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      End-Stage Renal Disease (ESRD)after Bone Marrow Transplantation: Poor Survival Compar ed to Other Causes of ESRD

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          Abstract

          Chronic renal failure after successful bone marrow transplantation (BMT) may diminish the quality of life and may also evolve to end-stage renal disease (ESRD) requiring chronic dialysis. Individual reports suggest poor survival of such patients. We evaluated the survival with ESRD after BMT by the case-control method. We found that patients who develop ESRD after BMT have a significantly decreased survival as compared with non-BMT patients. This was true for both diabetic and nondiabetic ESRD (both p < 0.03). These data demonstrate the poor outcome of ESRD after BMT which emphasizes the need for a better understanding of chronic renal failure after BMT.

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          Solid cancers after bone marrow transplantation.

          The late effects of bone marrow transplantation, including cancer, need to be determined in a large population at risk. We studied 19,229 patients who received allogeneic transplants (97.2 percent) or syngeneic transplants (2.8 percent) between 1964 and 1992 at 235 centers to evaluate the risk of the development of a new solid cancer. Risk factors relating to the patient, the transplant, and the course after transplantation were evaluated. The transplant recipients were at significantly higher risk of new solid cancers than the general population (observed cases, 80; ratio of observed to expected cases, 2.7; P<0.001). The risk was 8.3 times higher than expected among those who survived 10 or more years after transplantation. The cumulative incidence rate was 2.2 percent (95 percent confidence interval, 1.5 to 3.0 percent) at 10 years and 6.7 percent (95 percent confidence interval, 3.7 to 9.6 percent) at 15 years. The risk was significantly elevated (P<0.05) for malignant melanoma (ratio of observed to expected cases, 5.0) and cancers of the buccal cavity (11.1), liver (7.5), brain or other parts of the central nervous system (7.6), thyroid (6.6), bone (13.4), and connective tissue (8.0). The risk was higher for recipients who were younger at the time of transplantation than for those who were older (P for trend <0.001). In multivariate analyses, higher doses of total-body irradiation were associated with a higher risk of solid cancers. Chronic graft-versus-host disease and male sex were strongly linked with an excess risk of squamous-cell cancers of the buccal cavity and skin. Patients undergoing bone marrow transplantation have an increased risk of new solid cancers later in life. The trend toward an increased risk over time after transplantation and the greater risk among younger patients indicate the need for life-long surveillance.
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            Author and article information

            Journal
            NEF
            Nephron
            10.1159/issn.1660-8151
            Nephron
            S. Karger AG
            1660-8151
            2235-3186
            1998
            August 1998
            29 July 1998
            : 79
            : 4
            : 408-412
            Affiliations
            Departments of Medicine and Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisc., USA
            Article
            45085 Nephron 1998;79:408–412
            10.1159/000045085
            9689155
            © 1998 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Pages: 5
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/45085
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