Background
Serum phosphatidylethanol (PEth) is a highly sensitive test to detect alcohol use. We evaluated whether the availability of PEth testing impacted rates of liver transplant evaluation terminations and delistings.
Methods
Medical record data were collected for patients who initiated transplant evaluation due to alcohol‐related liver disease in the pre‐PEth (2017) or PEth (2019) eras. Inverse probability weighting (IPW) was used to balance baseline patient characteristics. Outcomes included termination of evaluation or delisting due to alcohol use; patients were censored at receipt of transplant; death was considered a competing risk. The Fine‐Gray method was performed to determine whether PEth testing affected risk of evaluation termination/ delisting due to alcohol use.
Results
Three hundred and seventy‐five patients with alcohol‐related indications for transplant (157 in 2017; 210 in 2019) were included. The final IPW‐adjusted model for the composite outcome of terminations/delisting due to alcohol use retained two significant variables (P < .05): PEth era and BMI category. Patients evaluated during the PEth era were almost three times more likely to experience an alcohol‐related termination/delisting than those in the pre‐PEth era (sHR = 2.86; 95%CI 1.67–4.97)
Conclusion
We found that availability of PEth testing at our institution was associated with a higher rate of exclusion of patients from eligibility for liver transplant. Use of PEth testing has significant potential to inform decisions regarding transplant candidacy for patients with alcohol‐related liver disease.
2028 Background: The main backbone of therapy for CNS lymphoma involves systemic treatment with high dose methotrexate (HDMTX)-based regimens,with radiotherapy reserved only for cases that fail systemic therapy due to the significant cognitive toxicity of radiation. Over the last decade, rituximab and subsequently temozolomide were added to HDMTX chemotherapy regimens. Methods: Patients diagnosed with CNS lymphoma between 2009 and 2015 were identified. A retrospective cohort study was conducted of patients who received HDMTX alone (Cohort A), HDMTX and rituximab (Cohort B) and HDMTX, rituximab and temozolomide (Cohort C). Data collected included treatment related adverse events along with OS and PFS. Results: 31 patients were diagnosed with CNS lymphoma. 11, 10 and 6 patients were in cohorts A, B and C respectively. Median PFS and OS for the entire cohort were 14 and 25 months respectively. Cohort results were compared to the respective reference trials published in the literature. Cohort A had a PFS of 11 months and OS of 12 months compared to 12.8 months and 22.8+ months in the reference Phase II trial. Cohort B had a median PFS of 25+ months and OS of 41 months compared to 21 months and 33.5 months in the reference trial. Cohort C had a 2-year PFS of 0.50 compared to 0.57 in the reference trial. 3 (9.6%), 5 (16.1%), and 2 (6.4%) patients developed renal dysfunction in cohorts A, B and C respectively. 4 (12.9), 2 (6.4%), and 0 patients developed leukopenia in cohorts A, B and C respectively. 3 (9.6), 2 (6.4%), and 1 (3.2%) patients developed anemia in cohorts A, B and C respectively. 1 (3.2%), 1 (3.2%) and 1 (3.2%) patient developed thrombocytopenia in cohorts A, B and C respectively. Conclusions: The addition of Rituximab to HDMTX treatment for the treatment of CNS lymphoma increased the PFS and OS compared to HDMTX alone and is in concordance with the reference phase II trials reported in the literature if not better. In addition, our data at HFH shows no increased risk of adverse events with combination therapies compared to HDMTX alone. The addition of Temozolomide to Rituximab and High Dose methotrexate treatment showed a median 2 year PFS of 0.50 which is comparable to published reports of a 2-year PFS of 0.59.
The effect of some insulinotrophic drugs on the transport of sugar was investigated in fasted, narcotized rats by continuous perfusion of cannulated long intestinal loops with galactose solution (18 mM.) circulated by air lift. Three consecutive perfusions (fifty minutes each) were performed in each rat, the drug being given in the second perfusion only. The rate of galactose disappearance was expressed as per cent of that in the first perfusion in the same rat.Tolbutamide (50 mg./l kg. weight), glycodiazine (50 mg./l kg. weight), glisoxepid (BAY 4231, 2 mg./l kg. weight) and glibenclamide (0.25 mg./l kg. weight) were found to increase the rate of galactose disappearance in the second perfusion by 21 per cent, 5 per cent, 12 per cent and 25 per cent, respectively, and in the third perfusion by 21 per cent, 26 per cent, 32 per cent and 21 per cent, respectively, as compared to the rate in the corresponding perfusion of a control group. This increase was significant (P values < 0.05) with all drugs in the second and third perfusions with the exception of glisoxepid in the second perfusion. These results are discussed in relation to the action of insulin and the effect of diabetes on intestinal absorption of sugars. DIABETES 23: 112-16, February, 1974. In a previous work, 1 we showed that metformin, an oral hypoglycemic agent of the biguanide group, markedly inhibited the transport of glucose by everted sacs of guinea pig intestine. In a later report, Kruger et al. , 2 using the same technic in rats, demonstrated a similar effect with phenformin.It seemed of interest to investigate the effect of the other group of oral hypoglycemics on the transport of sugar by the intestine. To the best of our knowledge, there were no reports in the literature concerning this point. The drugs selected for the present study were: tolbutamide (Rastinon), glycodiazine (Lycanol), glisoxepid (BAY 4231) and glibenclamide (Daonil).The present paper describes the effect of these insulinotrophic drugs on the transport of sugar by long intestinal loops continuously perfused in situ.
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