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elderly transplant

Samah Nassereddine, Taiga Nishihori, Eric Padron, Rami Mahfouz, Ali Bazarbachi, Rami S Komrokji, Mohamed A Kharfan-Dabaja
Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematopoietic neoplastic disorders most commonly occurring in the elderly population; MDS has a tendency to progress to acute leukemia. Although epigenetic therapies have improved the outcomes of MDS patients, allogeneic hematopoietic cell transplantation remains the only curative option. Molecular characterization of MDS using next-generation sequencing has expanded not only the knowledge on MDS but also the depth of understanding of evolution and contribution of recurrent somatic mutations in precursor conditions...
September 16, 2016: Clinical Lymphoma, Myeloma & Leukemia
Neehar D Parikh, Vincent D Marshall, Amit G Singal, Hari Nathan, Anna S Lok, Rajesh Balkrishnan, Vahakn Shahinian
: Sorafenib is the only chemotherapeutic approved for treatment of advanced hepatocellular carcinoma (HCC.) However, its effectiveness in patients with Child Pugh B cirrhosis and any moderating effects of health system characteristics are unclear. We aimed to examine the survival and cost-effectiveness associated with sorafenib in elderly patients with advanced HCC. We performed an analysis of Medicare beneficiaries with HCC diagnoses from 2007-2009. We compared advanced stage patients with HCC (AJCC stage III/IV) who received sorafenib within 6 months of diagnosis (and were otherwise untreated) to advanced stage patients with HCC who received no therapy (control...
October 22, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Martin I Montenovo, Ryan N Hansen, André A S Dick, Jorge Reyes
OBJECTIVES: Individuals older than 60 years represent a large proportion of the organs available for orthotopic liver transplant. However, the use of organs from older donors remains controversial. We hypothesized that the use of older donors would not affect patient and graft survival due to significant improvements in donor-recipient management. MATERIALS AND METHODS: We conducted a retrospective cohort analysis using the United Network for Organ Sharing database from February 2002 through December 2012, including non-HCV-infected adults (18 and older) who underwent primary orthotopic liver transplant...
October 14, 2016: Experimental and Clinical Transplantation
Felix Krenzien, Markus Quante, Timm Heinbokel, Midas Seyda, Koichiro Minami, Hirohito Uehara, Hector Rodriguez Cetina Biefer, Jeroen M Schuitenmaker, Steven Gabardi, Katrin Splith, Moritz Schmelzle, Athena K Petrides, Haruhito Azuma, Johann Pratschke, Xian C Li, Abdallah ElKhal, Stefan G Tullius
Immunosuppression in elderly recipients has been underappreciated in clinical trials. Here, we assessed age-specific effects of the calcineurin inhibitor Tacrolimus (TAC) in a murine transplant model and assessed its clinical relevance on human T-cells. Old recipient mice exhibited prolonged skin graft survival when compared to young animals following TAC administration. More importantly, half of the TAC dose was sufficient in old mice to achieve comparable systemic trough levels. TAC administration was able to reduce pro-inflammatory IFN-γ cytokine production and promote IL-10 production in old CD4(+) T-cells...
October 18, 2016: American Journal of Transplantation
Jiang-Tao Tang, Brenda C de Winter, Dennis A Hesselink, Ferdi Sombogaard, Lan-Lan Wang, Teun van Gelder
AIM: Elderly transplant recipients have a lower incidence of acute rejection, and a higher risk to die from infectious complications. Potentially this may be caused by differences in the pharmacokinetics (PK) or pharmacodynamics (PD) of the immunosuppressive drugs they are taking. This study was designed to comprehensively evaluate the influence of age on the PK and PD of mycophenolic acid (MPA). METHODS: In this study the PK and PD of MPA was studied in 26 elderly and 54 younger renal transplant recipients treated with mycophenolate mofetil and tacrolimus...
October 18, 2016: British Journal of Clinical Pharmacology
Renaud Snanoudj, Marc-Olivier Timsit, Marion Rabant, Claire Tinel, Hélène Lazareth, Lionel Lamhaut, Frank Martinez, Christophe Legendre
Use of expanded criteria donor (ECD) kidneys, which are associated with a reduced graft survival rate, has become widely adopted in elderly recipients in an old-to-old allocation system. However, the results are frequently unsatisfactory, and a high proportion of these ECD kidneys are discarded. Dual kidney transplantation (DKT) is an underutilized way to expand the pool of ECD kidneys and to rapidly transplant elderly patients with satisfactory results because of the transplantation of double the nephronic mass...
September 29, 2016: Transplantation
F J León Díaz, J L Fernández Aguilar, B Sánchez Pérez, C Montiel Casado, J M Aranda Narváez, J A Pérez Daga, M Á Suárez Muñoz, J Santoyo Santoyo
BACKGROUND: The inclusion of elderly donors can increase the pool of organs available for transplantation. The objective of this study was to compare clinical outcomes and survival rates of patients who received livers from donors aged ≥75 years versus younger donors. METHODS: We considered all liver transplantations performed in our unit from January 2006 to January 2015. Thirty-two patients received a liver from a cadaveric donor aged ≥75 years (study group), and their outcomes were compared with those of patients who received a liver from a younger donor (control group) immediately before and after each transplantation in the study group...
September 2016: Transplantation Proceedings
Kristopher P Croome, David D Lee, Justin M Burns, Dana K Perry, Justin H Nguyen, Andrew P Keaveny, Hani M Wadei, C Burcin Taner
:  Introduction and aim. Many transplant programs have expanded eligibility to include patients previously ineligible because of advanced age. Outcomes of simultaneous liver-kidney transplantation (SLK) in recipients with advanced age are not known. MATERIAL AND METHODS: Data from patients undergoing transplantation between 2002 and 2015 were obtained from the UNOS Standard Analysis and Research file. RESULTS: SLK recipients aged ≥ 65 years (N = 677), SLK recipients aged < 65 years (N = 4517), and recipients of liver transplant alone(LTA) aged ≥ 65 years(N = 8495) were compared...
November 2016: Annals of Hepatology
Jasmin Stettler, Urban Novak, Gabriela M Baerlocher, Katja Seipel, Behrouz Mansouri Taleghani, Thomas Pabst
Administering high-dose chemotherapy (HDCT) with melphalan to elderly myeloma patients represents a challenge with respect to achieving therapeutic efficacy whilst avoiding significant toxicity. We analyzed safety and efficacy of HDCT in 61 elderly myeloma patients older than 65 years, including 12 patients ≥70 years, and compared them with 237 MM patients below 65 years treated in the same period. We observed no differences in the time until neutrophil recovery, infection rate, and treatment related mortality until 100 days after ASCT...
October 13, 2016: Leukemia & Lymphoma
Hessel Peters-Sengers, Stefan P Berger, Martin B A Heemskerk, Doaa Al Arashi, Jaap J Homan van der Heide, Aline C Hemke, Ineke J M Ten Berge, Mirza M Idu, Michiel G H Betjes, Arjan D van Zuilen, Luuk B Hilbrands, Aiko P J de Vries, Azam S Nurmohamed, Maarten H Christiaans, L W Ernest van Heurn, Johan W de Fijter, Frederike J Bemelman
An increasing number of elderly patients (≥65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (≥18 years) who received a first DBD or DCD kidney during 2002-2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type...
October 11, 2016: Journal of the American Society of Nephrology: JASN
Elias David-Neto, Ana Heloisa Kamada Triboni, Fernanda Ramos, Fabiana Agena, Nelson Zocoler Galante, Marcelo Altona, Francine Brambate Carvalhinho Lemos, Marcelo Tatit Sapienza, William Carlos Nahas
Equations to estimate glomerular filtration rate (eGFR) were developed in patients using the variables: age, body weight and serum creatinine which may be different in the elderly. Elderly renal transplant patients (EG; n=70; mean age 65±4y) who measured plasma (51) Cr-EDTA-Clearance (mGFR) had mGFR compared to eGFR obtained by the Cockcroft-Gault corrected by body surface area (CG-BSA), the Modification of Diet in Renal Disease (MDRD-4), the Berlin Initiative Study (BIS-1) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)...
October 11, 2016: Clinical Transplantation
Yasuhito Nannya
The WHO classification system of MDS 4(th) edition was recently updated. This revision includes nomenclature changes, reflecting the policy of the revision team to emphasize morphological features over cytopenias. Other changes are 1) taking SF3B1 mutation status into account for the definition criteria of MDS-RS (ring sideroblasts), 2) allowing for one additional cytogenetic abnormality (excluding -7/del (7q)) to be diagnosed as 'MDS with isolated del (5q)', 3) sub-classifying MDS-U according to the reasons for being included in this category, and 4) changing the diagnostic rules for myeloid neoplasms with erythroid blast predominance...
2016: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Stephen S Y Lam, Eric S K Ho, Bai-Liang He, Wui-Wing Wong, Chae-Yin Cher, Nelson K L Ng, Cheuk-Him Man, Harinder Gill, Alice M S Cheung, Ho-Wan Ip, Chi-Chiu So, Jerome Tamburini, Chi Wai Eric So, Dona N Ho, Chun-Hang Au, Tsun-Leung Chan, Edmond S K Ma, Raymond Liang, Yok-Lam Kwong, Anskar Y H Leung
An in vitro drug-screening platform on patient samples was developed and validated to design personalized treatment for relapsed/refractory acute myeloid leukemia (AML). Unbiased clustering and correlation showed that homoharringtonine (HHT), also known as omacetaxine mepesuccinate, exhibited preferential antileukemia effect against AML carrying internal tandem duplication of fms-like tyrosine kinase 3 (FLT3-ITD). It worked synergistically with FLT3 inhibitors to suppress leukemia growth in vitro and in xenograft mouse models...
October 5, 2016: Science Translational Medicine
M Rayar, G B Levi Sandri, C Cusumano, C Locher, P Houssel-Debry, C Camus, N Lombard, V Desfourneaux, M Lakehal, B Meunier, L Sulpice, K Boudjema
During orthotopic liver transplantation (OLT), clamping of the portal vein induces splanchnic venous congestion and accumulation of noxious compounds. These adverse effects could increase ischemia-reperfusion injury and subsequently the risk of graft dysfunction, especially for grafts harvested from extended criteria donors (ECD). Temporary portocaval shunt (TPCS) could prevent these complications. Between 2002 and 2013, all OLT performed in our center were retrospectively analyzed and a propensity score matching analysis was used to compare the effect of TPCS in 686 patients (343 in each group)...
October 5, 2016: Liver Transplantation
S H Loosen, M Schmeding, C Roderburg, M Binnebösel, I Temizel, F M Mottaghy, J J W Tischendorf, F Tacke, N T Gaisa, K Hussein, U Lehmann, C Trautwein, U P Neumann, T Luedde
We report the case of a 53-year-old female patient who was transplanted with the liver of a 71-year-old male donor for advanced primary sclerosing cholangitis (PSC) and who additionally was diagnosed with a histologically non-classifiable colitis shortly before transplantation. Upon follow-up abdominal ultrasound 4 months after transplantation, a liver lesion measuring 16 × 23 mm was detected in the transplanted liver. This lesion had not been noticed immediately after transplantation and showed a pattern suspicious for malignancy in contrast-enhanced ultrasound...
October 5, 2016: Zeitschrift Für Gastroenterologie
Neslihan Edeer Karaca, Guzide Aksu, Ezgi Ulusoy, Serap Aksoylar, Salih Gozmen, Ferah Genel, Sanem Akarcan, Nesrin Gulez, Tatjana Hirschmugl, Savas Kansoy, Kaan Boztug, Necil Kutukculer
Alterations of immune homeostasis in the gut may result in development of inflammatory bowel disease. A five-month-old girl was referred for recurrent respiratory and genitourinary tract infections, sepsis in neonatal period, chronic diarrhea, perianal abscess, rectovaginal fistula, and hyperemic skin lesions. She was born to second-degree consanguineous, healthy parents. Her elder siblings were lost at 4 months of age due to sepsis and 1 year of age due to inflammatory bowel disease, respectively. Absolute neutrophil and lymphocyte counts, immunoglobulin levels, and lymphocyte subsets were normal ruling out severe congenital neutropenia and classic severe combined immunodeficiencies...
2016: Case Reports in Immunology
Guillemette Fouquet, Francesca Gay, Eileen Boyle, Sara Bringhen, Alessandra Larocca, Thierry Facon, Xavier Leleu, Antonio Palumbo
Multiple myeloma (MM) is a disease of the elderly, with a median age at diagnosis of approximately 70 years old, and more than 30 % of patients aged >75 years. This latter and very elderly population is going to significantly rise in the near future given the increase in life expectancy in Western countries, and, most importantly, global health status of elderly patients is improving, justifying appropriate treatments. Changes in treatment paradigm from the old melphalan-prednisone regimen used since the 1970s to its use as a backbone in a nontransplant setting since the late 1990s have highlighted different subgroups in elderly MM...
2016: Cancer Treatment and Research
Sonja M H J Scholten-Jaegers, Marianne K Nieuwenhuis, Magriet E van Baar, Anuschka S Niemeijer, Jakob Hiddingh, Gerard I J M Beerthuizen
In this study, the outcome of treatment with Flammacerium in burn patients is studied. The retrospective study involved patients with acute burns admitted to the Burn Centre of Martini Hospital, Groningen, The Netherlands, between 2009 and 2014. The outcome parameters were mortality, complications (noninfectious and infectious), need of surgery, and length of stay. The group of patients consisted of 853 patients, of which 554 were male (64.9%). There were 23 patients with a total burn size of 40% TBSA or more (2...
September 27, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Kim Ramil C Montaniel, David G Harrison
Hypertension affects 30% of the population and 70% of the elderly. Despite its frequency and decades of research, the etiology of most cases of adult hypertension remains undefined. Perturbations of the kidney, the vasculature and the central nervous system have all been implicated in the pathogenesis of hypertension. As examples, in most cases of adult hypertension, systemic vascular resistance is elevated and vasodilators lower blood pressure, supporting a vascular etiology. Alternatively, renal cross-transplantation studies have shown that hypertension follows the kidney and in most cases of experimental hypertension, pressure natriuresis is impaired...
September 27, 2016: Circulation
Michèle Voegeli, Stephanie Rondeau, Simona Berardi Vilei, Erika Lerch, Luciano Wannesson, Thomas Pabst, Jochen Rentschler, Mario Bargetzi, Lorenz Jost, Nicolas Ketterer, Angelika Bischof Delaloye, Michele Ghielmini
Standard conditioning regimens for autologous stem cell transplantation (ASCT) are often not tolerated by elderly patients, on one hand. Single high-dose melphalan, on the other hand, has been shown to be safe and active as a pretransplant preparative regimen in elderly patients. Y(90) -Ibritumomab tiuxetan (Y(90) -IT) is well tolerated and feasible in the transplantation setting. We therefore investigated the combination of high-dose melphalan and Y(90) -IT as a conditioning regimen for patients ≥65 years of age...
September 28, 2016: Hematological Oncology
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