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Gland Surgery Apr 2022Solid organ transplantation (SOT), which is the best remedy for end-stage organ failure, is accompanied by the risk of developing a postoperative malignant tumor. To...
BACKGROUND
Solid organ transplantation (SOT), which is the best remedy for end-stage organ failure, is accompanied by the risk of developing a postoperative malignant tumor. To date, assessments of the changes in the increased risk of thyroid cancer (TC) after SOT remain controversial. This study sought to reevaluate the risk of TC after SOT based on the latest literature. Our findings could improve the early diagnosis of tumors and the overall prognosis of patients after SOT.
METHODS
A computerized search of four major English-language databases (i.e., PubMed, EMBASE, Cochrane Library, and Web of Science) was performed to retrieve cohort studies on the risk of developing TC after SOT. The standardized incidence ratio (SIR) was used as the pooled-effect size and expressed as the 95% confidence interval (CI).
RESULTS
In total, 20 cohort studies, comprising 362,079 patients who underwent SOT, were included in the meta-analysis. We found that the patients all had an increased risk of developing TC after the transplantation of different solid organs, including the kidney, heart, lung, and liver (P<0.05), and patients had the highest risk of developing TC after kidney transplantation (SIR =5.28, 95% CI: 4.03-6.92, P<0.01).
CONCLUSIONS
Patients have an increased risk of developing TC after SOT. Aggressive and regular tumor screenings after SOT for early detection and timely treatment may improve patient prognosis.
PubMed: 35531105
DOI: 10.21037/gs-22-137 -
Clinics (Sao Paulo, Brazil) 2022The Coronavirus 19 (COVID-19) pandemic has dramatically impacted liver organ transplantation. The American Society of Transplantation recommends a minimum of 28 days... (Review)
Review
BACKGROUND
The Coronavirus 19 (COVID-19) pandemic has dramatically impacted liver organ transplantation. The American Society of Transplantation recommends a minimum of 28 days after symptom resolution for organ donation. However, the exact time for transplantation for recipients is unknown. Considering that mortality on the waiting list for patients with MELD >25 or fulminant hepatitis is higher than that of COVID-19, the best time for surgery after SARS-CoV-2 infection remains undetermined. This study aims to expand the current knowledge regarding the Liver Transplantation (LT) time for patients after COVID-19 and to provide transplant physicians with essential decision-making tools to manage these critically ill patients during the pandemic.
METHODS
Systematic review of patients who underwent liver transplantation after diagnosis of COVID-19. The MEDLINE, PubMed, Cochrane, Lilacs, Embase, and Scielo databases were searched until June 20, 2021. The MESH terms used were "COVID-19" and "Liver transplantation".
RESULTS
558 articles were found; of these 13 articles and a total of 18 cases of COVID-19 prior to liver transplantation were reported. The mean age was 38.7±14.6, with male prevalence. Most had mild symptoms of COVID. Five patients have specific treatment for COVID-19 with convalescent plasm or remdesivir/oseltamivir, just one patient received hydroxychloroquine, and 12 patients received only symptomatic treatment. The median time between COVID-19 to LT was 19 days (13.5‒44.5). Deceased donor liver transplantation accounted for 61% of cases, while living donor transplantation was 39%.
CONCLUSION
Despite the concerns regarding the postoperative evolution, the mortality of patients with high MELD or fulminant hepatitis transplanted shortly after COVID-19 diagnosis does not seem to be higher. (PROSPERO, registration number = CRD42021261790).
Topics: Humans; Male; United States; Young Adult; Adult; Middle Aged; COVID-19; Liver Transplantation; COVID-19 Testing; SARS-CoV-2; Massive Hepatic Necrosis; Living Donors; Transplant Recipients
PubMed: 35870265
DOI: 10.1016/j.clinsp.2022.100042 -
Frontiers in Immunology 2023Despite representing only 3% of the US population, immunocompromised (IC) individuals account for nearly half of the COVID-19 breakthrough hospitalizations. IC... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Despite representing only 3% of the US population, immunocompromised (IC) individuals account for nearly half of the COVID-19 breakthrough hospitalizations. IC individuals generate a lower immune response after vaccination in general, and the US CDC recommended a third dose of either mRNA-1273 or BNT162b2 COVID-19 vaccines as part of their primary series. Influenza vaccine trials have shown that increasing dosage could improve effectiveness in IC populations. The objective of this systematic literature review and pairwise meta-analysis was to evaluate the clinical effectiveness of mRNA-1273 (50 or 100 mcg/dose) vs BNT162b2 (30 mcg/dose) in IC populations using the GRADE framework.
METHODS
The systematic literature search was conducted in the World Health Organization COVID-19 Research Database. Studies were included in the pairwise meta-analysis if they reported comparisons of mRNA-1273 and BNT162b2 in IC individuals ≥18 years of age; outcomes of interest were symptomatic, laboratory-confirmed SARS-CoV-2 infection, SARS-CoV-2 infection, severe SARS-CoV-2 infection, hospitalization due to COVID-19, and mortality due to COVID-19. Risk ratios (RR) were pooled across studies using random-effects meta-analysis models. Outcomes were also analyzed in subgroups of patients with cancer, autoimmune disease, and solid organ transplant. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. Evidence was evaluated using the GRADE framework.
RESULTS
Overall, 17 studies were included in the pairwise meta-analysis. Compared with BNT162b2, mRNA-1273 was associated with significantly reduced risk of SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.75-0.97]; =0.0151; 67.7%), severe SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.77-0.93]; =0.0009; 0%), COVID-19-associated hospitalization (RR, 0.88 [95% CI, 0.79-0.97]; <0.0001; 0%), and COVID-19-associated mortality (RR, 0.63 [95% CI, 0.44-0.90]; =0.0119; 0%) in IC populations. Results were consistent across subgroups. Because of sample size limitations, relative effectiveness of COVID-19 mRNA vaccines in IC populations cannot be studied in randomized trials. Based on nonrandomized studies, evidence certainty among comparisons was type 3 (low) and 4 (very low), reflecting potential biases in observational studies.
CONCLUSION
This GRADE meta-analysis based on a large number of consistent observational studies showed that the mRNA-1273 COVID-19 vaccine is associated with improved clinical effectiveness in IC populations compared with BNT162b2.
Topics: Humans; BNT162 Vaccine; 2019-nCoV Vaccine mRNA-1273; COVID-19 Vaccines; COVID-19; SARS-CoV-2
PubMed: 37771594
DOI: 10.3389/fimmu.2023.1204831 -
World Journal of Gastroenterology Jul 2019Neoplasms arising in the esophagus may coexist with other solid organ or gastrointestinal tract neoplasms in 6% to 15% of patients. Resection of both tumors...
BACKGROUND
Neoplasms arising in the esophagus may coexist with other solid organ or gastrointestinal tract neoplasms in 6% to 15% of patients. Resection of both tumors synchronously or in a staged procedure provides the best chances for long-term survival. Synchronous resection of both esophageal and second primary malignancy may be feasible in a subset of patients; however, literature on this topic remains rather scarce.
AIM
To analyze the operative techniques employed in esophageal resections combined with gastric, pancreatic, lung, colorectal, kidney and liver resections and define postoperative outcomes in each case.
METHODS
We conducted a systematic review according to PRISMA guidelines. We searched the Medline database for cases of patients with esophageal tumors coexisting with a second primary tumor located in another organ that underwent synchronous resection of both neoplasms. All English language articles deemed eligible for inclusion were accessed in full text. Exclusion criteria included: (1) Hematological malignancies; (2) Head/neck/pharyngeal neoplasms; (3) Second primary neoplasms in the esophagus or the gastroesophageal junction; (4) Second primary neoplasms not surgically excised; and (5) Preclinical studies. Data regarding the operative strategy employed, perioperative outcomes and long-term outcomes were extracted and analyzed using descriptive statistics.
RESULTS
The systematic literature search yielded 23 eligible studies incorporating a total of 117 patients. Of these patients, 71% had a second primary neoplasm in the stomach. Those who underwent total gastrectomy had a reconstruction using either a colonic ( = 23) or a jejunal ( = 3) conduit while for those who underwent gastric preserving resections (., non-anatomic/wedge/distal gastrectomies) a conventional gastric pull-up was employed. Likewise, in cases of patients who underwent esophagectomy combined with pancreaticoduodenectomy (15% of the cohort), the decision to preserve part of the stomach or not dictated the reconstruction method (whether by a gastric pull-up or a colonic/jejunal limb). For the remaining patients with coexisting lung/colorectal/kidney/liver neoplasms (14% of the entire patient population) the types of resections and operative techniques employed were identical to those used when treating each malignancy separately.
CONCLUSION
Despite the poor quality of available evidence and the great interstudy heterogeneity, combined procedures may be feasible with acceptable safety and satisfactory oncologic outcomes on individual basis.
Topics: Clinical Decision-Making; Colorectal Neoplasms; Esophageal Neoplasms; Esophagectomy; Feasibility Studies; Gastrectomy; Hepatectomy; Humans; Kidney Neoplasms; Liver Neoplasms; Lung Neoplasms; Neoplasms, Multiple Primary; Nephrectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Patient Selection; Pneumonectomy; Stomach Neoplasms; Survival Analysis; Survival Rate; Treatment Outcome
PubMed: 31341367
DOI: 10.3748/wjg.v25.i26.3438 -
Dermatology Practical & Conceptual Jul 2023Solid organ transplant recipients (SOTR) are at an increased risk for developing keratinocyte carcinomas (KC). Four ultraviolet (UV) modifying factors have been... (Review)
Review
INTRODUCTION
Solid organ transplant recipients (SOTR) are at an increased risk for developing keratinocyte carcinomas (KC). Four ultraviolet (UV) modifying factors have been identified that impact the incidence of KC: Fitzpatrick Skin Type (FST), race, sun exposure, and sun-protective factors.
OBJECTIVES
We conducted a systematic review to summarize the association between UV modifying factors and the incidence of KC in SOTR.
METHODS
We systematically searched PubMed, Scopus, and Web of Science databases, and after screening for inclusion and exclusion criteria, we included 13 studies with 6,910 solid organ transplant recipients in our analysis.
RESULTS
Our review found that lower FST (I-II), white and Latinx populations, lack of regulated sunscreen application, and occupational and residential sun exposure are individual risk factors among solid organ transplant recipients for KC incidence. Although previous studies showed an in-creased SCC:BCC ratio, some studies found a contradictory increased BCC:SCC ratio. Limitations include few research studies that analyze these UV modifying factors and a lack of incorporating both varying immunosuppressant factors and transplantation follow-up times.
CONCLUSIONS
These findings support the need for dermatological advice in increased risk patient demographic populations, lower FST and white and Latinx populations, and subsequently moderating sun exposure and protective factors.
PubMed: 37557127
DOI: 10.5826/dpc.1303a65 -
Medicina (Kaunas, Lithuania) Jun 2021Neutropenic enterocolitis (NE), which in the past was also known as typhlitis or ileocecal syndrome for the segment of the gastrointestinal tract most affected, is a... (Review)
Review
Neutropenic enterocolitis (NE), which in the past was also known as typhlitis or ileocecal syndrome for the segment of the gastrointestinal tract most affected, is a nosological entity that is difficult to diagnose and whose pathogenesis is not fully known to date. Initially described in pediatric patients with leukemic diseases, it has been gradually reported in adults with hematological malignancies and non-hematological conditions, such as leukemia, lymphoma, multiple myeloma, aplastic anemia, and also myelodysplastic syndromes, as well as being associated with other immunosuppressive causes such as AIDS treatment, therapy for solid tumors, and organ transplantation. Therefore, it is associated with high mortality due to the rapid evolution in worse clinical pictures: rapid progression to ischemia, necrosis, hemorrhage, perforation, multisystem organ failure, and sepsis. : A case report is included to exemplify the clinical profile of patients with NE who develop sepsis. : To identify a specific profile of subjects affected by neutropenic enterocolitis and the entity of the clinical condition most frequently associated with septic evolution, a systematic review of the literature was conducted. The inclusion criteria were as follows: English language, full-text availability, human subjects, and adult subjects. Finally, the papers were selected after the evaluation of the title and abstract to evaluate their congruity with the subject of this manuscript. Following these procedures, 19 eligible empirical studies were included in the present review. : Despite the recent interest and the growing number of publications targeting sepsis and intending to identify biomarkers useful for its diagnosis, prognosis, and for the understanding of its pathogenesis, and especially for multi-organ dysfunction, and despite the extensive research period of the literature review, the number of publications on the topic "neutropenic enterocolitis and sepsis" appears to be very small. In any case, the extrapolated data allowed us to conclude that the integration of medical history, clinical and laboratory data, radiological imaging, and macroscopic and histological investigations can allow us to identify a specific pathological profile.
Topics: Adult; Child; Enterocolitis, Neutropenic; Humans; Lymphoma; Neoplasms; Prognosis; Sepsis
PubMed: 34203105
DOI: 10.3390/medicina57060638 -
Diagnostics (Basel, Switzerland) Feb 2022Radiofrequency (RF) is a minimally invasive procedure used to interrupt or alter nociceptive pathways for treating musculoskeletal pain. It seems a useful tool to... (Review)
Review
Radiofrequency (RF) is a minimally invasive procedure used to interrupt or alter nociceptive pathways for treating musculoskeletal pain. It seems a useful tool to relieve chronic pain syndromes, even if, to date, solid evidence is still needed about the effectiveness of this therapy. By this systematic review and meta-analysis, we aimed to evaluate the efficacy of RF in treating musculoskeletal pain. PubMed, Medline, Cochrane, and PEDro databases were searched to identify randomized controlled trials (RCTs) presenting the following: patients with chronic musculoskeletal pain as participants; RF as intervention; placebo, anesthetic injection, corticosteroid injection, prolotherapy, conservative treatment, physiotherapy, and transcutaneous electrical nerve stimulation as comparisons; and pain and functioning as outcomes. Continuous random-effect models with standardized mean difference (SMD) were used to compare the clinical outcomes. Overall, 26 RCTs were eligible and included in the systematic review. All of them analyzed the efficacy of RF in four different regions: cervical and lumbar spine, knee, sacroiliac (SI) joint, shoulder. The outcomes measures were pain, disability, and quality of life. A medium and large effect in favor of the RF treatment group (SMD < 0) was found for the shoulder according to the Visual Analogical Scale and for the SI joint according to the Oswestry Disability Index. A small effect in favor of the RF treatment group (SMD > 0) was found for the spine according to the 36-item Short Form Survey. Non-significant SMD was found for the other outcomes. RF represents a promising therapy for the treatment of chronic musculoskeletal pain, especially when other approaches are ineffective or not practicable. Further studies are warranted to better deepen the effectiveness of RF for pain and joint function for each anatomical region of common application.
PubMed: 35328153
DOI: 10.3390/diagnostics12030600 -
Revista Espanola de Salud Publica Mar 2023Vaccine-preventable infectious diseases are a cause of morbidity and mortality in transplanted children. The main objective of this study was to synthesize the available... (Review)
Review
OBJECTIVE
Vaccine-preventable infectious diseases are a cause of morbidity and mortality in transplanted children. The main objective of this study was to synthesize the available evidence of vaccination coverage in children and adolescents who are candidates or transplant recipients and to analyze beliefs, attitudes, and experiences about vaccination.
METHODS
A mixed-methods systematic review was performed (Open Science Framework registration: https://osf.io/auqn3/). Searches were conducted in PubMed/MEDLINE, EMBASE, IBECS and LILACS (from January 2000 to August 2021) and in gray literature. Quantitative and qualitative studies reported information on coverage, beliefs, attitudes and/or experiences about recommended vaccines in children who are candidates or recipients of solid organ or hematopoietic progenitor transplantation. Quality assessment was undertaken using Mixed Methods Appraisal Tool (MMAT). A narrative synthesis of the studies was carried out.
RESULTS
A total of thirty-two studies in thirty-five publications were included. The most studied interventions were vaccines against measles (n=21; 66%) and hepatitis B (n=20; 62%). Vaccination rates showed a high variability for the most represented vaccines (specifically, 2%-100% for measles, 0.4%-100% for hepatitis B, diphtheria-tetanus-pertussis and rubella), with coverages lower than 90% in at least 70% of the studies. The lowest rates were reported in post-transplantation and hematopoietic stem cell transplantation. Only one qualitative study was identified reporting information on beliefs and/or attitudes, although nine quantitative studies explored cognitive aspects.
CONCLUSIONS
This review shows a high variability in vaccination coverage in children and adolescents who are transplant candidates or recipients, with rates lower than those recommended. Further studies would be needed to identify beliefs and attitudes about immunization in this context.
Topics: Child; Humans; Adolescent; Vaccination Coverage; Spain; Vaccines; Vaccination; Measles; Hepatitis B; Attitude
PubMed: 36999242
DOI: No ID Found -
Clinical Microbiology and Infection :... Aug 2022A significant increased risk of complications and mortality in immunocompromised patients affected by COVID-19 has been described. However, the impact of COVID-19 in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A significant increased risk of complications and mortality in immunocompromised patients affected by COVID-19 has been described. However, the impact of COVID-19 in solid organ transplant (SOT) recipients is an issue still under debate, due to conflicting evidence that has emerged from different observational studies.
OBJECTIVES
We performed a systematic review with a meta-analysis to assess the clinical outcome in SOT recipients with COVID-19 compared with the general population.
DATA SOURCES
PubMed-MEDLINE and Scopus were independently searched until 13 October 2021.
STUDY ELIGIBILITY CRITERIA
Prospective or retrospective observational studies comparing clinical outcome in SOT recipients versus general populations affected by COVID-19 were included. The primary endpoint was 30-day mortality.
PARTICIPANTS
Participants were patients with confirmed COVID-19.
INTERVENTIONS
Interventions reviewed were SOTs.
METHODS
The quality of the included studies was independently assessed with the Risk of Bias in Non-randomized Studies of Interventions tool for observational studies. The meta-analysis was performed by pooling ORs retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method. Multiple subgroups and sensitivity analyses were conducted to investigate the source of heterogeneity.
RESULTS
A total of 3501 articles were screened, and 31 observational studies (N = 590 375; 5759 SOT recipients vs. 584 616 general population) were included in the meta-analyses. No difference in 30-day mortality rate was found in the primary analysis, including studies providing adjustment for confounders (N = 17; 3752 SOT recipients vs. 159 745 general population; OR: 1.13; 95% CI, 0.94-1.35; I = 33.9%). No evidence of publication bias was reported. A higher risk of intensive care unit admission (OR: 1.56; 95% CI, 1.03-2.63) and occurrence of acute kidney injury (OR: 2.50; 95% CI, 1.81-3.45) was found in SOT recipients.
CONCLUSIONS
No increased risk in mortality was found in SOT recipients affected by COVID-19 compared with the general population when adjusted for demographic and clinical features and COVID-19 severity.
Topics: COVID-19; Humans; Organ Transplantation; Prospective Studies; Retrospective Studies; Transplant Recipients
PubMed: 35289294
DOI: 10.1016/j.cmi.2022.02.039 -
Transplantation Reviews (Orlando, Fla.) Jul 2021The effect of solid organ transplantation (SOT) on the severity and mortality of coronavirus disease 2019 (COVID-19) remained controversial. There is still no consensus... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The effect of solid organ transplantation (SOT) on the severity and mortality of coronavirus disease 2019 (COVID-19) remained controversial. There is still no consensus on whether solid organ transplantation (SOT) recipients with COVID-19 are at greater risk of developing severe or fatal COVID-19. Therefore, we conducted a systematic review and meta-analysis to investigate the association between SOT, severe COVID-19 illness, and mortality.
METHODS
A systemically comprehensive search in Pubmed, Embase, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure was performed for relevant studies and articles. Consequently, we pooled the odds ratio (OR) from individual studies and performed heterogeneity, quality assessment and subgroup/sensitivity analysis.
RESULTS
A total number of 15 articles with 265,839 participants were included in this study. Among the total number of participants, 1485 were SOT recipients. The meta-analysis results showed that transplant patients with COVID-19 were remarkably associated with a higher risk of intensive care unit admission than non-transplant patients (OR = 1.57, 95%CI: 1.07 to 2.31, P = 0.02). On the other hand, there were no statistically significant differences between SOT recipients and non-SOT recipients in mechanical ventilation need (OR = 1.55, 95%CI: 0.98 to 2.44, P = 0.06). In addition, we found that SOT recipients with COVID-19 had 1.40-fold increased odds of mortality than non-SOT recipients (OR = 1.40, 95%CI: 1.10 to 1.79, P = 0.007). Moreover, pooled analysis of adjusted results revealed that SOT recipients had a greater risk of mortality compared with non-SOT patients (HR = 1.54, 95%CI: 1.03 to 2.32, P = 0.037).
LIMITATIONS
The main limitations in our study are attributed to the relatively small sample size, short follow-up period, and the fact that most of the studies included were retrospective in design.
CONCLUSIONS
The results of this study indicate that SOT recipients with COVID-19 had a more significant risk of COVID-19 severity and mortality than the general population.
Topics: COVID-19; Global Health; Humans; Organ Transplantation; Pandemics; SARS-CoV-2; Survival Rate; Transplant Recipients
PubMed: 34087553
DOI: 10.1016/j.trre.2021.100628