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Zelnik Yovel D, Santo E, Khader M, Tzadok R, Bar N, Aizic A, Shibolet O, Ben-Ami Shor D. Esophagogastroduodenal Findings in Patients with Intraductal Papillary Mucinous Neoplasms. Diagnostics (Basel) 2023; 13:2127. [PMID: 37371022 DOI: 10.3390/diagnostics13122127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
The association between intraductal papillary mucinous neoplasms (IPMNs) and extra-pancreatic malignancies is controversial. This cross-sectional study compared esophagogastroduodenal findings in 340 IPMN patients to those of age- and gender-matched controls without known IPMNs who underwent esophagogastroduodenoscopies (EGDs) for similar clinical reasons. The presence of gastric and esophageal cancer, Barrett's esophagus, neuroendocrine tumors (NETs), gastrointestinal stromal tumors (GISTs), gastric adenomas, and ampullary tumors was assessed. The results showed that 4/340 (1.2%) of the IPMN patients had gastric cancer and 1/340 (0.3%) had esophageal cancer. The matched control group had a similar incidence of gastric cancer (5/340) (1.5%), with no esophageal cancer cases (p > 0.999). The overall incidence of other esophagogastroduodenal conditions did not significantly differ between the IPMN patients and the controls. However, the incidence of gastric cancer in the IPMN patients was higher than expected based on national cancer registry data (standardized incidence ratio of 31.39; p < 0.001; CI 8.38-78.76). In conclusion, IPMN patients have a significantly higher incidence of gastric cancer compared to the general population. However, the incidence of esophagogastroduodenal findings, including gastric and esophageal cancer, is similar between IPMN patients and those who undergo an EGD for similar clinical indications. Further research is needed to determine optimal surveillance strategies for IPMN patients regarding their risk of developing gastric cancer.
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Affiliation(s)
- Dana Zelnik Yovel
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin 703000, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Erwin Santo
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Majd Khader
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Roie Tzadok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Nir Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Asaf Aizic
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Dana Ben-Ami Shor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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2
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Grupper A, Rabinowich A, Ben Shabat I, Tzadok R, Schwartz D, Schwartz IF, Goykhman Y, Kliuk Ben-Bassat O, Baruch R, Shashar M, Cohen-Hagai K, Katchman H. Nonalcoholic Fatty Liver Disease before Kidney Transplantation Correlates with New Onset Diabetes and Poor Metabolic Outcomes. Am J Nephrol 2022; 53:636-645. [PMID: 36075195 PMCID: PMC9808776 DOI: 10.1159/000526118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of morbidity and mortality after kidney transplantation. Metabolic syndrome is common in renal transplant recipients and is associated with increased CVD risk in those patients. Nonalcoholic fatty liver disease (NAFLD) is considered to be the hepatic manifestation of a multi-system disorder, including CVD and metabolic syndrome. The data about prevalence of NAFLD before kidney transplantation and its consequences following transplantation are scarce. METHODS A retrospective study of metabolic parameters and sonographic evidence of NAFLD, and an analysis of its metabolic outcomes, was performed in 341 consecutive kidney transplant recipients. RESULTS One-hundred twenty-four (36.4%) kidney recipients had NAFLD before transplantation. The risk of NAFLD before kidney transplantation was independently and significantly related to diabetes (OR = 1.8), male gender (OR = 1.4), older age (every year of age increased the risk by 4%), higher BMI (every increase of 1 kg/m2 increased the risk by 15%), and higher triglycerides level. Mean levels of liver enzymes were similar in patients with and without NAFLD. Recipients with NAFLD before transplantation had a higher prevalence of new onset diabetes, even after adjustment to covariables. In addition, they had a higher increase in liver enzymes, triglycerides, and FIB-4 score, as an indication of liver fibrosis, after transplantation. Furthermore, NAFLD pre-transplantation was independently associated with cardiovascular mortality (HR = 4.4) following kidney transplantation. CONCLUSIONS Sonographic evidence of NAFLD before kidney transplantation is associated with significant metabolic outcomes including de novo diabetes and cardiovascular mortality following transplantation and should be included as part of the assessment of kidney transplant candidate.
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Affiliation(s)
- Ayelet Grupper
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,*Ayelet Grupper,
| | - Aviad Rabinowich
- Department of Radiology, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Ben Shabat
- Internal Medicine Department “H”, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roie Tzadok
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Doron Schwartz
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit F. Schwartz
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaacov Goykhman
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Kliuk Ben-Bassat
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Baruch
- Department of Nephrology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helena Katchman
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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3
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Avni-Biron I, Mishael T, Zittan E, Livne-Margolin M, Zinger A, Tzadok R, Goldenberg R, Kopylov U, Ron Y, Hadar E, Helman S, Granovsky SG, Ollech JE, Arazi A, Farkash R, Pauker MH, Yanai H, Dotan I, Shitrit ABG. Ustekinumab during pregnancy in patients with inflammatory bowel disease: a prospective multicentre cohort study. Aliment Pharmacol Ther 2022; 56:1361-1369. [PMID: 36168705 DOI: 10.1111/apt.17224] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/17/2022] [Accepted: 09/05/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Women with inflammatory bowel diseases (IBD) often receive biologics to maintain remission during pregnancy. AIMS To assess maternal and neonatal outcomes in patients with IBD treated with ustekinumab (UST) during pregnancy METHODS: In a multicentre, prospective cohort study, we recruited women with IBD treated with UST during pregnancy between 2019 and 2021. Outcomes were compared among patients treated with UST, anti-tumour necrosis factor α, (anti-TNF) and non-UST, non-anti-TNF therapies. UST-treated patients were matched 1:2 to controls according to age, body mass index and parity. Newborns were followed up to 12 months. RESULTS We recruited 129 pregnant patients: UST 27; anti-TNF 52; non-UST, non-anti-TNF 50 (thiopurine or mesalazine 30, no therapy 20); Crohn's disease 25 (96.9%). Overall, pregnancy, neonatal and newborn outcomes were satisfactory, with no significant differences among patients treated with UST, anti-TNF and non-UST non-anti-TNF agents for obstetrical maternal complications [UST 3 (11.5%), anti TNF 12 (23.1%), non UST, non-anti-TNF 4 (8.2%), p = 0.095], pre-term delivery [1 (4.3%), 9 (18.4%), 4 (5.7%), p = 0.133], low birth weight [1 (4.2%), 5 (10.2%), 4 (8.3%), p = 0.679], or first year newborn hospitalisation [2 (9.1%), 4 (8.2%), 3 (6.1%), p = 0.885]. CONCLUSION Pregnant patients with IBD treated with UST demonstrated favourable pregnancy and neonatal outcomes that were comparable with those in patients treated with anti-TNF or other therapy. Data are reassuring for patients with IBD and their physicians when considering UST during pregnancy.
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Affiliation(s)
- Irit Avni-Biron
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Mishael
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Zittan
- Institute of Gastroenterology and Liver Diseases, IBD Unit, Emek Medical Center, Afula, Israel
| | - Moran Livne-Margolin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Adar Zinger
- Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Gastroenterology, Hadassah Medical Center, Jerusalem, Israel
| | - Roie Tzadok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Rosie Goldenberg
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Yulia Ron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maternal fetal medicine, Helen Schneider hospital of women, Rabin Medical Center, Petah Tikva, Israel
| | - Sarit Helman
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru Granovsky
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob E Ollech
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Arazi
- Institute of Gastroenterology and Liver Diseases, IBD Unit, Emek Medical Center, Afula, Israel
| | - Rivka Farkash
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maor H Pauker
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Henit Yanai
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Dotan
- IBD Center, Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariella Bar-Gil Shitrit
- IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
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Druckmann I, Yashar H, Schwartz D, Schwartz IF, Goykhman Y, Kliuk Ben-Bassat O, Baruch R, Tzadok R, Shashar M, Cohen-Hagai K, Grupper A. Presence of Sarcopenia before Kidney Transplantation Is Associated with Poor Outcomes. Am J Nephrol 2022; 53:427-434. [PMID: 35584614 PMCID: PMC9393828 DOI: 10.1159/000524774] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022]
Abstract
Introduction Kidney transplantation is the treatment of choice for patients with renal failure. It is crucial to select which patients may benefit from renal transplantation and which are at high risk for post-transplant complications. Sarcopenia is associated with poor outcome in various conditions, including in chronic kidney disease patients. The gold standard for measuring sarcopenia is computed tomography (CT) imaging to estimate muscle mass and quality since it is objective, reproducible, and reflects the overall health condition. The data regarding those measurements among kidney transplant recipients are limited, therefore we aimed to describe it in patients before kidney transplantation, assess the parameters associated with sarcopenia, and evaluate the clinical significance of those markers on outcomes following transplantation. Methods We retrospectively analyzed 183 kidney transplant recipients who had a CT scan 90 days prior to transplant. Sarcopenia was assessed by measuring the cross-sectional area (CSA) and mean muscle density of the psoas muscle at the third and fourth lumbar vertebrae levels and paravertebral muscles at the 12th thoracic vertebra level. Results There was a strong linear correlation between muscle size measured as CSA of the psoas muscle at the L3 and L4 vertebral body level and the CSA of the paravertebral muscles at the D12 vertebra level, and a moderate correlation to muscle density at those levels. Age was independently associated with risk of sarcopenia, defined as psoas CSA in the lowest tertile, with every year of age increasing the risk by 5%. CSA at the L3 level had a significant independent association with post kidney transplantation mortality, with an adjusted hazard ratio of 0.86 per cm2. There was a significantly longer hospitalization period postoperation in kidney recipients in the lower tertile of psoas CSA and density. Conclusions Sarcopenia as measured by psoas CSA is associated with poor short- and long-term outcomes following kidney transplantation and should be included as part of the assessment of kidney transplantation candidates.
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Affiliation(s)
- Ido Druckmann
- Radiology Department, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Yashar
- Radiology Department, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Schwartz
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Idit F. Schwartz
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yaacov Goykhman
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Kliuk Ben-Bassat
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roni Baruch
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roie Tzadok
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Shashar
- Nephrology Section, Laniado Hospital, Netanya, Israel
| | - Keren Cohen-Hagai
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ayelet Grupper
- Nephrology Department, Tel Aviv Medical Center, And Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Organ Transplantation Unit, Tel-Aviv Medical Center Tel-Aviv, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- *Ayelet Grupper,
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5
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Rosenberg V, Tzadok R, Chodick G, Kariv R. Proton pump inhibitors long term use-trends and patterns over 15 years of a large health maintenance organization. Pharmacoepidemiol Drug Saf 2021; 30:1576-1587. [PMID: 34453456 DOI: 10.1002/pds.5352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/05/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPI) are used for a variety of indications. Despite reported associations with undesirable effects, their long-term use is on the rise, while appropriate indications, dose, and treatment duration may deviate from guideline recommendations. OBJECTIVES Primary to examine the annual patterns of PPI use. Secondary- to assess indications for initiating PPI treatment, long-term use, and factors associated with long-term use in a large Israeli health maintenance organization. METHODS A historical cohort study of 528 420 eligible PPI users during 2000-2015, analyzed PPI use using defined daily doses and the proportion of patients covered method. Data on indications for treatment initiation, clinical and socio-demographic parameters were captured as well. A multivariable logistic-regression model was used to identify factors associated with long-term use of PPI. RESULTS The annual incidence rates of patients initiating PPI treatment were relatively constant, ranging between 2.4% and 3.1% of the adult population, with a monotonic increase in annual consumption and prevalence (reaching 12.7% in 2015). Reflux, functional symptoms, and Helicobacter pylori eradication were the most common indications for initiating PPI therapy. However, 27% of patients had no recorded indication for treatment. Fifteen percent of patients used PPI for over 6 months, especially in older age groups. CONCLUSIONS Utilization of PPI increases steadily, mainly due to chronic use. Prolonged consumption is associated with specific clinical indications and older age. Health organizations should encourage awareness of appropriate use among physicians, specifically in the elderly, patients with reflux, and those with functional disorders.
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Affiliation(s)
- Vered Rosenberg
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Roie Tzadok
- Department of Internal Medicine H, Sourasky Medical Center, Tel Aviv, Israel
| | - Gabriel Chodick
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Kariv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology, Sourasky Medical Center, Tel Aviv, Israel
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Tzadok R, Isman G, Baruch R, Goykhman Y, Ovdat E, Lubezky N, Rishpon A, Grupper A. Cutaneous Malignancies After Kidney and Simultaneous Pancreas-Kidney Transplantations. Transplant Proc 2021; 53:2369-2376. [PMID: 34399970 DOI: 10.1016/j.transproceed.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Organ transplant recipients are at increased risk of nonmelanotic skin cancers (NMSC). Scarce data exist regarding secondary malignancies developing post-simultaneous pancreas-kidney (SPK) transplantations. Our aim was to assess long-term risk of skin cancers among kidney alone (KA) and SPK transplantation recipients. METHODS In this study, 521 patients who underwent KA or SPK transplantation at our medical center were observed up by dedicated nephrologists and dermatologists. SPK transplantation recipients were matched with a control group of KA transplantation recipients based on demographic and clinical data. A multivariate analysis was performed to find independent cancer risk factors. RESULTS Patients who developed skin cancer were generally older, had a fair skin type, and had a higher incidence of NMSC before transplantation. Older age and fair skin type were independent risk factors on multivariate analysis. SPK transplantation in itself was not an independent risk factor. Cancer recurrence was associated with older age and male sex. Darker skin type and lowered immunosuppressive burden were protective. CONCLUSION In contrast to previous studies, the use of antithymocytic agents or SPK transplantation were not independently associated with increased skin cancer risk in this multivariate analysis. These findings emphasize the complex interplay between posttransplantation NMSC and various clinical and epidemiologic risk parameters.
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Affiliation(s)
| | | | - Roni Baruch
- Organ Transplantation Unit, Surgical Division; Nephrology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Nir Lubezky
- Organ Transplantation Unit, Surgical Division
| | | | - Ayelet Grupper
- Organ Transplantation Unit, Surgical Division; Nephrology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Hassidim A, Bratman Morag S, Giladi M, Dagan Y, Tzadok R, Reissman P, Dagan A. Perioperative complications of emergent and elective procedures in psychiatric patients. J Surg Res 2017; 220:293-299. [DOI: 10.1016/j.jss.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/19/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022]
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8
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Tzadok R, Shapira MY, Moses AE, Or R, Block C, Strahilevitz J. Reduction in incidence of invasive fungal infection in patients receiving allogeneic stem cell transplantation using combined diagnostic-driven approach and itraconazole oral solution. Mycoses 2015; 58:694-8. [PMID: 26429354 DOI: 10.1111/myc.12416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 01/28/2023]
Abstract
Invasive fungal infections are an important cause of morbidity and mortality after allogeneic haematopoietic stem cell transplantation. We evaluated, in our allogeneic stem cell transplant patients, the effect on the incidence of invasive fungal infection during neutropenia of a strategy combining a diagnostic-driven approach with chemoprophylaxis during higher risk periods of graft vs. host disease and prolonged neutropenia, using itraconazole oral solution with parenteral voriconazole bridging. One hundred and thirty patients admitted for allogeneic stem cell transplantation within two predefined 20 month periods were included in the study. Data for all patients were collected prospectively. Implementation of the protocol resulted in the administration of more prophylactic antifungals to more patients. Following implementation, there was a non-significant decrease in the overall number of invasive fungal infections (IFI) [11 of 65 patients (17.2%) vs. 4 of 65 patients (6.2%, P = 0.051)], as well as in the occurrence of invasive mould infections [8 of 65 patients (12.5%) vs. 2 of 65 patients (3.1%, P = 0.054)]. Survival rates at three and 6 months were not significantly affected. A combined diagnostic-driven approach and antifungal prophylaxis with oral itraconazole and an intravenous voriconazole bridging protocol, was associated with a reduced, albeit non-statistically significant, number of IFI in our medical centre.
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Affiliation(s)
- Roie Tzadok
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michael Y Shapira
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Allon E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Reuven Or
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Colin Block
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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