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PubMed2001

[Non-Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation-New Opinion about Hematopoietic Stem Cell Transplantation]

Non-myeloablative allogeneic hematopoietic stem cell transplantation (NMAT) is brought forward recent years. It is a modified transplant technology. NMAT treats malignant disease by graft versus tumor effect of chimerism after transplantation. The difference between this transplantation and standard allogeneic stem cell transplantation is the conditioning regimen. Non-myeloablative allogeneic stem cell transplantation increased the indication of allogeneic stem cell transplantation. This article focused on the background of this transplantation, the results of animal experimental and clinical research, the advantages and shortages of this transplantation.

Journal Article↗
PubMed2001

Female donors influence transplant-related mortality and relapse incidence in male recipients of sibling blood and marrow transplants.

INTRODUCTION: The male H-Y antigen is recognised as a minor histocompatibility antigen with debatable relevance and has not been substantiated thus far in clinical solid organ transplantation. An increase in transplant-related mortality in male recipients of female stem cells has been recognised and attributed to graft vs host effect against H-Y; in contrast, decreased incidence of relapse, a graft vs leukaemia effect has not yet been described. METHODS: To detect potentially small but significant differences, we performed an analysis in a highly homogeneous group. We have analysed 782 patients, 438 males and 344 females, who were transplanted from HLA-identical female donors for CML in 1st chronic phase between 1989 and 1997. The risk of transplant related mortality (TRM) and relapse incidence (RI) were compared for male and female recipients over three successive time periods, zero to three months, three months to two years and two to five years post-transplant. Both groups were comparable for known risk factors prior to transplant. RESULTS: The cumulative risk of TRM at five years was significantly higher in males (42%, s.e.=3.6) than in females (27%, s.e.=2.8; P=0.02) with no overall effect on risk of relapse. Within the three specified time intervals post-transplantation, the number of events of TRM and RI in the two groups of recipients diverged over time. There was no difference within the first time interval (zero to three months) for both events. TRM was higher in male recipients as manifested from three months onwards over the whole observation period of five years (P=0.02). Risk of relapse was significantly reduced in male patients; this difference became manifest only beyond two years (P=0.01). CONCLUSION: These data confirm the importance of male gender for both, TRM and RI: male recipients of female blood or marrow grafts are at risk of enhanced procedure related mortality, eg GvHD, but benefit from reduced incidence of disease recurrence, hence a GvL effect. GvL in this setting needs more time than GvHD. These data give indirect but convincing evidence for a clinical relevance of H-Y as a minor histocompatibility antigen in humans.

Adult↗
PubMed1997

UK National Transplant Database retransplantation in the UK and Republic of Ireland, 1987-1996. UKTSSA National Transplant Database.

At the end of 1996, 1,635 kidney, 17 liver and 24 cardiothoracic recipients were registered on the UK and Republic of Ireland national transplant waiting list to receive a second or subsequent transplant. These patients represented 20%, 9% and 4% of the total separate waiting lists, respectively. This clearly demonstrates a continuing requirement for retransplantation. A study of the characteristics of first and retransplant recipients and their donors shows that retransplant recipients tend to be younger and in the case of liver and heart/lung transplants are less likely to be male. Survival of liver regrafts is significantly worse than first transplant survival. Multifactorial analysis of the factors affecting the outcome of kidney retransplants showed outcome to be associated with the survival time of the first transplant. In the case of kidney transplantation, the younger and the better matched recipients selected for retransplant may at least partially explain the comparable one-year transplant survival estimates for first and retransplants of 81% and 78%, respectively, for the 1986-1993 dataset of 23 centers.

Adolescent↗
PubMed1987

Fetal tissue transplantation, bone marrow transplantation and prospective gene therapy in severe immunodeficiencies and enzyme deficiencies.

The successful development of fetal tissue transplantation has resulted in therapeutical solutions for patients with a variety of diseases. Fetal liver transplants as well as bone marrow transplants, can completely cure patients with severe combined immunodeficiency disease. These transplants can also be applied to treat other types of immunodeficiency, hemopathies, and inborn errors of metabolism, in association with immunosuppressive therapy. Despite complete HLA incompatibility between transplanted stem cells and host cells, functional activities of donor-derived T-lymphocytes are not restricted. In severe forms of Di George syndrome, immunological reconstitution can be obtained by fetal thymus transplantation. It is expected that, in the near future, pure stem cell transplants and gene transplants will develop and will provide remarkable solutions for the therapy of a large number of diseases.

Bone Marrow↗
PubMed1996

Transplantation of human striatal tissue into a rodent model of Huntington's disease: phenotypic expression of transplanted neurons and host-to-graft innervation.

The present study was undertaken to investigate the phenotypic expression and integration of human striatal neurons transplanted into an animal model of Huntington's disease. Sprague-Dawley rats were anesthetized and subjected to quinolinic acid lesions of the left striatum. Three human fetal cadavers were utilized for transplantation in this study (7, 8, and 10 weeks in gestation). The striatal primordia was dissected from each fetus and subsequently dissociated into cell suspensions. Following the initial lesion surgeries (3-4 months), the rats were reanesthetized and transplanted with human striatal cells (400,000 cells per rat). The animals were processed for histochemical analysis 9-17 weeks posttransplantation. Histochemistry was performed utilizing thionin (Nissl staining), acetylcholinesterase, NADPH-diaphorase, and antibodies against tyrosine hydroxylase and glial fibrillary acidic protein. Examination of stained brain sections demonstrate that human striatal transplants grow to fill a substantial portion of the remaining striatum, and contain clusters of immature and mature cells. Acetylcholinesterase activity is present in the transplant neuropil, varying in intensity, and distributed in a heterogeneous fashion. In addition, host afferent dopaminergic fibers penetrate into the transplant, and are occasionally found in patches. NADPH-diaphorase histochemistry revealed medium sized aspiny striatal neurons of donor origin in the transplants. The results of this study are similar to those obtained with rodent fetal striatal transplants, and suggest that human striatal tissue is capable of surviving, expressing normal striatal cell phenotypes, and receiving host dopaminergic innervation.

Acetylcholinesterase↗
PubMed2005

Predictors of mortality following heart transplantation: Spanish Registry of Heart Transplantation 1984-2003.

INTRODUCTION: Because the number of heart transplants performed per center is rather low, multicenter registries and databases are designed to analyze a large number of transplants to draw reliable conclusions. The objective of this study was to determine the factors associated with early and late mortality following heart transplantation. MATERIALS AND METHODS: All heart transplants performed in Spain since the start of activity (May 1984) to December 31, 2001 were analyzed. Using multivariate methods with Cox regression. The variables included donor, recipient, immunosuppression, surgical and follow-up factors (a total of 111 variables). RESULTS: The Total number of transplants was 4386. Early survival (at 30 days posttransplant) was 86%; survivals at 1, 5, and 10 years were 76%, 66%, and 54%, respectively. Variables associated with early mortality were acute graft failure, ventricular assistance, prior surgery, urgent transplant, bypass duration >180 minutes, and combined transplant. Variables associated with late mortality were acute graft failure, renal dysfunction, obesity, CMV+ serology, absence of induction therapy, infection, dialysis, and neurologic complications. CONCLUSIONS: Multicenter records of large databases are essential to draw reliable conclusions. This Registry provided reliable information on heart transplants in our country. The identification of factors associated with mortality provides a good perspective on the problems and a basis for future solutions and prospective studies.

Heart Diseases↗
PubMed1999

Renal transplantation for end-stage renal disease following bone marrow transplantation: a report of six cases, with and without immunosuppression.

UNLABELLED: BACKGROUND. Over 12000 bone marrow transplantations (BMT) are performed in the USA each year. This procedure is associated with significant morbidity including acute and chronic renal failure (CRF). CRF after BMT is usually secondary to radiation nephropathy and,or cyclosporine (CsA) toxicity. Survival on dialysis therapy for patients with radiation nephropathy is poor and renal transplantation may be a preferable form of renal-replacement therapy. METHODS: We report our experience with renal transplantation in 6 patients with end-stage renal disease (ESRD) following BMT: 4 as a result of radiation nephropathy; one secondary to hemolytic uremic syndrome; and 1 as a result of antitubular basement membrane nephritis. Ages at the time of BMT ranged from 26 to 40 yr. ESRD developed after a mean period of 94 months (range 42-140 months) after BMT. The kidney source was from a living donor in 5 patients, and a cadaveric donor (CAD) in 1 patient. In 3 recipients, the bone marrow and kidney were from the same donor. They are managed without any immunosuppressive therapy. The other 3 were initiated on triple therapy (prednisone, mycophenolate mofetil/azathioprine and cyclosporine/tacrolimus). RESULTS: These patients have been followed for up to 31 months (range 3-30 months) after kidney transplant, and 5 out of 6 are alive with functioning bone marrow and renal transplants. Their plasma creatinines range from 70 to 160 micromol/L (mean 97 micromol/L). One patient died following metastatic squamous cell cancer of the genital tract. CONCLUSIONS: 1) Renal transplant is a feasible alternative for patients with ESRD following BMT: 2) if bone marrow and kidney are from the same donor, the recipient requires little or no maintenance immunosuppression; 3) short-term results show good survival, but long-term follow-up is needed: 4) infections and malignancy post-renal transplantation were seen in recipients who needed immunosuppression; and 5) reduction in immunosuppression may be needed in such post-BMT patients who undergo kidney transplants.

Adult↗
PubMed1997

Haploidentical family member transplants for patients with chronic myeloid leukaemia: a report of the Chronic Leukaemia Working Party of off European Group for Blood and Marrow Transplantation (EBMT).

Within the registry of the chronic leukaemia working party of the European Group for Blood and Marrow Transplantation, data were available from 103 patients with chronic myeloid leukaemia who were treated by bone marrow transplantation from haploidentical family members. The patients of median age 30 years were transplanted between 1983 and 1994 in 25 European centres. The overall probabilities of survival and leukaemia-free survival (LFS) at 5 years were 32 and 25%, respectively. In univariate analysis, two factors were identified which affected survival and LFS, ie the state of disease at the time of transplant and the degree of HLA disparity. Fifty-nine patients were transplanted in first chronic phase and the probability of survival at 2 years was 47%. Forty-four patients received their transplants for advanced disease and their probability of survival at 2 years was 25% (P = 0.004). Donor bone marrow was HLA-mismatched for 0-1 antigens in 54 patients (group 1) and for 2-3 antigens in 49 patients (group 2). At 2 years, the probabilities of survival for groups 1 and 2 were 46 and 27% (P < 0.02) and the probabilities of LFS were 43 and 24% (P < 0.03), respectively. Multivariate analysis confirmed the prognostic importance of the disease stage and of the HLA disparity. Patients transplanted in first chronic phase from a donor mismatched for 0-1 HLA antigens had a probability of survival of 52% at 2 years compared with 19% for patients transplanted in advanced disease stage from donors mismatched for 2-3 HLA antigens.

Adolescent↗
PubMed1999

Autologous stem cell transplantation for T and null cell CD30-positive anaplastic large cell lymphoma: analysis of 64 adult and paediatric cases reported to the European Group for Blood and Marrow Transplantation (EBMT).

Anaplastic large cell lymphoma (ALCL) is a heterogeneous family of lymphoid tumours, among which the T and null cell types were recently listed in the REAL classification as a distinct entity. Reports on autologous stem cell transplantation (ASCT) in this group are only occasional. Sixty-four patients with T and null cell ALCL from 25 European centres had been registered with the European Group for Blood and Marrow Transplantation (EBMT) at the onset of this study. The median age was 25 years (range 3.2-53.0). Thirty of the 64 patients (47%) were in complete remission (CR), 18 (28%) in partial remission (PR), and the remaining 16 (25%) had a more advanced or chemotherapy-refractory disease at transplant. Eighty-one percent of the patients were conditioned with chemotherapy alone and 75% received marrow stem cells. All the patients transplanted in first CR (15), except one, maintained the CR over time; six of 15 transplanted in CR subsequent to first, six of 18 transplanted in PR and 14 of 16 transplanted in refractory or relapsed disease progressed. Actuarial overall survival (OS) at 10 years is 70%. Multivariate analysis showed that good status at transplant, younger age, absence of B symptoms and absence of extranodal disease indicated a better prognosis. These data suggest that ASCT should be considered as a possible treatment for chemosensitive patients in CR or PR. However, definitive conclusions cannot be drawn from this study and a prospective randomised trial between ASCT and conventional chemotherapy may be indicated.

Adolescent↗
PubMed2001

Successful bone marrow transplantation for severe aplastic anemia following orthotopic liver transplantation: long-term follow-up and outcome.

Severe aplastic anemia (SAA) is well described in children following liver transplantation for fulminant hepatic failure (FHF) secondary to non-A, non-B, non-C hepatitis, and is associated with a high mortality rate. Successful immunosuppressive treatment of SAA following liver transplantation has been reported, but death from infectious complications is not uncommon. We report the 8-year follow-up of a 3.5-year-old boy who underwent successful HLA-identical sibling donor bone marrow transplant for SAA 7 months following orthotopic liver transplant for non-A, non-B, non-C hepatitis. His post-bone marrow transplantation course was uneventful with no evidence of liver toxicity. Eight months following BMT he developed renal cell carcinoma metastatic to lymph nodes which was treated surgically. Six years following BMT he developed a mucoepidermoid carcinoma of the parotid gland also treated surgically. Despite these malignancies, he is currently well 8 years following liver and bone marrow transplantation, without signs of GVHD, growth failure or liver graft rejection. This is the first report of long-term follow-up of bone marrow transplantation for SAA following liver transplantation. The occurrence of two subsequent malignancies in this child underscores the need for close follow-up of future similar cases.

Anemia, Aplastic↗
PubMed2006

Pre-transplantation physical and mental functioning is strongly associated with self-reported recovery from stem cell transplantation.

Previous studies of quality of life (QOL) note compromised QOL after stem cell transplantation (HCT), but do not usually consider the impact of pre-transplantation deficits in QOL on post transplantation outcomes. To examine these associations, multivariate models for six self-reported QOL outcomes at 6 and 12 months were constructed, considering pre-transplantation clinical status and QOL, and subsequent clinical events. Outcomes measured overall subjective health, social functioning and agreement with statements such as 'Life has returned to normal.' Of 320 autologous and allogeneic HCT recipients who completed pre-transplantation surveys, 197 completed 6-month surveys and 175 completed 12-month surveys. Pre-transplantation overall health and mental health were independent predictors of all QOL outcomes at 6 months. Baseline physical health was also predictive of four of six outcomes at 12 months. In contrast, disease risk was predictive only of enjoying normal activities at 6 months. Relapse and chronic graft-versus-host disease were associated with poorer QOL. In conclusion, pre-transplantation self-reported physical and mental health are more strongly associated with QOL after HCT than commonly noted baseline clinical predictors such as age and disease risk. Measurement of baseline QOL can help place the effects of the transplantation procedure in context.

Adult↗
PubMed1996

Transplantation of peripheral blood progenitor cells from HLA-identical sibling donors. European Group for Blood and Marrow Transplantation (EBMT).

Transplantation of peripheral blood progenitor cells (PBPCs) has largely replaced autologous bone marrow transplantation. The same might occur in the allogeneic setting if the favourable initial experience with allogeneic PBPCT is confirmed. We analysed all primary transplants utilizing unmodified PBPC from HLA-identical sibling donors reported to the European Group for Blood and Marrow Transplantation (EBMT) for 1994. 59 patients with a median age of 39 years received myeloablative therapy for acute myelogenous leukaemia (23 patients, acute lymphoblastic leukaemia (13), chronic myelogenous leukaemia (nine), lymphoma (seven), or other diagnoses (seven) mostly of advanced stages followed by transplantation of allogeneic PBPC. Three patients died soon after grafting, the others showed prompt haemopoietic recovery with median times to recover an absolute neutrophil count (ANC) above 0.5 and 1.0 x 10(9)/I of 15 (range 9-27) and 17d (range 10-28) respectively. Time to platelet recovery above 20 or 50 x 10(9)/I was 16 (range 9-76) and 18d (range 12-100) respectively. 27 patients (46%) developed no or mild acute graft-versus-host disease (GVIID). The incidence of moderate (grade II) disease was 27%; 24% of the patients developed severe acute GVHD (grades III or IV), 55% of patients who were alive 90d after transplantation developed chronic GVHD, the probability to develop extensive chronic GVHD was 32% (95% confidence interval 22-42) with a median follow-up of 14 months. Overall and event-free survival (EFS) at 1 year were 54% (CI 48-60) and 50% (CI 43-57), respectively, the relapse incidence was 23% (CI 17-29). EFS was 67% (CI 55-79) in patients transplanted for acute leukaemias in first complete remission, chronic myelogenous leukaemia in first chronic phase, or severe aplastic anaemia. Transplantation of allogeneic PBPC resulted in prompt and durable engraftment. The incidence and severity of acute and chronic GVHD seemed comparable to that observed after allogeneic BMT. Overall and event-free survival in this cohort of patients, most of whom suffered from advanced leukaemia or lymphoma, is encouraging, suggesting that the high numbers of T lymphocytes and/or natural killer cells contained in a typical PBPC collection product exert a vigorous graft-versus-leukaemia effect. Further evaluation of allogeneic PBPCT is highly desirable.

Acute Disease↗
PubMed2005

Autologous stem cell transplantation in acute myocardial infarction: The ASTAMI randomized controlled trial. Intracoronary transplantation of autologous mononuclear bone marrow cells, study design and safety aspects.

OBJECTIVES: Intracoronary transplantation of different cell populations has been used in acute myocardial infarction (AMI) with promising results. The primary objective of the Autologous Stem cell Transplantation in Acute Myocardial Infarction (ASTAMI) study is to test whether intracoronary transplantation of autologous mononuclear bone marrow cells (mBMC) improves left ventricular ejection fraction (LVEF) after anterior wall AMI. DESIGN: The ASTAMI study is a randomized, controlled, prospective study. One hundred patients with acute anterior wall ST-elevation myocardial infarction (STEMI) treated with acute percutaneous coronary intervention (PCI) are randomized in a 1:1 way to either intracoronary transplantation of autologous mBMC 5-8 d after PCI or to control. Left ventricular function, exercise capacity, biochemical status, functional class, quality of life and complications are validated at baseline and during a 12-month follow-up. RESULTS: By August 2004, out of 1004 patients with STEMI, 49 patients have been included in the study. Twenty-four patients have been randomized to intracoronary mBMC transplantation. Twenty patients had chest pain and 16 patients had ischemic ECG changes during the mBMC transplantation procedure. One patient had ventricular fibrillation 24 h after transplantation. CONCLUSIONS: Intracoronary transplantation of autologous mBMC in the acute phase after AMI is feasible and seems safe in the short term.

Acute Disease↗
PubMed1996

Related donor liver transplant for veno-occlusive disease following T-depleted unrelated donor bone marrow transplantation.

Veno-occlusive disease (VOD) is the third leading cause of mortality after bone marrow transplant. Management consists of supportive care, with restricted fluids and diuretics. Most patients will recover, but approximately 25% may develop severe life threatening VOD with subsequent respiratory compromise and multiorgan failure. Orthotopic liver transplant has been attempted for a few patients with intractable VOD, but this approach is limited by availability of a cadaveric organ. We report a child who underwent a T-depleted unrelated donor bone marrow transplant for severe aplastic anemia as a manifestation of Schwachman-Diamond syndrome who developed severe VOD. She had evidence of engraftment when liver transplant was considered, and had no evidence of major organ dysfunction. The left lateral segment of her mother's liver was transplanted at day +33 following bone marrow transplantation. The child remains well ten months post-BMT and nine months after liver transplant. A related donor liver transplant may be a justifiable approach in a patient with severe VOD post-BMT.

Bone Marrow Cells↗
PubMed1997

Successful allogeneic bone marrow transplantation in a 2.5-year-old boy with ongoing cytomegalovirus viremia and severe aplastic anemia after orthotopic liver transplantation for non-A, non-B, non-C hepatitis.

BACKGROUND: A 2.5-year-old boy received a cadaveric orthotopic liver transplant for acute liver failure due to non-A, non-B, non-C hepatitis. After transplantation, he developed thrombocytopenia and neutropenia and subsequently severe aplastic anemia. The patient also suffered from recurrent cytomegalovirus (CMV) viremia, treated with foscarnet and ganciclovir. METHODS: For treatment of his aplastic anemia, the patient underwent an allogeneic bone marrow transplantation from his HLA-identical sister after conditioning with cyclophosphamide at 200 mg/kg and antithymocyte globulin at 3 mg/kg for 5 days. Prophylactic acyclovir was given because of ongoing CMV viremia at the time of bone marrow transplantation. RESULTS: The transplant course was uneventful, with rapid engraftment. There were no signs of liver dysfunction, graft-versus-host disease, or reactivation of CMV. The patient is in excellent health, with normal liver and bone marrow function 3 years after bone marrow transplantation. CONCLUSION: This case report shows that allogeneic bone marrow transplantation is feasible and well tolerated in a patient with severe aplastic anemia after liver transplantation for acute fulminant viral hepatitis.

Anemia, Aplastic↗
PubMed1993

Results of bone marrow transplants from human leukocyte antigen-identical sibling donors for treatment of childhood leukemias. A report from the International Bone Marrow Transplant Registry.

PURPOSE: Bone marrow transplantation is an effective treatment for leukemia. Cures are possible in 20-80% of transplant recipients depending on the stage of leukemia at the time of transplant. The antileukemia efficacy of transplants result from high-dose chemotherapy and/or radiation given pretransplant and from immune-mediated effects of the graft. RESULTS: Success of the procedure is limited by transplant-related complications, including graft rejection, graft-vs.-host disease and interstitial pneumonia. Five-year leukemia-free survival ranges from approximately 25% for children transplanted with advanced leukemia, to > 60% in those transplanted in first remission of acute leukemia or first chronic phase of chronic myeloid leukemia. CONCLUSIONS: Candidates for transplant include children failing conventional therapy and, possibly, those with early leukemia characterized by features predicting a poor response to conventional therapy.

Actuarial Analysis↗
PubMedDate not supplied

Correlation between endothelin expression in early post-transplant biopsy specimens and long-term allograft function in living-related renal transplantation.

OBJECTIVE: We investigated whether degree of immunohistochemically evident endothelin (ET) expression in early post-transplant biopsy specimens could predict long-term allograft function in living-related renal transplantation. METHODS: Allograft biopsy specimens obtained from 40 patients with living-related transplants were studied. Cases with episodes of acute rejection or calcineurin inhibitor toxicity were excluded. We immunostained graft biopsy specimens obtained at pre-transplantation (PRE) and at 3 months (3M) afterward with anti-ET antibody. The number of stained tubular epithelial cells per 1000 tubular cells was defined as the staining index (SI). In the 21 patients whom we could assess at 3 yr (3Y) after transplantation, the correlation between ET expression and long-term graft function was examined. RESULTS: Anti-ET antibody staining was appreciable in tubular epithelium but not in glomeruli. Tubular SI at PRE and at 3M were 10.6 +/- 15.3 and 32.0 +/- 35.6 (mean +/- SD) respectively (p < 0.01). When patients were classified according to SI (group A, SI < 25; group B, SI > 25), declining ratio in creatinine clearance at 3Y after transplantation for groups A and B with respect was 21.8% +/- 15.4% and 41.9% +/- 21.6% (p < 0.05). CONCLUSION: High ET expression in early post-transplantation, biopsy specimens was related to poor long-term allograft function following living-related renal transplantation.

Adolescent↗
PubMed2006

The impact of the pre-transplant renal replacement modality on outcome after cadaveric kidney transplantation: the ghent experience.

For suitable patients, renal transplantation is still the most preferable renal replacement modality, offering the best outcome in terms of survival and quality of life [Meier-Kriesche, H.U. et al: Semin Dial 2005;18:499-504]. The shorter the period on dialysis, the better the outcome after transplantation seems to be [Meier-Kriesche, H.U. et al: Transplantation 2002;74: 1377-1381]. However, for most patients, a pre-emptive transplantation is not an option by lack of a suitable organ. Therefore, most people have to undergo hemodialysis or peritoneal dialysis (PD) while awaiting a donor kidney. There is evidence that PD positively impacts on the outcome after transplantation [Van Loo, A.A. et al: J Am Soc Nephrol 1998;9:473-481], an effect that could be attributed to a more stable fluid homeostasis, but also to an independent effect of biocompatibility of the dialysis membrane [Van Biesen, W. et al: Transplantation 2000;69:508-514], which is by definition better in PD. Based on these findings, since 1999, all hemodialysis patients at the university of Ghent are dialyzed on a low complement activating dialyzer, and dialysis and especially ultrafiltration in the 24 h preceding the transplantation are avoided as much as possible. A recent re-analysis of the data of the outcome of our transplant program showed that this approach resulted in a reduction of delayed graft function in the hemodialysis patients, allowing to reach an outcome level comparable to that of the PD patients. However, the long-term patient survival still is slightly superior in the PD patients.

Cadaver↗