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At least 19 recordsLinked to original sources
PubMed2026

Outcomes of Suture Tape-Augmented ACL Reconstruction in Patients With High Internal Rotational Tibial Subluxation: A Minimum 3-Year Cohort Study.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts faces persistent challenges of graft failure, especially in patients with high internal rotational tibial subluxation (IRTS). HYPOTHESIS: Patients with high IRTS who undergo HT autograft ACLR with suture tape augmentation (STA) will have lower graft failure rates and superior clinical outcomes as compared with those without STA. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This retrospective cohort study included patients with high IRTS-defined as lateral minus medial anterior tibial subluxation >5.8 mm based on prior studies-who underwent primary ACLR using HT autografts with STA and had a minimum follow-up of 3 years. Propensity score matching (1:1) was performed to identify a control group of patients with similarly high IRTS who underwent HT ACLR without STA. Postoperative outcomes were assessed by the International Knee Documentation Committee score, Lysholm score, and Tegner activity scale, as well as by return-to-sport status and graft failure. Clinically meaningful improvements were evaluated by the minimal clinically important difference, Patient Acceptable Symptom State, and substantial clinical benefit. RESULTS: This study included 62 patients with high IRTS: 31 with STA and 31 matched controls. The mean IRTS was 6.6 mm (range, 5.9-8.9) in the STA group and 6.8 mm (range, 5.8-8.7) in the control group. The mean patient age was 32.9 years (range, 20-50), and the mean follow-up was 3.8 years (range, 3.1-5.0). At final follow-up, the STA group showed significantly higher proportions of patients achieving the minimal clinically important difference (93.5% vs 74.2%; P = .038), Patient Acceptable Symptom State (96.8% vs 74.2%; P = .012), and substantial clinical benefit (54.8% vs 25.8%; P = .020). The return-to-sport rate was also higher in the STA group (74.2% vs 48.4%; P = .037). Additionally, the STA group demonstrated a lower graft failure rate (0% vs 12.9%; P = .039). CONCLUSION: For patients with high IRTS, STA in ACLR with HT autografts is associated with improved clinical outcomes, a higher return-to-sport rate, and a lower risk of graft failure at midterm follow-up.

Humans↗
PubMed2026

The combined impact of HLA and non-HLA mismatch between donors and recipients on kidney transplant survival: a genomic analysis in a prospective cohort.

BACKGROUND: Kidney transplantation outcomes are strongly influenced by immunological compatibility between donor and recipient. While genetic mismatches in the human leukocyte antigen (HLA) region have long been recognised as key determinants of graft survival, increasing evidence, including our own previous work, suggests that non-HLA alloimmunity also plays a critical role. METHODS: We sequenced exomes of deceased kidney donor and recipient pairs in the prospective kidney transplant cohort at the Vienna General Hospital, recruited between January 1, 2012, and June 15, 2023. Out of 1209 pairs, 1187 passed quality control for analysis. Non-HLA mismatch was computed by considering non-synonymous single nucleotide polymorphisms specifically encoding trans-cell membrane or secreted proteins in the kidney (nsSNP-tcmsk). Using adjusted Cox proportional hazards models, we replicated results from our earlier work in recipients with primary graft function after 90 days, and extended the analysis to the combination of nsSNP-tcmsk with eplet mismatch to assess their associations with graft loss in the full cohort. FINDINGS: Of 20,421 human proteins, 2371 were considered for the nsSNP-tcmsk score. In our replication analysis we estimated for nsSNP-tcmsk a hazard ratio (HR) of 1.33 (95% CI 1.02-1.74) for graft loss per increase of one interquartile range. The nsSNP-tcmsk and eplet mismatch were uncorrelated (Spearman correlation coefficient 0.02, p = 0.47). A composite score of nsSNP-tcmsk and eplet mismatch was associated with graft loss with a HR of 1.76 (95% CI 1.20-2.57) corresponding to an absolute difference in 7-year restricted mean survival time between the first and fourth quartiles of 0.52 years (95% CI 0.16-0.87 years). INTERPRETATION: The impact of non-HLA donor-recipient mismatch on transplant loss is of the same magnitude as established mismatch scores in the HLA region. Together, these scores may be further validated as guiding markers for the required strength of maintenance immunosuppression. FUNDING: Vienna Science and Technology Fund, NIH/NIAID.

Humans↗
PubMed1977

[Keratoplasty in childhood (author's transl)].

Report on 36 keratoplasties (30 eyes) in children up to 15 years of age. An efficient postoperative care was of critical importance for the final outcome. The specific problems are discussed. Regarding the fact that generally children are only operated on in case of heavy corneal disease which brings about a higher risk of graft failure our results may be judged as "fair": 63% of the transplants were optically clear; 43% exhibited good and 30% fair functional results. The best results were achieved with keratoplasties in corneal dystrophies (keratoconus included). Another group with good results was that with herpetic corneal disease, whereas transplants after heavy perforating injuries mostly failed. A beter postoperative medical collaboration and consultation is needed to improve final results. This is especially true for correcting operative measures (loosening sutures) and for therapy and prophylaxis of graft reactions.

Age Factors↗
PubMed1977

First experiences with HLA-matched corneal grafts in high risk cases.

In highly vascularized corneas the number of graft failures caused by irreversible rejections is higher than in non-or slightly vascularized corneas. The importance of antigen compatibility is demonstrated, especially in these 'high risk' cases. Ten highly vascularized corneas were grafted with HLA-matched donor material; only one reversible rejection was seen in this group. Nine non-or slightly vascularized corneas were grafted with donor material chosen a random. Retrospective HLA matching was performed. Three irreversible rejections were seen in this group. The number of HLA incompatibilities was high.

Corneal Transplantation↗
PubMed2026

Efficacy and safety of Vertebral Body Sliding Osteotomy (VBSO) versus Anterior Cervical Corpectomy and Fusion (ACCF): A systematic review and meta-analysis.

Anterior cervical corpectomy and fusion (ACCF) is an established treatment for complex cervical myelopathy and ossification of the posterior longitudinal ligament (OPLL), yet it carries risks of dural injury and graft-related failure. Vertebral body sliding osteotomy (VBSO) is a novel technique that avoids direct OPLL manipulation by translating the vertebral body anteriorly to enlarge the spinal canal. Although early studies suggest VBSO may reduce complications, evidence remains limited to retrospective cohorts from the technique's developers, with no high-level synthesis directly comparing it to ACCF. We therefore conducted this meta-analysis to compare clinical outcomes, complications, and radiographic parameters between VBSO and ACCF, while critically evaluating the certainty of the evidence and its generalizability. A systematic search of PubMed, Embase, Scopus, the Cochrane Library, and Web of Science (through June 2025) identified four retrospective cohort studies (449 patients; VBSO n&#x2009;=&#x2009;209, ACCF n&#x2009;=&#x2009;240). A critical limitation of the included evidence is that all studies originated from a single institution (Asan Medical Center, Seoul, Korea) with overlapping enrollment periods (2006-2020), increasing the risk of duplicate patient cohorts. Furthermore, the first author (D.-H. Lee) is the same across all included studies, introducing substantial surgeon-expertise bias. Outcomes included neurological recovery, functional outcomes, complications, and radiographic parameters. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Neurological recovery and functional outcomes were comparable between groups. ACCF showed slightly higher postoperative JOA scores (MD -0.59, 95% CI -0.96 to -0.22; p&#x2009;<&#x2009;0.01), though the clinical relevance is uncertain. VBSO was associated with reduced risks of graft subsidence (RR 0.23; p&#x2009;<&#x2009;0.01), pseudarthrosis (RR 0.25; p&#x2009;<&#x2009;0.01), revision surgery (RR 0.17; p&#x2009;<&#x2009;0.01), and neurological deterioration (RR 0.17; p&#x2009;=&#x2009;0.02). CSF leakage appeared to be less frequent with VBSO, but the difference was not statistically significant. VBSO was also associated with greater postoperative cervical lordosis and shorter hospital stays. However, these findings must be interpreted with extreme caution: leave-one-out sensitivity analyses revealed that the results for postoperative JOA score, neurological deterioration, and pseudarthrosis were fragile and driven by a single large study, meaning these apparent advantages may not be robust. In addition, GRADE assessment revealed very low certainty across all assessed outcomes. Given the very low certainty of evidence, the preliminary nature of the available data, the fragility of several key findings, and the critical limitations of the underlying studies (single institution, overlapping patient cohorts, developer bias, and systematic imbalance in follow-up duration), the observed differences should be considered hypothesis-generating rather than definitive. VBSO should not be considered a proven superior alternative to ACCF based on the current evidence. Prospective, multicenter, international studies with balanced follow-up durations conducted by independent surgical teams are required before broader adoption can be recommended.

Humans↗
PubMed1977

Renal transplantation and a positive serological cross-match.

A renal transplant involving a recipient with a positive serological cross-match against donor lymphocytes generally results in hyperacute rejection of the graft. 13 cadaveric renal transplants were performed in recipients with a known positive serologic cross-match against donor B lymphocytes. 12 of these serological cross-matches were positive against donor blood, node, or spleen lymphocytes, but the reactivity was directed against donor B lymphocytes only. 3 transplants failed, 2 because of rejection and 1 because of renal-artery thrombosis. 10 transplants are functioning, 6 to 42 weeks after the operation. Of these 10 successful grafts, 3 had no acute rejection episodes, while 7 had an early acute rejection episode which responded to treatment. Histologically, the grafts showed a cellular rejection, similar to that in enhanced renal allografts in the rat. It is possible to transplant a kidney in a high-risk patient with a positive B lymphocyte cross-match with a low risk of failure. In addition active enhancement of the graft might sometimes occur.

Acute Disease↗
PubMed1978

Polytetrafluorethylene (PTFE) grafts for hemodialysis. 18 months' experience.

18 months clinical experience with 6 mm polytetrafluorethylene forearm grafts for hemodialysis access has been described. 35 grafts were implanted, all in patients who had unsuitable vessels for construction of a regular Brescia-Cimino forearm fistula. The overall patency was 71% with mean duration of 10.3 months, and at any one time more than 85% of the grafts at risk were functional. Complications, including undesirable flow rates, edema, thrombosis, aneurysm and cardiac failure have been discussed and rational methods of avoidance described. We believe the polytetrafluorethylene (PTFE) graft represents an important advance in hemodialysis access.

Adult↗
PubMed2026

Posterior Segment Risk Factors for Penetrating Keratoplasty Failure.

PURPOSE: To analyze the relationship between intraoperative and postpenetrating keratoplasty (PK) posterior segment variables and PK graft survival. DESIGN: Retrospective clinical cohort study. SUBJECTS: Patients undergoing PK between May 1, 2007 and September 1, 2018 at a single tertiary center. METHODS: Chart review for PKs performed was conducted, and the first PK completed at the institution for each patient was included for analysis. Data collected included demographics, medical and ocular history, preoperative and intraoperative findings, and intraoperative and postoperative posterior segment factors (pars plana vitrectomy [PPV], endolaser, retinal detachment [RD], and vitreous hemorrhage [VH]). After univariable analysis, variables were selected for multivariable Cox regression analysis. MAIN OUTCOME MEASURE: Graft failure, defined as irreversible and visually significant corneal edema, haze, or scarring. RESULTS: Eight hundred and thirty-five eyes of 835 patients were included. Mean age was 57.1 &#xb1; 22.0 (range: 0-100) years, and mean time from PK to final follow-up or graft failure was 3.2 &#xb1; 2.9 (range: 0.01-16.1) years. Graft failure occurred in 35.0% of cases with a mean onset of 1.9 &#xb1; 2.0 (range: 0.04-11.4) years after PK. After multivariable analysis, 9 variables had significant associations with failure. Two posterior segment variables were significant: intraoperative VH at the time of PK (hazard ratio [HR] 6.6, 95% confidence interval [CI] 1.6-27.7, P = .010) and silicone oil (SO) tamponade after the PK (HR 3.2, 95% CI 1.4-7.4, P = .007). CONCLUSIONS: Graft failure is a serious complication of PK. VH at the time of the PK and SO tamponade after the PK were associated with graft failure. In complex eyes that are undergoing PK grafts and that may also require posterior segment interventions, these findings may guide patient counseling and discussion of graft prognosis.

Humans↗
PubMed1977

The use of "fresh" unstented homograft valves for replacement of the aortic valve: analysis of 6 1/2 years experience.

Between August 1969 and January 1976, 561 patients underwent homograft replacement of the aortic valve (AVR). Isolated AVR was performed in 339 patients, ranging in age between 18 months and 74 years. The valves were sterilized in antibiotic solution and preserved at 4 degrees C in tissue culture medium. There were 11 early deaths (3.2%) and 23 late deaths (6.8%). Actuarial analysis showed 88% survival at 5 years and 85% at 6 years. Valve failure occurred in 13 patients (3.8%) due to prolapse of one cusp in five patients (1.5%), infective endocarditis in three and degeneration of the graft in five (1.5%). Degenerative valve failure was encountered after the fourth year with an incidence of 3.5% of patients at risk, and occurred only in grafts from donors over the age of 70 years. Diastolic murmurs were present in 22% of patients followed up for more than one month and increased very slightly with time. The clinical result was judged to be good or excellent in approximately 90% of the surviving patients.

Adolescent↗
PubMed1978

Histocompatibility (HLA) antigens and keratoplasty.

In 84 cases of keratoplasty, all patients had densely vascularized corneas and a history of prior exposure to HLA antigens by pregnancy, blood transfusion, or previous transplantation. Donors were selected on the basis of a negative crossmatch to avoid donor antigens to which the recipient was preimmunized. The overall rate of graft failure from rejection was 15%. A retrospective analysis of donor-recipient HLA matching in 103 high-risk cases showed no consistent correlation between the number of antigens shared and graft outcome. These findings indicated negative cross-match to be important in donor selection for keratoplasty in high-risk cases.

Adolescent↗
PubMed1978

Pathology of coronary artery bypass graft surgery.

Coronary artery bypass graft surgery has been available and widely successful for the symptomatic treatment of ischemic heart disease. Despite its widespread use, there is little information available on the pathological consequences of this procedure on the human heart. In this article, morphological consequences of coronary artery bypass graft surgery is reviewed. Intimal changes occurring within the vein graft itself consist predominately of fibrous initimal proliferation, which in some patients may progress to from an occlusive plaque. Most occlusions, however, occur at the coronary artery bypass graft anastomosis site and the mechanisms of occlusion include compression of the vascular lumen, thrombosis, and dissection of the coronary artery. Most graft failure occurs in the setting of too small a native coronary artery lumen. The myocardium is also at risk for alterations as a result of the bypass operation. Contraction band or reperfusion necrosis is the type of injury most commonly seen, and it appears to occur most often in the distribution of patent grafts. Accelerated atherosclerosis in vein grafts and the myocardial injury associated with revascularization require further detailed morphological studies, but these are important areas for pathological exploration since they bear on important and yet unanswered questions about coronary bypass surgery: can it in the long run perserve myocardium and prolong life?

Adult↗
PubMed1976

Transplant nephrectomy and simultaneous second graft retransplantation.

Tranplant nephrectomy and retransplantation has become an established modality in treating patients with rejected kidney allografts. Experience with 29 patients who underwent simultaneous transplant nephrectomy and retransplantation is presented. This procedure did not involve a considerably greater risk than a primary transplant and had an almost equal rate of success. There was no significant correlation between survival or failure of the second graft and the time the patient had been on dialysis prior to the first transplant, the duration of first graft survival, or the source of the first or second kidney. Seventy-five percent of the failures in the second transplant group were due to hyperacute or accelerated rejection, and only 25% were rejected in an acute or chronic fashion. The high frequency of hyperacute and accelerated rejections is presumably a result of presensitization by the first transplant. An inadequate supply of cadaver kidneys prevented performance of the simultaneous procedure in all patients that required it.

Adolescent↗
PubMed2026

Should we consider excessive weights in pediatric kidney transplant recepient candidates?: A systematic review and meta-analysis of kidney transplantation outcomes.

INTRODUCTION: In adult populations, excess body weight has been associated with an increased risk of adverse clinical outcomes and mortality following kidney transplantation. In contrast, the influence of obesity on transplantation outcomes among pediatric populations is not yet fully understood. This study aimed to evaluate the association between pre-transplant excess weight and post-transplant outcomes in pediatric kidney transplant recipients. MATERIAL & METHODS: A systematic literature search was performed across PubMed, ScienceDirect, and the Cochrane Library, covering publications up to December 31, 2025. The quality of the included studies was evaluated using the ROBINS-E tool. Statistical analysis was conducted using Review Manager version 5.4. RESULTS: From a total of 1465 records screened, six studies that included 65,483 participants were selected in the meta-analysis. The results indicated that pre-transplant excess weight was significantly associated with an increased risk of acute rejection (OR = 1.09; P = 0.009), delayed graft function (OR = 1.17; P < 0.00001), 1-year graft failure (OR = 1.16; P = 0.0002), and 5-year graft failure (OR = 1.13; P = 0.009). Although 5-year mortality was also higher among recipients with excess weight, this association was not statistically significant (OR = 1.08; P = 0.11). CONCLUSION: Pediatric patients with pre-transplant excess weight had higher post-transplant odds of acute rejection, delayed graft function, and both 1-year and 5-year graft failure compared to those without excess weight. These findings highlight the importance of assessing and managing excess weight prior to kidney transplantation to help prevent adverse outcomes in the future.

Humans↗
PubMed1976

Extra-anatomic bypasses for aortoiliac disease in high-risk patients.

A series of 75 patients, with an average age of 65 years, underwent the following extra-anatomic bypasses involving the crossover femorofemoral principle: femorofemoral (F-F), 54 patients; aortofemorofemoral (A-F-F), 12 patients; common iliac-femorofemoral (CI-F-F), six patients; and axillofemorofemoral (Ax-F-F), three patients. Fifty eight of the 75 patients (77 percent) initially presented with rest pain or gangrene. The operative mortality rate in this high-risk group of patients was 4 percent. Analysis by the life-table method showed the graft patency rate to be 91.1 percent at one year and 87.4 percent at 18 months. There have been no graft failures or deaths in the series of 20 patients followed longer than 18 months. Two amputations followed graft failures and nine of the remaining 11 amputations were done in patients with patent grafts during the same period of hospitalization, reflecting the severity of their gangrene upon admission. High-risk patients who are not suitable for crossover F-F grafts without an inflow procedure may be suitable for a CI-F-F or A-F-F bypass before being considered for an Ax-F-F bypass.

Adult↗
PubMed1976

Renal transplantation in high risk patients older than sixty years.

Nine patients between the ages of sixty and seventy-one years, with end-stage renal failure, received kidney grafts during a five year period. Five received related donor kidneys and four received cadaver donor kidneys. Six of these patients are still alive--four of the five (80%) with related kidneys and two fo the four (50%) with cadaver kidneys. All six patients have normal kidney function an average of twenty-seven months after transplantation. We believe the elderly uremic patient should not be categorically excluded as kidney graft recipients on the basis of age alone. The prognosis of these patients treated by transplantation far exceeds that for uremic patients of the same age who are restricted to hemodialysis therapy.

Age Factors↗
PubMed1976

The role of lymphocyte-dependent antibody in kidney transplantation.

The lymphocyte-dependent antibody (LDA) assay has been used in parallel with the microlymphocytotoxicity test detecting complement-dependent antibody (CDA) in 100 cadaver kidney transplant recipients, in order to assess the role of the LDA phenomenon in the rejection of human allografts. In 15 cases, acid eluates were prepared from the kidney graft after rejection or at autopsy and tested in parallel with pre- and post-transplantation sera. The results indicate a marked increase in sensitivity of LDA assay compared with the standard microlymphocytotoxicity test. In 12 patients the pretransplant serum was found retrospectively LDA positive, but CDA negative, using the kidney donor lymphocytes or allogeneic lymphocytes bearing the same incompatible antigen(s) for the recipient as targets. Ten of them lost their graft, mostly during the first month after transplantation. Graft survival was also poor in the 11 patients having both LDA and CDA activity in their pretransplant serum, even when the specificity of the serum did not appear to be directed against antigens shared by the donor. Although it is not clear yet, whether the two assays detect the same or different antibody molecules, it appears that the detection of even a low level of LDA activity before transplantation is associated with a high risk of early transplant failure.

Antibodies↗
PubMed1978

Endarterectomy of the popliteal artery for segmental occlusive disease.

Segmental occlusive disease though limited to the popliteal artery gives rise to significant ischemic symptoms such that surgical treatment is indicated. Endarterectomy with vein angioplasty was the primary procedure in 76 patients (79 limbs) over the past 15 years. Augmentive lumbar sympathectomy was performed in 30 patients. Endarterectomy restoration was successful in 73 patients (76 limbs). Acute postoperative thrombosis occurred in six limbs, four were restored, one survived, one underwent delayed amputation. Long term failures developed in 18 limbs, four were restored, 11 survived without further treatment, and three were amputated. All limbs were classified according to stages of outflow obstruction and extent of endarterectomy; however, there was no meaningful pattern of correlation with failures except to note that amputations occurred only in advanced stage III obstructions. Thirty-two patients (43%) were restudied by arteriography. Cumulative patency rate for 79 limbs at risk at five years was 75.6%, at ten years, 58.5%. Restoration of popliteal patency can be accomplished by endarterectomy with results comparable to femoral-popliteal saphenous vein graft for more proximal lesions. Endarterectomy affords the advantage that a bypass procedure can still be performed in most failures as the long saphenous vein, not sacrificed initially, is still available.

Adult↗