ABSTRACT
The outcomes of patients who undergo ABO-incompatible (ABO-I) living-donor liver transplantation (LDLT) have markedly improved as strategies have become more innovative and advanced. Here, we describe 25 cases of ABO-I LDLT with a simplified protocol and compare the outcomes to those of ABO-compatible LDLT. We analyzed outcomes via a retrospective review of 182 adult LDLT cases including 25 ABO-I LDLTs from January 2011 to December 2014. Propensity scoring was used to compare the groups. The desensitization protocol included plasma exchange, rituximab, and intravenous immunoglobulin without local infusion therapy. The triple immunosuppression protocol consisted of tacrolimus and steroids with mycophenolate mofetil; a splenectomy was not routinely performed. The median age of recipients was 51 years (range, 35-66 years), and the median mean Model for End-Stage Liver Disease (MELD) score was 15 (range, 7-37). The initial ranges of isoagglutinin IgM and IgG titers were 1:1 to 1:256 and 1:4 to 1:2048, respectively. There were no significant differences in patient demographics or perioperative variables between the groups. Although significant rebound elevation in anti-ABO antibody during the postoperative period was observed in 3 cases, neither C4d staining nor clinical signs of antibody-mediated rejection was apparent in these cases. No diffuse intrahepatic biliary stricture was encountered in any ABO-I LDLT patient within a mean follow-up of 22.6 ± 17.2 months. Moreover, no significant difference in overall or graft survival was observed between the groups. ABO-I LDLT can be performed safely under this new simplified protocol and may be proposed when ABO-compatible donors are unavailable.
Subject(s)
Blood Group Incompatibility/drug therapy , Desensitization, Immunologic/methods , Graft Rejection/prevention & control , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Immunosuppressive Agents/therapeutic use , Liver Transplantation/methods , Rituximab/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Blood Group Incompatibility/immunology , Female , Graft Rejection/immunology , Graft Survival , Humans , Living Donors , Male , Middle Aged , Mycophenolic Acid/therapeutic use , Plasma Exchange/methods , Propensity Score , Retrospective Studies , Tacrolimus/therapeutic useABSTRACT
OBJECTIVE: To determine the risk of further gynaecological surgery and gynaecological cancer following hysterectomy and endometrial ablation in women with heavy menstrual bleeding. DESIGN: Population-based retrospective cohort study. SETTING: Scottish hospitals between 1989 and 2006. Population or sample Scottish women treated with hysterectomy or endometrial ablation for heavy menstrual bleeding between 1989 and 2006. METHODS: Anonymised data collected by the Scottish Information Services Division were analysed using appropriate methods across the hysterectomy and endometrial ablation groups. Cox proportional hazards regression analysis was used to examine the survival experience for different surgical outcomes after adjustment for age, year of primary operation and Carstairs quintile. MAIN OUTCOME MEASURES: Further gynaecological surgery and gynaecological cancer in women. RESULTS: A total of 37,120 women had a hysterectomy, 11,299 women underwent endometrial ablation without a subsequent hysterectomy and 2779 women underwent endometrial ablation followed by a subsequent hysterectomy. The median (interquartile range) duration of follow-up was 11.6 years (7.9, 14.8) and 6.2 years (2.7, 10.8) in the hysterectomy and endometrial ablation (without hysterectomy) cohorts, respectively. Compared with women who underwent hysterectomy, those who underwent ablation were less likely to need pelvic floor repair [adjusted hazards ratio, 0.62; 95% confidence interval (95% CI), 0.50, 0.77] or tension-free vaginal tape surgery for stress urinary incontinence (adjusted hazards ratio, 0.55; 95% CI, 0.41, 0.74). Abdominal hysterectomy was associated with a lower chance than vaginal hysterectomy of pelvic floor repair surgery (hazards ratio, 0.54; 95% CI, 0.45, 0.64). Overall, the number of women diagnosed with cancer was small, the largest group being breast cancer (n = 584, 1.57% and n = 130, 1.15% in the hysterectomy and endometrial ablation groups respectively; adjusted hazards ratio, 1.14; 95% CI, 0.93-1.39). CONCLUSIONS: Hysterectomy is associated with a higher risk than endometrial ablation of surgery for pelvic floor repair and stress urinary incontinence. Surgery for pelvic floor prolapse is more common after vaginal than abdominal hysterectomy.
Subject(s)
Endometrial Ablation Techniques , Hysterectomy , Menorrhagia/surgery , Adult , Cohort Studies , Female , Genital Neoplasms, Female/etiology , Humans , Hysterectomy, Vaginal , Postoperative Complications , Proportional Hazards Models , Reoperation , Retrospective Studies , Suburethral Slings , Treatment Outcome , Urinary Incontinence, Stress/etiologyABSTRACT
BACKGROUND: The relationships between varicose veins (VVs) and leg symptoms have not been studied. The aim of this study was to define the relationships between age, sex, leg symptoms and VVs. METHODS: An age-stratified sample of 699 men and 867 women aged 18-64 years, selected randomly from 12 general practices distributed socioeconomically throughout the city, completed a questionnaire regarding leg symptoms (heaviness/tension, swelling, aching, restless legs, cramps, itching, tingling) and underwent a clinical examination. RESULTS: In men, swelling and cramps (both P
