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Kadife E, Harper A, Chien K, Lino TK, Brownfoot FC. Novel genes associated with a placental phenotype in knockout mice also respond to cellular stressors in primary human trophoblasts. Placenta 2023; 139:68-74. [PMID: 37331027 DOI: 10.1016/j.placenta.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/17/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Placental insufficiency is a leading cause of intrauterine growth restriction, contributing to perinatal morbidity and mortality. The molecular regulation of placental development and what causes placental insufficiency is poorly understood. Recently, a panel of genes were found to cause significant placental dysmorphologies in mice with severely growth restricted off-spring. We aimed to assess whether these genes were also implicated in human intrauterine growth restriction. METHODS We explored the expression of nine genes in primary cytotrophoblast cells in hypoxic (n = 6) and glucose starvation (n = 5) conditions in vitro. We also explored whether the genes were dysregulated in intrauterine growth restricted human placental samples (n = 11), with (n = 20) or without preeclampsia compared to gestationally matched controls (<34 weeks gestation) (n = 17). RESULTS Hypoxic stress significantly upregulated the expressions of BRD2 (p = 0.0313), SMG9 (p = 0.0313) genes. In contrast, glucose starvation significantly suppressed Kif1bp (p = 0.0089) in primary cytotrophoblasts. The FRYL, NEK9, CHTOP, PSPH, ATP11A, HM13 genes did not change under hypoxia or glucose starvation conditions. The expression of these genes was not altered in placenta from patients with intrauterine growth restriction, compared to gestationally matched controls. DISCUSSION We demonstrate that some of the genes that cause a placental phenotype in mice, respond to hypoxic and glucose mediated stress in human cytotrophoblast isolations. Despite this, they are unchanged in placenta from patients with intrauterine growth restriction. Therefore, dysregulation of these genes is less likely to contribute to preterm intrauterine growth restriction in humans.
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Affiliation(s)
- Elif Kadife
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Alesia Harper
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Keegan Chien
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Tu'uhevaha Kaitu'u Lino
- Diagnostics Discovery and Reverse Translation in Pregnancy, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Fiona C Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia.
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Binder NK, de Alwis N, Beard S, Kadife E, Harper A, Kaitu'u-Lino TJ, Brownfoot FC, Hannan NJ. Sulfasalazine for the treatment of preeclampsia in a nitric oxide synthase antagonist mouse model. Placenta 2023; 132:20-26. [PMID: 36623415 DOI: 10.1016/j.placenta.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/08/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Development of a therapeutic that targets the pathophysiological elements of preeclampsia would be a major advance for obstetrics, with potential to save the lives of countless mothers and babies. We recently identified anti-inflammatory drug sulfasalazine as a prospective candidate therapeutic for treatment of preeclampsia. In primary human cells and tissues in vitro, sulfasalazine potently decreased secretion of anti-angiogenic sFlt-1 and sENG, increased production of pro-angiogenic PlGF, mitigated endothelial dysfunction, and promoted whole vessel vasodilation. METHODS Using nitric oxide synthase antagonist Nω-Nitro-l-arginine methyl ester hydrochloride, a preeclampsia-like phenotype was induced in pregnant mice, including high blood pressure, fetal growth restriction, and elevated circulating sFlt-1. Mice were treated with sulfasalazine or vehicle from gestational day (D)13.5, with blood pressure measurements across gestation, fetal measurements at D17.5, and wire myograph assessment of vasoactivity. RESULTS Sulfasalazine had a modest effect on blood pressure, decreasing diastolic and mean blood pressure on D13.5, but not later in gestation, or systolic blood pressure. Sulfasalazine was not able to rescue fetal growth, in male or female fetuses. There was a suggestion of improved vasoactivity with sulfasalazine, but further clarification is required. DISCUSSION In this mouse model of preeclampsia, sulfasalazine did not sustain reductions in blood pressure nor affect fetal parameters of size and weight, both desirable attributes of a viable preeclampsia therapeutic. While these data suggest sulfasalazine might improve vasoactivity, murine toxicity considerations limited the dose range of sulfasalazine that could be tested in the current study.
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Affiliation(s)
- Natalie K Binder
- Therapeutics Discovery and Vascular Function, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Natasha de Alwis
- Therapeutics Discovery and Vascular Function, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Sally Beard
- Therapeutics Discovery and Vascular Function, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Elif Kadife
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Alesia Harper
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Tu'uhevaha J Kaitu'u-Lino
- Diagnostics Discovery and Reverse Translation, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Fiona C Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Natalie J Hannan
- Therapeutics Discovery and Vascular Function, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia.
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Kadife E, Hannan N, Harper A, Binder N, Beard S, Brownfoot FC. Hydroxychloroquine reduces soluble Flt-1 secretion from human cytotrophoblast, but does not mitigate markers of endothelial dysfunction in vitro. PLoS One 2022; 17:e0271560. [PMID: 36417467 PMCID: PMC9683551 DOI: 10.1371/journal.pone.0271560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Preeclampsia is a multi-system disease that can have severe, even fatal implications for the mother and fetus. Abnormal placentation can lead to ischaemic tissue injury and placental inflammation. In turn, the placenta releases anti-angiogenic factors into the maternal circulation. These systemically act to neutralise angiogenic factors causing endothelial dysfunction causing preeclampsia. Hydroxychloroquine is an immune modulating drug that is considered safe in pregnancy. There is epidemiological evidence suggesting it may reduce the risk of preeclampsia. Here, we examined the effects hydroxychloroquine on the production and secretion of sFlt-1, soluble endoglin (sENG), placental growth factor (PlGF) and vascular endothelial growth factor (VEGF) in primary human placenta, cytotrophoblasts and umbilical vein endothelial cells (endothelial cell model). Hydroxychloroquine treatment decreased mRNA expression of two sFlt-1 isoforms and its protein secretion. sENG was not reduced. Hydroxychloroquine treatment increased secretion of pro-angiogenic factor PIGF from endothelial cells. It did not significantly reduce the expression of the endothelial cell inflammation marker, ET-1, and inflammation induced expression of the adhesion molecule, VCAM. Hydroxychloroquine could not overcome leukocyte adhesion to endothelial cells. Hydroxychloroquine mitigates features of preeclampsia, but it does not reduce key markers of endothelial dysfunction.
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Affiliation(s)
- Elif Kadife
- Department of Obstetrics and Gynaecology, Obstetric Diagnostics and Therapeutics Group, University of Melbourne, Melbourne, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Natalie Hannan
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Therapeutics Discovery and Vascular Function in Pregnancy, University of Melbourne, Melbourne, Victoria, Australia
| | - Alesia Harper
- Department of Obstetrics and Gynaecology, Obstetric Diagnostics and Therapeutics Group, University of Melbourne, Melbourne, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Natalie Binder
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Therapeutics Discovery and Vascular Function in Pregnancy, University of Melbourne, Melbourne, Victoria, Australia
| | - Sally Beard
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Therapeutics Discovery and Vascular Function in Pregnancy, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona C. Brownfoot
- Department of Obstetrics and Gynaecology, Obstetric Diagnostics and Therapeutics Group, University of Melbourne, Melbourne, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- * E-mail:
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Hastie R, Bergman L, Walker SP, Kaitu'u-Lino T, Hannan NJ, Brownfoot F, Schell S, Harper A, Cannon P, Cluver CA, Tong S. Associations Between Soluble fms-Like Tyrosine Kinase-1 and Placental Growth Factor and Disease Severity Among Women With Preterm Eclampsia and Preeclampsia. J Am Heart Assoc 2022; 11:e024395. [PMID: 35943054 PMCID: PMC9496300 DOI: 10.1161/jaha.121.024395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The angiogenic factors soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and placental growth factor (PlGF) are postulated to be pathogenic disease drivers of preeclampsia. If true, then circulating levels should become more deranged with increasing disease severity. Methods and Results We investigated the association between circulating sFlt‐1 and PlGF levels and severe adverse maternal outcomes among 348 women with preeclampsia. Compared with 125 women with preeclampsia without severe features, 25 women with preeclampsia and any of hemolysis, elevated liver enzymes, low platelet count syndrome, disseminated intravascular coagulation, or severe renal involvement had sFlt‐1 levels that were 2.63‐fold higher (95% CI, 1.81–3.82), sFlt‐1/PlGF levels that were 10.07‐fold higher (95% CI, 5.36–18.91) and PlGF levels that were 74% lower (adjusted fold change, 0.26 [95% CI, 0.18–0.39]). Compared with 125 women with preeclampsia without severe features, 37 with eclampsia had sFlt‐1 levels that were 2‐fold higher (2.02 [95% CI, 1.32–3.09]), sFlt‐1/PIGF levels that were 4.71‐fold higher (95% CI, 2.30–9.66) and PIGF levels that were 63% lower (0.43‐fold change [95% CI, 0.27–0.68]). Compared with those without severe features, preeclampsia with severe hypertension (n=146) was also associated with altered angiogenic levels (sFlt‐1, 1.71‐fold change [95% CI, 1.39–2.11]; sFlt/PlGF, 2.91 [95% CI, 2.04–4.15]; PlGF, 0.59 [95%CI 0.47–0.74]). We also found that sFlt‐1 and PlGF levels were altered by the number of maternal complications experienced. Conclusions Further angiogenic imbalance among women with preeclampsia is likely a pathogenic disease driver responsible for the life‐threatening maternal complications.
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Affiliation(s)
- Roxanne Hastie
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia.,Department of Women's and Children's health Uppsala University Uppsala Sweden
| | - Lina Bergman
- Department of Women's and Children's health Uppsala University Uppsala Sweden.,Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa.,Department of Obstetrics and Gynecology Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Susan P Walker
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia
| | - Tu'uhevaha Kaitu'u-Lino
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia
| | - Natalie J Hannan
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia
| | - Fiona Brownfoot
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia
| | - Sonja Schell
- Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - Alesia Harper
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia
| | - Ping Cannon
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia
| | - Catherine A Cluver
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia.,Department of Obstetrics and Gynaecology Stellenbosch University Cape Town South Africa
| | - Stephen Tong
- Mercy Perinatal Mercy Hospital for Women Melbourne Australia.,Translational Obstetrics Group, Department of Obstetrics and Gynaecology University of Melbourne Heidelberg Australia
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5
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Sandhu J, Harper A, Combeer A. P.42 Unsuccessful conversion of epidural analgesia to epidural anaesthesia in obstetric patients. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Clemens P, Connolly A, Harper A, Mah J, McDonald C, Rao V, Smith E, Zaidman C, Nakagawa T, Hoffman E. DMD - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hastie R, Bergman L, Walker S, Kaitu'u-Lino T, Hannan N, Brownfoot F, Harper A, Cannon P, Cluver C, Tong S. P-009. Associations between circulating sFlt-1 and PlGF and preeclampsia with severe maternal complications, or eclampsia. Pregnancy Hypertens 2021. [DOI: 10.1016/j.preghy.2021.07.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Brooks S, Harper A, Pack L, Wheatley T. 460 THE IMPACT OF THE BONE MDT: EXPLORING CHANGES IN BONE PROTECTION DECISIONS BETWEEN 2015 AND 2018. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The Hip fracture Multidisciplinary metabolic bone Team (MDT) was developed in June 2016 as a collaboration between Orthogeriatricians and the Metabolic Bone Team. The objective was to improve the quality of bone protection treatment decisions. This audit aimed to assess the impact of the new MDT by reviewing treatment decisions prior to and post its introduction. Data collection and.
Methodology
Case notes were reviewed for admissions from September to October 2015 and from September to November 2018. For both time periods the inpatient list, discharge summary and blood tests were reviewed in order to collect data regarding demographics, type of surgery, co-morbidities, calcium and vitamin D levels, bone protection prior to admission and bone protection decisions at discharge.
Results
In 2015, 83% of patients were admitted with no form of bone protection. Around 6% of patients were admitted on a bisphosphonate and 36% were discharged on a bisphosphonate. Less than 2% of people received denosumab prior to their admission, with this number rising to 9.4% at discharge. In 2018, 77% of patients were admitted on no form of bone protection. 5.4% were admitted on a bisphosphonate rising to 16% on discharge. No patients were admitted on denosumab, but 27% were discharged having received it in hospital, or with a plan to receive it from their GP.
Conclusions
There was a fall in bisphosphonate use and a significant increase in the frequency of denosumab prescription after the introduction of the Bone MDT. This MDT facilitated better decision-making through access to the further specialist skills from the endocrinologist and specialist nurses. Individual case discussion enhanced the delivery of personalised medicine.
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Affiliation(s)
- S Brooks
- Princess Royal Hospital, Haywards Heath
| | - A Harper
- Princess Royal Hospital, Haywards Heath
| | - L Pack
- Princess Royal Hospital, Haywards Heath
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Brownfoot F, Binder N, Hastie R, Harper A, Beard S, Tuohey L, Keenan E, Tong S, Hannan N. Nicotinamide and its effects on endothelial dysfunction and secretion of antiangiogenic factors by primary human placental cells and tissues. Placenta 2021; 109:28-31. [PMID: 33957335 DOI: 10.1016/j.placenta.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023]
Abstract
Preeclampsia is a serious pregnancy complication associated with elevated antiangiogenic markers and endothelial dysfunction. Recently nicotinamide (vitamin B3) was shown to reduce high blood pressure and proteinuria in mice models of the disease. Using primary human pregnancy tissue we show nicotinamide did not change antiangiogenic factor secretion including soluble fms-like tyrosine kinase 1 or soluble endoglin from primary cytotrophoblasts and placental explants. Furthermore, it did not reverse markers of endothelial dysfunction. Therefore, we did not demonstrate an effect of nicotinamide on reducing markers of preeclampsia from primary human placental tissues and vascular cells.
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Affiliation(s)
- Fiona Brownfoot
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia.
| | - Natalie Binder
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
| | - Roxanne Hastie
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
| | - Alesia Harper
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
| | - Sally Beard
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
| | - Laura Tuohey
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
| | - Emerson Keenan
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
| | - Stephen Tong
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
| | - Natalie Hannan
- Mercy Perinatal, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia; Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne. Mercy Perinatal, Mercy Hospital for Women 163 Studley Rd, Heidelberg, 3084, Victoria, Australia
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Batra A, Cuthbert C, Harper A, Boyne D, Yang L, Cheung W. P-239 Patient-reported outcomes in patients with metastatic gastric and esophageal cancers near end-of-life. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Batra A, Cuthbert C, Yang L, Harper A, Boyne D, Cheung W. PD-11 Impact of baseline symptom burden as assessed by patient-reported outcomes on overall survival of patients with metastatic gastrointestinal cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Harper A, Gerth A, Marsh C, Park C. Atrial fibrillation and non-ischaemic cardiomyopathy in the peripartum period. Anaesth Rep 2020; 8:152-155. [PMID: 33305289 DOI: 10.1002/anr3.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/07/2022] Open
Abstract
A 31-year-old primiparous woman with a history of bigeminy as a teenager developed atrial fibrillation with rapid ventricular response during elective caesarean section. Initial postoperative medical management was undertaken on the maternal high dependency unit and involved the administration of beta-blockers and digoxin. On postoperative day 1 the patient was transferred to the coronary care unit where she subsequently required synchronised direct current cardioversion to restore sinus rhythm. The patient remained on the coronary care unit for 5 days before discharge. Magnetic resonance imaging undertaken 6 weeks postpartum showed non-ischaemic cardiomyopathy. In this report, we discuss tachycardia-induced and peripartum cardiomyopathies, along with their potential underlying pathologies, incidence and associated morbidity. We describe potential pharmacological therapies including beta-blockers and angiotensin-converting enzyme inhibitors, as well as the implications of such medications for breastfeeding mothers. Patients presenting with palpitations in the antenatal period should receive prompt investigation including electrocardiography with ambulatory monitoring considered for those with persistent symptoms. Anyone with a proven cardiac arrhythmia should undergo echocardiography. This report illustrates the importance of the investigation of the symptoms of arrhythmia during pregnancy and emphasises the role of multidisciplinary working in the management of obstetric patients with complex medical comorbidity.
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Affiliation(s)
- A Harper
- Department of Paediatric Intensive Care Bristol Royal Hospital for Children Bristol UK
| | - A Gerth
- Addenbrookes Hospital Cambridge UK
| | - C Marsh
- Department of Anaesthesia Royal United Hospital Bath UK
| | - C Park
- Department of Obstetrics Royal United Hospital Bath UK
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13
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Kaitu'u-Lino TJ, MacDonald TM, Cannon P, Nguyen TV, Hiscock RJ, Haan N, Myers JE, Hastie R, Dane KM, Middleton AL, Bittar I, Sferruzzi-Perri AN, Pritchard N, Harper A, Hannan NJ, Kyritsis V, Crinis N, Hui L, Walker SP, Tong S. Circulating SPINT1 is a biomarker of pregnancies with poor placental function and fetal growth restriction. Nat Commun 2020; 11:2411. [PMID: 32415092 PMCID: PMC7228948 DOI: 10.1038/s41467-020-16346-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 04/24/2020] [Indexed: 11/09/2022] Open
Abstract
Placental insufficiency can cause fetal growth restriction and stillbirth. There are no reliable screening tests for placental insufficiency, especially near-term gestation when the risk of stillbirth rises. Here we show a strong association between low circulating plasma serine peptidase inhibitor Kunitz type-1 (SPINT1) concentrations at 36 weeks' gestation and low birthweight, an indicator of placental insufficiency. We generate a 4-tier risk model based on SPINT1 concentrations, where the highest risk tier has approximately a 2-5 fold risk of birthing neonates with birthweights under the 3rd, 5th, 10th and 20th centiles, whereas the lowest risk tier has a 0-0.3 fold risk. Low SPINT1 is associated with antenatal ultrasound and neonatal anthropomorphic indicators of placental insufficiency. We validate the association between low circulating SPINT1 and placental insufficiency in two other cohorts. Low circulating SPINT1 is a marker of placental insufficiency and may identify pregnancies with an elevated risk of stillbirth.
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Affiliation(s)
- Tu'uhevaha J Kaitu'u-Lino
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia. .,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia.
| | - Teresa M MacDonald
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Ping Cannon
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Tuong-Vi Nguyen
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Richard J Hiscock
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Nick Haan
- Foresight Health, Adelaide, 169 Fullarton Rd., Dulwich, 5065, South Australia, Australia
| | - Jenny E Myers
- University of Manchester, Manchester Academic Health Science Centre, St Mary's Hospital, Manchester, M13, OJH, UK
| | - Roxanne Hastie
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Kirsten M Dane
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Anna L Middleton
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Intissar Bittar
- Pathology Department, Austin Health, Heidelberg, 3084, Victoria, Australia
| | - Amanda N Sferruzzi-Perri
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Natasha Pritchard
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Alesia Harper
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Natalie J Hannan
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Valerie Kyritsis
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Nick Crinis
- Pathology Department, Austin Health, Heidelberg, 3084, Victoria, Australia
| | - Lisa Hui
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Susan P Walker
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Stephen Tong
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia. .,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia.
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Batra A, Cuthbert C, Rigo R, Harper A, Boyne D, Yang L, Cheung W. 187P Patient-reported outcomes near end-of-life in patients with breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Donkervoort S, Sabouny R, Yun P, Gauquelin L, Chao KR, Hu Y, Al Khatib I, Töpf A, Mohassel P, Cummings BB, Kaur R, Saade D, Moore SA, Waddell LB, Farrar MA, Goodrich JK, Uapinyoying P, Chan SS, Javed A, Leach ME, Karachunski P, Dalton J, Medne L, Harper A, Thompson C, Thiffault I, Specht S, Lamont RE, Saunders C, Racher H, Bernier FP, Mowat D, Witting N, Vissing J, Hanson R, Coffman KA, Hainlen M, Parboosingh JS, Carnevale A, Yoon G, Schnur RE, Boycott KM, Mah JK, Straub V, Foley AR, Innes AM, Bönnemann CG, Shutt TE. MSTO1 mutations cause mtDNA depletion, manifesting as muscular dystrophy with cerebellar involvement. Acta Neuropathol 2019; 138:1013-1031. [PMID: 31463572 PMCID: PMC6851037 DOI: 10.1007/s00401-019-02059-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 01/12/2023]
Abstract
MSTO1 encodes a cytosolic mitochondrial fusion protein, misato homolog 1 or MSTO1. While the full genotype–phenotype spectrum remains to be explored, pathogenic variants in MSTO1 have recently been reported in a small number of patients presenting with a phenotype of cerebellar ataxia, congenital muscle involvement with histologic findings ranging from myopathic to dystrophic and pigmentary retinopathy. The proposed underlying pathogenic mechanism of MSTO1-related disease is suggestive of impaired mitochondrial fusion secondary to a loss of function of MSTO1. Disorders of mitochondrial fusion and fission have been shown to also lead to mitochondrial DNA (mtDNA) depletion, linking them to the mtDNA depletion syndromes, a clinically and genetically diverse class of mitochondrial diseases characterized by a reduction of cellular mtDNA content. However, the consequences of pathogenic variants in MSTO1 on mtDNA maintenance remain poorly understood. We present extensive phenotypic and genetic data from 12 independent families, including 15 new patients harbouring a broad array of bi-allelic MSTO1 pathogenic variants, and we provide functional characterization from seven MSTO1-related disease patient fibroblasts. Bi-allelic loss-of-function variants in MSTO1 manifest clinically with a remarkably consistent phenotype of childhood-onset muscular dystrophy, corticospinal tract dysfunction and early-onset non-progressive cerebellar atrophy. MSTO1 protein was not detectable in the cultured fibroblasts of all seven patients evaluated, suggesting that pathogenic variants result in a loss of protein expression and/or affect protein stability. Consistent with impaired mitochondrial fusion, mitochondrial networks in fibroblasts were found to be fragmented. Furthermore, all fibroblasts were found to have depletion of mtDNA ranging from 30 to 70% along with alterations to mtDNA nucleoids. Our data corroborate the role of MSTO1 as a mitochondrial fusion protein and highlight a previously unrecognized link to mtDNA regulation. As impaired mitochondrial fusion is a recognized cause of mtDNA depletion syndromes, this novel link to mtDNA depletion in patient fibroblasts suggests that MSTO1-deficiency should also be considered a mtDNA depletion syndrome. Thus, we provide mechanistic insight into the disease pathogenesis associated with MSTO1 mutations and further define the clinical spectrum and the natural history of MSTO1-related disease.
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16
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Guillen A, Finotello R, Wynne P, Harper A, Killick D, Amores-Fuster I, Blackwood L. Toxicity of cytarabine constant rate infusion in dogs with high-grade non-Hodgkin lymphoma with bone marrow or central nervous system involvement. Aust Vet J 2019; 98:69-78. [PMID: 31769013 DOI: 10.1111/avj.12895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cytarabine, a cell-cycle phase-specific antimetabolite, has been reported to improve outcomes in dogs with bone marrow (BM) or central nervous system (CNS) lymphoma involvement receiving combination chemotherapy. The objective of this study was to evaluate the incidence and severity of toxicity of cytarabine constant rate infusion (CRI) in dogs with high-grade non-Hodgkin lymphoma. METHODS Medical records of canine lymphoma patients with confirmed or suspected BM (group 1) or CNS (group 2) involvement, treated with a modified cyclophosphamide, epirubicin, vincristine and prednisolone protocol, including a single dose of cytarabine given as CRI, were reviewed and adverse events graded. RESULTS Twenty-six dogs were included. Gastrointestinal toxicity occurred in 17 dogs (65.3%), with 5 (19.2%) experiencing grade III or IV toxicity. Neutropenia occurred in nine dogs (34.6%), but was grade I or II in most cases. Three dogs (11.5%) had thrombocytopenia: one grade III and two grade IV. Four dogs (15.3%) experienced increases in alanine amino transferase: one each grade I and II and two grade III. Five dogs (19.2%) required hospitalisation to manage toxicity after completing cytarabine CRI, and haematological toxicity resulted in treatment delays in five dogs (median delay of 4 days, range: 3-7 days). CONCLUSION Our findings suggest that gastrointestinal toxicity should be expected in lymphoma patients undergoing cytarabine CRI.
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Affiliation(s)
- A Guillen
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - R Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - P Wynne
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - A Harper
- Southfields Veterinary Specialists, Southfields, Laindon Essex, SS15 6TP, UK
| | - D Killick
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - I Amores-Fuster
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - L Blackwood
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
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17
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Guglieri M, Clemens P, Haberlova J, Horrocks I, Selby K, Webster R, Smith E, Straub V, McMillan H, Yang M, Harper A, Tulinius M, Mah J, Childs A, Finkel R, Nevo Y, McDonald C, Morgenroth L, Bendixon R, Hoffman E. P.336Vision DMD: a phase IIb randomized, double-blind, parallel group, placebo- and active-controlled study to assess the efficacy and safety of vamorolone in boys with Duchenne muscular dystrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Clemens P, Rao V, Connolly A, Zaidman C, Harper A, Mah J, Morgenroth L, Yamashita T, Hoffman E. P.337Dystrophin restoration by exon 53 skipping in patients with Duchenne muscular dystrophy after viltolarsen treatment: phase 2 study update. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Yung C, MacDonald TM, Walker SP, Cannon P, Harper A, Pritchard N, Hannan NJ, Kaitu'u-Lino TJ, Tong S. Death associated protein kinase 1 (DAPK-1) is increased in preeclampsia. Placenta 2019; 88:1-7. [PMID: 31563554 DOI: 10.1016/j.placenta.2019.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/27/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Death associated protein kinase-1 (DAPK-1) is highly expressed in the placenta relative to all other human tissues. We examine whether it is differentially expressed with preeclampsia. METHODS We examined samples from a large prospective collection of plasma from 2002 women. We split the samples into two cohorts: Cohort 1 (n = 1000) and Cohort 2 (n = 1002). We first measured circulating DAPK-1 at 36 weeks' gestation in a nested case-control group (from Cohort 1) of 39 women who developed preeclampsia and 98 controls. We then validated our findings by measuring circulating levels in all samples from both cohorts. We also measured DAPK-1 in the circulation and placentas of women who were diagnosed with preterm preeclampsia or delivered a growth restricted infant at <34 weeks' gestation. RESULTS In the case-control study, circulating DAPK-1 was significantly increased in women destined to develop preeclampsia (p < 0.01). We validated this by measuring circulating levels in Cohorts 1 and 2. Again, circulating DAPK-1 was significantly higher (p < 0.001) among women destined to develop preeclampsia (Cohort 1, Area under the receiver operator characteristic curve (AUC) = 0.66; Cohort 2 AUC = 0.67). Circulating DAPK-1 was also significantly elevated in women with established preterm preeclampsia. Placental DAPK-1 mRNA and protein expression were elevated in women with established preeclampsia. DISCUSSION DAPK-1 is a novel placenta-enriched molecule that is elevated in the circulation of women preceding the diagnosis of preeclampsia and is likely to be secreted from the placenta.
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Affiliation(s)
- Cameron Yung
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Teresa M MacDonald
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Susan P Walker
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Ping Cannon
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Alesia Harper
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Natasha Pritchard
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Natalie J Hannan
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
| | - Tu'uhevaha J Kaitu'u-Lino
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia.
| | - Stephen Tong
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Victoria, Australia
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Bjornsdottir-Butler K, Abraham A, Harper A, Dunlap PV, Benner RA. Biogenic Amine Production by and Phylogenetic Analysis of 23 Photobacterium Species. J Food Prot 2018; 81:1264-1274. [PMID: 29985067 DOI: 10.4315/0362-028x.jfp-18-022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Photobacterium species are members of the bacterial communities typically associated with scombrotoxin-forming fish. Reclassification and discovery of new Photobacterium species has caused confusion as to which species are capable of biogenic amine production. We analyzed histamine, cadaverine, and putrescine production by 104 Photobacterium strains representing 23 species. The presence of the genes for histidine decarboxylase ( hdc), lysine decarboxylase ( ldc), and ornithine decarboxylase ( odc) was determined by real-time or conventional PCR and whole genome sequencing. Significant histamine production (>200 ppm) was detected in five Photobacterium species: P. angustum, P. aquimaris, P. kishitanii, P. damselae, and P. phosphoreum. The hdc gene was detected in all of these histamine-producing species except P. phosphoreum. Cadaverine was produced by eight Photobacterium species: P. angustum, P. aquimaris, P. damselae, P. iliopiscarium, P. kishitanii, P. leiognathi, P. mandapamensis, and P. phosphoreum. Putrescine was produced by six Photobacterium species: P. angustum, P. aquimaris, P. kishitanii, P. leiognathi, P. mandapamensis, and Photobacterium sp. Cadaverine production correlated closely with the presence of the ldc gene, but putrescine production did not correlate closely with the presence of the odc gene. Characterization of the biogenic amine production by Photobacterium species will allow identification of these marine bacteria and help ensure that current guidelines account for mitigation of these bacteria.
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Affiliation(s)
- K Bjornsdottir-Butler
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
| | - A Abraham
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
| | - A Harper
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
| | - P V Dunlap
- 2 Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - R A Benner
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
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21
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Crossland D, Jansen K, O'Sullivan JJ, Best KE, Parry G, MacGowan GA, Harper A, Perri G, Derita F, Davidson A, Hasan A, Coats L. P3473Outcome following assessment for orthotopic heart transplant in adults with congenital heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Crossland
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - K Jansen
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - J J O'Sullivan
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - K E Best
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, United Kingdom
| | - G Parry
- Freeman Hospital, Cardiology Department, Newcastle upon Tyne, United Kingdom
| | - G A MacGowan
- Freeman Hospital, Cardiology Department, Newcastle upon Tyne, United Kingdom
| | - A Harper
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - G Perri
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - F Derita
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - A Davidson
- Freeman Hospital, Cardiology Department, Newcastle upon Tyne, United Kingdom
| | - A Hasan
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - L Coats
- Newcastle University, Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, United Kingdom
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22
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Blackwood L, Tanis JB, Harper A, Amores-Fuster I, Killick DR, Finotello R. Acute radiotherapy toxicity in 57 dogs with gross and microscopic mast cell tumours. Vet Comp Oncol 2018; 16:431-440. [PMID: 29761612 DOI: 10.1111/vco.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 10/16/2022]
Abstract
Mast cell tumours (MCTs) are commonly treated with radiation therapy, most often in a microscopic disease setting. Poorer outcomes are expected in patients with gross disease, and irradiation of gross disease may be associated with greater toxicity. The aim of this study was to compare acute radiation adverse events (AE) in dogs with gross and microscopic MCTs receiving radiotherapy. Fifty-seven dogs were included, 28 with gross disease and 29 with microscopic. In order to assess mucosal and skin toxicity, patients were assigned to 2 groups: head (29 patients, 14 patients with gross and 15 microscopic) and other sites (28 patients, 14 each). All were treated with external beam radiotherapy, and toxicity assessed at the end of treatment and 10 to 14 days later (first recheck). All patients developed some acute radiation toxicity by the end of the course. However, there was no difference in the severity of toxicity between gross and microscopic disease in either site group at either time point. The only variable associated with an increased frequency of grade 2 or 3 toxicity at the first recheck was the use of prednisolone prior to radiotherapy (P = .05). No other factors were identified which were associated with increased toxicity. For the head group, the site of highest grade toxicity was mucosa or, if included in the field, nasal planum, which was often more severely affected than the mucosa. No significant late toxicity was identified. Two dogs developed acute haematemesis during the radiotherapy course, but both completed the course without further events.
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Affiliation(s)
- L Blackwood
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - J B Tanis
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - A Harper
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - I Amores-Fuster
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - D R Killick
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - R Finotello
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
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23
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Tanis JB, Mason SL, Maddox TW, Blackwood L, Killick DR, Amores-Fuster I, Harper A, Finotello R. Evaluation of a multi-agent chemotherapy protocol combining lomustine, procarbazine and prednisolone (LPP) for the treatment of relapsed canine non-Hodgkin high-grade lymphomas. Vet Comp Oncol 2018; 16:361-369. [PMID: 29380942 DOI: 10.1111/vco.12387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/22/2017] [Accepted: 01/04/2018] [Indexed: 11/27/2022]
Abstract
The standard of care treatment for canine lymphoma is multi-agent chemotherapy containing prednisolone, cyclophosphamide, vincristine and an anthracycline such as doxorubicin (CHOP) or epirubicin (CEOP). Lomustine, vincristine, procarbazine, and prednisone (LOPP) has been evaluated as a rescue, with encouraging results; however, resistance to vincristine is likely in patients relapsing on CHOP/CEOP, and this agent may enhance LOPP toxicity without improving efficacy. The aim of this study was to evaluate responses to a modified-LOPP protocol that does not include vincristine (LPP) and is administered on a 21-day cycle. Medical records of dogs with high-grade multicentric lymphoma from 2012 to 2017 were reviewed. Dogs with relapsed lymphoma that received LPP as a rescue protocol were enrolled. Response, time from initiation to discontinuation (TTD) and toxicity of LPP were assessed. Forty-one dogs were included. Twenty-five dogs (61%) responded to LPP including 12 complete responses (CR) and 13 partial responses (PR). Responders had a significantly longer TTD (P < .001) compared to non-responders with 84 days for CR and 58 days for PR. Neutropenia was documented in 20 dogs (57%): 12 grade I to II, 8 grade III to IV. Thrombocytopenia was infrequent (20%): 5 grade I to II, 2 grade III to IV. Twelve dogs developed gastrointestinal toxicity (30%): 10 grade I to II and 2 grade III. Nineteen dogs had elevated ALT (59%): 9 grade I to II, 10 grade III to IV. Treatment was discontinued due to toxicity in 8 dogs (19%). The LPP protocol shows acceptable efficacy and toxicity-profile and minimizes in-hospital procedures.
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Affiliation(s)
- J-B Tanis
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - S L Mason
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - T W Maddox
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - L Blackwood
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - D R Killick
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - I Amores-Fuster
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - A Harper
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - R Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
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Daien V, Nguyen V, Essex RW, Morlet N, Barthelmes D, Gillies MC, Gillies M, Hunt A, Essex R, Dayajeewa C, Hunyor A, Fraser-Bell S, Younan C, Fung A, Guymer R, Louis D, Arnold J, Chan D, Cass H, Harper A, O’Day J, Daniell M, Field A, Chow L, Barthelmes D, Cohn A, Young S, Lal S, Ferrier R, Barnes R, Thompson A, Vincent A, Manning L, Lake S, Phillips R, Perks M, Chen J, Landers J, Niladri, Banerjee G, Swamy B, Windle P, Dunlop A, Tang K, McLean I, Amini A, Hunt A, Clark G, McAllister I, Chen F, Squirrell D, Ng C, Hinchcliffe P, Barry R, Ah-Chan J, Steiner H, Morgan M, Thompson C, Game J, Murray N. Incidence and Outcomes of Infectious and Noninfectious Endophthalmitis after Intravitreal Injections for Age-Related Macular Degeneration. Ophthalmology 2018; 125:66-74. [DOI: 10.1016/j.ophtha.2017.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
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25
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Harper A, Blackwood L. Toxicity of metronomic cyclophosphamide chemotherapy in a UK population of cancer-bearing dogs: a retrospective study. J Small Anim Pract 2017; 58:227-230. [DOI: 10.1111/jsap.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/20/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A. Harper
- Institute of Veterinary Sciences; University of Liverpool; Liverpool Wirral CH64 7TE UK
| | - L. Blackwood
- Institute of Veterinary Sciences; University of Liverpool; Liverpool Wirral CH64 7TE UK
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Davies J, Harper A, Kadir RA. The role of rotational thromboelastometry in assessment of haemostasis during pregnancy in women with factor XI deficiency. Haemophilia 2015; 22:276-284. [DOI: 10.1111/hae.12807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 12/01/2022]
Affiliation(s)
- J. Davies
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
| | - A. Harper
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
| | - R. A. Kadir
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
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Hollingworth M, Harper A, Hamer M. An observational study of erectile dysfunction, infertility, and prostate cancer in regular cyclists: Cycling for health UK study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arnold JJ, Campain A, Barthelmes D, Simpson JM, Guymer RH, Hunyor AP, McAllister IL, Essex RW, Morlet N, Gillies MC, Gillies M, Hunt A, Hunyor A, Arnold J, Young S, Clark G, Banerjee G, Phillips R, Perks M, Essex R, McAllister I, Constable I, Guymer R, Guymer R, Lim L, Harper A, Chow L, Wickremansinghe S, Wickremasinghe S, Wickremasinghe S. Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 2015; 122:1212-9. [PMID: 25846847 DOI: 10.1016/j.ophtha.2015.02.009] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) using a treat and extend treatment regimen in routine clinical practice. DESIGN Database observational study. PARTICIPANTS We included treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice treated using a treat and extend regimen that were tracked in the Fight Retinal Blindness observational registry. METHODS A cohort of eyes treated by practitioners using exclusively a treat and extend regimen was extracted from the Fight Retinal Blindness observational registry. MAIN OUTCOME MEASURES Change in visual acuity (VA) over 2 years and number of injections and visits. RESULTS Data from 1198 eyes from 1011 patients receiving anti-VEGF therapy using a treat and extend regimen for treatment-naïve nAMD between January 2007 and December 2012 and with 24-month follow-up were included in the analysis. Mean VA increased by +5.3 logarithm of the minimum angle of resolution letters from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters at 24 months. Mean VA gains improved and number of injections increased with successive years from +2.7 letters for eyes commencing in 2007 after a mean of 9.7 injections in 2 years, to +7.8 letters for eyes commencing in 2012 after a mean of 14.2 injections over 2 years. The proportion of eyes with VA >20/40 increased from 27% when starting treatment to 45% after 24 months; the proportion with vision of <20/200 remained unchanged (13% initial, 11% at 24 months). Of the included eyes, 90.5% avoided a vision loss of ≥15 letters. There was an overall mean of 13.0 injections over the 24 months, 7.5 injections in the first year and 5.5 in the second year, with a mean of 14.8 clinic visits. CONCLUSIONS These data indicate that eyes managed in routine clinical practice with a treat and extend regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
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Affiliation(s)
| | - Anna Campain
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Judy M Simpson
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Alex P Hunyor
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Vision Science, University of Western Australia, Western Australia
| | - Rohan W Essex
- Academic Unit of Ophthalmology, Australian National University, Acton, Canberra, Australia
| | - Nigel Morlet
- University of Western Australia Department of Population Health, Perth, Western Australia
| | - Mark C Gillies
- Marsden Eye Specialists, Parramatta, New South Wales, Australia
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Williams C, Jiang YH, Shashi V, Crimian R, Schoch K, Harper A, McHale D, Goldstein D, Petrovski S. Additional evidence thatPGAP1loss of function causes autosomal recessive global developmental delay and encephalopathy. Clin Genet 2015; 88:597-9. [DOI: 10.1111/cge.12581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/20/2015] [Accepted: 03/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. Williams
- Duke School of Medicine; Duke University; Durham NC USA
| | - Y.-H. Jiang
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
- Department of Neurobiology; Duke University; Durham NC USA
| | - V. Shashi
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
| | - R. Crimian
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
| | - K. Schoch
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
| | - A. Harper
- Department of Neurology; Wake Forest University North Carolina Baptist Hospital; Durham NC USA
| | | | - D. Goldstein
- Institute for Genomic Medicine; Columbia University; New York NY USA
| | - S. Petrovski
- Institute for Genomic Medicine; Columbia University; New York NY USA
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
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Hollingworth M, Harper A, Hamer M. Dose-response associations between cycling activity and risk of hypertension in regular cyclists: The UK Cycling for Health Study. J Hum Hypertens 2014; 29:219-23. [PMID: 25273856 PMCID: PMC4357858 DOI: 10.1038/jhh.2014.89] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 11/09/2022]
Abstract
Most population studies on physical activity and health have involved largely inactive men and women, thus making it difficult to infer if health benefits occur at exercise levels above the current minimum guidelines. The aim was to examine associations between cycling volume and classical cardiovascular risk markers, including hypertension and hypercholesterolemia, in a population sample of habitual cyclists. A nationwide sample comprising 6949 men and women (aged 47.6 years on average) completed questions about their cycling levels, demographics and health. Nearly the entire sample (96.3%) achieved the current minimum physical activity recommendation through cycling alone. There was a dose–response association between cycling volume and risk of diagnosed hypertension (P-trend =0.001), with odds ratios of 0.98 (95% confidence interval (CI), 0.80–1.21), 0.86 (0.70, 1.06), 0.67 (95% CI, 0.53–0.83) across categories of 23–40, 40–61 and >61 metabolic equivalent hours/week (MET-h/week) compared with <23 MET-h/week. These associations persisted in models adjusted for age, sex, smoking, alcohol, body mass index (BMI) and other moderatevigorous physical activities. We also observed inverse associations between cycling volume and other risk factors including BMI and hypercholesterolemia. In summary, results from a population sample of cyclists suggest that additional cardiovascular health benefits can be achieved beyond the current minimum physical activity recommendation.
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Affiliation(s)
| | - A Harper
- University College London Medical School, London, UK
| | - M Hamer
- Physical Activity Research Group, Department of Epidemiology and Public Health, University College London, London, UK
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Anbazhagan A, Harper A, Hunter A, Benson G, Cadden I, Cash J, McDougall N. Budd-Chiari syndrome during puerperium requiring liver transplantation. J OBSTET GYNAECOL 2014; 33:739-40. [PMID: 24127969 DOI: 10.3109/01443615.2013.810200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Anbazhagan
- Department of Obstetrics and Gynaecologist, Royal Jubilee Maternity Hospital
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Smith JM, Biggins SW, Haselby DG, Kim WR, Wedd J, Lamb K, Thompson B, Segev DL, Gustafson S, Kandaswamy R, Stock PG, Matas AJ, Samana CJ, Sleeman EF, Stewart D, Harper A, Edwards E, Snyder JJ, Kasiske BL, Israni AK. Kidney, pancreas and liver allocation and distribution in the United States. Am J Transplant 2012; 12:3191-212. [PMID: 23157207 PMCID: PMC3565841 DOI: 10.1111/j.1600-6143.2012.04259.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney transplant and liver transplant are the treatments of choice for patients with end-stage renal disease and end-stage liver disease, respectively. Pancreas transplant is most commonly performed along with kidney transplant in diabetic end-stage renal disease patients. Despite a steady increase in the numbers of kidney and liver transplants performed each year in the United States, a significant shortage of kidneys and livers available for transplant remains. Organ allocation is the process the Organ Procurement and Transplantation Network (OPTN) uses to determine which candidates are offered which deceased donor organs. OPTN is charged with ensuring the effectiveness, efficiency and equity of organ sharing in the national system of organ allocation. The policy has changed incrementally over time in efforts to optimize allocation to meet these often competing goals. This review describes the history, current status and future direction of policies regarding the allocation of abdominal organs for transplant, namely the kidney, liver and pancreas, in the United States.
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Affiliation(s)
- J. M. Smith
- Department of Pediatrics, University of Washington, Seattle, Washington, DC,Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - S. W. Biggins
- Division of Gastroenterology and Hepatology, University of Colorado, Denver, CO
| | - D. G. Haselby
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - W. R. Kim
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - J. Wedd
- Division of Gastroenterology and Hepatology, University of Colorado, Denver, CO
| | - K. Lamb
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - B. Thompson
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - D. L. Segev
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S. Gustafson
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - R. Kandaswamy
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Surgery, University of Minnesota, Minneapolis, MN
| | - P. G. Stock
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Surgery, University of California, San Francisco, CA
| | - A. J. Matas
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | | | - D. Stewart
- United Network for Organ Sharing, Richmond, VA
| | - A. Harper
- United Network for Organ Sharing, Richmond, VA
| | - E. Edwards
- United Network for Organ Sharing, Richmond, VA
| | - J. J. Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B. L. Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - A. K. Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN,Corresponding author: Ajay K. Israni,
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Donkervoort S, Hu Y, Dastgir J, Meilleur K, Zou Y, Foley A, Harper A, Bonnemann C. G.P.22 Possible mutation dependent mechanisms for intra-familial variation of severity in Collagen VI-Related Myopathies (COL6-RM). Neuromuscul Disord 2012. [DOI: 10.1016/j.nmd.2012.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Viswanathan GV, Harper A, Balasubramaniam K, Badimon JJ, Marshall SM, Zaman AZ. 113 Blood thrombogenicity is inversely related to coronary lesion severity in patients with non ST-elevation acute coronary syndrome and type 2 diabetes mellitus. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chambers A, Harper A. Removal of a titanium ring using a dental saw. J Plast Reconstr Aesthet Surg 2012; 65:e128-9. [DOI: 10.1016/j.bjps.2011.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/23/2011] [Indexed: 11/17/2022]
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Fogh S, Farach A, Intenzo C, Axelrod R, McCue P, Harper A, Nelson A, Werner-Wasik M. Pathologic Correlation of PET-CT Based Auto Contouring for Radiation Planning in Lung Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Guiteau JJ, Cotton RT, Washburn WK, Harper A, O'Mahony CA, Sebastian A, Cheng S, Klintmalm G, Ghobrial M, Halff G, Mieles L, Goss J. An early regional experience with expansion of Milan Criteria for liver transplant recipients. Am J Transplant 2010; 10:2092-8. [PMID: 20883543 DOI: 10.1111/j.1600-6143.2010.03222.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Milan Criteria (MC) showed that orthotopic liver transplantation (OLT) was an effective treatment for patients with nonresectable, nonmetastatic HCC. There is growing evidence that expanding the MC does not adversely affect patient or allograft survival following OLT. The adult OLT programs in UNOS Region 4 reached an agreement allowing lesions outside MC (one lesion <6 cm, ≤3 lesions, none >5 cm and total diameter <9 cm-[R4 T3]) to receive the same exception points as MC lesions. Kaplan-Meier curves and log-rank tests were used to compare survival data. Chi-squared and Mann-Whitney U tests were used to compare patient data. A p-value of <0.05 was considered significant. All statistical analyses were performed on SPSS 15 (SPSS, Chicago, IL). Four hundred and forty-five patients were transplanted for HCC (363-MC and 82-R4 T3). Patient demographics were found to be similar between the two groups. Three year patient, allograft and recurrence free survival between MC and R4 T3 were found to be 72.9% and 77.1%, 71% and 70.2% and 90.5% and 86.9%, respectively (all p > 0.05). We report the first regionalized multicenter, prospective study showing benefit of OLT in patients exceeding MC based on preoperative imaging.
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Affiliation(s)
- J J Guiteau
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
Patients with hepatocellular carcinoma (HCC) within Milan criteria receive priority on the liver transplant waiting list (WL) and compete with non-HCC patients. Dropout from the WL is an indirect measure of transplant access. Competing risks (CR) evaluation of dropout for HCC and non-HCC patients has not previously been reported. Patients listed between 16 March 2005 and 30 June 2008 were included. Probability of dropout was estimated using a CR technique as well as a Cox model for time to dropout. Overall, non-HCC patients had a higher dropout rate from the WL than HCC patients (p < 0.0001). This was reproducible throughout all regions. In Cox regression, tumor size, model for end-stage liver disease (MELD) score and alpha fetoprotein (AFP) were associated with increased dropout risk. Multivariable analysis with CR showed that MELD score and AFP, were most influential in predicting dropout for HCC patients. The index of concordance for predicting dropout with the CR was 0.70. HCC patients appear to be advantaged in the current allocation scheme based on lower dropout rates without regard to geography. A continuous score incorporating MELD, AFP and tumor size may help to prioritize HCC patients to better equate dropout rates with non-HCC patients and equalize access.
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Affiliation(s)
- K Washburn
- University of Texas Health Science Center, San Antonio, USA.
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Menas P, Merkel DE, Hui W, Carro GW, Lawton J, Blankenship A, Harper A. Management and monitoring of arthralgias in breast cancer patients treated with aromatase inhibitors in an outpatient oncology clinic. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jee C, Brockstein B, Hui W, Lawton J, Harper A, Carro G. Incidence and management of bevacizumab associated hypertension in outpatient oncology clinic. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20677 Background: Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor is utilized to treat a wide range of cancers. However, clinical trials of bevacizumab reported the incidence of hypertension (HTN) up to 36%. A national guideline has not been established to manage bevacizumab-induced HTN. The incidence and management of bevacizumab associated HTN were evaluated in an outpatient oncology clinic. Methods: A randomized, retrospective chart review of 100 patients who received at least one dose of bevacizumab from 1/1/07 to 12/31/07 was conducted. The overall incidence and management of hypertension were evaluated. Other bevacizumab associated toxicities were compared in patients with or without hypertension. Results: The overall incidence of bevacizumab-induced HTN was 31% (95%CI: 22%-40%) with CTC (v 3.0) grade 3 HTN rate of 10%. The number of patients with a history of HTN or uncontrolled BP prior to bevacizumab therapy was significantly different across the four HTN grade groups (p= 0.0019). Out of 31 patients who had grade 1–3 HTN, 8 patients (26%) were managed by the oncologists, 8 patients (26%) by the primary care physicians, and 15 patients (48%) had no management. Bevacizumab was held in 3 patients due to high blood pressure (BP) resulting in one patient discontinuing bevacizumab therapy. The odds of other bevacizumab associated adverse events in patients with grades 1–3 HTN was 2.776 times than that of patients with grade 0 HTN (p=0.0201). Conclusions: Bevacizumab was associated with HTN in 31% of patients. Patients with history of HTN or uncontrolled BP prior to initiating bevacizumab were at an increased risk to develop a higher grade of HTN. Management of bevacizumab-induced HTN could be improved since BP of 63% of patients with grades 2 and 3 HTN was not adequately controlled. No significant financial relationships to disclose.
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Affiliation(s)
- C. Jee
- NorthShore University HealthSystem, Evanston, IL
| | | | - W. Hui
- NorthShore University HealthSystem, Evanston, IL
| | - J. Lawton
- NorthShore University HealthSystem, Evanston, IL
| | - A. Harper
- NorthShore University HealthSystem, Evanston, IL
| | - G. Carro
- NorthShore University HealthSystem, Evanston, IL
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Gonzales J, Thompson B, Thistlethwaite J, Harper A, Scheuermann B. Muscle Strength and Pressor Response. Int J Sports Med 2009; 30:320-4. [DOI: 10.1055/s-0028-1111109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wong N, Wang SS, Lamoureux E, Wong TY, Tikellis G, Harper A, Wang JJ. Blood pressure control and awareness among patients with diabetes and hypertension attending a tertiary ophthalmic clinic. Diabet Med 2009; 26:34-9. [PMID: 19125758 DOI: 10.1111/j.1464-5491.2008.02614.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To assess the proportion of patients who had diabetes and hypertension with optimal blood pressure (BP) control and to describe patients' awareness of the importance of BP control. METHODS A cross-sectional survey of out-patients with diabetes who attended the Royal Victorian Eye and Ear Hospital (Melbourne, Australia) was conducted between October 2006 and February 2007. Of 245 patients invited, 220 (90%) participated. Optimal BP control was defined as BP < 130/80 mmHg recorded at the latest visit; proportions of patients with awareness of BP control were defined non-exclusively by: (i) ability to recall a previous BP record and rate the appropriateness of that BP level; (ii) ability to recall the recommended optimal BP control level by current diabetes management guidelines; (iii) knowledge that optimal BP control is important to diabetes management; and (iv) knowledge that optimal BP control is important to eye health. RESULTS Of the 220 patients, 176 had both diabetes and hypertension. Of these, 49 of 176 (28%) had BP controlled optimally, and 30 of 176 (17%) recalled and rated a previous recorded BP level appropriately. Fewer than one in four (22%) acknowledged the recommended optimum BP level of < 130/80 mmHg, fewer than one in two (48%) rated BP as important to diabetes management, and one in three (35%) rated BP control as important to eye health. CONCLUSIONS In this sample of patients with diabetes and hypertension, fewer than one-third achieved the BP level recommended by clinical guidelines, and fewer than half were aware of the importance of BP control.
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Affiliation(s)
- N Wong
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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Affiliation(s)
- A Harper
- Burns Service of Western Australia, Royal Perth Hospital, Mc Comb Foundation, School of Paediatrics University of Western Australia, WA, Australia
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Zeller M, DiMuzio SJ, Bee K, Clemente J, Frederick J, Fucci A, Gordon L, Harper A, Kasmar A, Kasmar C, Polomsky S, Simmons A, Smallsreed D, Underwood T, Hunter AD. Crystal structures of the methylene chloride disolvates of tetrakis ( 3,5 - dimethoxy phenyl) porphyrin and its isotypic copper (II) and nickel (II) complexes , C52H46N4O8 · 2CH2C12 , Cu (C52H44N4O8)· 2CH2C12 , Ni(C12H44N4O8) · 2CH2C12. Z KRIST-NEW CRYST ST 2006. [DOI: 10.1524/ncrs.2006.221.14.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zeller M, DiMuzio SJ, Bee K, Clemente J, Frederick J, Fucci A, Gordon L, Harper A, Kasmar A, Kasmar C, Polomsky S, Simmons A, Smallsreed D, Underwood T, Hunter AD. Crystal structures of the methylene chloride disolvates of tetrakis(3,5- dimethoxyphenyl)porphyrin and its isotypic copper(II) and nickel(II) complexes, C52H46N4O8 · 2CH2Cl2, Cu(C52H44N4O8) · 2CH2Cl2, Ni(C52H44N4O8) · 2CH2Cl2. Z KRIST-NEW CRYST ST 2006. [DOI: 10.1524/ncrs.2006.221.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract C54H50Cl4N4O8, triclinic, P1̅ (no. 2), a = 11.295(1) Å, b = 11.255(1) Å, c = 11.797(1) Å, α = 108.904(2)°, β = 101.091(2)°, γ = 110.992(2)°, V = 1241.4 Å3, Z = 1, Rgt(F) = 0.056, wRref(F2) = 0.135, T = 100 K.C54H48Cl4CuN4O8, triclinic, P1̅ (no. 2), a = 11.2204(5) Å, b = 11.3499(6) Å, c = 11.7610(6) Å, α = 109.187(1)°, β = 100.830(1)°, γ = 110.681(1)°, V = 1242.7 Å3, Z = 1, Rgt(F) = 0.033, wRref(F2) = 0.092, T = 100 K.C54H48Cl4N4NiO8, triclinic, P1̅ (no. 2), a = 11.196(1) Å, b = 11.329(1) Å, c = 11.785(1) Å, α = 109.486(2)°, β = 101.230(2)°, γ = 110.607(2)°, V = 1233.8 Å3, Z = 1, Rgt(F) = 0.040, wRref(F2) = 0.110, T = 100 K.
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Affiliation(s)
- M. Zeller
- 1Youngstown State University, STaRBURSTT-Cyberdiffraction Consortium @ YSU & Department of Chemistry, 1 University Plaza, Youngstown, OH 44555-3663, USA
| | - S. J. DiMuzio
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - K. Bee
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - J. Clemente
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - J. Frederick
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Fucci
- 1Youngstown State University, STaRBURSTT-Cyberdiffraction Consortium @ YSU & Department of Chemistry, 1 University Plaza, Youngstown, OH 44555-3663, USA
| | - L. Gordon
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Harper
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Kasmar
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - C. Kasmar
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - S. Polomsky
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Simmons
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - D. Smallsreed
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - T. Underwood
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. D. Hunter
- 1Youngstown State University, STaRBURSTT-Cyberdiffraction Consortium @ YSU & Department of Chemistry, 1 University Plaza, Youngstown, OH 44555-3663, USA
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Abstract
The objective of the study was to assess factors associated with treatment satisfaction among patients receiving antihypertensive therapy. A weighted cross-sectional online survey was conducted with hypertensive patients participating in a chronic disease panel in the US. Patients on monotherapy with medications from the following classes were identified: ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta blockers (BBs), calcium channel blockers (CCBs), and diuretics. The control group included patients without treatment. Pairwise comparisons between groups were conducted for factors that may affect patients' satisfaction. The study population had a mean age of 54.7+/-14.2 years and was 56.7% female. Participants with blood pressure (BP) controlled to JNC 7 guidelines were more satisfied with their medication than those with uncontrolled BP (90.3 vs 71.5%, P<0.05). Patients who had not experienced adverse events had higher satisfaction than patients experiencing adverse events (90.9 vs 75.8%, P<0.05). The most frequently self-reported adverse events were frequent urination, sexual dysfunction, and fatigue ranging from 7.0 to 9.6% across classes. The adverse event rates differed by class and were lowest among the ARBs. Patients on ARBs were the most likely to have switched from a previous antihypertensive class as compared to other classes (57.1% ARBs vs 49.8% ACEIs, 38.7% diuretics, 36.3% CCBs, and 31.7% BBs). Physician recommendation was the most common reason for switching. In conclusion, the ability to effectively treat hypertension depends upon a patient's satisfaction with antihypertensive therapy, which may be improved by achieving BP control and minimizing the occurrence of adverse events.
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Affiliation(s)
- K Chen
- Cerner Health Insights, Beverly Hills, CA, USA
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Selva KA, Harper A, Downs A, Blasco PA, Lafranchi SH. Neurodevelopmental outcomes in congenital hypothyroidism: comparison of initial T4 dose and time to reach target T4 and TSH. J Pediatr 2005; 147:775-80. [PMID: 16356430 DOI: 10.1016/j.jpeds.2005.07.024] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 06/28/2005] [Accepted: 07/18/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare neurodevelopmental outcomes in severe and moderate congenital hypothyroidism (CH) among 3 different initial L-thyroxine doses and to examine the effect of the time to thyroid function normalization on neurodevelopmental outcomes. STUDY DESIGN Neurodevelopmental assessments of 31 subjects included the Mullen Scales of Early Learning, Wechsler Preschool and Primary Scale of Intelligence-Revised, Wechsler Intelligence Scale for Children, Wide-Range Achievement Test, and Child Behavioral Checklist. RESULTS Subjects started on higher initial L-thyroxine doses (50 mug) had full-scale IQ scores 11 points higher than those started on lower (37.5 mug) initial doses. However, verbal IQ, performance IQ, and achievement scores did not differ among the 3 treatment cohorts. Subjects with moderate CH had higher full-scale IQ scores than subjects with severe CH, regardless of the initial treatment dose. Subjects who took longer than 2 weeks to normalize thyroid function had significantly lower cognitive, attention, and achievement scores than those who achieved normal thyroid function at 1 or 2 weeks of therapy. CONCLUSIONS Initial L-thyroxine dose and faster time to normalization of thyroid function are important to optimal neurodevelopmental outcome. In severe CH, it is important to choose an initial dose at the higher end of the recommended range to achieve these goals.
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Affiliation(s)
- Karin A Selva
- Children's Diabetes & Endocrine Center, Legacy Emanuel Hospital, Portland, Oregon 97229, USA.
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49
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Affiliation(s)
- W H M Saris
- Nutrition and Toxicology Research Institute Maastricht, Department of Human Biology, Maastricht University, Maastricht, The Netherlands
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50
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Abstract
The MELD/PELD (M/P) system for liver allocation was implemented on February 27, 2002, in the United States. Since then sufficient time has elapsed to allow for assessment of posttransplant survival rates under this system. We analyzed 4163 deceased donor liver transplants performed between February 27, 2002, and December 31, 2003, for whom follow-up reporting was 95% and 67% complete at 6 and 12 months, respectively. Kaplan-Meier survival analysis revealed 1-year patient and graft survival rates for status 1 of 76.9% and 70.4%, respectively, and 87.3% and 82.9% for patients prioritized by M/P (P < .0001 for status 1 vs M/P). When adult candidates were stratified by MELD score quartile at transplant, 1-year survival rates were 89.5%, 88.3%, 86.6%, and 78.1% for lowest to highest quartile (P = .0002) and graft survival rates were similarly distributed (85.0%, 84.5%, 82.7%, 73.0%, P < .0001). Candidates with hepatocellular cancer (89.6%) and other MELD score exceptions (88.8%) had slightly higher 1-year survival rates compared with standard MELD recipients (86.0%), which did not reach statistical significance (P = .089). Pediatric recipients had slightly better patient (88.7%) and graft (86.5%) survival rates at 1 year than adults but there were no significant differences among the PELD strata due to small numbers of patients in each PELD quartile. We conclude that patient and graft survival have remained excellent since implementation of the MELD/PELD system. Although recipients with MELD scores in the highest quartile have reduced survival compared with other quartiles, their 1-year survival rate is acceptable when their extreme risk of dying without a transplant is taken into consideration.
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Affiliation(s)
- R B Freeman
- Division of Transplant Surgery, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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