%CI 33%-53%) over a mean follow-up of 40.6±37.7 months. Patients with very early (single ≤ 2 cm) iCCA exhibited superior pooled 5-year RFS (67%, 95%CI 47%-86%) versus advanced iCCA (34%, 95%CI 23%-46%).
Cirrhotics with very early iCCA or carefully selected patients with advanced iCCA after neoadjuvant therapy may benefit from LT under research protocols.
Cirrhotics with very early iCCA or carefully selected patients with advanced iCCA after neoadjuvant therapy may benefit from LT under research protocols.
The use of therapeutic drug monitoring (TDM) to guide treatment with long-acting injectable (LAI) antipsychotics, which are increasingly prescribed, remains a matter of debate. The aim of this review was to provide a practical framework for the integration of TDM when switching from an oral formulation to the LAI counterpart, and in maintenance treatment.
The authors critically reviewed 3 types of data (1) positron emission tomography data evaluating dopamine (D2/D3) receptor occupancy related to antipsychotic concentrations in serum or plasma; D2/D3 receptors are embraced as target sites in the brain for antipsychotic efficacy and tolerability, (2) pharmacokinetic studies evaluating the switch from oral to LAI antipsychotics, and (3) pharmacokinetic data for LAI formulations. Based on these data, indications for TDM and therapeutic reference ranges were considered for LAI antipsychotics.
Antipsychotic concentrations in blood exhibited interindividual variability not only under oral but also under LAI formulations because these concentrations are affected by demographic characteristics such as age and sex, genetic peculiarities, and clinical variables, including comedications and comorbidities.