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PubMed1988

Prediction of severe postoperative complications in patients admitted to neuroanaesthesia.

The purpose of this study was to identify factors which will predict the risk of severe postoperative complications in individual patients in a neurosurgical unit. Eleven risk factors were investigated in 363 neurosurgical patients, of whom 40 (11%) developed postoperative complications requiring mechanical ventilation for more than 24 h in an intensive care unit, 16 were found to be severely disabled or in a vegetative state at follow-up 1 month after admission, and 28 patients died. By applying stepwise, logistic regression analysis to the patient's data, we were able to select two significant risk variables, i.e. the Glasgow Coma Scale (GCS) 8 or less preoperatively and emergency anaesthesia. The presence of GCS 8 or less on the consciousness scale was associated with postoperative complications in approximately 40% of the cases. Emergency patients with severe neurological damage had the greatest risk of postoperative complications (93%). Fatal outcome for patients with postoperative complications was seen in 40% of the cases.

Adolescent↗
PubMed1999

Early postoperative complications of splenectomy for hematologic disease.

Splenectomy may be indicated in a variety of hematologic diseases for diagnostic reasons, therapeutic reasons, or both. Most reviews reveal a high proportion of procedures performed as part of the staging process for Hodgkin disease. Splenectomy for myelofibrosis has been associated with an increased postoperative complication rate. Other determinants of morbidity have been splenic weight and operative blood loss. The authors reviewed a series of 83 adult patients from a prospective database established in 1991 to determine the incidence of early postoperative complications associated with splenectomy for hematologic disease and to analyze patient characteristics that may predict their occurrence. Morbidity that occurred within 30 days of splenectomy was considered to be an early postoperative complication. Operative estimated blood loss and incidence of postoperative complications were correlated with patient age, preoperative platelet count, splenic weight, and diagnosis of myelofibrosis as regression covariates. Indications for splenectomy were therapeutic in 76 patients (92%). Median splenic weight was 760 g, and 22 patients had massive splenomegaly. Patients with splenic weight more than 1,500 g had a significantly higher median estimated blood loss (300 ml; p = 0.02). Splenic weight was the main determinant of estimated blood loss in a multiple linear regression analysis (p = 0.02). Twenty-two patients (27%) experienced postoperative complications and five of those patients died (6%). Patients with myelofibrosis had the highest incidence of complications (50%) and the highest postoperative mortality (21%; p = 0.04). In a logistic regression model, estimated blood loss was the only variable significantly correlated with postoperative complications (p = 0.02). Splenectomy for hematologic disease is associated with an acceptable early postoperative complication rate, even when the indication is predominantly therapeutic. Patients at particularly high risk include those with elevated operative blood loss, massive splenomegaly, and myelofibrosis.

Adult↗
PubMed2003

Postoperative complications after en bloc salvage surgery for head and neck cancer.

OBJECTIVE: To analyze the frequency of and risk factors for postoperative complications after en bloc salvage surgery for head and neck cancer. DESIGN: Retrospective cohort study. SETTING: Patients were evaluated from February 7, 1990, to November 17, 1999, in a tertiary cancer center hospital. PATIENTS: Consecutive sample of 124 patients from the hospital database. Only patients with recurrent head and neck squamous cell carcinoma undergoing en bloc salvage resection were eligible for the study. MAIN OUTCOME MEASURES: We analyzed the frequency of and risk factors for complications after salvage surgery. RESULTS: The tumor location was the lip in 6 patients, oral cavity in 55, oropharynx in 31, larynx in 24, and hypopharynx in 8. Previous treatment was surgery alone in 20 patients, radiotherapy alone in 68, surgery and radiotherapy in 21, and radiotherapy and chemotherapy in 14. An additional patient received chemotherapy alone before salvage surgery. The clinical stage of the recurrent tumor was I or II in 23 patients and III or IV in 101 patients. Postoperative complications occurred in 66 patients (53.2%). Fifty-three patients (42.7%) had minor complications, and 23 patients (18.5%) had major ones. There were 4 postoperative deaths (3.2%). The major factor associated with the overall occurrence of postoperative complications was the clinical stage of the recurrent tumor (P =.02). The occurrence of minor complications correlated with the previously treated site, with complications occurring more often in patients undergoing locoregional vs local treatment (P =.04). Major complications were associated with the time between initial treatment and salvage surgery (P =.05). CONCLUSIONS: Salvage surgery can be performed with acceptable rates of postoperative complications. The clinical stage of the recurrent tumor and the previous site treated were the 2 major factors associated with the occurrence of postoperative complications.

Adolescent↗
PubMed2005

Etiology of bile infection and its association with postoperative complications following pancreatoduodenectomy.

UNLABELLED: Currently controversy exists whether bile infection following preoperative biliary drainage has an impact on postoperative complications and mortality rate. The objective of the study was to determine etiology of preoperative bile infection and to evaluate its influence on postoperative complications and mortality after pancreatoduodenectomy. METHODS: Data on 64 patients, undergoing pancreatoduodenectomy at Kaunas University of Medicine Hospital between 2002 and 2004 were collected prospectively. We evaluated etiology and the impact of bile infection on development of post-operative complications. Patients were divided into groups according to results of intraoperative bile culture. RESULTS: In 31 patients (48.4%) intraoperative bile cultures were negative, while in remaining 33 patients (51.6%) infected bile was documented. Both patient groups were homogenous according to demographic data, preoperative and intraoperative variables. Pancreaticoduodenectomy was performed in 21 patients after preoperative biliary drainage (endoscopic stenting, bilidigestive anastomosis or percutaneous bile drainage), others (n=43) had primary operation. Infected bile was found more often in patients who underwent biliary drainage (p<0.0001). Among 43 patients with primary pancreaticoduodenectomy 22 patients underwent endoscopic retrograde cholangiopancreatography without stenting, while remaining 21 had no preoperative endoscopic manipulation. Infected bile was present in 9 patients after endoscopic retrograde cholangiopancreatography (40.9%) and in 4 without preoperative endoscopy (19%). Enterococcus and Escherichia coli dominated in bile cultures of patients with primary pancreaticoduodenectomy, while multiple species (3 and more microorganisms) dominated following drainage procedures. Septic postoperative complications were identified in 26.6% of cases. Infected bile did not influence both overall and septic postoperative complications. Bacteria causing abdominal cavity and wound infections matched bile cultures in 7.7% of cases only. CONCLUSIONS: Our data show that infected bile is found more often after preoperative biliary drainage procedures. However, bile infection did not increase statistically significantly the number of postoperative septic complication.

Adult↗
PubMed2003

[Postoperative complications of refractive cornea surgery with excimer laser, Lasik technique].

PURPOSE: To determine the postoperative complications of laser Excimer surgery, LASIK technique. MATERIAL AND METHOD: We studied 142 eyes with different refractive defects operated with laser Excimer. RESULTS: The early postoperative complications were: DLK stage II/III--6 eyes, Hase--24 eyes, Epitelial Ingrowth in 2 eyes and Central Islands in 2 cases. Late postoperative complications were: secondary glaucoma after steroids administration in 1 case and subcorrection in 19 eyes. CONCLUSION: A quickly treatment of postoperative complications after LASIK technique assure the estimated functional results.

Adult↗
PubMed1987

Postoperative complications in colorectal surgery in relation to preoperative clinical and nutritional state and postoperative nutritional treatment.

The impact of the pre-operative nutritional and clinical state on post-operative morbidity and mortality is not fully known and the effect of total parenteral nutrition (TPN) on the postoperative complication rate has not been established. We have investigated the effects of postoperative TPN on the complication rate in 92 patients after major colorectal surgery for carcinoma of the large bowel or inflammatory bowel disease in a controlled, randomised study. The complication rate was analysed against seven commonly used nutritional (biochemical and anthropometric) variables and against the diagnosis, clinical inflammatory activity and presence of pre-operative septic complication. Patients were randomly allocated to postoperative TPN or conventional fluid and electrolyte support. The results show no correlation between the complication rate and the nutritional and clinical state of the patients as assessed pre-operatively. The complication rate was not significantly reduced by postoperative TPN. This study indicates that biochemical and anthropometric nutritional variables do not identify patients at risk to develop postoperative complications. The presence of pre-operative complications showed a marginal correlation with postoperative morbidity, in agreement with previous experience. The result of this study obviates the use of TPN in routine postoperative care.

Adult↗
PubMed2001

[The therapeutic effects and postoperative complications of cataract surgery in Laiwu City].

OBJECTIVE: To decrease the prevalence of blindness and low vision in Laiwu City. METHODS: The therapeutic effects and postoperative complications of each method of cataract surgery were investigated and statistically analyzed. The cases with postoperative complications were treated after surgery. RESULTS: In the investigation, 1,274 eyes of 1,089 cases had undergone cataract surgeries, including couching for cataract, intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE) and ECCE with intraocular lens implantation. The prevalence of blindness and low vision was 4.87% and 23.70%, respectively. There were postoperative complications in 650 eyes (51.02%). They were corneal decompensation, secondary glaucoma, opacity of posterior capsuler, cystoid macular edema and retinal detachment. After treatment for the postoperative complications, the prevalence of blindness and low vision was decreased to 1.96% and 6.01%, respectively. The cases having escaped the blindness and handicap after treatment were lowest in the groups of couching and ICCE. CONCLUSIONS: The survey on the population having undergone cataract surgery in rural district is important. The postoperative complications can be treated in time and the prevalence of blindness and low vision can be decreased.

Cataract↗
PubMed1987

Evaluation of the premature infant at risk for postoperative complications.

We reviewed anaesthetic records of 35 infants with a history of prematurity, who presented for elective herniorrhaphy. We applied a scoring system to help evaluate risk of postoperative complications. Six patients experienced postoperative complications. All six patients had a score of five or more and gave history of either apnoea or a history of moderate bronchopulmonary dysplasia. A preoperative history of apnoea and/or moderate bronchopulmonary dysplasia appear to be valuable markers for postoperative complications. A conceptual age of 40 weeks is an acceptable lower limit of age providing there is no history of apnoea or pulmonary disease.

Anesthesia, Inhalation↗
PubMed2001

Postoperative complications after pelvic lymphadenectomy for the surgical staging of endometrial cancer.

OBJECTIVE: To assess whether pelvic lymphadenectomy at surgical staging for endometrial carcinoma is an independent risk factor for the occurrence of postoperative complications. METHODS: Women with uterine cancer who underwent radical abdominal hysterectomy type I or II of Piver-Rutledge with or without pelvic lymph nodes dissection were considered. The occurrence of intraoperative and early postoperative complications (deep vein thrombosis, lymphocysts, febrile morbidity, extraoperative site infections, wound dehiscence, relaparotomy, and death) was prospectively recorded. Non parametric tests, receiver characteristic curve analysis, and multiple logistic regressions were used for statistical purposes. RESULTS: Two hundred six subjects were enrolled, of whom 133 underwent pelvic lymphadenectomy. The rate of postoperative complications was 26.7% (55 of 206). Women with complications had a higher median (range) number of lymph nodes removed than those without complications (17 [3-62] versus 11 [1-74], P <.01). The performance of a type II hysterectomy (OR = 2.49, P <.05) and the removal of more than 14 lymph nodes (OR = 3.05, P <.005) were significantly associated with the occurrence of at least one complication. Multiple logistic regression revealed that, after adjustment for the type of surgery, the removal of more than 14 nodes was the only condition associated with postoperative complications (OR = 2.56, P <.01). The only variable significantly associated with the development of two postoperative complications was the removal of more than 19 nodes (OR = 9.7, P <.01). CONCLUSIONS: The extension of retroperitoneal lymph nodes (more than 14) dissection is an independent risk factor for the occurrence of postoperative complications in patients undergoing surgical staging for endometrial carcinoma.

Adult↗
PubMed1998

[A preliminary study on the relationship between nutritional status and postoperative complications in patients with head and neck malignancies].

OBJECTIVES: To study the role of nutritional factor in the development of postoperative complications in patients with head and neck malignancies. METHODS: Postoperative complications of 96 patients with head and neck malignancies who were operated on were surveyed. Twenty-seven developed postoperative complications; the remaining 69 went uneventful. Comparisons of nutritional status and clinical variables between these two groups were made. RESULTS: 1. The prevalence of poor preoperative nutritional status in the complication group (56%) was higher as compared with that in the noncomplication group (20%) (P < 0.001); 2. values of body weight, triceps skin fold thickness, arm circumference, arm muscle circumference, and creatinine-height index in the complication group decreased much more significantly than in the noncomplication group (P < 0.001); 3. the nitrogen and calorie intake within the first postoperative week was lower in the complication group than in the non-complication group (P < 0.001). CONCLUSIONS: Nutritional factor plays a very important role in the development of postoperative complication and the perioperative nutritional support for head and neck surgical patients should not be ignored.

Adult↗
PubMed2005

[Relaparascopy in the treatment of postoperative complications].

Videoendoscopic technologies were used in the treatment of postoperative complications in 289 patients. All repeated laparoscopic procedures in early postoperative period after laparoscopic and laparotomic surgeries are integrated under the term "relaparoscopy". The algorithm of choice of a surgical method during laparoscopic examination is presented, technical principles of laparoscopic surgeries, indications and contraindications are formulated. Postoperative peritonitis was diagnosed in 66 (22.7%) patients, abdominal abscesses -- in 64 (22.1%), early intestinal obstruction -- in 58 (20.1%), bile outflow -- in 53 (18.2%), postoperative bleedings -- in 26 (9.1%), local liquid accumulations -- in 17 (5.8%), abdominal foreign bodies --- in 5 (1.9%) patients. Relaparoscopy was a final method of treatment of postoperative complications in 74.5% patients. In 8.6% patients videoendoscopic procedures permitted performing some elements of surgery and to convert to minilaparotomy. In 16.9% patients indications for relaparotomy were revealed during relaparoscopy, after which dynamic relaparoscopy was used as programmed sanations.

Algorithms↗
PubMed1998

Incidence and management of intraoperative and early postoperative complications in 1000 consecutive laser in situ keratomileusis cases.

OBJECTIVE: To identify intraoperative and early postoperative complications of laser in situ keratomileusis (LASIK) surgery learning curve and to offer recommendations on prevention and management. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: The first 1000 consecutive myopic LASIK eyes (April 1995-February 1997) operated on by one surgeon (HVG) were examined. INTERVENTION: Myopic LASIK surgery was performed with the Chiron Corneal Shaper and NIDEK EC-5000 excimer laser. MAIN OUTCOME MEASURES: The preoperative and 6-month postoperative spherical equivalent, best-corrected visual acuity, and corneal status were recorded, as was the incidence of intraoperative and early postoperative complications. The rate of retreatments was also recorded. RESULTS: There were 32 (3.2%) intraoperative complications and surgical events recorded, including 19 (1.9%) microkeratome-related flap complications and 13 (1.3%) nonmicrokeratome-related surgical events such as inability to obtain sufficient suction. There were 18 (1.8%) postoperative complications requiring repositioning of microwrinkled or shifted flaps. Six-month spherical equivalent was -0.52 diopter [D] +/- 1.19 D for eyes with microkeratome complications, -0.56 D +/- 1.07 D for the group with nonmicrokeratome-related intraoperative events, and -0.78 D +/- 0.92 for eyes requiring postoperative flap repositioning. None of the 32 eyes with intraoperative complications and surgical events lost 2 or more lines of vision. One eye in the postoperative complications group lost two lines of vision. The rate of microkeratome complications related to surgical technique and the overall surgery times decreased over the course of the first 1000 myopic LASIK cases. CONCLUSION: The complications encountered during the early learning curve of LASIK surgery have not in this series resulted in a significant loss of best-corrected visual acuity. With increasing surgical experience, the incidence of complications, along with surgical times, has decreased.

Adult↗
PubMed2000

Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer.

BACKGROUND: D2 lymph node dissection in gastric cancer is controversial in Western countries because of the relatively high complication and mortality rates. The purpose of this study was to clarify the effects of fat volume on operation factors, postoperative complications, and survival in gastric cancer surgery.METHODS: We studied 293 consecutive patients who had undergone distal gastrectomy with D2 dissection for gastric cancer at our hospital between 1990 and 1997. The patients were classified into three groups according to their body mass index (BMI; kg/m(2)). We analyzed differences in the operation time, the amount of blood loss, the postoperative complications and the survival rate among the three groups.RESULTS: Group A patients had a BMI of less than 20 ( n = 61), group B had a BMI of 20-25 ( n = 178), and group C had a BMI of more than 25 ( n = 54). There were significant differences in operation time (group A, 206 +/- 66 min; group B, 226 +/- 61 min; group C, 252 +/- 61 min; P < 0.05), blood loss (group A, 417 +/- 282 ml; group B, 501 +/- 295 ml; group C, 605 +/- 333 ml; P < 0.05), and postoperative complications (group A, 3.3%; group B, 5.6%; group C, 22.0%). There were significant differences in postoperative complications between groups A and C, and between groups B and C. However, the difference between groups A and B was not significant, and no significant difference in survival rate was seen among the three groups.CONCLUSION: Fat volume definitely increases the postoperative complications. Accordingly, the high rate of postoperative complications of D2 surgery in Western countries may be related to the patients' relative obesity.

Journal Article↗
PubMedDate not supplied

Postoperative complications in the treatment of chagasic megaesophagus.

The postoperative complications of Chagasic megaesophagus were studied in 250 Chagasic patients referred to the Gastroenterology Clinic of Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Brazil. The treatment was balloon dilatation in 45 (18.0%), myotomy and cardioplasty in 63 (25.2%), Merendino's surgery in 139 (55.6%), esophagogastroplasty in 2 (0.8%) and esophagocoloplasty in 1 (0.4%). There were 125 (50%) early and 30 (12%) late postoperative complications, and in 65 patients (26%) recurrent dysphagia was noted: nineteen (7.6%) after myotomy and cardioplasty, 9 (3.6%) after Merendino's operation and 37 (14.8%) after balloon dilatation. Eighty-five patients (34%) needed reoperations either to correct recurrent dysphagia (56 patients, 22.4%) or to treat other complications (29 patients, 11.6%). The reoperations to correct the 19 recurrences after myotomy and cardioplasty were Merendino's operation (12 patients, 4.8%), forceful dilatation (1 patient, 0.4%), forceful dilatation followed by Merendino's (2 patients, 0.8%), another myotomy (2 patients, 0.8%), myotomy followed by Merendino and balloon dilatation (1 patient, 0.4%) or esophagogastroplasty (1 patient, 0.4%). The recurrences after dilatation were treated by myotomy (15 cases, 6%), Merendino's operation (12 cases, 4.8%) and myotomy followed by Merendino's (3 cases, 1.2%). After Merendino seven reoperations (2.8%) were done: reduction of interposed loop (6 cases, 2.4%) and esophagocoloplasty (1 case, 0.4%). The time elapsed between the first operation and reoperation or dilatation varied from a few weeks to 18 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Brazil↗
PubMed1991

[Early and late postoperative complications in thoracic surgery interventions].

Two types of postoperative complications should be distinguished, i.e. early complications including a lethality within 30 days and delayed complications which may occur after several years. In the period between 8/1985 and 12/1987 216 operations were carried out on patients with bronchial carcinoma. The operative lethality rate was 2.3%. The most frequently performed operation was lobectomy with 59% followed by pneumonectomy including extended pneumonectomy with 17.5%. 57.7% of patients with bronchial carcinomata were resected in the early stage I and II, and 26.4% of patients in stage IIIa. Squamous cell carcinomata occurred most frequently, with an incidence of 41%. Of the common postoperative complications cardiac arrhythmia was to be found most often (27%). Pulmonary embolism developed in 5% of all cases, cerebral complications in 3.7%, wound infections in 2.3% and post-operative haemorrhages in 1.3%. Bronchus stump insufficiency and dehiscence of suture were found in 2.2%, and pleural empyema in 4.2% of the complications directly resulting from the operation. Only 6 of 9 patients had suffered an persistent bronchopleural fistula lasting 7 days. Infections of the respiratory tree were identified in 18.3% and pneumonia in only 8.3% of cases. Delayed empyemas and bronchus fistulas belong in the category of delayed complications. The risk of deformation of the vertebral column caused by processes of involution in the cavity of pneumonectomy should be kept in mind following pneumonectomy. A distinction shall be made between the postthoracotomy syndrome an classical intercostal neuralgia, which has a sharply defined clinical picture and may be treated by operative neurolysis or resection of the nerve.

Berlin↗
PubMed2000

Ogilvie syndrome as a postoperative complication.

HYPOTHESIS: Ogilvie syndrome is a postoperative complication. DESIGN: Case series. SETTING: University-affiliated tertiary-care hospital. PATIENTS AND METHODS: The medical records of patients diagnosed as having Ogilvie syndrome after trauma or operation between 1989 and 1998 were reviewed. Medical charts were examined for history, treatment, cecal diameter, and outcome. MAIN OUTCOME MEASURES: Data were summarized in an attempt to identify patient populations at risk for Ogilvie syndrome. RESULTS: Ogilvie syndrome was diagnosed in 36 patients, 24 of whom were men. Average age at diagnosis was 68.9 years. Abdominal radiographs were obtained at time of diagnosis (mean cecal diameter, 13.4 cm; range, 8-20 cm). Operations preceding Ogilvie syndrome were orthopedic or spinal (n= 14), cardiothoracic (n= 12), abdominal (n= 5), and vascular (n= 2). Nonoperative trauma accounted for 3 cases. Coronary artery bypass grafting was the single most frequent procedure leading to Ogilvie syndrome (n=9 [25%]). Conservative treatment was successful in 52.8% of cases (n = 19). Twenty colonoscopic decompressions were performed on 13 patients, with an overall success rate of 77% (n= 10). Of the 3 patients in whom colonoscopic decompression failed, 2 died and 1 required operation. Five of the 36 patients required surgical intervention, with a mortality rate of 60% (n= 3). CONCLUSIONS: Previous studies have shown Ogilvie syndrome to occur most commonly after obstetrical/ gynecologic, abdominal/pelvic, and orthopedic procedures. Our data confirm that patients undergoing orthopedic and spinal procedures are at higher risk, but that the surgical procedure most commonly leading to Ogilvie syndrome was coronary artery bypass grafting. Cardiothoracic surgeons, orthopedic surgeons, and neurosurgeons should be cognizant of this complication in the patient whose abdomen becomes distended postoperatively. If recognized early and treated appropriately, pseudo-obstruction will resolve in most patients. If surgical intervention is required, the subsequent mortality rate is high.

Aged↗
PubMed2002

Incidents and postoperative complications of laparoscopic cholecystectomies for acute cholecystitis.

The purpose of this study was to analyze incidents and postoperative complications of the laparoscopic cholecystectomies performed for acute cholecystitis in 1453 patients in the 3rd Surgical Clinic, Cluj-Napoca. Hemorrhage occurred in 139 (9.5%) cases from which 75 (54%) lesions of the cystic artery, 63 (45.3%) cases of bleeding from the vesicular bed and 1 patient (0.72%) with section of the hepatic artery. Lesions of the bile ducts occurred in 13 (0.9%) patients from which 4 (3.07%) were on the right hepatic duct and 9 (6.93%) on the common bile duct. We encountered 152 (10.46%) early postoperative complications from which 92 (60.5%) were grade I, 56 (37%) grade II, 0 grade III and 4 (2.63%) grade IV, according to Clavien's classification. There were 35 (2.4%) nonspecific postoperative complications from which there where phlebitic reactions in 25 (71.4%) patients, phlebitis in 9 (25.7%) and upper digestive hemorrhage due to acutization of a duodenal ulcer in 1 patient (2.9%). We also registered a number of 20 (1.38%) later postoperative complications: 10 (50%) residual biliary lithiasis in the first postoperative year, and 10 (50%) hernias at the umbilical trocar insertion site.

Acute Disease↗
PubMed2006

Calcineurin inhibitor avoidance versus steroid avoidance following kidney transplantation: Postoperative complications.

This study compared early postoperative complications in kidney transplant recipients treated with either a sirolimus-based calcineurin inhibitor (CNI)-free regimen or a tacrolimus-based steroid-free regimen. We used a single-center, prospective, sequential but nonrandomized study design. Consecutive recipients of primary cadaveric or non-HLA identical kidney transplant recipients received either a CNI-free regimen, consisting of sirolimus 5 mg daily beginning postoperative day 3, mycophenolate mofetil 1 gm twice a day, and methylprednisolone 500 mg intraoperatively, then prednisone 30 mg daily tapered to 10 mg daily at 3 months, or a prednisone-free regimen, consisting of methylprednisolone 500 mg, 250 mg, and 125 mg from days 0 to 2, then no further steroids, tacrolimus 0.075 mg/kg twice a day, and mycophenolate mofetil 1 g twice a day. All patients received thymoglobulin induction 6 mg/kg total dose. Outcome measures were patient and graft survival, BPAR, surgical and wound complications, viral infections and posttransplant diabetes mellitus (PTDM). Both groups had excellent early outcomes with no significant difference in patient or graft survival, early renal function, BPAR, surgical or wound complications, or viral infections between the two groups. Patients in the sirolimus-based CNI-free group had a significantly higher incidence of PTDM and a trend toward more discontinuation due to drug toxicity. Whether either regimen improves long-term outcomes awaits longer follow-up.

Adrenal Cortex Hormones↗