Donor characteristics and hematopoietic stem cell transplantation outcome: experience of a single center in Southern Brazil

ABSTRACT Background: Hematopoietic stem cell transplantation is a curative treatment for many patients with hematological disorders. Donor-recipient genetic disparity, especially involving the human leukocyte antigen system is a critical factor for transplant outcome. Objective: To evaluate retrospectively donor characteristics and correlations with the occurrence of acute and chronic graft-versus-host disease, disease-free survival and overall survival in a Brazilian population submitted to allogeneic hematopoietic stem cell transplantation between 1994 and 2012 in a single center. Results: Three hundred and forty-seven consecutive transplantations were included. Related transplants (81.2%) were significantly more common than unrelated transplants (18.7%); donor and recipient median ages were 34 (range: 1-61) and 33 (range: 3-65) years respectively with donor HLAs being matched for 333 (95.9%) patients. Donor gender, cytomegalovirus status and ABO incompatibility did not influence the five-year overall survival. In univariate analyses, overall survival was negatively influenced by the presence of acute graft-versus-host disease (33% vs. 47%, respectively; p-value = 0.04), unrelated transplant (41.5% vs. 50.9%, respectively; p-value = 0.045) and donors aged over 40 years (41% vs. 52%, respectively; p-value = 0.03). Older donors were associated with a higher rate of acute (52% vs. 65.8%; p-value = 0.03) and chronic graft-versus-host disease (60% vs. 43%, respectively; p-value = 0.015). In multivariate analyses, acute graft-versus-host disease [relative risk (RR): 1.8; 95% confidence interval (CI): 1.1-29; p-value = 0.008] and older donors (RR: 1.6; 95% CI 1.11-2.24; p-value = 0.013) were associated with higher transplant-related mortality. Conclusions: In transplant patients, to have a donor older than 40 years of age seems to significantly increase the incidence of acute and chronic graft-versus-host disease and transplant-related mortality with no impact on disease-free survival and overall survival. In spite of the rather small cohort of patients, these findings are similar to what is described in the literature suggesting that a younger donor should be chosen whenever possible.

Associação das sub-escalas de Braden com o risco do desenvolvimento de úlcera por pressão / Association of Braden subscales with the risk of development of pressure ulcer / Evaluación de las subescalas de Braden en una corte de pacientes hospitalizados

Úlceras por pressão (UP) podem aumentar a incidência de complicações hospitalares, devendo-se prevenir este dano. A Escala de Braden destaca-se como instrumento para avaliar o risco de UP. O estudo objetivou identificar quais alterações, na pontuação das subescalas de Braden, estão associadas com o risco do desenvolvimento de UP. Empregou-se regressão logística em uma coorte retrospectiva realizada no Hospital de Clínicas de Porto Alegre, em adultos hospitalizados em unidades clínicas e cirúrgicas, de outubro de 2005 a junho de 2006. Foram avaliados os registros de banco de dados de 1503 pacientes, com idade de 55,5±16 anos, sendo 52,7% do sexo feminino. A incidência de UP foi de 1,8%, e foi associada com diabetes e insuficiência cardíaca. Houve mais UP em pacientes com pior percepção sensorial, mobilidade, atividade e na presença de umidade. Não houve associação entre nutrição e UP. Exceto nutrição, as demais subescalas de Braden mostraram-se preditivas de UP.

Pressure ulcers (PU) may increase the incidence of hospital complications, and one should prevent this damage. The Braden Scale stands out as a tool to assess the risk of PU. The study aimed to identify changes in the score of the Braden subscales are associated with the risk of developing PU. Logistic regression was used in a retrospective cohort study conducted in Hospital de Clínicas de Porto Alegre in adults hospitalized in surgical clinical units from October 2005 to June 2006. We evaluated the records database of 1503 patients with a mean aged 55.5±16 years, 52.7% female. The incidence of PU was 1.8% and was associated with diabetes and heart failure. There was a higher PU in patients worst in sensory perception, mobility, and activity and the presence of moisture. No association was found between nutrition and PU. Except nutrition, the other Braden sub-scales shown to be predictive of PU.

Úlceras por presión (UPP) pueden aumentar la incidencia de complicaciones hospitalarias, y se debe evitar este daño. La Escala de Braden se destaca como una herramienta para evaluar el riesgo de UPP. El objetivo fue identificar como los cambios en las subescalas se asocian con el riesgo de desarrollar UPP. Regresión logística fue utilizada en estudio de corte retrospectivo realizado en Hospital de Clínicas de Porto Alegre en adultos hospitalizados en unidades clínicas quirúrgicas de octubre 2005 a junio 2006. Se evaluó la base de datos de 1503 pacientes con edad de 55,5±16 años, 52,7% mujeres. La incidencia de UPP fue un 1,8% y se asoció con diabetes e insuficiencia cardiaca. Hubo mayor UPP en pacientes con peor percepción sensorial, movilidad y actividad y presencia de humedad. No se encontró asociación entre nutrición y la ocurrencia de UPP. Excepto nutrición, las otras subescalas de Braden demostraron ser predictivo de UPP.