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Furuya Y, Jayarajan SN, Taghavi S, Cordova FC, Patel N, Shiose A, Leotta E, Criner GJ, Guy TS, Wheatley GH, Kaiser LR, Toyoda Y. The Impact of Alemtuzumab and Basiliximab Induction on Patient Survival and Time to Bronchiolitis Obliterans Syndrome in Double Lung Transplantation Recipients. Am J Transplant 2016; 16:2334-41. [PMID: 26833657 DOI: 10.1111/ajt.13739] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 04/22/2015] [Revised: 01/04/2016] [Accepted: 01/10/2016] [Indexed: 01/25/2023]
Abstract
We examined the effect of alemtuzumab and basiliximab induction therapy on patient survival and freedom from bronchiolitis obliterans syndrome (BOS) in double lung transplantation. The United Network for Organ Sharing database was reviewed for adult double lung transplant recipients from 2006 to 2013. The primary outcome was risk-adjusted all-cause mortality. Secondary outcomes included time to BOS. There were 6117 patients were identified, of whom 738 received alemtuzumab, 2804 received basiliximab, and 2575 received no induction. Alemtuzumab recipients had higher lung allocation scores compared with basiliximab and no-induction recipients (41.4 versus 37.9 versus 40.7, p < 0.001) and were more likely to require mechanical ventilation before to transplantation (21.7% versus 6.5% versus 6.2%, p < 0.001). Median survival was longer for alemtuzumab and basiliximab recipients compared with patients who received no induction (2321 versus 2352 versus 1967 days, p = 0.001). Alemtuzumab (hazard ratio 0.80, 95% confidence interval 0.67-0.95, p = 0.009) and basiliximab induction (0.88, 0.80-0.98, p = 0.015) were independently associated with survival on multivariate analysis. At 5 years, alemtuzumab recipients had a lower incidence of BOS (22.7% versus 55.4 versus 55.9%), and its use was independently associated with lower risk of developing BOS on multivariate analysis. While both induction therapies were associated with improved survival, patients who received alemtuzumab had greater median freedom from BOS.
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Affiliation(s)
- Y Furuya
- Division of Pulmonary & Critical Care, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - S N Jayarajan
- Department of Surgery, Section of Vascular Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - S Taghavi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - F C Cordova
- Section of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA
| | - N Patel
- Section of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA
| | - A Shiose
- Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA
| | - E Leotta
- Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA
| | - G J Criner
- Section of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA
| | - T S Guy
- Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA
| | - G H Wheatley
- Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA
| | - L R Kaiser
- Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA
| | - Y Toyoda
- Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA
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Guy TS, Kelly MP, Cason B, Tseng E. Retrograde cerebral perfusion and delayed hyperbaric oxygen for massive air embolism during cardiac surgery. Interact Cardiovasc Thorac Surg 2008; 8:382-3. [DOI: 10.1510/icvts.2008.194472] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
The surgical treatment of Crohn's disease of the colon is distinct from that used in treating ulcerative colitis. Crohn's disease often involves the small bowel and is not "cured" by colorectal resection. The popular ileo-anal pouch procedures used in the management of ulcerative colitis generally are not used for the treatment of Crohn's colitis, because of higher complication rates. Commonly performed operations include ileostomy, segmental colon resection, subtotal colectomy, and proctocolectomy. The general surgeon, therefore, is provided with many options when faced with complications of Crohn's colitis. This article examines the attributes of and results reported for each of these options.
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Affiliation(s)
- T S Guy
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA
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Markmann JF, Campos L, Velidedeoglu E, Guy TS, Moainie SL, Desai NM, Gorman RC, Brayman KL, Naji A, Barker CF. Annual literature review--clinical transplants 2000. Clin Transpl 2000:411-65. [PMID: 11512357 DOI: pmid/11512357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J F Markmann
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Guy TS, Montany PF. Thoracoscopic diaphragmatic plication. Surg Laparosc Endosc Percutan Tech 1998; 8:319-21. [PMID: 9703610] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report on thoracoscopic plication of the the paralyzed right hemidiaphragm of a 33-year-old woman with a history of reactive airway disease. The paralysis was secondary to transection of the phrenic nerve during right first rib resection for thoracic outlet syndrome 1 year prior to evaluation. By use of video-assisted thoracoscopic surgery (VATS), the diaphragm was plicated as with open thoracotomy. Postoperative recovery was uneventful, with minimal pain and early discharge. Preoperative symptoms of exertional dyspnea and orthopnea were significantly improved.
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Affiliation(s)
- T S Guy
- Department of Surgery, Landstuhl Regional Medical Center, U.S. Army, Germany
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Abstract
Artificial hearts have been used for temporary and permanent replacement of failing human hearts. Attempts at permanent implantation during the 1980s were complicated by a high incidence of infection and thromboembolism, combined with a low quality of life for recipients. Given the success of cardiac transplantation, the artificial heart was relegated to temporary use in critically ill patients who were waiting for a donor heart. Continued difficulties with complications, combined with the success of ventricular assist devices for this purpose, dramatically reduced the use of the artificial heart. However, the recent development of compact electromechanical artificial hearts powered by transcutaneous energy systems has led to renewed hope for the possibility of permanent implantation. Some of these devices have been successful in animal studies and are approaching human trials. After years of hope and disappointment, artificial heart technology may be on the verge of efficacy. The history, status, and future of the artificial heart are discussed.
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Affiliation(s)
- T S Guy
- Landstuhl Regional Medical Center, Department of Surgery, U.S. Army Medical Department, Germany
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Frist WH, Merrill WH, Eastburn TE, Stewart JR, Hammon JW, Fortune DS, Guy TS, Bender HW. Nashville antithymocyte serum: a safe and efficacious agent for prophylaxis after heart transplantation. Transplant Proc 1991; 23:1160-1. [PMID: 1846455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- W H Frist
- Vanderbilt Transplant Center, Nashville, Tennessee
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