BACKGROUND: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. STUDY DESIGN AND METHODS: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. RESULTS: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. DISCUSSION: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

• MeSH
• Intensive Care Units * MeSH
• Plasma * MeSH
• Hemorrhage therapy   etiology   prevention & control   MeSH
• Middle Aged MeSH
• Humans MeSH
• Blood Component Transfusion * MeSH
• Prospective Studies MeSH
• Aged MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

BACKGROUND: Skeletal muscle alterations are associated with higher mortality and morbidity in patients with liver cirrhosis. Assessing these changes seems to be a promising method for identifying patients at a high risk of poor outcomes following liver transplantation (LT). This is particularly important given the current global shortage of organ donors. However, evidence of the impact of these alterations on the prognosis of patients undergoing LT is inconclusive. The aim of our prospective study was to evaluate the impact of skeletal muscle changes, reflected in sarcopenia, myosteatosis and metabolic changes in the calf muscles, on perioperative outcomes and long-term survival after LT. We also sought to determine the posttransplant evolution of the resting muscle metabolism. METHODS: We examined 134 adult LT candidates. Of these, 105 underwent LT. Sarcopenia and myosteatosis were diagnosed by measuring the skeletal muscle index and mean psoas muscle radiation attenuation, respectively, which were obtained from computed tomography (CT) scans taken during pretransplant assessment. Additionally, patients underwent 31P MR spectroscopy (MRS) of the calf muscles at rest before LT and 6, 12 and 24 months thereafter. The median follow-up was 6 years. RESULTS: Patients with abnormal 31P MRS results and CT-diagnosed myosteatosis prior to LT had significantly worse long-term survival after LT (hazard ratio (HR), 3.36; 95% confidence interval (CI), 1.48-7.60; p = 0.0021 and HR, 2.58; 95% CI, 1.06-6.29; p = 0.03, respectively). Multivariable analysis showed that abnormal 31P MR spectra (HR, 3.40; 95% CI, 1.50-7.71; p = 0.003) were a better predictor of worse long-term survival after LT than myosteatosis (HR, 2.78; 95% CI, 1.14-6.78; p = 0.025). Patients with abnormal 31P MR spectra had higher blood loss during LT (p = 0.038), required a higher number of red blood cell transfusions (p = 0.006) and stayed longer in ICU (p = 0.041) and hospital (p = 0.007). Myosteatosis was associated with more revision surgeries following LT (p = 0.038) and a higher number of received red blood cell transfusion units (p = 0.002). Sarcopenia had no significant effect on posttransplant patient survival. An improvement in the resting metabolism of the calf muscles was observed at 12 and 24 months after LT. CONCLUSIONS: Abnormal 31P MRS results of calf muscles were superior to CT-based diagnosis of myosteatosis and sarcopenia in predicting perioperative complications and long-term survival after LT. Resting muscle metabolism normalized 1 year after LT in most recipients.

• MeSH
• Adult MeSH
• Muscle, Skeletal * diagnostic imaging   metabolism   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Spectroscopy * methods   MeSH
• Tomography, X-Ray Computed * methods   MeSH
• Prognosis MeSH
• Prospective Studies MeSH
• Sarcopenia etiology   metabolism   MeSH
• Aged MeSH
• Liver Transplantation * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Anticoagulation during extracorporeal membrane oxygenation (ECMO) might still lead to severe bleeding complications. Heparin is the most frequently used anticoagulant, but novel drugs could be promising. Argatroban is a new alternative to heparin. To date, no robust studies have confirmed the clear superiority of argatroban (AG) over heparin, although it has some advantages and may be safer. STUDY DESIGN AND METHODS: An observational study was conducted in all adult veno-venous ECMO patients with COVID-19-associated acute respiratory distress syndrome admitted to the University Hospital Ostrava (n = 63). They were anticoagulated with heparin in the first period and with AG in the second period, targeting the same activated partial thromboplastin time (aPTT; 45-60 s). Bleeding complications requiring transfusion and life-threatening bleeding events were evaluated. The primary objective was to compare heparin and AG in terms of bleeding, transfusion requirements and mortality-related bleeding. RESULTS: The total time on ECMO per patient was 16 days with an in-hospital mortality of 55.6%. The red blood cell consumption in the AG group (median 2.7 transfusions/week) was significantly lower than in the heparin group (median 4.2 transfusions/week, p = 0.011). Life-threatening bleeding complications were higher in the heparin group compared to the AG group (35.7% vs. 10.2%, p = 0.035), and mortality-related bleeding complications were also higher in the heparin group (21.4% vs. 2.0%, p = 0.032). DISCUSSION: Argatroban is an interesting alternative to heparin with less bleeding, less need for red blood cell transfusions and improved safety of ECMO with less mortality-related bleeding.

• MeSH
• Anticoagulants * adverse effects   therapeutic use   MeSH
• Arginine * analogs & derivatives   MeSH
• COVID-19 complications   MeSH
• Adult MeSH
• Heparin * adverse effects   MeSH
• Hemorrhage * chemically induced   therapy   MeSH
• Pipecolic Acids * therapeutic use   administration & dosage   MeSH
• Middle Aged MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * MeSH
• Hospital Mortality MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Sulfonamides * MeSH
• Respiratory Distress Syndrome therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Comparative Study MeSH

Pacientka náhle v domácím prostředí dušnost, kolaps a bezvědomí. Provedena laická telefonicky navigovaná kardiopulmonální resuscitace, po příjezdu lékaře rychlé záchranné služby úspěšná rozšířená kardiopulmonální resuscitace a poté pacientka převezena na oddělení urgentního příjmu Nemocnice České Budějovice. Byla provedena základní stabilizace klinického stavu, zajištění pacientky, intubace a odvoz na CT. Zde byla pomocí CT verifikována masivní bilaterální plicní embolie. Ihned v prostorách urgentního příjmu byla provedena trombolýza, stabilizace oběhu a pacientka byla uložena na ARO. Za hodinu na oddělení ARO znovu těžká oběhová nestabilita – vysoká podpora oběhu noradrenalinem. Provedeno UZ a následně CT břicha s nálezem masivního hemoperitonea. Urgentní chirurgické konzilium a doporučena operace z vitální indikace. Provedena urgentní laparotomie u hemodynamicky těžce nestabilní pacientky s TK 60/30 a pulzy 180/min. Za masivní oběhové podpory a převodů erymasy odsáty 4 l zcela nesrážlivé krve v oblasti jater. Játra byla tržena na několika místech od zlomených žeber a nejvíce dorzálně v levém laloku v oblasti jaterních žil. Chirurgicky při těžké oběhové nestabilitě neověřitelné a bylo rozhodnuto o stabilizaci pomocí perihepatického packingu a pacientka byl uložena na ARO RES. ARO pokračuje v konzervativní terapii a dochází k postupnému zmenšení odpadů do drénu. Provedena second-look operace za 48 hod – revize původní ranou, odstranění roušek. Nalezeny mnohočetné trhliny na pravém laloku od zlámaných žeber a dorzálně silně krvácející jaterní žíla. Provedena kombinace selektivních sutur s elektrokoagulací trhlin, pro přetrvávající oběhovou nestabilitu se znovu rozhodujeme dát pouze perihepatický packing. Pacientku znovu necháváme na ARO k oběhové stabilizaci a domlouváme se znovu na operační revizi po stabilizaci oběhu za 48 hod. Přistupujeme k další operační revizi. Provádíme znovu revize perihepatického prostoru a anatomickou resekci jaterního segmentu II a III a selektivní podvaz jaterní žíly. Následně dochází k hemodynamické stabilizaci oběhu. V rámci pooperačního průběhu nejprve dochází k rozvoji fluidothoraxu, který byl vyřešen hrudní drenáží, a akutní akalkulozní cholecystitidě, která byla vyřešena punkční cholecystostomií. Pacientka je nyní primárně zhojena a angiologiem nasazena trvalá antikoagulační terapie. Příčina plicní embolizace nebyla zjištěna.

The patient suddenly experienced shortness of breath, collapse, and loss of consciousness at home. Layperson-performed, telephone-guided cardiopulmonary resuscitation was initiated, and upon the arrival of the emergency medical team, successful extended CPR was performed, after which the patient was transported to the emergency department at Hospital of České Budějovice. Basic stabilization of the clinical condition was carried out, the patient was secured, intubated, and transported to the CT scanner. A massive bilateral pulmonary embolism was verified byCT. Thrombolysis was immediately performed in the emergency room, circulation was stabilized, and the patient was transferred to the ICU. An hour later, the patient experienced severe circulatory instability in the ICU, requiring high-dose norepinephrine support. Ultrasound was performed, followed by a CT scan of the abdomen, which revealed massive hemoperitoneum. An urgent surgical consultation was performed, and surgery was recommended on a vital indication. An urgent laparotomy was performed on a hemodynamically unstable patient with the blood pressure 60/30 and the pulse 180/min. Despite massive circulatory support and erythrocyte transfusion, 4 liters of noncoagulable blood were drained from the hepatic region. The liver was torn in several places due to fractured ribs, most severely in the left lobe at the hepatic veins. Due to severe circulatory instability, the injury was deemed inoperable, and it was decided to stabilize the condition with perihepatic packing, after which the patient was transferred to the ICU. The ICU continued conservative therapy, and there was a gradual reduction in the drainage output. A second-look operation was performed after 48 hours – revision of the original wound and removal of the drapes. Multiple fissures were found in the right lobe, caused by broken ribs, with heavy bleeding from the dorsal hepatic veins. A combination of selective suturing and electrocoagulation of the fissures was performed. Due to ongoing circulatory instability, the decision was made to use perihepatic packing once again. The patient was left in the ICU for further circulatory stabilization, with a plan to do another surgical revision after stabilization in 48 hours. Another surgical revision was performed, revisiting the perihepatic space and performing an anatomical resection of liver segments II and III, followed by selective ligation of the hepatic vein. Hemodynamic stabilization was achieved. Postoperatively, a fluidothorax developed, which was managed by thoracic drainage, and acute acalculous cholecystitis, which was treated with puncture cholecystostomy. The patient is now primarily healed and has been started on long-term anticoagulation therapy by the angiologist. The cause of the pulmonary embolism was not determined.

Cíl: Paroxyzmální noční hemoglobinurie (PNH) představuje vzácné, ale závažné onemocnění krvetvorby způsobené nedostatkem přirozených inhibitorů aktivace komplementu na povrchu buněk projevující se intravaskulární hemolýzou, trombotickými komplikacemi a selháním kostní dřeně. Zavedení léčebného podávání inhibitorů komplementu znamenalo zásadní obrat v prognóze nemocných s PNH. Naše studie shrnuje zkušenosti s podáváním inhibitorů komplementu v ÚHKT v Praze. Soubor nemocných a léčba: Dvacet jedna nemocných s hemolytickou formou PNH bylo léčeno podáním inhibitorů C5 složky komplementu eculizumabu či ravulizumabu. Indikačními kritérii byla recidivující manifestní hemolýza s hodnotami hemoglobinu (Hb) < 100 g/l a event. transfuzní závislost, prodělaná trombotická komplikace či přítomnost renálního selhání. Léčebná odpověď byla měřená vzestupem hodnot Hb, vymizením transfuzní závislosti a poklesem počtu retikulocytů a hodnot LDH. Nemocní s nedostatečnou odpovědí na C5 inhibitor byli převedeni na léčbu inhibitorem C3 složky komplementu pegcetacoplanem. Výsledky: Odpověď na léčbu C5 inhibitorem byla přítomna u 13 z 21 nemocných (61,6 %), 8 nemocných nedosáhlo požadované léčebné odpovědi, u 2 z nich došlo k rozvoji myelodysplastického syndromu (MDS). Šest nemocných s nedostatečnou odpovědí na C5 inhibitor bylo převedeno na léčbu inhibitorem C3 složky komplementu pegcetacoplanem, léčebná odpověď byla přítomna u všech nemocných. Celkem odpovědělo na léčbu inhibitory komplementu 85,1 % nemocných. U žádného z nemocných nebyla při léčbě pozorována trombotická komplikace, tzv. průlomová hemolýza se vyskytla u 6 nemocných (19 %). Průměrná délka přežití činí v současnosti 80,5 měsíce (6,6 roku), pravděpodobnost přežití 10 let a 15 let je 100 %, resp. 79 %. Závěr: Léčba inhibitory komplementu zásadně zlepšila prognózu nemocných s PNH a naše výsledky ukazují v souladu s výsledky jiných studií, že v současnosti přežívají téměř všichni léčení nemocní 10 a více let.

Introduction: Paroxysmal nocturnal hemoglobinuria represents a rare but serious disorder of hematopoiesis. A deficiency in natural complement inhibitors results in intravascular hemolysis, hemoglobinuria, thrombotic complications and bone marrow failure. Introduction of complement inhibitors in the treatment of PNH completely changed the prognosis of the patients. Our study summarizes experience with the treatment of PNH patients using complement inhibitors in Institute of Hematology in Prague. Patients and treatment: Twenty-one patients with hemolytic PNH were treated with C5 complement inhibitors eculizumab or ravulizumab. Indication criteria were recurrent hemolysis with Hb < 100 g/l +/- transfusion dependency, thrombotic complications or chronic kidney disease. Criteria of treatment response were: increase in Hb level, decrease of number of RBC transfusions or transfusion independence and decrease of RTC count and LDH level. Patients with insufficient response to C5 inhibitors were switched to treatment with C3 inhibitor pegcetacoplan. Results: Response to the C5 inhibitors was present in 13 out of 21 patients (61,6%), 8 patients did not achieve sufficient response to the treatment, 2 of them developed myelodysplastic syndrome (MDS). Six patients not responding to C5 inhibitors were switched to C3 inhibitor, the treatment response was present in all of them. Taken together, 85,1% of patients responded to complement inhibitor treatment. No thrombotic complications were observed during the treatment, Breakthrough hemolysis occurred in 6 patients (19%). Median survival of treated patients is currently 80,5 months (6,6 years), estimated 10 years and 15 years survival are 100% and 79% respectively. Conclusions: Treatment with complement inhibitors substantially improved prognosis of PNH patients and our results show (similarly as other studies) that currently almost all treated patients may survive 10 years or more.

• Keywords
• eculizumab,
• MeSH
• Antibodies, Monoclonal, Humanized pharmacology   therapeutic use   MeSH
• Complement Inactivating Agents pharmacology   therapeutic use   MeSH
• Humans MeSH
• Hemoglobinuria, Paroxysmal * drug therapy   MeSH
• Check Tag
• Humans MeSH

Danikopan je selektivní inhibitor faktoru D komplementu, který působí přes alternativní cestu aktivace komplementu. Blokádou alternativní dráhy komplementu danikopan inhibuje extravaskulární hemolýzu (EVH). Účinnost a bezpečnost danikopanu u dospělých pacientů s paroxyzmální noční hemoglobinurií (PNH) s klinicky významnou EVH byly hodnoceny v multicentrické, randomizované, dvojitě zaslepené, placebem kontrolované studii fáze 3 ALXN2040-PNH-301. Danikopan přidaný k ravulizumabu nebo ekulizumabu prokázal superioritu v primárním cílovém parametru zvýšení hladiny hemoglobinu oproti placebu. Danikopan také dosáhl statisticky významného zlepšení ve srovnání s placebem u všech 4 sekundárních cílových parametrů, které byly podíl pacientů se zvýšením hladiny hemoglobinu o ≥ 20 g/l, počet pacientů bez potřeby transfuze, změna ve skóre únavy podle FACIT a změna absolutního počtu retikulocytů. Kombinace léčby danikopanem s inhibitory terminální fáze komplentu C5 stabilizuje i primární intravaskulární hemolýzu danou základním onemocněním PNH. Danikopan je indikován jako přídatná léčba k ravulizumabu nebo ekulizumabu k léčbě dospělých pacientů s paroxyzmální noční hemoglobinurií, kteří mají reziduální hemolytickou anémii.

Danicopan is a selective inhibitor of complement factor D that acts through the alternative pathway of complement activation. By blocking the alternative pathway of complement, danikopan inhibits extravascular hemolysis (EVH). The efficacy and safety of danikopan in adult PNH patients with clinically significant EVH were evaluated in a multicenter, randomized, double-blind, placebo-controlled, phase 3 study ALXN2040-PNH-301. Danicopan added to ravulizumab or eculizumab demonstrated superiority over placebo in the primary endpoint of increase in hemoglobin levels. Danicopan also achieved statistically significant improvements compared to placebo in all 4 secondary endpoints, which were the proportion of patients with an increase in hemoglobin levels of ≥ 20 g/L, the number of patients without a transfusion, the change in FACIT fatigue score, and the change in absolute reticulocyte count. The combination of danicopan treatment with C5 terminal phase inhibitors also stabilizes primary intravascular hemolysis due to the underlying PNH disease. Danicopan is indicated as an add-on therapy to ravulizumab or eculizumab for the treatment of adult patients with paroxysmal nocturnal hemoglobinuria who have residual hemolytic anemia.

• Keywords
• danikopan,
• MeSH
• Complement Factor D antagonists & inhibitors   pharmacology   therapeutic use   MeSH
• Humans MeSH
• Hemoglobinuria, Paroxysmal * drug therapy   MeSH
• Randomized Controlled Trials as Topic MeSH
• Check Tag
• Humans MeSH

The WAA registry has been active since 2002. It allows bed side registration of safety and efficacy data. The data each center enters is accessible for its own use but also used for merged analysis. Most types of procedures are represented. Treatments of many severe diseases as well as the collection of autologous and donor cells for therapeutic use especially in oncologic diseases are recorded. Previous reports have shown a successive reduction in adverse events (AE) over the years. The aim of the present report is to update data of the risk for AE during the years from 2013 to Oct 2024. Contributions of 44 centers from 20 countries were analysed. Over these years, more than 169,000 apheresis procedures have been registered in more than 26,000 patients. During the study period the mean incidence of AE, merged for all types of procedures, was 1.6 /100 procedures for mild, 2.0/100 for moderate and 0.20/100 for severe AE, and reduced since 2013. Since 2002, death due to apheresis could not be excluded in one patient. There was an increased risk of hypotension during apheresis in patients with neurological diagnoses (ICD-10 chapter G) versus those with diseases of the musculoskeletal or connective tissue (ICD-10 chapter M) and vice versa for urticaria and tingling. In conclusion, the present data show the risk for various degrees of AE in apheresis procedures. Many patients suffer from severe illness and apheresis is often offered as a rescue therapy. Although the risk of death due to the apheresis procedure is extremely rare the concomitant severe disease itself poses a risk for severe events.

• MeSH
• Humans MeSH
• Registries * MeSH
• Blood Component Removal * adverse effects   methods   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Patient blood management (PBM) představuje systematickou, multidisciplinární a multimodální léčebnou strategii založenou na důkazech a zaměřenou na pacienta s cílem optimalizovat a zachovat jeho vlastní krevní zdroje. Historie PBM sahá až do 19. století, zatímco moderní praxi formovaly programy jako „bezkrevní chirurgie“ dr. Dentona Cooleyho. Navzdory pokrokům transfuzního lékařství podnítily rozvoj PBM bezpečnostní rizika a nežádoucí účinky transfuze. Dnes tento program zahrnuje optimalizaci hematopoézy, snížení krevních ztrát a zlepšení tolerance anémie. PBM zlepšuje klinické výsledky a bezpečnost pacientů a Světová zdravotnická organizace (WHO) tento program doporučuje implementovat ve všech zemích světa jako standard zdravotní péče.

Patient blood management (PBM) is a patient-centered, systematic, evidence-based, multidisciplinary, and multimodal approach to improve patient outcomes by managing and preserving the patient’s own blood. The history of PBM dates back to the 19th century, while modern practice has been shaped by programs such as Dr. Denton Cooley’s "bloodless surgery". Despite advances in transfusion medicine, the safety risks and side effects of transfusion have driven the development of PBM. Today, this program includes optimizing hematopoiesis, reducing blood loss, and improving the tolerance of anemia. PBM improves clinical outcomes and patient safety, and the World Health Organization recommends implementing this program in all countries of the world as a standard of care.

• Keywords
• Patient Blood Management (PBM),
• MeSH
• Anemia prevention & control   therapy   MeSH
• Bloodless Medical and Surgical Procedures * MeSH
• Blood Transfusion * history   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH

BACKGROUND: In our previous study on erythropoiesis-stimulating agent (ESA) treatment in lower risk myelodysplastic syndromes from the European MDS (EUMDS) Registry, we showed that patients treated with ESAs had longer survival compared with patients who receive red blood cell transfusion (RBCT). In this study, with a longer follow up time and more patients included, we aimed to assess long-term effects on survival and health-related quality of life (HRQoL) of exposure to ESAs with or without RBCT in patients with lower risk myelodysplastic syndromes. METHODS: The EUMDS Registry is a non-interventional, longitudinal, real-world registry prospectively enrolling newly diagnosed patients older than 18 years with lower risk (International Prognostic Scoring System low or intermediate-1) myelodysplastic syndromes from 16 European countries and Israel. The analysis was restricted to patients with haemoglobin concentrations less than 100 g/L enrolled between Jan 1, 2008, and July 1, 2019, with last censoring of data on Dec 31, 2021. Patient management was recorded every 6 months, including treatment, transfusions, and HRQoL. ESA treatment followed local guidelines. The patients were separated into four groups at each study visit: no ESA or RBCT, ESA only, ESA plus RBCT, and RBCT only. The data were analysed longitudinally over time according to ESA and RBCT status during each 6-month interval, using propensity score matching. The main outcomes were median overall survival and leukaemia-free survival, and HRQoL. This study is registered with ClinicalTrials.gov, NCT00600860, as is ongoing. FINDINGS: 2448 patients (the ESA-unexposed group [n=1265] and ESA-exposed group [n=1183]) were diagnosed before July 1, 2019; 1520 (62·1%) were male and 928 (37·9%) were female. Median follow-up time was 3·9 years (IQR 1·6-6·5). After applying eligibility criteria and propensity matching, there were 426 patients in the ESA-unexposed group and 744 patients in the ESA-exposed group. Median overall survival in the ESA exposed group was 44·9 months (95% CI 40·2-50·5) compared with 34·8 months (28·6-39·2) in the ESA unexposed group; the absolute difference was 10·1 months (95% CI 2·2-18·0; hazard ratio [HR] 0·70 [95% CI 0·59-0·83]; p<0·0001). Patients without RBCT in the presence or absence of ESA exposure maintained significantly better HRQoL than those with RBCT, irrespective of ESA exposure (linear mixed effect model of EQ-5d-3L index score, RBCT coefficient -0·04 [95% CI -0·06 to 0·03], p<0·0001; linear mixed effect model of VAS, -4·57 [-6·02 to -3·13], p<0·0001). INTERPRETATION: ESA treatment in patients with lower risk myelodysplastic syndromes significantly improves overall survival when started before or early after the onset of regular transfusion therapy. Avoiding RBCT is associated with significantly better HRQoL. FUNDING: H2020 European Research Council, Novartis Pharmacy B V Oncology Europe, Amgen, BMS/Celgene International, Janssen Pharmaceutica, Takeda Pharmaceuticals International, and Gilead Sciences.

• MeSH
• Hematinics * therapeutic use   MeSH
• Cohort Studies MeSH
• Quality of Life * MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Myelodysplastic Syndromes * drug therapy   mortality   therapy   complications   MeSH
• Registries MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Erythrocyte Transfusion adverse effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

The influence of surgical volume on partial nephrectomy (PN) outcomes is a subject of debate. The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel performed a protocol-driven systematic review of the association between hospital volume (HV) and oncological, functional, and complication outcomes following PN for RCC. The intervention was PN performed in a higher-volume hospital (defined according to the number of procedures per unit time) and the comparator was PN performed in a lower-volume hospital. Ten studies involving a total of 106 569 patients were included in the review. Higher HV was associated with lower complication rates, shorter length of stay, lower positive surgical margin rates, and lower transfusion rates. For six studies, multivariable analyses showed that low HV was an independent risk factor for inpatient complications, PSM presence, longer LOS, and failure to achieve a trifecta of no complications, warm ischemia time <25 min, and negative surgical margins. Most studies were judged to have high risk of bias. The available evidence suggests a potential association between higher HV and better PN outcomes in RCC. The EAU RCC guidelines panel encourages the development and rigorous evaluation of indicators of surgery quality in RCC to better inform the designation of high-quality centers within models of centralized care.

• MeSH
• Hospitals, Low-Volume * statistics & numerical data   MeSH
• Length of Stay MeSH
• Carcinoma, Renal Cell * surgery   MeSH
• Humans MeSH
• Kidney Neoplasms * surgery   MeSH
• Nephrectomy * methods   standards   adverse effects   MeSH
• Postoperative Complications epidemiology   MeSH
• Practice Guidelines as Topic MeSH
• Hospitals, High-Volume * statistics & numerical data   MeSH
• Urology standards   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Systematic Review MeSH
• Geographicals
• Europe MeSH