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Leah B Edwards

Publications and source records attributed to Leah B Edwards.

At least 19 recordsLinked to original sources
PubMed2006

Mycophenolate mofetil and risk of developing malignancy after orthotopic heart transplantation: analysis of the transplant registry of the International Society for Heart and Lung Transplantation.

BACKGROUND: Malignancy after organ transplantation has been described as the "price of immunotherapy." Evolving strategies aimed at effective immunosuppression could have differing effects on the likelihood of developing malignancy. We analyzed data from the transplant registry of the International Society for Heart and Lung Transplantation (ISHLT) to ascertain which factors are associated with the development of malignancy after orthotopic heart transplantation (OHT). METHODS: Multivariate modeling was performed to determine factors predictive of first post-transplant malignancy in patients taking standard immunosuppressive regimens, defined as cyclosporine or tacrolimus and azathioprine or mycophenolate mofetil (MMF), who underwent OHT between January 1, 1995 and December 31, 1997. RESULTS: Of the 3,895 transplants described in the cohort, 703 (18%) developed post-transplant malignancy at any time during the follow-up period, and 549 (14%) developed malignancy within the first 5 years post-transplant. The breakdown of malignancy was as follows: skin: 47%; post-transplant lymphoproliferative disease: 10%; other malignancies: 24%; combination of types: 10%; and unreported: 10%. Multivariate modeling revealed that independent predictors of increased risk were prior malignancy and increased age, whereas the use of MMF as part of a standard immunosuppressive regimen was associated with an adjusted relative risk (RR) = 0.73 (95% confidence interval 0.56 to 0.95). Relative to a recipient age of 55 years, the risk of malignancy for 30, 45 and 60 years of age was 0.32, 0.46 and 1.37, respectively. Although the use of tacrolimus appeared protective in the univariate analysis, it was not significant according to multivariate analysis. Female gender appeared to be protective. Neither OKT3 nor anti-thymocyte globulin (ATG) use was associated with a significantly increased risk of malignancy. CONCLUSIONS: The choice of immunosuppressive regimen may affect the likelihood of developing malignancy after OHT. Induction immunosuppression does not appear to increase the risk of subsequent malignancy. The use of MMF in standard immunosuppressive regimens is associated with a significantly lower risk of developing malignancy.

Aging↗
PubMed2004

Optimal timing of cardiac transplantation after ventricular assist device implantation.

OBJECTIVE: We sought to determine the influence of the interval from ventricular assist device implantation to cardiac transplantation on end-organ function and posttransplantation survival. METHODS: United Network for Organ Sharing data on 2692 heart transplantations performed in adult patients in the United States between October 1999 and March 2001 were reviewed. RESULTS: Seventeen percent (466) of adult heart transplant recipients were bridged to transplantation with a ventricular assist device. Almost half of patients with ventricular assist devices undergoing transplantation were upgraded to status 1A as a result of ventricular assist device-related complications occurring more than 30 days after ventricular assist device implantation. Creatinine and total bilirubin levels were less in patients undergoing transplantation after 2 to 4 weeks of mechanical support. One-year survival was higher in the nonventricular assist device than in the ventricular assist device group (85.7% vs 79.7%, P =.0004). Within the ventricular assist device group, survival was lower for patients undergoing transplantation within 2 weeks of ventricular assist device implantation compared with those undergoing transplantation later (74.2% vs 84.2 %, P =.03). One-year survival among patients supported with a ventricular assist device for more than 30 days without complications was 91.4%. Multivariate analysis demonstrated a significant independent effect of the time interval from ventricular assist device implantation to transplantation on posttransplantation mortality and suggested that a period of lowest risk might exist between 1 and 3 months after implantation. CONCLUSIONS: Survival after cardiac transplantation is influenced by the time interval from ventricular assist device insertion to transplantation. Survival is significantly lower when performed within 2 to 4 weeks of ventricular assist device implantation.

Adult↗
PubMed2004

Outcomes of COPD lung transplant recipients after lung volume reduction surgery.

STUDY OBJECTIVES: We sought to assess the outcomes of COPD lung transplant recipients who had previously undergone lung volume reduction surgery (LVRS), and to compare these patients to those COPD lung recipients who had not previously undergone LVRS. DESIGN: Retrospective analysis of the United Network for Organ Sharing transplant database over the period between October 25, 1999, and December 31, 2002. PATIENTS: All COPD patients who were listed and underwent transplantation during the time period were analyzed and categorized according to who did and did not have a history of LVRS. The two groups were compared for demographics, severity of illness, and various measures of outcomes after transplantation, including survival. RESULTS: There were 791 COPD patients who underwent transplantation, of whom 50 had a history of LVRS. The two groups had similar demographics and severity of disease. There was no difference in the need for reoperation, hospital length of stay, or survival between the groups. CONCLUSION: A history of LVRS does not impact on outcomes after lung transplantation and should not influence a patient's candidacy for transplantation. Similarly, a patient's potential need for lung transplantation should not impact on the decision-making process for undergoing LVRS.

Female↗
PubMed2004

Current status of thoracic organ transplantation and allocation in the United States.

The new Lung Allocation Score (LAS) system was created to address issues related to extended candidate waiting time, limited organ supply, waitlist mortality, and post-transplant survival. All candidates age 12 and older will be assigned an LAS that determines their priority for receiving lung offers. Waiting time will no longer play a factor in allocating organs to these candidates. Pediatric candidates under age 12 will continue to be allocated donor lungs based primarily on their accumulated waiting time. The LAS is the end product of an algorithm that assigns priority to lung candidates who are at higher risk of death if they do not receive a transplant (waitlist urgency) and who are likely to receive a greater benefit of longer lifetime with a transplant than without a transplant (transplant benefit). A variety of clinical factors, including disease diagnosis, were found to be predictive of waitlist urgency and post-transplant survival among transplant candidates, and are used in the calculation of each candidate's LAS. Pediatric and adolescent lung transplant candidates will have first priority for receiving offers from pediatric and adolescent lung donors. The lung allocation system will undergo frequent periodic reviews by OPTN/UNOS Committees to ensure that the performance goals of the system are being met and to address modifications to the system as they become necessary. The heart allocation system is an urgency status system under which adult and pediatric candidates are prioritized for organ offers by increasing levels of medical urgency. Median waiting time to transplant is shortest in the more medically urgent categories: Adult Status 1A=52 days, 1B=82 days, 2=468 days; Pediatric Status 1A=53 days, 1B=61 days, 2=149 days. Mortality among adult candidates after listing is strongly influenced by the medical urgency status at listing. Similarly mortality after transplantation for adult recipients also appears to be affected by the medical urgency status at transplant.

Adult↗