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Bakthavatsalam A, Sibulesky L, Leca N, Rayhill SC, Bakthavatsalam R, Perkins JD. Impact of Obesity on Kidney Transplant Outcomes in Older Adults. Transplant Proc 2024; 56:58-67. [PMID: 38195283 DOI: 10.1016/j.transproceed.2023.11.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The prevalence of obesity in older patients undergoing kidney transplantation is increasing. Older age and obesity are associated with higher risks of complications and mortality post-transplantation. The optimal management of this group of patients remains undefined. METHODS We retrospectively analyzed the United Network for Organ Sharing database of adults ≥70 years of age undergoing primary kidney transplant from January 1, 2014, to December 31, 2022. We examined patient and graft survival stratified by body mass index (BMI) in 3 categories, <30 kg/m2, 30 to 35 kg/m2, and >35 kg/m2. We also analyzed other risk factors that impacted survival. RESULTS A total of 14,786 patients ≥70 years underwent kidney transplantation. Of those, 9,731 patients had a BMI <30 kg/m2, 3,726 patients with a BMI of 30 to 35 kg/m2, and 1,036 patients with a BMI >35 kg/m2. During the study period, there was a significant increase in kidney transplants in patients ≥70 years old across all BMI groups. Overall, patient survival, death-censored graft survival, and all-cause graft survival were lower in obese patients compared with nonobese patients. Multivariable analysis showed worse patient survival and graft survival in patients with a BMI of 30 to 35 kg/m2, a BMI >35 kg/m2, a longer duration of dialysis, diabetes mellitus, and poor functional status. CONCLUSION Adults ≥70 years should be considered for kidney transplantation. Obesity with a BMI of 30 to 35 kg/m2 or >35 kg/m2, longer duration of dialysis, diabetes, and functional status are associated with worse outcomes. Optimization of these risk factors is essential when considering these patients for transplantation.
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Affiliation(s)
- Arvind Bakthavatsalam
- Department of Surgery, Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York
| | - Lena Sibulesky
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington; Clinical and Bio-Analytics Transplant Laboratory, University of Washington, Seattle, Washington.
| | - Nicolae Leca
- Clinical and Bio-Analytics Transplant Laboratory, University of Washington, Seattle, Washington; Division of Nephrology, Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Stephen C Rayhill
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Ramasamy Bakthavatsalam
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - James D Perkins
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington; Clinical and Bio-Analytics Transplant Laboratory, University of Washington, Seattle, Washington
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Olsson KW, Mani K, Burdess A, Patterson S, Scali ST, Kölbel T, Panuccio G, Eleshra A, Bertoglio L, Ardita V, Melissano G, Acharya A, Bicknell C, Riga C, Gibbs R, Jenkins M, Bakthavatsalam A, Sweet MP, Kasprzak PM, Pfister K, Oikonomou K, Heloise T, Sobocinski J, Butt T, Dias N, Tang C, Cheng SWK, Vandenhaute S, Van Herzeele I, Sorber RA, Black JH, Tenorio ER, Oderich GS, Vincent Z, Khashram M, Eagleton MJ, Pedersen SF, Budtz-Lilly J, Lomazzi C, Bissacco D, Trimarchi S, Huerta A, Riambau V, Wanhainen A. Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease. JAMA Surg 2023; 158:832-839. [PMID: 37314760 PMCID: PMC10267845 DOI: 10.1001/jamasurg.2023.2128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/03/2023] [Indexed: 06/15/2023]
Abstract
IMPORTANCE Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma. OBJECTIVE To assess the midterm outcomes of endovascular aortic repair in patients with CTD. DESIGN, SETTING, AND PARTICIPANTS For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022. EXPOSURE All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta. MAIN OUTCOMES AND MEASURES Short-term and midterm survival, rates of secondary procedures, and conversion to open repair. RESULTS In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions. CONCLUSIONS AND RELEVANCE This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.
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Affiliation(s)
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anne Burdess
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Suzannah Patterson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Ahmed Eleshra
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Luca Bertoglio
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Vincenzo Ardita
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Germano Melissano
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Amish Acharya
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Colin Bicknell
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Celia Riga
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Richard Gibbs
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Jenkins
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Arvind Bakthavatsalam
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Matthew P. Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Piotr M. Kasprzak
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Tessely Heloise
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jonathan Sobocinski
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Talha Butt
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Nuno Dias
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ching Tang
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Stephen W. K. Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China
| | - Sarah Vandenhaute
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Rebecca A. Sorber
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - James H. Black
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Emanuel R. Tenorio
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Gustavo S. Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Zoë Vincent
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Matthew J. Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Steen Fjord Pedersen
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Chiara Lomazzi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Bissacco
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Abigail Huerta
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Anders Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Stephen ZR, Dayringer CJ, Lim JJ, Revia RA, Halbert MV, Jeon M, Bakthavatsalam A, Ellenbogen RG, Zhang M. Approach to Rapid Synthesis and Functionalization of Iron Oxide Nanoparticles for High Gene Transfection. ACS Appl Mater Interfaces 2016; 8:6320-8. [PMID: 26894609 PMCID: PMC4829641 DOI: 10.1021/acsami.5b10883] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Surface functionalization of theranostic nanoparticles (NPs) typically relies on lengthy, aqueous postsynthesis labeling chemistries that have limited ability to fine-tune surface properties and can lead to NP heterogeneity. The need for a rapid, simple synthesis approach that can provide great control over the display of functional moieties on NP surfaces has led to increased use of highly selective bioorthoganol chemistries including metal-affinity coordination. Here we report a simple approach for rapid production of a superparamagnetic iron oxide NPs (SPIONs) with tunable functionality and high reproducibility under aqueous conditions. We utilize the high affinity complex formed between catechol and Fe((III)) as a means to dock well-defined catechol modified polymer modules on the surface of SPIONs during sonochemical coprecipitation synthesis. Polymer modules consisted of chitosan and poly(ethylene glycol) (PEG) copolymer (CP) modified with catechol (CCP), and CCP functionalized with cationic polyethylenimine (CCP-PEI) to facilitate binding and delivery of DNA for gene therapy. This rapid synthesis/functionalization approach provided excellent control over the extent of PEI labeling, improved SPION magnetic resonance imaging (MRI) contrast enhancement and produced an efficient transfection agent.
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Affiliation(s)
- Zachary R. Stephen
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195
| | - Christopher J. Dayringer
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195
| | - Josh J. Lim
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195
| | - Richard A. Revia
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195
| | - Mackenzie V. Halbert
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195
| | - Mike Jeon
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195
| | | | - Richard G. Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington 98195
- Department of Radiology, University of Washington, Seattle, Washington 98195
| | - Miqin Zhang
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195
- Department of Neurological Surgery, University of Washington, Seattle, Washington 98195
- Miqin Zhang, Department of Materials Science & Engineering, University of Washington, , 302L Roberts Hall, Box 352120, Seattle, WA 98195, Fax: (206) 543-3100
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Wang K, Kievit FM, Sham JG, Jeon M, Stephen ZR, Bakthavatsalam A, Park JO, Zhang M. Iron-Oxide-Based Nanovector for Tumor Targeted siRNA Delivery in an Orthotopic Hepatocellular Carcinoma Xenograft Mouse Model. Small 2016; 12:477-87. [PMID: 26641029 PMCID: PMC4829640 DOI: 10.1002/smll.201501985] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/24/2015] [Indexed: 05/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the deadliest cancers worldwide. Small interfering RNA (siRNA) holds promise as a new class of therapeutics for HCC, as it can achieve sequence-specific gene knockdown with low cytotoxicity. However, the main challenge in the clinical application of siRNA lies in the lack of effective delivery approaches that need to be highly specific and thus incur low or no systemic toxicity. Here, a nonviral nanoparticle-based gene carrier is presented that can specifically deliver siRNA to HCC. The nanovector (NP-siRNA-GPC3 Ab) is made of an iron oxide core coated with chitosan-polyethylene glycol (PEG) grafted polyethyleneimine copolymer, which is further functionalized with siRNA and conjugated with a monoclonal antibody (Ab) against human glypican-3 (GPC3) receptor highly expressed in HCC. A rat RH7777 HCC cell line that coexpresses human GPC3 and firefly luciferase (Luc) is established to evaluate the nanovector. The nanoparticle-mediated delivery of siRNA against Luc effectively suppresses Luc expression in vitro without notable cytotoxicity. Significantly, NP-siLuc-GPC3 Ab administered intravenously in an orthotopic model of HCC is able to specifically bound to tumor and induce remarkable inhibition of Luc expression. The findings demonstrate the potential of using this nanovector for targeted delivery of therapeutic siRNA to HCC.
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Affiliation(s)
- Kui Wang
- Department of Materials Science and Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Forrest M Kievit
- Department of Neurological Surgery, University of Washington, Seattle, WA, 98195, USA
| | - Jonathan G Sham
- Department of Surgery, University of Washington, Seattle, WA, 98195, USA
| | - Mike Jeon
- Department of Materials Science and Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Zachary R Stephen
- Department of Materials Science and Engineering, University of Washington, Seattle, WA, 98195, USA
| | | | - James O Park
- Department of Surgery, University of Washington, Seattle, WA, 98195, USA
| | - Miqin Zhang
- Department of Materials Science and Engineering, University of Washington, Seattle, WA, 98195, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, 98195, USA
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