Abstract:
OBJECTIVE:The aim of the study is to evaluate whether intra-operative induction with anti-lymphocytic serum (ALS) is superior to no induction in adult liver transplantation (LT). BACKGROUND:The efficacy of ALS induction remains inconclusive in LT, because of poorly designed trials. METHODS:A randomized controlled trial was conducted, including 206 adults (>15 years) and comparing tacrolimus monotherapy (TAC, n = 109) and tacrolimus plus a single, intraoperative, high-dose (9 mg/kg), rabbit anti-T-lymphocyte globulins (ATLG; n = 97). All patients had similar follow-up, including Banff-scored biopsies. Rejection was considered clinically relevant and treated if pathologic and biochemical changes were concordant. The primary endpoint was immunosuppression minimization to monotherapy; secondary endpoints were biopsy-proven rejection, clinical rejection, patient (PS) and graft (GS) survival. RESULTS:At 1 year, 79/81 (96.3%) ATLG and 101/102 (99.0%) TAC patients were steroid-free (P = 0.585); 28 (34.6%) ATLG, and 31 (30.4%) TAC patients were on double-drug immunosuppression (P = 0.633). One-year PS and GS of ATLG and TAC patients were 84% and 92% (P = 0.260) and 76% and 90% (P = 0.054).Despite significantly a fewer day-7 moderate-to-severe acute cellular rejections (ACR) in ATLG group (10.0% vs 24.0% in TAC group, P = 0.019), cumulative proportion of patients experiencing steroid-sensitive (11.3% ATLG vs 14.7% TAC, P = 0.539), steroid-resistant (2.1% ATLG vs 3.7% TAC, P = 0.686) and chronic rejection (1.0% ATLG vs 0.9% TAC, P = 1.000) were similar. ATLG administration brought about greater hemodynamic instability and blood products use (P = 0.001). CONCLUSIONS:At 1 year from LT, ATLG induction did not significantly affect immunosuppressive load, treated rejection, patient, and graft survival. The observed adverse events justify a modification of dosing and timing of ATLG infusion. Long-term results are required to judge the ATLG possible benefits on immunosuppressive load and tolerance induction.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Iesari S,Ackenine K,Foguenne M,De Reyck C,Komuta M,Bonaccorsi Riani E,Ciccarelli O,Coubeau L,Lai Q,Gianello P,Lerut Jdoi
10.1097/SLA.0000000000002943subject
Has Abstractpub_date
2018-11-01 00:00:00pages
776-783issue
5eissn
0003-4932issn
1528-1140pii
00000658-201811000-00011journal_volume
268pub_type
杂志文章,随机对照试验abstract:OBJECTIVE:This study determined the association between proximal gastrointestinal (GI) colonization and the development of intensive care unit (ICU)-acquired infection and multiple organ failure (MOF) in a population of critically ill surgical patients. SUMMARY BACKGROUND DATA:ICU-acquired infection in association wit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199308000-00001
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVES:Because neural invasion (NI) is still inconsistently reported and not well characterized within gastrointestinal malignancies (GIMs), our aim was to determine the exact prevalence and severity of NI and to elucidate the true impact of NI on patient's prognosis. BACKGROUND:The union internationale contre le ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000968
更新日期:2014-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of debriefing and feedback on intraoperative nontechnical performance as an instructional strategy in surgical training. BACKGROUND:Regulatory authorities for accreditation in North America have included nontechnical skills such as communication and teamwork in the competencies ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000001297
更新日期:2016-05-01 00:00:00
abstract::The relationship between two variables may be mathematically coupled if either one or both variables are derived and/or calculated, and this can lead to erroneous results and invalid conclusions. The purpose of this report is to identify four types of mathematic coupling of data. Type 1 coupling involves directional c...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198103000-00008
更新日期:1981-03-01 00:00:00
abstract:OBJECTIVE:To analyze the utility of quick intraoperative parathyroid hormone (PTH) measurement in the surgical management of primary hyperparathyroidism. BACKGROUND DATA:The use of intraoperative PTH monitoring is well established in the surgery of primary hyperparathyroidism. However, some false-negative predictions ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000145927.29265.8a
更新日期:2004-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the outcome of preoperative gemcitabine-based chemoradiation therapy (CRT) for borderline resectable pancreatic cancer (BRPC), focusing on the associations among the tumor-vascular relationship, surgical outcomes, and pattern of recurrence. SUMMARY BACKGROUND DATA:Among the various multimodal tre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001547
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to identify the association between early postoperative troponin elevations and outcomes after major colorectal surgery. BACKGROUND:Myocardial infarction is the leading cause of death after noncardiac surgery. Most postoperative myocardial infarctions are clinically silent, and asymp...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001854
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To examine the prevalence of BRAF mutation among thyroid cancer histologic subtypes and determine the association of BRAF mutation with indicators of poor prognosis for papillary thyroid cancer and patient outcome. SUMMARY BACKGROUND DATA:The appropriate extent of surgical treatment, adjuvant therapy and fol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318148563d
更新日期:2007-09-01 00:00:00
abstract::Records of 32 patients with 34 villous and tubulovillous adenomas of the duodenum, treated at the Cleveland Clinic over the past 21 years, were reviewed. Twenty-two patients (69%) had complete resection of the adenoma; the incidence of malignancy was 47%. Five patients underwent a Whipple procedure; 4 patients had seg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198803000-00002
更新日期:1988-03-01 00:00:00
abstract::Cadaver kidneys remain a scarce resource, yet single pediatric donor kidneys are underutilized at some centers. Between 1967 and 1984, 133 single pediatric and 318 adult donor cadaver transplants were performed. Patient and graft survival, renal function, and complications in adult recipients grouped by donor age were...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198608000-00011
更新日期:1986-08-01 00:00:00
abstract::This study sought to minimize juxta-anastomotic neointimal hyperplasia (JNIH) following the use of polytetrafluorethylene (PTFE) conduits. PTFE anastomoses to canine carotid arteries (noncuff grafts) were compared with grafts with vein cuffs interposed proximally and distally between the graft and native artery. This ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198806000-00011
更新日期:1988-06-01 00:00:00
abstract::This is the first reported case of mumps hemorrhagic pancreatitis in a child, documented at operation, and by rising mumps titers and complicated by a pseudocyst. In severe cases when surgery is indicated, drainage of the lesser sac usually prevents pseudocyst formation. If a pseudocyst occurs, drainage is required to...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197407000-00012
更新日期:1974-07-01 00:00:00
abstract:OBJECTIVE:To present the objectively assessed very long-term results of a prospective study of 149 patients with achalasia of the cardia who underwent Heller myotomy and posterior partial fundoplication. SUMMARY BACKGROUND DATA:Very few studies evaluate objectively the very long-term results to analyze whether the eff...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318159d7dd
更新日期:2008-02-01 00:00:00
abstract::A case report and review of the literature regarding multiple primary melanomas, and a discussion of the histologic differentiation between cutaneous primary melanomas and dermal metastases are presented. This report concerns a patient who, following wide surgical resection of a 1.3 mm thick primary melanoma with sate...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198102000-00021
更新日期:1981-02-01 00:00:00
abstract:OBJECTIVE:This study compares the quality of valve replacement and repair performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement. SUMMARY BACKGROUND DATA:With the advent of minimally invasive laparoscopic approaches to orthopedic surgery, urology, g...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199710000-00003
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To compare surgical versus medical treatment of type 2 diabetes mellitus (T2DM) remission and comorbidities in patients with a body mass index (BMI) less than 35 kg/m2. BACKGROUND:Obesity surgery can achieve remission of T2DM and its comorbidities. Metabolic surgery has been proposed as a treatment option fo...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1097/SLA.0000000000001014
更新日期:2015-03-01 00:00:00
abstract::Between June 1977 and November 1981, 26 children and adults with ulcerative colitis have undergone a total colectomy, an endorectal dissection of the rectal mucosa, and an ileoanostomy. A combined abdominoperineal approach was used to perform the operation, and the mucosal-submucosal rectal tube was dissected out inta...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1983-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to assess the reduction in the incidence of parastomal hernia (PH) after placement of prophylactic synthetic mesh using a modified Sugarbaker technique when a permanent end-colostomy is needed. SUMMARY OF BACKGROUND DATA:Prevention of PH formation is crucial given the high prevalenc...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000001684
更新日期:2016-12-01 00:00:00
abstract::A prospective, manometric trial of anal fissure treated by subcutaneous lateral internal sphincterotomy (SLIS) was designed to elucidate the pathophysiology of this condition. Anorectal manometry with a closed, precalibrated, water-filled microballoon using the station pull-through technique was performed on 13 patien...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199002000-00017
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:This study investigated the pathogenesis of water and sodium metabolism derangements in obstructive jaundice. SUMMARY BACKGROUND DATA:Obstructive jaundice is associated with hypodipsia, depletion of extracellular water, alterations of the water and sodium regulating hormones, and an increased incidence of re...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199401000-00012
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To review the current concepts in the mediastinal staging of nonsmall cell lung cancer (NSCLC), evaluating traditional and modern staging modalities. SUMMARY BACKGROUND DATA:Staging of NSCLC includes the assessment of mediastinal lymph nodes. Traditionally, computed tomography (CT) and mediastinoscopy are us...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/01.SLA.0000081086.37779.1a
更新日期:2003-08-01 00:00:00
abstract::Thrombosis of the portal vein with or without patency of its tributaries used to be a contraindication to orthotopic liver transplantation (OLTX) until quite recently. Rapid progress in the surgical technique of OLTX in the last few years has demonstrated that most patients with portal vein thrombosis can be safely an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199103000-00003
更新日期:1991-03-01 00:00:00
abstract:OBJECTIVES:To compare the effects of intraoperative goal-directed fluid therapy (GDFT) with conventional fluid therapy, and determine whether there was a difference in outcome between studies that did and did not use Enhanced Recovery After Surgery (ERAS) protocols. METHODS:Meta-analysis of randomized controlled trial...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析
doi:10.1097/SLA.0000000000001366
更新日期:2016-03-01 00:00:00
abstract::A previously described balloon tipped dilatation catheter has been used during revascularization surgery to dilate lesions which potentially could limit the runoff of the saphenous bypass grafts. A total of 34 lesions were dilated in 25 patients. Restudy of 12 patients (15 lesions) demonstrated positive results and no...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198002000-00017
更新日期:1980-02-01 00:00:00
abstract:OBJECTIVE:To test whether frailty, a novel measure of physiologic reserve, is associated with longer kidney transplant (KT) length of stay (LOS), and modifies the association between LOS and mortality. BACKGROUND:Better understanding of LOS is necessary for informed consent and discharge planning. Mortality resulting ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002025
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To determine whether the acute anti-inflammatory influence of epinephrine (EPI) extends to changes in heart rate variability (HRV) induced by the prototypical inflammatory stimulus, endotoxin (lipopolysaccharide [LPS]). SUMMARY BACKGROUND DATA:HRV reflects fluctuating cardiac autonomic inputs and is acutely ...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181a40193
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:To determine whether imputed data can be used to produce unbiased hospital quality measures. BACKGROUND:Different methods for handling missing data may influence which hospitals are designated as quality outliers. METHODS:Monte-Carlo simulation study based on 63,020 patients with no missing data in 68 hospi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31818e544b
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution. SUMMARY OF BACKGROUND DATA:Outcomes after resection of PMNSGCTs are not well-characterized, with limit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003754
更新日期:2020-01-21 00:00:00
abstract:OBJECTIVES:To clarify whether bowel preparation use or its individual components [mechanical bowel preparation (MBP)/oral antibiotics] impact specific outcomes after colorectal surgery. METHODS:National Surgical Quality Improvement Program-targeted colectomy data initiated in 2012 capture information on the use/type o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001416
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:The authors determined whether radioligand binding of neuropeptide Y (NPY) to hypothalamus taken from nonanorectic and anorectic tumor-bearing rats was altered as compared with similar tissue taken from freely-feeding and food-restricted control rats. SUMMARY BACKGROUND DATA:Previous results indicate that tu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199505000-00016
更新日期:1995-05-01 00:00:00