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Abou Azar S, Tobias J, Applewhite M, Angelos P, Keutgen XM. Medullary Thyroid Cancer: Single Institute Experience over Three Decades and Risk Factors for Recurrence. J Clin Endocrinol Metab 2024:dgae279. [PMID: 38651609 DOI: 10.1210/clinem/dgae279] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
CONTEXT Medullary thyroid cancer has a historic recurrence rate up to 50%, and surgery remains the only cure. OBJECTIVE This study aims to assess factors related to recurrence and metastatic spread in MTC. DESIGN Retrospective chart review was performed from 1990-2023. Descriptive analysis and regression models were used for analysis. SETTING Single specialized tertiary care referral center. PATIENTS 68 patients with MTC, who underwent surgery, were included. MAIN OUTCOME MEASURE Recurrence. RESULTS Mean age at diagnosis was 54.9years(42.2-64.1), 65%(n=44) females. Lymph node and distant metastases were found in 24%(n=16) and 4%(n=3), respectively. RET mutations were present in 52%(n=35): MTC risk levels Highest 6%, High 7%, and Moderate 39%. Mean tumor size was 1.9cm(1.2-3.2) and mean preoperative calcitonin was 504.4pg/mL(133.2-1833.8). Total thyroidectomy(TT) was performed in 10 patients, TT+central neck dissection(CND) in 28, and TT+CND+lateral neck dissection(LND) in 25. On final pathology, 40% had positive central nodes and 25% had positive lateral nodes. Recurrence was 22%, median follow-up 4.7years(1.2-28.0). Male gender(HR=5.81, p=0.021), positive lateral neck nodes(HR 8.10, p=0.011) and high/highest MTC risk level RET mutations(HR 8.66, p=0.004) were significantly associated with recurrence. Preoperative calcitonin>2,175 pg/mL was a strong predictor for distant metastasis(AUC0.893) and a good predictor for lateral neck disease(AUC0.706). Extent of surgery was not significantly associated with recurrence(p=0.634). CONCLUSION One of 4 patients undergoing surgery for MTC will recur. Risk factors associated with recurrence are male gender, lateral LN metastasis and high/highest MTC risk level mutations, but not necessarily surgery type. Preoperative calcitonin>2,175 pg/mL is suggestive of advanced disease and should prompt further evaluation.
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Affiliation(s)
- Sara Abou Azar
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6040, Chicago, IL 60637, USA
| | - Joseph Tobias
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6040, Chicago, IL 60637, USA
| | - Megan Applewhite
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6040, Chicago, IL 60637, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6040, Chicago, IL 60637, USA
| | - Xavier M Keutgen
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6040, Chicago, IL 60637, USA
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Abou Azar S, Stratton L, Memeh K, Nordgren R, Kaplan EL, Angelos P, Keutgen XM. Clinical Significance of Pheochromocytoma Size on the Timing and Extent of Surgery. J Surg Res 2024; 298:88-93. [PMID: 38593602 DOI: 10.1016/j.jss.2024.03.004] [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: 09/13/2023] [Revised: 01/18/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Elevated metanephrine and catecholamine levels 3-fold upper limit of normal (ULN) are diagnostic for pheochromocytoma. We sought to determine whether size correlates with biochemical activity or symptoms which could guide timing of surgery. METHODS Data from consecutive patients undergoing adrenalectomy for pheochromocytoma at our institution over a 10-year period were retrospectively collected. These included maximal lesion diameter on preoperative imaging, plasma/urine metanephrine and/or catecholamine levels, demographic variables and presence of typical paroxysmal symptoms. Receiver operating characteristic curves were used to assess predictive accuracy. RESULTS Sixty-three patients were included in the analysis (41 females and 22 males). Median age was 56 (43, 69) years. Due to various referring practices, 31 patients had documented 24-h urine metanephrine, 26 had 24-h urine catecholamine, and 52 had fractionated plasma metanephrine levels available for review. Values were converted to fold change compared to ULN and the maximum of all measured values was used for logistic regression. Median tumor size was 3.40 (2.25, 4.55) cm in greatest dimension. Tumor size at which pheochromocytoma produced > 3-fold ULN was ≥2.3 cm (AUC of 0.84). Biochemical activity increased with doubling tumor size (odds ratio = 8, P = 0.0004) or ≥ 1 cm increase in tumor size (odds ratio = 3.03, P = 0.001). 40 patients had paroxysmal symptoms, but there was no significant correlation between tumor size/biochemical activity and symptoms. CONCLUSIONS In our study, tumor size directly correlated with the degree of biochemical activity and pheochromocytomas ≥2.3 cm produced levels 3 times ULN. These findings may allow clinicians to adjust timing of operative intervention.
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Affiliation(s)
- Sara Abou Azar
- Department of Surgery, University of Chicago, Chicago Illinois.
| | - Lee Stratton
- Department of Surgery, University of Chicago, Chicago Illinois
| | - Kelvin Memeh
- Department of Surgery, University of Chicago, Chicago Illinois
| | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago Illinois
| | - Edwin L Kaplan
- Department of Surgery, University of Chicago, Chicago Illinois
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago Illinois
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Tumati A, Egan CE, Lee-Saxton YJ, Marshall TE, Lee J, Jain K, Heymann JJ, Gokozan H, Azar SA, Schwarz J, Keutgen XM, Laird AM, Beninato T, Zarnegar R, Fahey TJ, Finnerty BM. Clinical utility of a microRNA classifier in cytologically indeterminate thyroid nodules with RAS mutations: A multi-institutional study. Surgery 2024; 175:234-240. [PMID: 37907382 DOI: 10.1016/j.surg.2023.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Molecular testing guides the management of cytologically indeterminate thyroid nodules. We evaluated the real-world clinical benefit of a commercially available thyroid mutation panel plus microRNA risk classifier in classifying RAS-mutated nodules. METHODS We performed a subgroup analysis of the results of molecular testing of Bethesda III/IV nodules using the ThyGenX/ThyGeNEXT-ThyraMIR platform at 3 tertiary-care centers between 2017 and 2021, defining a positive result as 10% or greater risk of malignancy. RESULTS We identified 387 nodules from 375 patients (70.7% female, median age 59.3 years) who underwent testing. Positive nodules (32.3%) were associated with increased surgical intervention (74.4% vs 14.9%, P < .0001) and carcinoma on surgical pathology (46.4% vs 3.4%, P < .0001) compared to negative modules. RAS mutations were the most common mutations, identified in 71 of 380 (18.7%) nodules, and were classified as ThyraMIR- (28 of 71; 39.4%) or ThyraMIR+ (43 of 71; 60.6%). Among RAS-mutated nodules, there was no significant difference in operative rate (P = .2212) or carcinoma diagnosis (P = .6277) between the ThyraMIR+ and ThyraMIR- groups, and the sensitivity, specificity, negative predictive value, and positive predictive value of ThyraMIR were 64.7%, 34.8%, 40.0%, and 59.5%, respectively. CONCLUSION Although testing positive is associated with malignancy in surgical pathology, the ThyraMIR classifier failed to differentiate between benign and malignant RAS-mutated nodules. Diagnostic lobectomy should be considered for RAS-mutated nodules, regardless of microRNA expression status.
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Affiliation(s)
- Abhinay Tumati
- Department of Surgery, Weill Cornell Medicine, New York, NY.
| | - Caitlin E Egan
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/CaitlinEgan18
| | - Yeon J Lee-Saxton
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/YeonJooLeeMD
| | - Teagan E Marshall
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/TeaganEMarshall
| | - Joyce Lee
- Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Kavita Jain
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY. https://twitter.com/HeymannJonas
| | - Hamza Gokozan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY. https://twitter.com/GokozanMD
| | - Sara Abou Azar
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL. https://twitter.com/SaraAbouAzar
| | - Jason Schwarz
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL
| | - Xavier M Keutgen
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL. https://twitter.com/XKeutgen
| | - Amanda M Laird
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. https://twitter.com/amlaird
| | - Toni Beninato
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. https://twitter.com/BeninatoToni
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/RasaZarnegarMD
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/tjf3endosurg
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/FinnertyMD
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Miller SM, Azar SA, Farrelly JS, Salzman GA, Broderick ME, Sanders KM, Anto VP, Patel N, Cordova AC, Schuster KM, Jones TJ, Kodadek LM, Gross CP, Morton JM, Rosenthal RA, Becher RD. Current use of the National Surgical Quality Improvement Program surgical risk calculator in academic surgery: a mixed-methods study. Surg Pract Sci 2023; 13:100173. [PMID: 37502700 PMCID: PMC10373440 DOI: 10.1016/j.sipas.2023.100173] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Background This study aims to quantitatively assess use of the NSQIP surgical risk calculator (NSRC) in contemporary surgical practice and to identify barriers to use and potential interventions that might increase use. Materials and methods We performed a cross-sectional study of surgeons at seven institutions. The primary outcomes were self-reported application of the calculator in general clinical practice and specific clinical scenarios as well as reported barriers to use. Results In our sample of 99 surgeons (49.7% response rate), 73.7% reported use of the NSRC in the past month. Approximately half (51.9%) of respondents reported infrequent NSRC use (<20% of preoperative discussions), while 14.3% used it in ≥40% of preoperative assessments. Reported use was higher in nonelective cases (30.2% vs 11.1%) and in patients who were ≥65 years old (37.1% vs 13.0%), functionally dependent (41.2% vs 6.6%), or with surrogate consent (39.9% vs 20.4%). NSRC use was not associated with training status or years in practice. Respondents identified a lack of influence on the decision to pursue surgery as well as concerns regarding the calculator's accuracy as barriers to use. Surgeons suggested improving integration to workflow and better education as strategies to increase NSRC use. Conclusions Many surgeons reported use of the NSRC, but few used it frequently. Surgeons reported more frequent use in nonelective cases and frail patients, suggesting the calculator is of greater utility for high-risk patients. Surgeons raised concerns about perceived accuracy and suggested additional education as well as integration of the calculator into the electronic health record.
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Affiliation(s)
- Samuel M. Miller
- Department of Surgery, Yale School of Medicine, United States
- National Clinician Scholars Program, Yale School of Medicine, United States
| | - Sara Abou Azar
- Department of Surgery, Yale School of Medicine, United States
| | - James S. Farrelly
- Department of Surgery, Quinnipiac University School of Medicine, United States
| | - Garrett A. Salzman
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, United States
- Department of Surgery, Greater Los Angeles Veterans Affairs Healthcare System, United States
| | | | | | - Vincent P. Anto
- Department of Surgery, University of Pittsburgh School of Medicine, United States
| | - Nathan Patel
- Department of Surgery, Wake Forest School of Medicine, United States
| | - Alfredo C. Cordova
- Department of Surgery, The Ohio State University College of Medicine, United States
| | | | - Tyler J. Jones
- Department of Surgery, Yale School of Medicine, United States
| | - Lisa M. Kodadek
- Department of Surgery, Yale School of Medicine, United States
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, United States
| | - John M. Morton
- Department of Surgery, Yale School of Medicine, United States
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Chao GF, Montgomery JR, Abou Azar S, Telem DA. Venous thromboembolism: risk factors in the sleeve gastrectomy era. Surg Obes Relat Dis 2021; 17:1905-1911. [PMID: 34389247 DOI: 10.1016/j.soard.2021.06.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Of complications after bariatric surgery, venous thromboembolism (VTE) has the greatest impact on mortality. OBJECTIVES To examine risk factors for postoperative VTE and identify high-risk patients who may benefit from prolonged prophylaxis. SETTING National Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database METHODS: Patients who underwent primary, laparoscopic bariatric surgery 2015-2019 were identified. Risk factors were sex, age, body mass index (BMI), history of VTE, immobility, venous stasis disease, operative time greater >3 hours, and procedure type. Multivariable logistic regression was used to examine associations between factors and the outcome of postoperative VTE. We examined contributions of each factor through average marginal effects and E-values. We added Black versus White race to the same regression model to understand whether race acted as a moderating factor. RESULTS In our study, 1677 of 605,782 (.28%) patients experienced postoperative VTE. On multivariable analysis, previous history of VTE had the greatest association, increasing risk of postoperative VTE by +.90% points (95% CI [confidence interval] +.73% to +1.07%). Lower-95% CI E-value bounds were 1.43 for men, 1.11 preoperative BMI, 7.38 history of VTE, and 2.15 operative length >3 hours. Black patients had an additional +.18% (95% CI +.14 to +.22%) risk of postoperative VTE, corresponding to a lower E-value bound of 2.50. CONCLUSION In this study using recent years' national bariatric surgery data, we find history of VTE is the greatest driver of postoperative VTE. Most importantly, Black patients are more likely to suffer postoperative VTE. Now is the time to use the power of quality improvement programs to ensure health equity for all our patients.
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Affiliation(s)
- Grace F Chao
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor, Ann Arbor, Michigan; Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - John R Montgomery
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sara Abou Azar
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Dana A Telem
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Maduka RC, Gibson CE, Chiu AS, Jean RA, Wills-Johnson N, Azar SA, Oliveira K, Ahuja V. Racial disparities in surgical outcomes for benign thyroid disease. Am J Surg 2020; 220:1219-1224. [DOI: 10.1016/j.amjsurg.2020.06.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/22/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
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Dong W, Nicolson NG, Choi J, Barbieri AL, Kunstman JW, Abou Azar S, Knight J, Bilguvar K, Mane SM, Lifton RP, Korah R, Carling T. Clonal evolution analysis of paired anaplastic and well-differentiated thyroid carcinomas reveals shared common ancestor. Genes Chromosomes Cancer 2018; 57:645-652. [PMID: 30136351 DOI: 10.1002/gcc.22678] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 06/19/2018] [Revised: 07/12/2018] [Accepted: 08/03/2018] [Indexed: 02/04/2023] Open
Abstract
Foci of papillary or follicular thyroid carcinoma are frequently noted in thyroidectomy specimens of anaplastic thyroid carcinoma (ATC). However, whether ATCs evolve from these co-existing well-differentiated thyroid carcinomas (WDTCs) has not been well-understood. To investigate the progression of ATC in patients with co-existing WDTCs, five ATC tumors with co-existing WDTCs and matching normal tissues were whole-exome sequenced. After mapping the somatic alteration landscape, evolutionary lineages were constructed by sub-clone analysis. Though each tumor harbored at least some unique private mutations, all five ATCs demonstrated numerous overlapping mutations with matched WDTCs. Clonal analysis further demonstrated that each ATC/WDTC pair shared a common ancestor, with some pairs diverging early in their evolution and others in which the ATC seems to arise directly from a sub-clone of the WDTC. Though the precise lineal relationship remains ambiguous, based on the genetic relationship, our study clearly suggests a shared origin of ATC and WDTC.
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Affiliation(s)
- Weilai Dong
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Norman G Nicolson
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jungmin Choi
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Andrea L Barbieri
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - John W Kunstman
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sara Abou Azar
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - James Knight
- Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Connecticut
| | - Kaya Bilguvar
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Connecticut
| | - Shrikant M Mane
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Connecticut
| | - Richard P Lifton
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Reju Korah
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Tobias Carling
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Khosroshahi HT, Badrogli N, Jahannavard N, Oskuii R, Bahluli A, Azar SA, Ardalan M. Safety of low-dose cyclosporine therapy before transplantation in kidney allograft recipients. Transplant Proc 2009; 41:2757-60. [PMID: 19765427 DOI: 10.1016/j.transproceed.2009.06.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Graft dysfunction immediately posttransplantation can vary from subtle slowing of the expected decrease in creatinine concentration to frank oliguria requiring dialysis therapy for days to weeks. Risk factors for slow and delayed graft function include prolonged preservation, older donor age, and high plasma renin activity in the recipient. Cyclosporine (CsA) nephrotoxicity is another cause of early kidney allograft dysfunction. OBJECTIVE To evaluate early kidney allograft function in patients who received low-dose CsA therapy for 48 hours before transplant surgery for comparison with that in recipients who received CsA therapy after improvement in allograft function. PATIENTS AND METHODS In a case-control comparative study, 66 kidney recipients were divided into 2 groups on the basis of time of initiation of CsA therapy. In group 1, patients received CsA, 100 mg twice a day, for 48 hours before surgery, and in group 2, patients received CsA therapy after surgery when allograft function had improved (serum creatinine concentration <or=3 mg/dL). Other immunosuppression medications were the same in both groups. Statistical analysis was performed to compare kidney allograft function in the first month posttransplantation. RESULTS In group 1 vs group 2, at day 1 posttransplantation, mean (SD) blood urea concentration was 73.72 (31.00) mg/dL vs 87.52 (29.82) mg/dL, serum creatinine concentration was 5.11 (1.83) mg/dL vs 6.42 (3.64) mg/dL, and urine volume in 24 hours was 11,052 (4290) mL vs 9629 (45.30) mL. At the end of the study, blood urea concentration was 49.61 (12.18) mg/dL vs 69.11 (33.76) mg/dL, serum creatinine concentration was 1.22 (0.28) mg/dL vs 1.47 (0.79) mg/dL, and urine volume in 24 hours was 3202 (986) mL vs 3095 (726) mL. No significant difference was noted between the 2 groups for age, sex, and immunosuppression medications. CONCLUSION Low-dose CsA therapy before transplant surgery preserves early allograft function without deleterious effects.
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Abstract
BACKGROUND Restless legs syndrome (RLS) is a common cause of sleep disturbance frequently experienced by hemodialysis patients. It is a neurological movement disorder. Patients with RLS suffer an irresistible urge to move the legs during inactivity with relief by motion and various activities. MATERIALS AND METHODS We investigated the clinical course of RLS in 30 (12 female and 18 male) hemodialysis patients with mean dialysis duration of 16.8 +/- 14.13 months who underwent kidney transplantation. Patients were given a standardized questionnaire evaluating details of RLS at baseline and twice after kidney transplantation. They were diagnosed to have RLS by International RLS Study Group criteria. Biochemical (serum calcium, phosphate, Na, and K and blood urea and creatinine) and hematological indices (serum iron, hemoglobin) were measured at each time. RESULTS RLS in hemodialysis patients was significantly reduced by renal transplantation (43.3%; P<.0001). There was a significant association between RLS and lower serum iron (P<.01) and phosphorus (P<.02) after renal transplantation: We did not observe any association between hemoglobin levels, age, sex, dialysis duration, and time after transplantation with RLS. CONCLUSION Kidney transplantation showed a strong, positive influence on RLS symptoms in hemodialysis patients. Correction of serum phosphate and serum iron (by mechanisms different than its effect on hemoglobin) can affect RLS in kidney transplant patients.
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Affiliation(s)
- S A Azar
- Transplantation Ward, Imam Khomeini Hospital, Tabriz University, IRAN Tabriz, Iran.
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Abstract
OBJECTIVE Living donor kidney transplantation (LDKT) yields the best results of all renal replacement therapies in terms of patient and graft survival. It is the main method in many countries because of worsening patient outcomes due to the accumulation of aged patients with long periods on dialysis and no possibility to increase the number of cadaver donor transplantations. Because of concerns dealing the risks inflicted on the donors, we sought to evaluate the long-term complications of LDKT. PATIENTS AND METHODS We evaluated over 3 years 86 living kidney donors (58 men, 28 women) whose procedures were >1 year ago. The mean time postoperatively was 17.24 +/- 5.04 months and their mean age, 28.97 +/- 4.75 years. Basic information regarding current health status, including physical examination and blood pressure as well as serum urea, creatinine serum albumin, blood glucose, lipid profile, urinanalysis, and 24-hour urine protein were evaluated every 6 months after donation. Also an ultrasound of the kidney, urinary tract, and testis was performed at these times. RESULTS Donor nephrectomies were left sided in 60 (69.8%) cases and right sided in 26 (30.2%) cases. The majority of the donors (n=80) were unrelated (93%). There was a total complication rate of 54.6%. The most common complication was hypertension (37.5%). Serious complications occurred in five cases (5.8%). In six (6.9%) the patients serum creatinine was >or=1.4 mg/dL. Microalbuminuria was found in 10.4%; hematuria in 13.9%; pyuria in 8.1%; and renal stone in 6.9%. Varicocele was found in 24.1% of male patients (23.3% of patients who had left nephrectomised). Persistent pain was reported by 44.1%. Antidepressants were prescribed to 9.3% of donors because of severe depression. CONCLUSION Living kidney donation is not so safe and has some late complications. Precise predonation evaluation and long-term follow-up of kidney donors for detection and prevention of complications is necessary.
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Affiliation(s)
- S A Azar
- Transplantation Ward, Emam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
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Azar SA, Ghods AJ. Effect of renal transplantation on left ventricular hypertrophy. Transplant Proc 2003; 35:2714-5. [PMID: 14612087 DOI: 10.1016/j.transproceed.2003.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S A Azar
- Renal Transplant Ward, Emam Hospital, Tabriz University, Tabriz, Iran.
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