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Park WY, Kim JH, Ko EJ, Min JW, Ban TH, Yoon HE, Kim YS, Jin K, Yang CW, Han S, Chung BH. Impact of Kidney Donor Profile Index Scores on Post-Transplant Clinical Outcomes Between Elderly and Young Recipients, A Multicenter Cohort Study. Sci Rep 2020; 10:7009. [PMID: 32332846 PMCID: PMC7181596 DOI: 10.1038/s41598-020-64055-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
We investigated if clinical outcomes after kidney transplantation (KT) from deceased donors (DDs) with high Kidney Donor Profile Index (KDPI) can be different according to the age of KT recipients (KTRs). Six-hundred fifty-seven KTRs from 526 DDs were included from four transplant centers. We divided KTRs into elderly-KTR and young-KTR groups based on age 60 and each group was subdivided into high- or low-KDPI subgroup based on KDPI score of 65%. We compared short-term and long-term clinical outcomes among those four subgroups (low KDPI-young KTR, low KDPI-elderly-KTR, high KDPI-young-KTR, high KDPI-elderly-KTR). In short-term outcomes including acute rejection, BK virus and CMV infection, there was no significant difference among the four subgroups. In the long-term outcomes, the development of cardiovascular disease was higher in the high KDPI-elderly-KTR group than the other groups. In comparison of allograft survival rate, the high KDPI-young KTR subgroup showed highest risk for allograft failure and there was significant interaction between high-KDPI donors and young-KTR on allograft survival rate (P = 0.002). However, there was no significant difference in comparison of the patient survival rate. In conclusion, clinical impact of high-KDPI in DDs on post-transplant allograft survival may be less significant in elderly-KTR than in young-KTR.
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Affiliation(s)
- Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.,Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Jeong Ho Kim
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Eun Jung Ko
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Won Min
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Tae Hyun Ban
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye-Eun Yoon
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Young Soo Kim
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.,Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Chul Woo Yang
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. .,Keimyung University Kidney Institute, Daegu, Republic of Korea.
| | - Byung Ha Chung
- Transplant research center, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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2
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Ko EJ, Yang J, Ahn C, Kim MS, Han DJ, Kim SJ, Yang CW, Chung BH, Ahn C, Chae DW, Yang J, Choi BS, Jung CW, Kim MS, Kwon OJ, Kim S, Kim YH, Choi S, Han SY, Han DJ, Lee SH, Jeong KH, Kim SJ, Jeon JS, Park YH, Roh YN, Lee JJ, Lee KW, Han SY, Kim CD, Park JW, Kim JK, Lee DR, Lee DW, Seong EY, Kong JM, Cho HR, Park SK, Lee SY, Park JH. Clinical outcomes of kidney transplantation in older end‐stage renal disease patients: A nationwide cohort study. Geriatr Gerontol Int 2019; 19:392-398. [DOI: 10.1111/ggi.13630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Eun Jeong Ko
- Transplantation Research Center, Division of Nephrology, Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Jaeseok Yang
- Department of Transplantation CenterSeoul National University Hospital Jongno Korea
| | - Curie Ahn
- Department of Transplantation CenterSeoul National University Hospital Jongno Korea
- Department of Internal Medicine‐NephrologySeoul National University Hospital Jongno Korea
| | - Myoung Soo Kim
- Department of Surgery‐TransplantationSeverance Hospital Seodaemun Korea
| | - Duck Jong Han
- Department of Surgery‐TransplantationAsan Medical Center, University of Ulsan College of Medicine Songpa Korea
| | - Sung Joo Kim
- Department of Surgery‐TransplantationSamsung Medical Center Gangnam Korea
| | - Chul Woo Yang
- Transplantation Research Center, Division of Nephrology, Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Byung Ha Chung
- Transplantation Research Center, Division of Nephrology, Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Curie Ahn
- Transplantation CenterSeoul National University Hospital
| | - Dong Wan Chae
- Transplantation CenterSeoul National University Hospital
| | - Jaeseok Yang
- Transplantation CenterSeoul National University Hospital
| | - Bum Soon Choi
- Department of Internal Medicinethe Catholic University of Korea
| | | | - Myoung Soo Kim
- Department of Surgery, Severance HospitalYonsei University College of Medicine
| | - Oh Jung Kwon
- Department of SurgeryHanyang University Hospital
| | - Sung‐Joo Kim
- Department of Surgery, Samsung Medical CenterSungkyunkwan University School of Medicine
| | - Yeong Hoon Kim
- Organ Transplantation Center, Busan Paik HospitalInje University College of Medicine
| | | | - Seung Yeup Han
- Department of Internal MedicineKeimyung University School of Medicine
| | - Duck Jong Han
- Department of SurgeryUlsan Medical Center and University of Ulsan College of Medicine
| | - Sang Ho Lee
- Department of Internal MedicineKyunghee University College of Medicine
| | - Kyung Hwan Jeong
- Department of Internal MedicineKyunghee University College of Medicine
| | - Seung Jung Kim
- Department of Internal MedicineEwha Womans University Medical Center
| | - Jin Seok Jeon
- Department of Internal MedicineSoon Chun Hyang University Hospital
| | - Yeon Ho Park
- Department of SurgeryGachon University Gil Medical Center
| | - Young Nam Roh
- Organ Transplantation CenterInje University Ilsan Paik Hospital
| | - Jeong Joon Lee
- Department of Surgery, CHA Bundang Medical CenterCHA university
| | - Kang Wook Lee
- Department of Internal MedicineChungnam National University Hospital
| | - Seung Yeup Han
- Department of Internal MedicineKeimyung University Dongsan Medical Center
| | - Chan Duck Kim
- Department of Internal MedicineKyungpook National University Hospital
| | - Jong Won Park
- Department of Internal MedicineYeungnam University Hospital
| | | | | | - Dong Won Lee
- Department of Internal MedicinePusan National University Hospital
| | - Eun Young Seong
- Department of Internal MedicinePusan National University Hospital
| | - Jin Min Kong
- Department of Internal MedicineBHS Han Seo Hospital
| | | | - Sung Kwang Park
- Department of Internal MedicineChonbuk National University Hospital
| | | | - Jung Hwan Park
- Department of Internal MedicineKonkuk University Medical Center
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3
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Hod T, Goldfarb-Rumyantzev AS. Clinical issues in renal transplantation in the elderly. Clin Transplant 2015; 29:167-75. [DOI: 10.1111/ctr.12481] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Tammy Hod
- Center for Vascular Biology Research; Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Division of Nephrology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Alexander S. Goldfarb-Rumyantzev
- Division of Nephrology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Transplant Institute; Beth Israel Deaconess Medical Center; Boston MA USA
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Cannon A, Elliott T, Ballew C, Cavey J, O'Shea G, Franzwa J, Puhlman M, Bennett J, Ryan T, Lockard K, Avrahami N, Brennan P, Kurien S, Andrus S, Dick S, Davis E. Variability in infection control measures for the percutaneous lead among programs implanting long-term ventricular assist devices in the United States. Prog Transplant 2013. [PMID: 23187051 DOI: 10.7182/pit2012612] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ventricular assist devices (VADs) are a surgical treatment for heart failure. These devices may be implanted as a bridge to transplant or as destination therapy. After surgical recovery and education regarding device care, patients are discharged home. Meticulous care of the driveline must be taken to prevent infection and trauma of the site throughout the perioperative event and for the duration of support. Currently a standardized protocol for care of the driveline and exit site does not exist. VAD coordinators from across the country discussed the variability in care at different centers in the United States through a series of conference calls. A survey consisting of 16 questions was developed. The survey included questions on preoperative antibiotic recommendations, driveline placement and exit site suturing, frequency of dressing changes, and showering practices. VAD coordinators shared center-specific dressing protocols and any driveline success stories. This survey was sent to 73 centers; 38 centers (52%) responded. The purpose of the survey was to define current practice in order to move toward a standard of practice or protocol based on expert opinion for VAD driveline care and to assess the need for future studies.
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Affiliation(s)
- Anne Cannon
- University of Colorado Hospital, Aurora, CO, USA.
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Møller MH, Adamsen S, Thomsen RW, Møller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol 2010; 45:785-805. [PMID: 20384526 DOI: 10.3109/00365521003783320] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Mortality and morbidity following perforated peptic ulcer (PPU) is substantial and probably related to the development of sepsis. During the last three decades a large number of preoperative prognostic factors in patients with PPU have been examined. The aim of this systematic review was to summarize available evidence on these prognostic factors. MATERIAL AND METHODS MEDLINE (January 1966 to June 2009), EMBASE (January 1980 to June 2009), and the Cochrane Library (Issue 3, 2009) were screened for studies reporting preoperative prognostic factors for mortality in patients with PPU. The methodological quality of the included studies was assessed. Summary relative risks with 95% confidence intervals for the identified prognostic factors were calculated and presented as Forest plots. RESULTS Fifty prognostic studies with 37 prognostic factors comprising a total of 29,782 patients were included in the review. The overall methodological quality was acceptable, yet only two-thirds of the studies provided confounder adjusted estimates. The studies provided strong evidence for an association of older age, comorbidity, and use of NSAIDs or steroids with mortality. Shock upon admission, preoperative metabolic acidosis, tachycardia, acute renal failure, low serum albumin level, high American Society of Anaesthesiologists score, and preoperative delay >24 h were associated with poor prognosis. CONCLUSIONS In patients with PPU, a number of negative prognostic factors can be identified prior to surgery, and many of these seem to be related to presence of the sepsis syndrome.
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Affiliation(s)
- Morten Hylander Møller
- Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Herlev, Denmark.
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Jensen K, Schaffer L, Olstad OK, Bechensteen AG, Hellebostad M, Tjønnfjord GE, Kierulf P, Gautvik KM, Osnes LTN. Striking decrease in the total precursor B-cell compartment during early childhood as evidenced by flow cytometry and gene expression changes. Pediatr Hematol Oncol 2010; 27:31-45. [PMID: 20121553 DOI: 10.3109/08880010903420687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The number of circulating B-cells in peripheral blood plateaus between 2 and 24 months of age, and thereafter declines gradually. How this reflects the kinetics of the precursor B-cell pool in the bone marrow is of clinical interest, but has not been studied thoroughly in humans. The authors analyzed bone marrow (n = 37) from healthy children and adults (flow cytometry) searching for age-related changes in the total precursor B-cell compartment. In an age-matched cohort (n = 25) they examined age-related global gene expression changes (Affymetrix) in unsorted bone marrow with special reference to the recombination activating gene 1, RAG1. Subsequently, they searched the entire gene set for transcripts correlating to the RAG1 profile to discover other known and possibly new precursor B-cell related transcripts. Both methods disclosed a marked, transient increase of total precursor B-cells at 6-20 months, followed by a rapid decrease confined to the first 2 years. The decline thereafter was considerably slower, but continued until adulthood. The relative composition of total precursor B-cells, however, did not change significantly with age. The authors identified 54 genes that were highly correlated to the RAG1 profile (r >or= .9, p < 1 x 10(-8)). Of these 54 genes, 15 were characteristically B-lineage associated like CD19, CD79, VPREB, EBF1, and PAX5; the remaining 39 previously not described as distinctively B-lineage related. The marked, transient increase in precursor B-cells and RAG1 transcriptional activity is not reflected by a similar peak in B-cells in peripheral blood, whereas the sustained plateau concurs in time.
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Affiliation(s)
- Kristin Jensen
- Department of Pediatrics, Faculty Division Ullevål, University of Oslo, Oslo, Norway.
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Badowski M, Gurk-Turner C, Cangro C, Weir M, Philosophe B, Klassen D, Haririan A. The impact of reduced immunosuppression on graft outcomes in elderly renal transplant recipients. Clin Transplant 2009; 23:930-7. [DOI: 10.1111/j.1399-0012.2009.01028.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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8
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Sunil VR, Patel KJ, Mainelis G, Turpin BJ, Ridgely S, Laumbach RJ, Kipen HM, Nazarenko Y, Veleeparambil M, Gow AJ, Laskin JD, Laskin DL. Pulmonary effects of inhaled diesel exhaust in aged mice. Toxicol Appl Pharmacol 2009; 241:283-93. [PMID: 19729031 DOI: 10.1016/j.taap.2009.08.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 08/20/2009] [Accepted: 08/23/2009] [Indexed: 11/25/2022]
Abstract
Pulmonary morbidity and mortality resulting from exposure to fine particulate matter (PM) increases with age. The present studies analyzed potential mechanisms underlying increased susceptibility of the elderly to PM using diesel exhaust (DE) as a model. Mice (2 m and 18 m) were exposed to DE (0, 300, and 1000 microg/m(3)) for 3 h once (single) or 3 h/day for 3 days (repeated). Bronchoalveolar lavage fluid (BAL), serum and lung tissue were collected 0 and 24 h later. Exposure to DE resulted in structural alterations in the lungs of older but not younger mice, including patchy thickening of the alveolar septa and inflammatory cell localization in alveolar spaces. These effects were most pronounced 24 h after a single exposure to the higher dose of DE. Significant increases in BAL nitrogen oxides were also noted in older mice, as well as expression of lipocalin 24p3, an oxidative stress marker in the lung with no effects in younger mice. Following DE inhalation, expression of Tumor Necrosis Factor alpha (TNFalpha) was upregulated in lungs of both younger and older mice; however, this was attenuated in older animals. Whereas exposure to DE resulted in increases in lung Interleukin-6 (IL-6) expression in both older and younger mice, IL-8 increased only in older animals. In younger mice, constitutive expression of manganese superoxide dismutase (MnSOD) decreased after DE exposure, while in older mice, constitutive MnSOD was not detectable and DE had no effect on expression of this antioxidant. Taken together, these results suggest that altered generation of inflammatory mediators and MnSOD may contribute to increased susceptibility of older mice to inhaled DE.
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Affiliation(s)
- Vasanthi R Sunil
- Department of Pharmacology and Toxicology, Rutgers University, Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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Møller MH, Shah K, Bendix J, Jensen AG, Zimmermann-Nielsen E, Adamsen S, Møller AM. Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol 2009; 44:145-52, 2 p following 152. [PMID: 18785067 DOI: 10.1080/00365520802401261] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The overall mortality for patients undergoing surgery for perforated peptic ulcer has increased despite improvements in perioperative monitoring and treatment. The objective of this study was to identify and describe perioperative risk factors in order to identify ways of optimizing the treatment and to improve the outcome of patients with perforated peptic ulcer. MATERIAL AND METHODS Three hundred and ninety-eight patients undergoing emergency surgery in four university hospitals in Denmark were included in the study. Information regarding the pre-, intra- and postoperative phases were recorded retrospectively from medical records. Data were analysed using multiple logistic regression analysis. The primary end-point was 30-day mortality. RESULTS The 30-day mortality rate was 27%. The following variables were independently associated with death within 30 days of surgery: ASA (American Society of Anaesthesiologists) class, age, shock upon admission, preoperative metabolic acidosis, elevated concentration of creatinine upon admission, subnormal concentration of albumin upon admission and insufficient postoperative nutrition. CONCLUSIONS Thus, preoperative metabolic acidosis, renal insufficiency upon admission and insufficient postoperative nutrition have been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon admission and preoperative metabolic acidosis are independently related to 30-day mortality could indicate that patients with peptic ulcer perforation are septic upon admission, and thus might benefit from a perioperative care protocol with early source control and early goal-directed therapy according to The Surviving Sepsis Campaign. This hypothesis should be addressed in future studies.
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Affiliation(s)
- Morten Hylander Møller
- Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev, Denmark.
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