Objectives: To test the hypothesis that risk analysis from the time of listing for liver transplantation (LT) focuses attention on areas where outcomes can be improved. Study design: Competing outcomes and multivariat...Objectives: To test the hypothesis that risk analysis from the time of listing for liver transplantation (LT) focuses attention on areas where outcomes can be improved. Study design: Competing outcomes and multivariate models were used to determine significant risk factors for pretransplantation and posttransplantati on mortality and graft failure in patients with biliary atresia (BA) listed for LT and enrolled in the Studies of Pediatric Liver Transplantation (SPLIT) regist ry. Results: Of 755 patients, most were infants (age < 1 year). Significant wait ing list mortality risk factors included infancy and pediatric end-stage liver disease (PELD) score ≥20, whose components were also continuous risk factors. S urvival posttransplantation (n = 567) was 88%at 3 years. Most deaths were from infection (37%). Posttransplantation mortality risk factors included infant rec ipients, height/weight < -2 standard deviations (SD), use of cyclosporine versu s tacrolimus and retransplantation. Graft failure risks included height/weight < -2 SD, cadaveric partial donors,donor age ≤5 months, use of cyclosporine vers us tacrolimus, and rejection. Conclusions: Referral for LT should be anticipator y for infants with BA with failed portoenterostomies. Failing nutrition should p rompt aggressive support. Post-LT risk factors are mainly nonsurgical, includin g nutrition, the relative risk of infection over rejection, and the choice of im munosuppression.展开更多
Objective: The purpose of this study was to evaluate pregnancy outcomes before and after diagnosis of lupus. Study design: Successive selection criterion applied to 148 lupus and 78,905 non-lupus pregnancies, generate...Objective: The purpose of this study was to evaluate pregnancy outcomes before and after diagnosis of lupus. Study design: Successive selection criterion applied to 148 lupus and 78,905 non-lupus pregnancies, generated 3 groups: lupus group, 84 pregnancies (not-yet-diagnosed group, 15 women; already-diagnosed group, 69 women), and control group, 51,000 pregnancies. Three-way analysis of variance and the chisquared test were used for analyses. Results: Stillbirth outcome was increased in the lupus group compared with the control group (odds ratio, 4.84 95%CI, 1.72,11.08 ); the not-yet-diagnosed group (odds ratio, 9.89 95%CI, 1.09,42.63 ), and the already-diagnosed group (odds ratio, 3.85 95%CI, 1.02,10.31 ). Considering >1 pregnancy per patient would have overestimated the stillbirth rate. Stillbirth risk was increased significantly in severe maternal disease that was marked by central nervous system involvement. The already-diagnosed group had more hypertensive complications (P = .001 and .0001). Both lupus groups showed a significantly greater proportion of preterm births (P = .03),growth restriction (P = .019), and infants in the very low birth weight category (P = .021) compared with the control group. Conclusion: Poor fetal outcomes are seen in pregnancies that are complicated by lupus, even before clinical appearance of disease, which supports a predisease state.展开更多
文摘Objectives: To test the hypothesis that risk analysis from the time of listing for liver transplantation (LT) focuses attention on areas where outcomes can be improved. Study design: Competing outcomes and multivariate models were used to determine significant risk factors for pretransplantation and posttransplantati on mortality and graft failure in patients with biliary atresia (BA) listed for LT and enrolled in the Studies of Pediatric Liver Transplantation (SPLIT) regist ry. Results: Of 755 patients, most were infants (age < 1 year). Significant wait ing list mortality risk factors included infancy and pediatric end-stage liver disease (PELD) score ≥20, whose components were also continuous risk factors. S urvival posttransplantation (n = 567) was 88%at 3 years. Most deaths were from infection (37%). Posttransplantation mortality risk factors included infant rec ipients, height/weight < -2 standard deviations (SD), use of cyclosporine versu s tacrolimus and retransplantation. Graft failure risks included height/weight < -2 SD, cadaveric partial donors,donor age ≤5 months, use of cyclosporine vers us tacrolimus, and rejection. Conclusions: Referral for LT should be anticipator y for infants with BA with failed portoenterostomies. Failing nutrition should p rompt aggressive support. Post-LT risk factors are mainly nonsurgical, includin g nutrition, the relative risk of infection over rejection, and the choice of im munosuppression.
文摘Objective: The purpose of this study was to evaluate pregnancy outcomes before and after diagnosis of lupus. Study design: Successive selection criterion applied to 148 lupus and 78,905 non-lupus pregnancies, generated 3 groups: lupus group, 84 pregnancies (not-yet-diagnosed group, 15 women; already-diagnosed group, 69 women), and control group, 51,000 pregnancies. Three-way analysis of variance and the chisquared test were used for analyses. Results: Stillbirth outcome was increased in the lupus group compared with the control group (odds ratio, 4.84 95%CI, 1.72,11.08 ); the not-yet-diagnosed group (odds ratio, 9.89 95%CI, 1.09,42.63 ), and the already-diagnosed group (odds ratio, 3.85 95%CI, 1.02,10.31 ). Considering >1 pregnancy per patient would have overestimated the stillbirth rate. Stillbirth risk was increased significantly in severe maternal disease that was marked by central nervous system involvement. The already-diagnosed group had more hypertensive complications (P = .001 and .0001). Both lupus groups showed a significantly greater proportion of preterm births (P = .03),growth restriction (P = .019), and infants in the very low birth weight category (P = .021) compared with the control group. Conclusion: Poor fetal outcomes are seen in pregnancies that are complicated by lupus, even before clinical appearance of disease, which supports a predisease state.
