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Resumen Antecedentes: El tratamiento de la infección crónica por el virus de la hepatitis C (VHC) con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). Objetivo: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). Material y métodos: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. Resultados: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. Conclusión: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.
Abstract Background: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rates higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. Objective: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. Material and methods: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. Results: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. Conclusion: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.
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Resumen El sangrado varicoso es una urgencia médica con altas tasas de morbimortalidad. De los pacientes que llegan para recibir manejo hospitalario, hasta un 10% no responden a medidas hemostáticas convencionales, por lo que se ha planteado el uso de prótesis metálicas autoexpandibles para el manejo con resultados prometedores de dichos pacientes. En el presente documento se discute la literatura mundial disponible acerca de la experiencia en el uso de dichos dispositivos; la eficacia en el control agudo; el pronóstico a largo plazo; el tipo de prótesis utilizadas y las alternativas, complicaciones y retos del manejo de pacientes con esta técnica, que puede considerarse emergente en nuestro medio.
Abstract Variceal bleeding is a medical emergency which has high rates of morbidity and mortality. Up to 10% of these patients treated in hospitals do not respond to conventional hemostatic measures. For this reason, the use of self-expanding metal stents (SEMS) has been proposed for management of these patients. It has had promising results. This paper discusses the literature available internationally about experience with the use of SEMS, their efficacy for acute control, long-term patient prognoses, types of stents, alternatives, complications, and challenges for the use of SEMS for patient management that should be considered in our environment.
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Humans , Prostheses and Implants , Stents , Hemorrhage , PrognosisABSTRACT
No abstract available.
Subject(s)
Drug Resistance, Multiple , Hepatitis B virus , Hepatitis B , Hepatitis B, Chronic , Hepatitis , TenofovirABSTRACT
Background:Of patients with acute severe ulcerative colitis (ASUC),30% -40% is steroid-refractory and required second-line medical therapy or colectomy. Infliximab (IFX)may be effective as rescue therapy. Aims:To explore preliminarily the efficacy and safety of IFX as rescue therapy in ASUC in China. Methods:A retrospective study was conducted in 10 consecutive ASUC patients receiving IFX as rescue therapy from June 2012 to September 2016 at Peking Union Medical College Hospital. The modified Mayo score and laboratory parameters were compared at baseline and on week 2,week 12 and week 30 of the treatment course. Results:The response rates on week 2,week 12 and week 30 of IFX treatment were 90. 0% (9/ 10),90. 0% (9/ 10)and 71. 4% (5/ 7),respectively,and the remission rates were 20. 0% (2/10),30. 0% (3/ 10)and 28. 6% (2/ 7),respectively. One patient was primary non-responder to IFX,and two lost response on week 30 (secondary non-response). Seven patients were followed up for 38 weeks. Two patients underwent colectomy. After (9. 6 ± 7. 0)months on average,endoscopic improvement occurred in 50. 0% (5/ 10)of patients,of which one achieved mucosal healing. During treatment course,one case of herpes zoster virus infection and one case of cytomegalovirus infection were recorded. Conclusions:This retrospective study revealed good short-term response to IFX treatment in patients with ASUC in China. It may reduce colectomy rate and promote mucosal healing. However,the rate of secondary loss of response is relatively high. During treatment course,viral infection should be monitored.
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In recent years, the eradication rate of standard triple therapy for Helicobacter pylori (Hp) infection has been reduced to less than 80% because of many factors, such as strain variation, drug resistance and cross infection of different strains.As more and more cases with failure of initial eradication therapy, the focus of clinical practice is to explore new alternative rescue therapies.Aims: To assess the efficacy and safety of Saccharomyces boulardii combined with moxifloxacin-based triple regimen for rescue therapy of Hp infection.Methods: A total of 400 patients with chronic gastritis who had failed initial bismuth quadruple therapy were enrolled and randomly assigned into two groups: 200 cases of control group and 200 cases of test group.Patients in control group received a rescue triple therapy (esomeprazole, amoxicillin and moxifloxacin) for 14 days and those in test group with the further addition of Saccharomyces boulardii sachets.Hp eradication was assessed by 13C/14C-urea breath test four weeks after treatment, and the adverse events during treatment course were observed.Results: The Hp eradication rates in control group and test group were 80.1% (121/151) and 90.4% (142/157) by per-protocol (PP) analysis, respectively, and 60.5% (121/200) and 71.0% (142/200) by intention-to-treat (ITT) analysis, respectively.The eradication rate in test group was significantly higher than that in control group by both PP and ITT analyses (P<0.05).The incidence rate of adverse events was significantly lower in test group than in control group (9.6% vs.17.9%, P<0.05).Conclusions: Saccharomyces boulardii added to moxifloxacin-based rescue triple therapy could increase the eradication rate of Hp infection with less adverse events.
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Background:Of patients with acute severe ulcerative colitis (ASUC),30% -40% is steroid-refractory and required second-line medical therapy or colectomy. Infliximab (IFX)may be effective as rescue therapy. Aims:To explore preliminarily the efficacy and safety of IFX as rescue therapy in ASUC in China. Methods:A retrospective study was conducted in 10 consecutive ASUC patients receiving IFX as rescue therapy from June 2012 to September 2016 at Peking Union Medical College Hospital. The modified Mayo score and laboratory parameters were compared at baseline and on week 2,week 12 and week 30 of the treatment course. Results:The response rates on week 2,week 12 and week 30 of IFX treatment were 90. 0% (9/ 10),90. 0% (9/ 10)and 71. 4% (5/ 7),respectively,and the remission rates were 20. 0% (2/10),30. 0% (3/ 10)and 28. 6% (2/ 7),respectively. One patient was primary non-responder to IFX,and two lost response on week 30 (secondary non-response). Seven patients were followed up for 38 weeks. Two patients underwent colectomy. After (9. 6 ± 7. 0)months on average,endoscopic improvement occurred in 50. 0% (5/ 10)of patients,of which one achieved mucosal healing. During treatment course,one case of herpes zoster virus infection and one case of cytomegalovirus infection were recorded. Conclusions:This retrospective study revealed good short-term response to IFX treatment in patients with ASUC in China. It may reduce colectomy rate and promote mucosal healing. However,the rate of secondary loss of response is relatively high. During treatment course,viral infection should be monitored.
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Nowadays, nucleos(t)ide analogues (NAs) are important drugs for the treatment of chronic hepatitis B and can suppress the virus through inhibiting the activity of hepatitis B virus (HBV) polymerase. However, rtA181 mutation in HBV can reduce the sensitivity of HBV to various NAs, which brings new challenges to antiviral therapy. This article briefly introduces the research advances in the clinical detection rate of rtA181 mutation and its influence on therapeutic effect and prognosis.
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Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.
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BACKGROUND/AIMS: This study evaluated the eradication rate of levofloxacin-containing rescue therapy by treatment duration in patients in whom previous first- and second-line treatment failed. METHODS: Fifty-five patients with persistent Helicobacter pylori infection after first-line therapy and second-line therapy were studied in a single referral academic center. We compared the eradication rates by the treatment duration of third-line therapy. RESULTS: Of 55 patients, 12 (21.8%) received rescue therapy for seven days, 24 (43.6%) received rescue therapy for 10 days, and 19 (34.5%) received rescue therapy for 14 days. The eradication rates of therapy with levofloxacin were 65.5% in the 55 enrolled patients and 73.5% in the 49 patients who underwent follow-up testing. In cases where follow-up testing was performed, the eradication rate of 7-day therapy was 58.3%, of 10-day 68.2%, and of 14-day therapy 93.3%. Eradication rate of 14-day therapy was higher than 7-day (p=0.06) and 10-day (p=0.108), but chance could not be ruled out in the difference among groups. CONCLUSIONS: This study showed somewhat increasing of H. pylori eradication rate by extending the duration of levofloxacin-containing rescue therapy to 14 days.
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Humans , Follow-Up Studies , Helicobacter pylori , Helicobacter , Levofloxacin , Referral and Consultation , Treatment FailureABSTRACT
Background:Helicobacter pylori (Hp)infection is correlated with the development of chronic gastritis,peptic ulcer, mucosa-associated lymphoid tissue lymphoma and gastric cancer.Studies showed that Lactobacillus acidophilus could improve the eradication rate of Hp and reduce the occurrence of side-effects.Aims:To evaluate the efficacy of compound Lactobacillus acidophilus tablets combined with bismuth-containing quadruple therapy for the treatment of failed eradiction of Hp infection.Methods:One hundred and eighty patients with Hp-positive peptic ulcer in whom standard triple therapy failed were enrolled and then randomly assigned into experimental group and control group.Patients in experimental group received compound Lactobacillus acidophilus tablets 1 g tid for 14 days,followed by rabeprazole 10 mg bid +amoxicillin 1 000 mg bid +furazolidone 100 mg bid +bismuth 300 mg qid for 10 days.Patients in control group received rabeprazole 10 mg bid +amoxicillin 1 000 mg bid +furazolidone 100 mg bid +bismuth 300 mg qid for 10 days.13 C-urea breath test was conducted at least 4 weeks after completion of the course,Hp eradication rate and side-effects were evaluated. Results:No significant differences in PP eradication rate and ITT eradication rate were found between experimental group and control group (PP:81.2% vs.78.2%,χ2 =0.241,P =0.623;ITT:76.7% vs.75.6%,χ2 =0.031,P =0.861).Incidences of nausea and vomiting (2.4% vs.11.5%),diarrhea (0 vs.9.2%)in experimental group were significantly decreased than those in control group (P <0.05).Conclusions:Compound Lactobacillus acidophilus tablets combined with bismuth-containing quadruple therapy is efficient for Hp-positive patients with failed standard triple therapy and can reduce side-effects.
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Objective To understand the Helicobacter pylori ( Hp) infection eradication rate of standard tri-ple therapy in Guangdong Meizhou and the drug resistance situation for metronidazole ,clarithromycin ,amoxicillin and levofloxacin ,in order to look for the treatment countermeasures in Hp eradication failure .Methods 297 cases of Hp positive patients because of gastrointestinal symptoms to our hospital examined from April 2011 and March 2013,were randomly assigned into three standard triple therapy groups:A ( OCA ) group and B ( OCM ) group and C ( OCL ) group.The Hp eradication rate was analyzed .Patients with primary treatment failure were selected as group D (OBAL),proceed to (PPl+B+A+L)7 d therapy,the Hp eradication rate was analyzed .230 Hp strains were isola-ted and cultured from 297 cases received the first eradication therapy and 87 cases received again eradication therapy . The minimum inhibitory concentration (MIC) of metronidazole,clarithromycin,amoxicillin and levofloxacin were tested by E-test,in order to determine the resistance of these four antibiotics in clinical isolated Hp strains .Results With intention-to-treat(ITT) analysis,the Hp eradication rates of group A (OCA),group B(OCM) and group C(OCL) were 72.0%(72/100),63.0%(63/100) and 72.2%(70/97),respectively.With per-protocol(PP) analysis,the Hp eradication rates of group A (OCA),group B(OCM) and group C(OCL) were 72.7%(72/99),64.3%(63/98),73.7%(70/95),respectively.The eradication rate among three standard triple therapy groups had no obvi-ous difference (ITT:P=0.278,PP:P=0.288,P>0.05).With ITT analysis,the Hp eradication rate in the quadrup-le therapy group D(OBAL) was 92.0%(80/87).With per-protocol(PP) analysis,the Hp eradication rate in the quadruple therapy group D(OBAL) was 97.6%(80/82),which was higher than that of the three standard triple ther-apy groups(ITT:P=0.000,PP:P=0.000).In 230 clinical isolated Hp strains,the resistant rates of levofloxacin,amoxicillin,clarithromycin and metronidazole were 6.08%(14/230),6.52%(15/230),25.65%(59/230), 70.87%(163/230),respectively.Of those 37 strains were mixed resistance,the mixed resistant rate was 16.09%(37/230).The resistant rate of metronidazole was higher than levofloxacin , amoxicillin and clarithromycin ( P =0.000,P<0.01),the resistant rate of clarithromycin was higher than levofloxacin and amoxicillin (P=0.000),no statistically significant difference between amoxicillin and levofloxacin (P=0.848).Conclusion The Hp resistance is similar to the national average in Guangdong Meizhou ,the eradication rate of standard triple therapy is lower than 80%,contain bismuth agent of quadruple therapy is good rescue therapy .
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BACKGROUND/AIMS: In hospitalized patients with acute steroid-refractory UC, infliximab has been demonstrated to be one of the medical rescue therapies to avoid colectomy. We report the result of a retrospective observational study to find the efficacy and safety of infliximab as a rescue therapy in our hospital. METHODS: Between January 2007 and January 2010, 9 hospitalized patients with steroid-refractory UC were selected to receive three infusions of infliximab (5 mg/kg), at weeks 0, 2, and 6. Efficacy of treatment was evaluated at 8 weeks after the first infliximab infusion and at the end of follow-up period. Adverse events related to infliximab rescue therapy were also collected. RESULTS: Seven patients (77.8%) had completed 3 infusions of infliximab and achieved clinical response at 8 weeks after the first infliximab infusion. Clinical remission rate and the rate of mucosal healing at 8 weeks were 57.1% (4/7) and 71.4% (5/7), respectively. They were followed up for median time of 24.9 months (19.5-53.6 months). One patient underwent emergency colectomy at weeks 2, due to colon perforation, while another patient had discontinued infliximab treatment at weeks 4, because of Clostridium difficile-associated colitis. Finally, colectomy was avoided in 77.8% (7/9) of cases. There was no mortality. CONCLUSIONS: Rescue therapy with infliximab has sustained clinical benefit in 88.9% of our hospitalized patients with acute steroid-refractory UC. Future prospective and long-term follow-up trials with a large number of patients are needed to confirm the efficacy and safety of the treatment.
Subject(s)
Humans , Antibodies, Monoclonal , Clostridium , Colectomy , Colitis , Colitis, Ulcerative , Colon , Emergencies , Follow-Up Studies , Infliximab , Retrospective Studies , UlcerABSTRACT
BACKGROUND/AIMS: The aim of this study was to evaluate the eradication rate of a triple therapy regimen that included a proton pump inhibitor, amoxicillin, and tetracycline instead of clarithromycin in treatment-Naive patients and in patients who did not respond to standard triple therapy. METHODS: This study included 110 patients infected with Helicobacter pylori. Patients in groups A and B were treatment-Naive, and those in group C were not responsive to previous standard triple therapy. Patients in group A (n=40) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and clarithromycin 500 mg b.i.d. for 14 days. Patients in groups B (n=40) and C (n=30) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and tetracycline 500 mg q.i.d. for 14 days. RESULTS: In group A, eradication was achieved in 18 (45%) of the 40 patients included in the intention-to-treat (ITT) analysis and in 18 (47.4%) of the 38 patients included in the per-protocol (PP) analysis. In group B, eradication was achieved in 15 (37.5%) of the 40 patients included in the ITT analysis and in 15 (39.3%) of the 38 patients included in the PP analysis. In group C, eradication was achieved in 14 (46.6%) of the 30 patients included in the ITT analysis and in 14 (43.8%) of the 29 patients included in the PP analysis. There was no statistically significant difference among the 3 groups with regard to eradication rates (p>0.05). CONCLUSIONS: Despite the low rate of resistance to tetracycline, the combination of lansoprazole, amoxicillin, and tetracycline instead of clarithromycin is not a good option for the eradication of H. pylori.
Subject(s)
Humans , 2-Pyridinylmethylsulfinylbenzimidazoles , Amoxicillin , Clarithromycin , Helicobacter , Helicobacter pylori , Pilot Projects , Proton Pumps , TetracyclineABSTRACT
BACKGROUND/AIMS: Proton pump inhibitor (PPI)-based standard triple therapy for Helicobacter pylori infection is widely used, but it has a considerable failure rate. The aim of this study was to evaluate the efficacy and tolerability of rescue therapies with a quadruple regimen and a rifabutin-based regimen for patients who experienced failure with PPI-based standard triple therapy. METHODS: From July 2004 through October 2006, 52 patients for whom first line triple therapy (PPI, amoxicillin and clarithromycin) had failed were included in this study. They were treated with a quadruple regimen for 7 days (PPI, bismuth, tetracycline and metronidazole) as a second line therapy. For third line therapy, a rifabutin-based regimen (PPI, rifabutin and amoxicillin) was prescribed for 14 days. The H. pylori status was determined before and at least 4 weeks after therapy by the 13C urea breath test or by endoscopy with antral and corpus biopsies for a rapid urease test, histological examination and culture. RESULTS: The mean age was 52.6 years. Thirteen patients (25%) of the 52 patients were dropped. The eradication rate of the quadruple therapy was 84.6% (33/39). Three patients of the 6 failures with quadruple therapy were then treated with the rifabutin-based regimen. The eradication rate of the rifabutin-based therapy was 100% (3/3). Adverse effects (10.2%) were reported in 4 patients who were treated with quadruple regimen. CONCLUSIONS: The quadruple regimen is still an effective second-line therapy for Korean patients who experience failure with PPI-based standard triple therapy. The rifabutin-based regimen could be used as a third-line rescue therapy in Korea.
Subject(s)
Humans , Amoxicillin , Biopsy , Bismuth , Breath Tests , Carbamates , Endoscopy , Helicobacter , Helicobacter pylori , Organometallic Compounds , Proton Pumps , Protons , Rifabutin , Tetracycline , Urea , UreaseABSTRACT
BACKGROUND/AIMS: Proton-pump inhibitor (PPI)-based triple therapy for Helicobacter pylori eradication is widely used with considerable failure rate. Bismuth-based, second-line therapy is also associated with failures in more than 20% of cases in Korea. Our aim was to evaluate the efficacy and tolerability of third-line therapy containing moxifloxacin as a rescue in Korea. METHODS: The subjects consisted of 201 patients infected with H. pylori, who were treated with PPI-based therapy, 42 patients treated with bismuth-based after failure of initial PPI triple therapy, and 10 patients treated with moxifloxacin-containing triple therapy after failure of successive initial and second-line therapy. Eradication rate, compliance and side effect rates were compared. RESULTS: The eradication rates of initial, second-line, and third-line therapy were as follows: 67.2%/83.3%, 54.8%/76.7%, 80.0%/88.9% by intention-to-treat and per protocol analysis, respectively. The compliance of patients for each treatment was 98.2%, 90.9%, 100%, respectively. The side effect rate was significantly higher in the bismuth triple therapy than in the PPI- or moxifloxacin-containing triple therapy (p<0.05). CONCLUSIONS: Moxifloxacin-containing triple therapy shows high eradication rate with fewer side effects and good compliance. Thus, this regimen could be used as a rescue therapy.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antacids/administration & dosage , Anti-Bacterial Agents/administration & dosage , Aza Compounds/administration & dosage , Bismuth/administration & dosage , Drug Therapy, Combination , Helicobacter Infections/drug therapy , Helicobacter pylori , Proton Pumps/antagonists & inhibitors , Quinolines/administration & dosageABSTRACT
Effectively functioning arterio-venous fistula (AVF) is so important as to be called a lifeline of the patient with end stage renal disease by maintaining hemodialysis. Not infrequent development of complications of AVF is a major cause of patient's admission and medical cost. Rescue therapy of complicated AVF had several advantages; delay or prevention of new AVF formation, prevention of temporary percutaneous central vein cannulation, and maintenance of psychologic stability. PURPOSE: In order to analyse the patterns of AVF complications and the short- and long-term results of rescue therapy, we made a clinical review retrospectively. PATIENTS & METHODS: We performed AVF in 1503 cases from Jan. 1986 to Dec. 1997. Among them, we performed 93 rescue therapies in 70 patients. Rescue therapy is defined to be a secondary procedure to correct complications while maintaining the primary anastomosis. Secondary procedures in immediate postoperative failure due to technical cause, such as improper selection of vein, were excluded. RESULTS: The most common indication of rescue therapy in 93 cases was thrombosis (78 cases, 83.9%), which is followed by aneurysm in 9 cases, venous hypertension in 2 cases, steal syndrome in 2 cases, high output cardiac failure in 1 case. Autogenous veins were used in initial operation in 55 cases and PTFEs in 38 cases. Early failure within 1 month after rescue therapy happened in 20 cases (21.5%). Complications occured in 4 cases, such as infection (2), brachial plexus injury (1), and arm edema. (1) Mean follow up duration was 3.9 months (1~123 months). Secondary patency rate after 3, 6, 12, 24 months were 70.3+/-3.97, 62.0+/-4.89, 50.6+/-5.85, 37.9+/-7.03% respectively. Secondary patency rate in successfully rescued patients excluding early failure within 1 month after rescue therapy were 91.5+/-3.11, 80.9+/-4.46, 68.9+/-6.15, 54.1+/-8.19%. CONCLUSIONS: Thrombosis or malfunction due to neointimal hyperplasia was the most common complication in AVF. Early and proper rescue therapy in complicated fistula could salvage the AVF. So careful and prompt evaluation of the inflow and outflow of the complicated fistula is necessary, and every effort to rescue the fistula should be made.
Subject(s)
Humans , Aneurysm , Arm , Brachial Plexus , Catheterization , Edema , Fistula , Follow-Up Studies , Heart Failure , Hyperplasia , Hypertension , Kidney Failure, Chronic , Polytetrafluoroethylene , Renal Dialysis , Retrospective Studies , Thrombosis , VeinsABSTRACT
Acute rejection in renal transplantation is a major risk factor threatening the longterm graft survival. Acute rejections refractory to conventional anti-rejection therapy using steroid pulse or antilymphocyte preparations occur in minority, preceding to progressive deterioration of renal function and graft loss. Recent reports showed that tacrolimus rescue therapy in this refractory rejections has converted rejection process. In order to evaluate the clinical outcome of tacrolimus rescue therapy in refractory rejections, we performed a retrospective study. Since April 1997, we performed tacrolimus rescue therapy intent-to-treat for steroid- or OKT3- resistant rejections in 5 patients. All rejections were histologically confirmed according to Banff criteria. As conventional antirejection therapy, steroid pulse therapy (solumedrol 500~1000 mg iv for 3 days) or OKT3 therapy (5 mg/day for 14 days) was performed. The outcome of the rescue therapy is classified into three categories by the change of serum creatinine level or the histologic findings; Improvement-return of serum creatinine level (sCr) to or below the prerejection baseline (nadir) level, Stabilization-arrested sCr increase, Failure-progressive deterioration of renal function, or graft loss. All were men and the mean age was 38 years. Living related- & unrelated-donor transplantation were 2 and 3 cases respectively. Immunosuppression were done with CsA Pd+ (3) or CsA+ Pd+ AZA (2). Acute rejection grades according to Banff criteria were mild (2) or moderate (3). The mean interval between transplantation and tacrolimus conversion was 54.4 days. The outcome was as follows; improvement 2 cases, stabilization 1 case and failure 2 cases. During 3~10 months followup PTLD occured in 1 case, treated with graft nephrectomy and no other complications in other 4 cases. In conclusion, we can convert ongoing refractory rejections to steroid and OKT3 therapy by tacrolimus rescue therapy in 60% (3/5) successfully. Although longterm followup result is necessary to confirm the efficacy and safety of the tacrolimus rescue therapy, the result of this early trial is so good that we may try tacrolimus in refractory rejections for rejection reversal.