Matrix Metalloproteinase Levels Are Elevated in Patients with Marfan Syndrome and Chronic Descending Thoracic Aortic Dissection

LeMaire, Scott A.; Lu, Xiuzhang; Hou, Xiaoyang; Russell, Ludivine; Milewicz, Dianna M.; Belmont, John W.; Adams, Gerald J.; Shen, Ying H.; Coselli, Joseph S.

doi:10.1016/j.jss.2009.11.014

Cited by 2 publications

(4 citation statements)

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“…Of the 42,766 patients with CRLM, 40,645 patients (95.0%) did not undergo operative management of their metastatic liver disease. In turn, 2,121 patients (5.0%) were identified as having undergone operative management of their hepatic metastasis as determined by the established selection algorithm 23 and represent the study cohort.…”

Section: Resultsmentioning

confidence: 99%

“…As such, unlike previous studies that only employed the SEER database, 17,18,38 we utilized linked SEER–Medicare data, which can improve the accuracy of analyzing cancer care. 19 Furthermore, by using a specific algorithm, 23 we were able to identify that population of patients within SEER who had CRC and then identify the subset of patients who underwent liver-directed procedures for their CRLM based on CPT codes from Medicare. Data from the current study are important, because our findings reflect more accurately how CRLM is being managed throughout the United States.…”

Section: Discussionmentioning

confidence: 99%

“…A gastrointestinal pathologist at the Johns Hopkins Hospital (RAA) reviewed all of the histology codes to determine which codes were relevant to colorectal adenocarcinoma. Identification of patients with primary CRC who had hepatic metastasis was accomplished using an established algorithm 23 that employed the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes and Current Procedural Terminology (CPT) codes for malignant neoplasm of liver, secondary malignant neoplasm of liver, hepatectomy, and ablation of liver lesion or tissue (Table II). The study cohort included only patients enrolled in both Medicare parts A and B who were not enrolled in a managed care plan during the study period.…”

Section: Methodsmentioning

confidence: 99%

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Shifting trends in liver-directed management of patients with colorectal liver metastasis: A population-based analysis

Mayo

Heckman

Shore

et al. 2011

Surgery

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Background We sought to evaluate population-based temporal trends in perioperative management, as well as short- and long-term outcomes associated with the operative management of colorectal liver metastasis (CRLM). Methods Using Surveillance, Epidemiology and End Results–Medicare linked data, we identified 2,121 patients with operatively managed CRLM between 1991 and 2006. Clinicopathologic data, trends in operative management, and survival were examined. Results Preoperative evaluation included computed tomography (CT; 66%), magnetic resonance imaging (MRI; 5%), and positron emission tomography (PET; 2%) with a temporal increase in the use of all 3 modalities over time (all P < .05). Patients undergoing hepatectomy only (n = 1,267; 60%) decreased over time, whereas the use of ablation alone (n = 668; 32%) and combined resection plus ablation (n = 186; 9%) increased (all P < .05). The use of both preoperative (10% to 16%) and adjuvant chemotherapy (35% to 47%) increased over time (P < .05). There was a marked temporal increase in patient comorbidities (>3 comorbidities: 1991–1995, 3%; 2003–2006, 12%; P < .001); however, perioperative complications (63%) and 30-day mortality (3%) did not change over time (both P > .05); 90-day mortality decreased from 9% to 7% over the study period (P = .007). Overall the 1-, 3-, and 5-year survivals were 74%, 42%, and 28% with no improvement over time (P = .19). On multivariate analysis, synchronous disease (hazard ratio [HR], 1.7) and use of ablation alone (HR, 1.2) were associated independently with a worse survival (both P < .05). Conclusion Most patients were evaluated with CT; PET was employed rarely. Although there was a temporal increase in chemotherapy utilization, only one half of patients received perioperative chemotherapy. Mortality associated with hepatic operations was low, but morbidity remained high with no temporal change despite an increased number of patient medical comorbidities.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Shifting trends in liver-directed management of patients with colorectal liver metastasis: A population-based analysis

Mayo

Heckman

Shore

et al. 2011

Surgery

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“…Subgroup analysis revealed that survival benefit is also dependent upon wait-list time to receiving a DBD liver. 29 Others have demonstrated that critically ill recipients with MELD >30 at a single center had similar graft survival with DCD compared to DBD liver transplants. 3 In our analysis, MELD score was not found to impact the risk of biliary complications.…”

Section: Discussionmentioning

confidence: 99%

Biliary Complications After Liver Transplantation From Donation After Cardiac Death Donors

et al. 2011

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Objective This study evaluates the long-term outcomes, biliary complication rates, and risk factors for biliary complications after liver transplantation from donation after cardiac death (DCD) donors. Summary Background Data Recent enthusiasm toward increased use of DCD donor livers is mitigated by high biliary complication rates. Predictive risk factors for the development of biliary complications after DCD liver transplantation remain incompletely defined. Methods We performed a retrospective review of 1157 donation after brain death (DBD) and 87 DCD liver transplants performed between January 1, 1993 and December 31, 2008. Patient and graft survivals, and complication rates within the first year of transplantation were compared between DBD and DCD groups. Cox proportional hazards models were used to assess the influence of potential risk factors. Results Patient survival was significantly lower in the DCD group compared to the DBD group at 1, 5, 10 and 15 years (DCD: 84%, 68%, 54%, 54% vs. DBD: 91%, 81%, 67%, 58%, p<0.01). Graft survival was also significantly lower in the DCD group compared to the DBD group at 1, 5, 10 and 15 years (DCD: 69%, 56%, 43%, 43% vs. DBD: 86%, 76%, 60%, 51%, p<0.001). Rates of overall biliary complications (OBC) (DCD: 47% vs. DBD: 26%, p<0.01) and ischemic cholangiopathy (IC) (DCD: 34% vs. DBD: 1%, p<0.01) were significantly higher in the DCD group. Donor age (HR: 1.04, p<0.01) and donor age >40 years (HR: 3.13, p < 0.01) were significant risk factors for the development of OBC. Multivariate analysis revealed cold ischemic time (CIT) >8 hours (HR: 2.46, p=0.05), donor age >40 (HR: 2.90, p< 0.01) significantly increased the risk of IC. Conclusions Long-term patient and graft survival after DCD liver transplantation remain significantly lower but acceptable when compared to DBD liver transplants. Donor age and CIT >8 hours are the strongest predictors for the development of ischemic cholangiopathy. Careful selection of younger DCD donors and minimizing CIT may limit the incidence of severe biliary complications and improve the successful utilization of DCD donor livers.

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Matrix Metalloproteinase Levels Are Elevated in Patients with Marfan Syndrome and Chronic Descending Thoracic Aortic Dissection

Cited by 2 publications

References 0 publications

Shifting trends in liver-directed management of patients with colorectal liver metastasis: A population-based analysis

Shifting trends in liver-directed management of patients with colorectal liver metastasis: A population-based analysis

Biliary Complications After Liver Transplantation From Donation After Cardiac Death Donors

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