Background:Malignancy is a common complication after renal transplantation. Death with functioning graft and chronic graft loss are two competing outcomes in patients with post-transplant malignancies.Objectives:The purpose of our study was to evaluate the risk factors associated with cumulative incidence of these two outcomes.Patients and Methods:Fine-Gray model was used for 266 cases with post-transplant malignancy in Iran. These patients were followed-up from the diagnosis until the date of last visit, chronic graft loss, or death, subsequently.Results:At the end of the study, as competing events, chronic graft loss and death with functioning graft were seen in 27 (10.2%) and 53 cases (19.9%), respectively, while 186 cases (69.9%) were accounted as censored. The incidence rate of death was approximately two-time of the incidence rate of chronic graft loss (8.6 vs. 4.4 per 100 person-years). In multivariate analysis, significant risk factors associated with cumulative incidence of death included age (P < 0.007, subhazard ratio (SHR) = 1.03), type of cancer (P < 0.0001), and response to treatment (P < 0.0001, SHR = 0.027). The significant risk factors associated with cumulative incidence of chronic graft loss were gender (P = 0.05, SHR = 0.37), treatment modality (P < 0.0001), and response to treatment (P = 0.048, SHR = 0.47).Conclusions:Using these factors, nephrologists may predict the occurrence of graft loss or death. If the probability of graft loss was higher, physicians can decrease the immunosuppressive medications dosage to decrease the incidence of graft loss.
Context: Randomized controlled trials (RCTs) have a major role in making the evidence-based decisions on healthcare. Therefore, the assessment of the quality of RCTs is important to properly apply the evidence-based healthcare. The current study aimed at assessing the quality of RCT reports published in Trauma Monthly Journal. Evidence Acquisition: The quality assessment of each report was performed using a checklist based on the CONSORT (consolidated standards of reporting trials) Statement and Jadad criteria. Results: Fifteen RCTs were published from 2011 to 2015 in Trauma Monthly journal out of which 5 (33.3%) reported the pain outcomes, 7 (46.6%) reports included surgical interventions, and 3 (33.3%) reports included patients with different types of fractures. According to the CONSORT checklist, the best report belonged to the definition of interventions for each group with sufficient details. The mean score of Jadad was 2.27 (45.4% of maximum possible total score). According to both scales, there was an increase in the periods of time in the quality of reporting. Conclusions:The results showed a moderate quality score in RCTs and a minor improvement over the years. Training courses for researchers, managing reporting standard tools presented by editors (CONSORT checklist) and employing methodologists and statistical experts can develop the quality of published RCTs.Keywords: Quality Assessment, Randomized Controlled Trial, Checklist, Trauma Context Quality Assessment of Randomized Controlled TrialsRCTs are often performed to assess the effect of new treatments and are considered evidence-based for clinical trials (1). Therefore, it is of paramount importance to design and report high-quality RCTs. Also, for proper use and exploration of the evidence-based approach, it is important and necessary to assess the quality of RCTs.The quality of a trial was explained by the validity and accuracy of analysis and design. But, the quality of reporting was explained as reporting characteristics about the analysis and design of the RCT (2).There are various approaches to assess the quality of RCTs. It is usually performed using 3 tools of the component, checklist, and scale.Also, the quality of RCTs was evaluated in the metaanalysis studies. The CONSORT (consolidated standards of reporting trials) guidelines and Jadad criteria are often used in meta-analysis studies. Recently, to integrate the results of RCTs, meta-analyses are conducted increasingly (3, 4). Therefore, there is a great interest to evaluate the quality of RCTs to include them in the meta-analyses (5-7). Therefore, since the quality of trials affect the results of meta-analyses, results may be less valuable if the quality of RCTs is not assessed (2). To achieve the valuable results of a trial, the quality of RCT is very important.It is recommended that journals implement more CONSORT guidelines (8). The works should be complete and clear before publishing.However, RCTs are increasingly published in journals (9). It is important for the promotion ...
Background:All recipients of kidney transplantation, especially those with posttransplant malignancy, are at risk of long-term graft failure.Objectives:The purpose of our study was to evaluate the risk factors associated with graft survival after diagnosis of malignancy.Patients and Methods:To reach this purpose, we conducted a historical cohort study in Iran and 266 cases with posttransplant malignancy were followed up from diagnosis of malignancy until long-term graft loss or the date of last visit. These patients were taken as a census from 16 Transplant Centers in Iran during 22 years follow-up period since October 1984 to December 2008. A Cox proportional hazards model was performed to determine the important independent predictors of graft survival after malignancy.Results:At the end of the study, long-term graft failure was seen in 27 (10.2%) cases. One-year and 2-year graft survival after diagnosis of cancer were 93.6% and 91.7%, respectively. The univariate analysis showed that the incidence of chronic graft loss was significantly higher in male patients with solid cancers, withdrawal of immunosuppressant regimen, no response to treatment, and tumor metastasis. In continuation, the Cox model indicated that the significant risk factors associated with graft survival were type of cancer (P < 0.0001), response to treatment (P < 0.0001, HR = 0.14, 95% CI: 0.06 - 0.32), metastasis (P < 0.0001, HR = 5.68, 95% CI: 2.24 - 14.42), and treatment modality (P = 0.0001).Conclusions:By controlling the modifiable risk factors and modality of treatment in our study, physicians can reach more effective treatment.
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