The risk of (skin) cancer is highly increased in organ-transplant recipients who are kept on immunesuppressive drugs to prevent graft rejection. This thesis dealt with the epidemiologic aspects and... Show moreThe risk of (skin) cancer is highly increased in organ-transplant recipients who are kept on immunesuppressive drugs to prevent graft rejection. This thesis dealt with the epidemiologic aspects and risk factors for cancer focused on cutaneous squamous cell carcinoma and basal cell carcinoma. Show less
Cardiovascular disease are a leading cause of mortality and morbidity in the Western world. Platelets play an important role in the development of cardiovascular disease, not only in the acute... Show moreCardiovascular disease are a leading cause of mortality and morbidity in the Western world. Platelets play an important role in the development of cardiovascular disease, not only in the acute onset of thrombosis after atherosclerotic plaque rupture but also in the initiation and progression of atherosclerosis and plaque formation. In recent years, the awareness has grown that platelet function may vary among individuals and that high platelet reactivity may increase the risk of cardiovascular events. This thesis addresses variation in platelet reactivity in relation to occurrence of cardiovascular events. We show that high platelet reactivity in subjects with cardiovascular disease using aspirin or clopidogrel as well as in antiplatelet drug-na_ve healthy subjects is related to the risk of cardiovascular events. We also revealed several genetic and clinical risk factors of high platelet reactivity. Moreover, we show that the 110-year old antiplatelet drug aspirin has interesting time-dependent pleiotropic effects on various pressor systems underlying blood pressure. As discussed in this thesis, although promising results have been published, routine platelet reactivity testing in daily clinical practice would currently be premature. Future studies are warranted to further investigate the clinical applicability of platelet reactivity testing in subjects at risk for cardiovascular events. Show less
Transfusion-related acute lung injury (TRALI) is the most common serious side effect of blood transfusion. TRALI could be caused by donor leukocyte antibodies, present primarily in female and... Show moreTransfusion-related acute lung injury (TRALI) is the most common serious side effect of blood transfusion. TRALI could be caused by donor leukocyte antibodies, present primarily in female and transfused donors (Chapters 1 and 2). In The Netherlands this led to the exclusion of female and transfused donors from the donation of plasma for transfusion from 1st October 2006. In this thesis we aimed to quantitatively estimate the expected effect of the implementation of this measure. Chapters 5 through 7 suggest nearly all TRALI caused by plasma rich products to be preventable by the deferral of female or allo-exposed donors, while there is no such effect on TRALI caused by plasma poor products. Further, we evaluate the effectiveness of the plasma measure and other potential donor deferral strategies at keeping leukocyte antibodies out of the blood supply (Chapter 8), address several common methodological problems in research of side effects of blood transfusions (Chapters 3 and 4) and discuss all our findings and some more general issues concerning the use of the population attributable risk, as opposed to the relative risk, and correction of the population attributable risk for confounding (Chapter 9). Show less
