ABSTRACT
BACKGROUND: Lesser degrees of perioperative ischemia-reperfusion injury that does not require dialysis may nonetheless influence allograft outcomes, necessitating evaluation of suitable surrogate indicators of perioperative allograft injury. METHODS: This retrospective analysis of pediatric kidney transplants evaluated two indicators representing pace and completeness of recovery, for association with 12-month estimated glomerular filtration rate (eGFR) and first-year rate of eGFR decline: time to creatinine nadir (TTN) and ratio of recipient/donor unadjusted GFR (uGFRR/D ) at 1-month post-transplant. Donor, recipient, and perioperative risk factors were tested further for association with these 2 indicators. RESULTS: 179 patients (190 transplants) aged 13 (IQR 7-17) years and 56% male were included. Twelve-month eGFR was strongly associated with unadjusted GFR at 1 month (uGFR1M , p < .001) and uGFRR/D (p = .003), but not with TTN. None of the indicators was associated with the rate of subsequent eGFR decline after 1-month post-transplant. As a potential surrogate indicator, uGFR1M is effectively modeled by TTN and uGFRR/D (adjusted R2 = 0.57) and is associated with 12-month eGFR (ß = 0.81 ± 0.08; p < .001). Clinical factors associated with uGFRR/D included donor uGFR (p < .001), BSA (p = .026), age (p = .074), and recipient BSA (p < .001). Factors associated with pace of recovery (TTN) included donor uGFR (p = .018), type (p = .019), and recipient BSA (p = .022). CONCLUSIONS: The uGFRR/D ratio, but not TTN, is a useful indicator of perioperative allograft damage that is associated with one-year functional outcome; and uGFR1M is a potential early surrogate outcome. Donor, recipient, and perioperative factors that are associated with slow allograft function are identified.
Subject(s)
Kidney Transplantation , Child , Creatinine , Female , Glomerular Filtration Rate , Graft Survival , Humans , Kidney , Kidney Transplantation/adverse effects , Living Donors , Male , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
We describe 12 pediatric patients (8-16 years) with primary refractory (N = 6) or first relapse (N = 6) Hodgkin lymphoma (HL) treated with ifosfamide, gemcitabine, and vinorelbine (IGEV). The overall response rate to IGEV was 100%, with seven (58%) complete responses (CR) and five (42%) partial responses. Successful CD34+ stem cell mobilization was achieved in all patients. Following subsequent autologous stem cell transplantation, 10 patients (83%) achieved CR. At a median follow-up of 71 months, 11 patients had no evidence of disease. Five-year second event-free survival and overall survival were 83% ± 11.0% and 90.0% ± 9.5%, respectively. IGEV is an effective salvage regimen for children with relapsed/refractory HL.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Hematopoietic Stem Cell Mobilization , Hodgkin Disease , Salvage Therapy , Stem Cell Transplantation , Adolescent , Autografts , Child , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Disease-Free Survival , Female , Hodgkin Disease/mortality , Hodgkin Disease/therapy , Humans , Ifosfamide/administration & dosage , Male , Survival Rate , Vinorelbine/administration & dosage , GemcitabineABSTRACT
OBJECTIVE: Dual-energy CT (DECT) is an innovative imaging modality that allows superior detection of pulmonary embolism, enhanced detection of urate in gout, and improved assessment of metal prostheses when compared with conventional CT. CONCLUSION: The primary aim of this review is to describe these DECT protocols and compare each to its respective diagnostic reference standards. Moreover, this review will describe how to recognize, reduce, and eliminate DECT artifacts, thereby maximizing its diagnostic capabilities.
