Browsing by Subject "Allografts"

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    B-cell activating factor (BAFF) plasma level at the time of chronic GvHD diagnosis is a potential predictor of non-relapse mortality
    (Nature Publishing Group, 2017-07) Saliba, R.M.; Sarantopoulos, S.; Kitko, C.L.; Pawarode, A.; Goldstein, S.C.; Magenau, J.; Alousi, A.M.; Churay, T.; Justman, H.; Paczesny, Sophie; Reddy, P.; Couriel, D.R.; Pediatrics, School of Medicine
    Biological markers for risk stratification of chronic GvHD (cGvHD) could improve the care of patients undergoing allogeneic hematopoietic stem cell transplantation. Increased plasma levels of B-cell activating factor (BAFF), chemokine (C-X-C motif) ligand 9 (CXCL9) and elafin have been associated with the diagnosis, but not with outcome in patients with cGvHD. We evaluated the association between levels of these soluble proteins, measured by ELISA at the time of cGvHD diagnosis and before the initiation of therapy, with non-relapse-mortality (NRM). Based on the log-transformed values, factor levels were divided into tertiles defined respectively as low, intermediate, and high levels. On univariable analysis, BAFF levels were significantly associated with NRM, whereas CXCL9 and elafin levels were not. Both low (⩽2.3 ng/mL, hazard ratio (HR)=5.8, P=0.03) and high (>5.7 ng/mL, HR=5.4, P=0.03) BAFF levels were associated with a significantly higher NRM compared with intermediate BAFF level. The significant effect of high or low BAFF levels persisted in multivariable analysis. A subset of cGvHD patients had persistently low BAFF levels. In conclusion, our data show that BAFF levels at the time of cGvHD diagnosis are associated with NRM, and also are potentially useful for risk stratification. These results warrant confirmation in larger studies.
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    Impact of Variant Donor Hepatic Arterial Anatomy on Clinical Graft Outcomes in Liver Transplantation
    (Wiley, 2018-10) Schroering, Joel R.; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Hathaway, Taylor J.; Robinson, Ross C.; Mangus, Richard S.; Surgery, School of Medicine
    Standard hepatic arterial anatomy is composed of the common hepatic artery proceeding from the celiac trunk and giving rise to the gastroduodenal artery (GDA) and proper hepatic arteries. Reconstruction of the hepatic arterial supply during liver transplantation, often complex in nature, can be required in cases of accessory or replaced vessels. A recent review summarized the hepatic arterial anatomy reported in over 19,000 cases from 20 individual studies. (1) It has been suggested that the presence of nonstandard donor arterial anatomy may be related to an increased incidence of hepatic artery thrombosis (HAT).(2) Although the overall incidence of HAT is low, it can have devastating effects, including the need for retransplantation, long-term biliary complications, and increased patient mortality. This article describes the arterial anatomy in a large number of liver transplants, with routine anastomosis of a very short hepatic artery and routine reconstruction of the accessory right hepatic artery to the GDA. Study outcomes include incidence of HAT within 30 days of transplant, early graft loss up to 1 year after transplant, and 10-year graft survival.