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The first endpoint was to establish a quality control of the BIMA grafting surgery used by the surgical team of Mont-Godinne. The second endpoint was to analyze the impact of some comorbidities (obesity, diabetes mellitus, moderate chronic lung disease) on the in-hospital and out-hospital prognostic. The third endpoint was to evaluate the durability of the BIMA grafting surgery.Our work can be definied as a retrospective study, based on a consecutive serie of 340 patients, who had been operated between 2000 and 2001. We chose to focus on four groups of patients : isolated BIMA grafting surgery, BIMA surgery associated with endarterectomy, off pump BIMA grafting surgery and BIMA redo surgery. The use of a single interna! mamrnary artery was an exclusion criteria. We collected the clinical data either with OrnniPro© or with the patient's paper medical folder. For each patient of the serie, we calculated a number of scores who predicted the risk of complications : EuroSCORE 1, EuroSCORE II and STS score.Our in-hospital mortality (3.80%) is smaller than the EuroSCORE's I predicted mortality (4.66), even if there is no evidence of a statistical significance. At the opposite, our in-hospital mortality is greater than the EuroSCORE's II predicted mortality (2.03%), even if we explained this statistically significant difference in our work. Our 30-day mortality (2.10%) is greater than the STS's predicted mortality (1.75%). One of the stronger explanation of this fact is that we have a very high BIMA's using rate of 70.69%. According to the postoperative complication' s prevalences (cerebrovascular events, prolonged ventilation, reoperation for bleeding or sternal infection), we can say that we are in the norm because our results are similar to the STS study. The use of BIMA grafting surgery in patients with comorbidities (obesity, diabetes mellitus, moderate chronic lung disease) wasn't associated with a greater in-hospital mortality or reoperation's risk. Finally, we can conclude that the BIMA grafting surgery is a durable strategy. Indeed, we observe a very small prevalence of coronary artery bypass surgery (0.59%) in the out-hospital follow-up. Le premier objectif était d'établir un contrôle de qualité de la revascularisation myocardique, utilisant deux greffons mammaires internes, entreprise par l'équipe chirurgicale de Mont Godinne. Le deuxième objectif était d'analyser l'impact de certaines comorbidités (obésité, diabète, maladie pulmonaire chronique modérée) sur le pronostique postopératoire intra hospitalier et extra-hospitalier. Le troisième objectif était d'évaluer la durabilité de la technique de pontage bimammaires employée par l'équipe chirurgicale.Notre travail correspond à une étude rétrospective basée sur une série consécutive de 340 patients, opérés en 2000 et 2001. Nous nous sommes intéressés à quatre groupes de patients opérés : les PAC bimammaires isolés, les PAC bimammaires associés à une endartériectomie carotidienne, les PAC bimarnmaires réalisés sur cœur battant et les PAC bima Redo.L'utilisation d'un greffon mammaire unique était un critère d'exclusion dans toutes les catégories précitées. Nous avons réalisé une collecte de données cliniques encodées sous forme électronique et/ou scannées dans le dossier médical du patient, accessible via le logiciel OmniPro©. Pour chacun des patients de la série, nous avons calculé des scores de prédiction de complications : EuroSCORE 1, EuroSCORE II et STS score.Notre mortalité intra-hospitalière (3.80%) est inférieure à la mortalité prédite par l'EuroSCORE 1(4.66%), même si on observe une absence de signification statistique. De l'autre côté, elle est significativement supérieure à la mortalité prédite par l'EuroSCORE II (2.03%), même si cette différence a été justifiée dans notre travail. Notre mortalité à un mois (2.10%) est supérieure à la mortalité prédite par le score STS (1.75%). Un des arguments les plus forts pour justifier cela concerne notre taux d'utilisation des greffons bimarnmaires, qui est de 70.69%. En termes de complications postopératoire s (accidents cérébrovasculaires, ventilation prolongée, réopérations pour saignement ou infection sternale), nous sommes dans les normes et présentons des chiffres similaires à l'étude STS. L'utilisation de la chirurgie bimammaires chez des patients présentant une ou plusieurs des comorbidités précitées ne s'est pas soldée ni par une augmentation de la mortalité intra-hospitalière ni par une augmentation du risque de réopération. Enfin, nous pouvons conclure que la chirurgie bimarnmaires réalisée était durable. En effet, nous observons une prévalence de revascularisation par PAC, dans le suivi post-hospitalier, de 0.59%, ce qui est très faible.
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ORGAN TRANSPLANTATION --- MAJOR HISTOCOMPATIBILITY COMPLEX --- ANTIBODIES --- GRAFT REJECTION --- GRAFT SURVIVAL --- ORGAN TRANSPLANTATION --- MAJOR HISTOCOMPATIBILITY COMPLEX --- ANTIBODIES --- GRAFT REJECTION --- GRAFT SURVIVAL
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Le respect de la compatibilité HLA en transplantation rénale est connu et appliqué depuis de nombreuses années. Il permet de diminuer l'incidence des différents rejets, aigus et chroniques, et de prolonger la survie des patients. En transplantation cardiaque en revanche, le respect de la compatibilité HLA donneur - receveur n'est pas effectué, ceci à cause du temps d'ischémie du greffon qui est trop court (4 heures). Un délai si court ne s'accorde pas avec la logistique pour permettre le typage H LA du greffon.Un nombre croissant d'études rétrospectives s'intéressent cependant à l'analyse de la compatibilité HLA en transplantation cardiaque. Cette étude fait de même en explorant les différents impacts du système HLA sur la survie à long terme des greffons cardiaques.Méthode : De 1985 à 2013, 453 transplantations cardiaques ont été réalisées aux cliniques universitaires de Saint Luc, chez 427 patients, et 26 retransplantations. Parmis ces transplantations, 289 ont répondu à nos critère de sélection, à savoir : une survie au delà de 30 jours et la disponibilité des informations concernant le typage HLA. Cette étude examine rétrospectivement la survie des patients, les rejets aigus, ainsi que les coronaropathies du greffon.Résultats : Nous avons trouvé une corrélation entre la compatibilité HLA-DR et l'incidence des rejets cellulaires. La survie moyenne exempte de rejet cellulaire 3a étant de 296 mois avec 0 à 1mismatch HLA-DR, contre 252 mois avec 2 mismatchs (p=0.047). De plus, le rejet cellulaire présent durant les premières années post transplantation, diminue significativement la survie des patients. Son impact ne se fait pas ressentir uniquement lors des premières années, mais au contraire se majore au fil du temps. Sa répercussion est maximale à 15 ans post transplantation. Le taux de survie à 15 ans est de 28.3% si présence de rejet cellulaire 3a la première année post transplantation contre, 59.3% sans rejet cellulaire.Les résultats concernant l'influence des anticorps anti-HLA au sein de notre cohorte sont épars et souvent non significatifs. Ceci est du à la faible représentation de certains sous groupes, notam ment les catégories avec anticorps « de novo » spécifiques aux donneurs.Conclusion : Les mésappariements HLA-DR augmentent l'incidence des rejets cellulaires. Les rejets cellulaires quant à eux diminuent la survie. Il est donc probable que la compatibilité HLA-DR influence la survie des patients.Quant aux anticorps anti-HLA, nous n'avons pas retrouvé d'influence globale sur la survie de patients . Ceci en raison d'un manque de recul et d'homogénéité dans la récolte et dans l'analyse des données HLA. Cependant d'autres études montrent un potentiel intérêt dans la mesure des anticorps anti HLA pour la détection précoce des rejets. HLA matching in kidney transplantation is well known and applied for years. It reduces the number and intensity of cellular rejection, both acute and chronic. It also increases the survival. However, in heart transplantation, HLA matching is not possible, because of the short ischemic time of the graft (4 hours). Such a short time does not allow the logistic to proceed these analyses. However, a growing number of studies is concerning with the HLA system and the resulting applications. This study explores the HLA domain and the impacts on long-term survival in heart transplantation.Method : From 1985 to 2013, 453 heart transplantations were performed in university hospital of Saint Luc, Bruxelles, Belgium. There were 26 retransplantations . Among these transplants, 289 met the criteria of survival beyond 30 days, whose information H LA typing were available. This study retrospectively examines patient survival, acute rejection: cellular and humoral, and cardiac allograft vasculopathy (CAV). Results : We found a correlation between the HLA-D R matching and cellular rejection. The mean freedom from cellular rejection survival is 296 months with 0 to 1HLA-DR mismatch, against 252 months with 2 mismatches (p = 0.047). In addition, the cellular rejection du ring the first years post transplantation significantly decreases the global survival of patients. The impact does not occur on the first years of survival, but increases with time. The maximum effect appears after 15 years. The percentage of survival after 15 years is 28.3% if there is at least 1cellular rejection grade 3a or more during the first year post transplantation, against 59.3% without rejection.The results on the influence of HLA antibodies in our cohort are scattered and usually not significant. This is due to the low representation of certain sub-groups, including groups presenting de novo donor specific antibodies (DSA).Conclusion : HLA-DR matching influences the incidence of cellular rejection, which in turn influences patient survival. We can extrapolate that HLA matching affects patient survival. As for H LA antibodies, we did not find an overall influence on the survival of patients. This is because of a lack of detachment and homogeneity in the collection and analysis of our data. However, other studies show a potential interest in measuring circulating antibodies for the early detection of rejection episodes.
HLA-A1 Antigen --- HLA-A2 Antigen --- Coronary Artery Disease --- Graft Survival
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Blood Transfusion. --- Graft Survival. --- Graft Survivals --- Survival, Graft --- Survivals, Graft --- Transplantation Tolerance --- Delayed Graft Function --- Blood Transfusions --- Transfusion, Blood --- Transfusions, Blood --- Theses --- Pathological haematology --- Nefrology --- Blood Transfusion --- Graft Survival
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This eBook is a collection of articles from a Frontiers Research Topic. Frontiers Research Topics are very popular trademarks of the Frontiers Journals Series: they are collections of at least ten articles, all centered on a particular subject. With their unique mix of varied contributions from Original Research to Review Articles, Frontiers Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author by contacting the Frontiers Editorial Office: frontiersin.org/about/contact
Medicine --- Immunology --- organ transplantation --- marginal donors --- expanded criteria donors --- machine perfusion --- organ allocation --- graft survival --- delayed graft function --- antigen silencing --- organ transplantation --- marginal donors --- expanded criteria donors --- machine perfusion --- organ allocation --- graft survival --- delayed graft function --- antigen silencing
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This eBook is a collection of articles from a Frontiers Research Topic. Frontiers Research Topics are very popular trademarks of the Frontiers Journals Series: they are collections of at least ten articles, all centered on a particular subject. With their unique mix of varied contributions from Original Research to Review Articles, Frontiers Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author by contacting the Frontiers Editorial Office: frontiersin.org/about/contact
Medicine --- Immunology --- organ transplantation --- marginal donors --- expanded criteria donors --- machine perfusion --- organ allocation --- graft survival --- delayed graft function --- antigen silencing
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This eBook is a collection of articles from a Frontiers Research Topic. Frontiers Research Topics are very popular trademarks of the Frontiers Journals Series: they are collections of at least ten articles, all centered on a particular subject. With their unique mix of varied contributions from Original Research to Review Articles, Frontiers Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author by contacting the Frontiers Editorial Office: frontiersin.org/about/contact
organ transplantation --- marginal donors --- expanded criteria donors --- machine perfusion --- organ allocation --- graft survival --- delayed graft function --- antigen silencing
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In 1986, the Committee of Experts on Blood Transfusion and Immunohae- tology of the Council of Europe chose for their Programme of Co-ordinated Research "An investigation of the procurement and sharing of transplantable organs for potential recipients who are highly sensitized to HLA-antigens". This topic was of common concern to all centres practising renal transplan- tion. The terms of reference of the study were: To estimate the number of patients who are virtually "untransplantable" because of high sensitization in each European country. To study the nature of immunization in terms of the type and specificity of antibodies present in the blood and techniques used for their detection. To investigate possible practical solutions - both current and future, invo- ing cross-matching procedures, the circulation of reference material from patients, and the willingness of the national organizations to share resources. 4. To explore other methods of resolving this problem. Although the study did not offer the prospect of a brilliant new insight into the problem of high sensitization, it was unique in several ways: for the first time we saw all European organizations collaborating in a common project to provide information on their activities, their problems and the methods to resolve them; it introduced, for this subject, relatively novel statistical methods to investigate susceptibility to sensitization and factors affecting transplant outcome; it enabled a large database of transplanted highly sensitized patients and matched controls to be assembled, that would have been unavailable as a research resource at any single centre.
Kidneys --- Graft survival. --- Hla antigens. --- Kidney --- Transplantation immunology. --- Transplantation --- Immunological aspects. --- Transplantation. --- HLA histocompatibility antigens. --- Medicine. --- Immunology. --- Nephrology. --- Surgery. --- Medicine & Public Health.
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In this book, world-renowned experts in the field express well-reasoned opinions on a range of issues and controversies relating to haploidentical transplantation with the aim of providing practicing hematologists with clinically relevant and readily applicable information. Among the areas covered are graft manipulation and methods to control T-cell alloreactivity, the nature of the ideal graft and donor, haploidentical transplantation in pediatric and adult patients with malignant and nonmalignant diseases, immunologic reconstitution following transplantation, complications, and the prevention and treatment of relapse post transplantation. Attention is drawn to the implications of high-impact clinical trials whenever such trials are available. The readily intelligible text is complemented by numerous helpful tables, algorithms, and figures. The book will provide practical support for hematologists and transplant physicians as they attempt to provide optimal care in this exciting but increasingly complex medical specialty.
Hematopoietic stem cells --- Hematopoietic stem cell disorders --- Transplantation. --- Treatment. --- Medicine. --- Hematology. --- Oncology. --- Medicine & Public Health. --- Tumors --- Haematology --- Internal medicine --- Blood --- Clinical sciences --- Medical profession --- Human biology --- Life sciences --- Medical sciences --- Pathology --- Physicians --- Diseases --- Hematopoietic stem cell diseases --- Oncology . --- Transplantation, Haploidentical --- Transplantation Tolerance. --- methods --- adverse effects --- Allograft Tolerance --- Graft Tolerance --- Tolerance, Allograft --- Tolerance, Graft --- Tolerance, Transplantation --- Graft Survival
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In recent years, artificial intelligence has increasingly been playing an essential role in diverse areas in medicine, assisting clinicians in patient management. In nephrology and transplantation, artificial intelligence can be utilized to enhance clinical care, such as through hemodialysis prescriptions and the follow-up of kidney transplant patients. Furthermore, there are rapidly expanding applications and validations of comprehensive, computerized medical records and related databases, including national registries, health insurance, and drug prescriptions. For this Special Issue, we made a call to action to stimulate researchers and clinicians to submit their invaluable works and present, here, a collection of articles covering original clinical research (single- or multi-center), database studies from registries, meta-analyses, and artificial intelligence research in nephrology including acute kidney injury, electrolytes and acid–base, chronic kidney disease, glomerular disease, dialysis, and transplantation that will provide additional knowledge and skills in the field of nephrology and transplantation toward improving patient outcomes.
Medicine --- tacrolimus --- C/D ratio --- tacrolimus metabolism --- everolimus --- conversion --- kidney transplantation --- gut microbiome --- renal transplant recipient --- diarrhea --- immunosuppressive medication --- gut microbiota --- 16S rRNA sequencing --- butyrate-producing bacteria --- Proteobacteria --- torquetenovirus --- immunosuppression --- transplantation --- immunosuppressed host --- outcome --- renal transplantation --- Goodpasture syndrome --- anti-GBM disease --- epidemiology --- hospitalization --- outcomes --- acute kidney injury --- risk prediction --- artificial intelligence --- patent ductus arteriosus --- conservative management --- blood pressure --- eradication --- interferon-free regimen --- hepatitis C infection --- kidney transplant --- allograft steatosis --- lipopeliosis --- transplant numbers --- live donors --- public awareness --- Google TrendsTM --- machine learning --- big data --- nephrology --- chronic kidney disease --- NLR --- PLR --- RPGN --- predictive value --- hemodialysis --- withdrawal --- cellular crescent --- global sclerosis --- procurement kidney biopsy --- glomerulosclerosis --- minimally-invasive donor nephrectomy --- robot-assisted surgery --- laparoscopic surgery --- organ donation --- living kidney donation --- MeltDose® --- LCPT --- renal function --- liver transplantation --- metabolism --- erythropoietin --- fibroblast growth factor 23 --- death --- weekend effect --- in-hospital mortality --- comorbidity --- dialysis --- elderly --- klotho --- α-Klotho --- FGF-23 --- kidney donor --- Nephrology --- CKD-MBD --- CKD-Mineral and Bone Disorder --- deceased donor --- Eurotransplant Senior Program --- risk stratification --- intensive care --- kidney transplant recipients --- long-term outcomes --- graft failure --- cardiovascular mortality --- lifestyle --- inflammation --- vascular calcification --- bone mineral density --- dual-energy X-ray absorptiometry --- living donation --- repeated kidney transplantation --- graft survival --- prolonged ischaemic time --- patient survival --- pre-emptive transplantation --- metabolomics --- urine --- acute rejection --- allograft --- cystatin C --- hyperfiltration --- kidney injury molecule (KIM)-1 --- tubular damage --- genetic polymorphisms --- (cardiac) surgery --- inflammatory cytokines --- clinical studies --- chronic kidney disease (CKD) --- no known kidney disease (NKD) --- ICD-10 billing codes --- phenotyping --- electronic health record (EHR) --- estimated glomerular filtration rate (eGFR) --- machine learning (ML) --- generalized linear model network (GLMnet) --- random forest (RF) --- artificial neural network (ANN), clinical natural language processing (clinical NLP) --- discharge summaries --- laboratory values --- area under the receiver operating characteristic (AUROC) --- area under the precision-recall curve (AUCPR) --- fibrosis --- extracellular matrix --- collagen type VI --- living-donor kidney transplantation --- ethnic disparity --- tacrolimus --- C/D ratio --- tacrolimus metabolism --- everolimus --- conversion --- kidney transplantation --- gut microbiome --- renal transplant recipient --- diarrhea --- immunosuppressive medication --- gut microbiota --- 16S rRNA sequencing --- butyrate-producing bacteria --- Proteobacteria --- torquetenovirus --- immunosuppression --- transplantation --- immunosuppressed host --- outcome --- renal transplantation --- Goodpasture syndrome --- anti-GBM disease --- epidemiology --- hospitalization --- outcomes --- acute kidney injury --- risk prediction --- artificial intelligence --- patent ductus arteriosus --- conservative management --- blood pressure --- eradication --- interferon-free regimen --- hepatitis C infection --- kidney transplant --- allograft steatosis --- lipopeliosis --- transplant numbers --- live donors --- public awareness --- Google TrendsTM --- machine learning --- big data --- nephrology --- chronic kidney disease --- NLR --- PLR --- RPGN --- predictive value --- hemodialysis --- withdrawal --- cellular crescent --- global sclerosis --- procurement kidney biopsy --- glomerulosclerosis --- minimally-invasive donor nephrectomy --- robot-assisted surgery --- laparoscopic surgery --- organ donation --- living kidney donation --- MeltDose® --- LCPT --- renal function --- liver transplantation --- metabolism --- erythropoietin --- fibroblast growth factor 23 --- death --- weekend effect --- in-hospital mortality --- comorbidity --- dialysis --- elderly --- klotho --- α-Klotho --- FGF-23 --- kidney donor --- Nephrology --- CKD-MBD --- CKD-Mineral and Bone Disorder --- deceased donor --- Eurotransplant Senior Program --- risk stratification --- intensive care --- kidney transplant recipients --- long-term outcomes --- graft failure --- cardiovascular mortality --- lifestyle --- inflammation --- vascular calcification --- bone mineral density --- dual-energy X-ray absorptiometry --- living donation --- repeated kidney transplantation --- graft survival --- prolonged ischaemic time --- patient survival --- pre-emptive transplantation --- metabolomics --- urine --- acute rejection --- allograft --- cystatin C --- hyperfiltration --- kidney injury molecule (KIM)-1 --- tubular damage --- genetic polymorphisms --- (cardiac) surgery --- inflammatory cytokines --- clinical studies --- chronic kidney disease (CKD) --- no known kidney disease (NKD) --- ICD-10 billing codes --- phenotyping --- electronic health record (EHR) --- estimated glomerular filtration rate (eGFR) --- machine learning (ML) --- generalized linear model network (GLMnet) --- random forest (RF) --- artificial neural network (ANN), clinical natural language processing (clinical NLP) --- discharge summaries --- laboratory values --- area under the receiver operating characteristic (AUROC) --- area under the precision-recall curve (AUCPR) --- fibrosis --- extracellular matrix --- collagen type VI --- living-donor kidney transplantation --- ethnic disparity
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