Objectives Following a maintenance course of rituximab (RTX) for ANCA-associated vasculitis (AAV), relapses occur on cessation of therapy, and further dosing is considered. This study aimed to develop relapse and infection risk prediction models to help guide decision making regarding extended RTX maintenance therapy. Methods Patients with a diagnosis of AAV who received 4–8 grams of RTX as maintenance treatment between 2002 and 2018 were included. Both induction and maintenance doses were included; most patients received standard departmental protocol consisting of 2× 1000 mg 2 weeks apart, followed by 1000 mg every 6 months for 2 years. Patients who continued on repeat RTX dosing long-term were excluded. Separate risk prediction models were derived for the outcomes of relapse and infection. Results A total of 147 patients were included in this study with a median follow-up of 63 months [interquartile range (IQR): 34–93]. Relapse: At time of last RTX, the model comprised seven predictors, with a corresponding C-index of 0.54. Discrimination between individuals using this model was not possible; however, discrimination could be achieved by grouping patients into low- and high-risk groups. When the model was applied 12 months post last RTX, the ability to discriminate relapse risk between individuals improved (C-index 0.65), and once again, clear discrimination was observed between patients from low- and high-risk groups. Infection: At time of last RTX, five predictors were retained in the model. The C-index was 0.64 allowing discrimination between low and high risk of infection groups. At 12 months post RTX, the C-index for the model was 0.63. Again, clear separation of patients from two risk groups was observed. Conclusion While our models had insufficient power to discriminate risk between individual patients they were able to assign patients into risk groups for both relapse and infection. The ability to identify risk groups may help in decisions regarding the potential benefit of ongoing RTX treatment. However, we caution the use of these prediction models until prospective multi-centre validation studies have been performed.
Objective: Fenestrated and branched endovascular aneurysm repair (F/ B-EVAR) is increasingly performed to treat complex aortic aneurysms (juxtarenal abdominal aortic aneurysms [AAAs], pararenal AAAs, thoracoabdominal aortic aneurysms [TAAAs]); however, the outcome of the procedures is usually reported separately by each single center, and a wider overview is lacking. The aim of this study was therefore to report the experience of four high-volume centers nationwide to evaluate predictors of outcome.Methods: Between 2008 and 2019, all consecutive patients undergoing F/B-EVAR in four Italian university centers were prospectively recorded and retrospectively analyzed. Preoperative comorbidities and postoperative complications were classified according to the Society for Vascular Surgery reporting standards. Postoperative complications and perioperative mortality were assessed as early outcomes. Survival, freedom from reintervention, and target visceral vessel patency were assessed as follow-up outcomes by Kaplan-Meier analysis. Risk factors for perioperative mortality and spinal cord ischemia (SCI) were determined by multivariate analysis. Risk factors for late mortality were evaluated by Cox regression model.Results: Overall, 596 patients underwent F/B-EVAR for 124 (21%) juxtarenal AAAs, 112 (19%) pararenal AAAs, and 360 (60%) TAAAs. Elective and urgent procedures were performed in 520 (87%) and 76 (13%) cases, respectively. Postoperative cardiac, pulmonary, and renal complications were reported in 41 (7%), 50 (8%), and 80 (13%) patients, respectively. Seven cases (1%) of bowel ischemia and 13 (2%) cerebrovascular complications occurred. Thirty-nine (7%) patients suffered SCI, with 16 (3%) cases of permanent paraplegia. Crawford extent I to extent III TAAAs (odds ratio [OR], 13.41; 95% confidence interval [CI], 1.77-101.65; P ¼ .012) and postoperative renal complications (OR, 3.84; 95% CI, 1.70-8.69; P ¼ .001) independently predicted SCI. Thirty-two (5%) patients died in the perioperative period. Preoperative chronic renal failure (
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