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1.
Exp Clin Transplant ; 17(3): 320-325, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29363415

RESUMO

OBJECTIVES: Posttransplant lymphoproliferative disorder is a known complication of solid-organ transplant. The use of depleting induction agents has demonstrated varying associations with incidence of posttransplant lymphoproliferative disorder. Alemtuzumab, a depleting induction agent for kidney transplant patients, has shown promising results in reducing the risk of acute rejection and graft loss in the first year. Its unique mechanism of depleting both T-cell and B-cell populations may be beneficial in preventing the occurrence of posttransplant lymphoproliferative disorder. MATERIALS AND METHODS: We examined the known risk factors for posttransplant lymphoproliferative disorder in the setting of alemtuzumab induction to determine whether incidence increases with this induction agent. We reviewed medical records of all alemtuzumab-induced kidney transplants from March 2006 to November 2015. RESULTS: Of the 675 transplant patients who received alemtuzumab induction, 10 developed posttransplant lymphoproliferative disorder, with a cumulative incidence rate of 1.5%. All diagnosed patients had several known risk factors associated with posttransplant lymphoproliferative disorder: 7 with advanced age over 60 years, 5 being cytomegalovirus-negative recipients, and all 10 donor kidneys being male patients and Epstein-Barr virus positive before transplant. CONCLUSIONS: The incidence rate seen in our patient population was within the range of the average in the United States but far lower than the incidence rates associated with other induction agents. Alemtuzumab is associated with a lower cumulative incidence rate of posttransplant lymphoproliferative disorder compared with published reports of other induction treatments.


Assuntos
Alemtuzumab/uso terapêutico , Transplante de Rim , Transtornos Linfoproliferativos/epidemiologia , Transtornos Linfoproliferativos/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
2.
J Endourol ; 30(12): 1296-1300, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27758147

RESUMO

INTRODUCTION: With healthcare reform, cost and patient satisfaction will directly affect hospital reimbursement. We present data on same-day discharge (SDD) for patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: Patient data were gathered in an IRB-approved database. In April 2015, the surgeon (S.J.) began SDD. The SDD protocol for RALP includes multimodal anesthesia/analgesia and extended recovery. Interim analysis revealed that government insurance (CMS) refused hospital reimbursement for SDD. As of that time, only patients with commercial insurance were offered SDD. The demographic and peri-operative data were compared between the two cohorts (Group 1, SDD; Group 2, Admitted patients) by using Mann-Whitney U, chi-squared, or fisher exact tests, where appropriate. RESULTS: During the study period, 21 patients had undergone RALP. Eleven of 21 patients were offered SDS, and nine (81.8%) were discharged. Both those who elected to stay were successfully discharged on the next day. Patient age, body mass index (BMI), prostate-specific antigen, operative time, estimated blood loss (EBL), prostate weight, distance from home to hospital, margin status, marital status, and household income were not statistically significantly different between the two groups. The same is true between patients who underwent RALP both before and after initiation of the SDD protocol with the exception of EBL (greater in the SDD group). There have been no reported complications or readmissions for any of the patients in Group 1. CONCLUSION: Our novel pilot study reveals that SDS is safe and feasible. We are currently conducting a further evaluation of patient satisfaction. Future research is needed to verify these conclusions.


Assuntos
Laparoscopia , Alta do Paciente , Prostatectomia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Anestesia , Índice de Massa Corporal , Bases de Dados Factuais , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Segurança do Paciente , Satisfação do Paciente , Período Perioperatório , Projetos Piloto , Antígeno Prostático Específico/sangue , Estudos Retrospectivos
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