Change of Body Composition Analyzed by Bioelectrical Impedance Analysis (BIA) in Renal Transplant Recipients / 대한신장학회지

PURPOSE: To investigate the changes of body fluid status after kidney transplantation (KT) and to find out the associated factors. METHODS: Forty-five patients who had received KT were classified into hemodialysis (n=32), peritoneal dialysis (n=5), and preemptive (n=8) groups by dialysis modality. %TBW, %ECF, %ICF, and edema index which were examined by bioelectrical impedance analysis as well as clinical parameters were prospectively measured before KT and 1st month, 3rd month, 6th month after KT. RESULTS: Before KT, there were no significant differences in all of the parameters listed above among the three groups. Mean %TBW and %ICF were not different compared to those of before KT. In contrast, mean %ECF markedly decreased within 1st month (before KT 21.13+/-3.04 L/kg, 1st month 20.03+/-2.37 L/kg, 3rd month 19.61+/-2.18 L/kg, 6th month 18.32+/-5.02 L/kg: p=0.007, p<0.001, p=0.001, respectively). Edema index also decreased from 1st month (1st month 0.354+/-0.014, 3rd month 0.352+/-0.011, 6th month 0.348+/-0.014: p=0.016, p=0.012, respectively). Only edema index was higher at 1st and 3rd month in hemodialysis group. Serum creatinine and 24 hour urine total protein were positively correlated with %ECF at 1st and 3rd month, and with %TBW at 3rd month. CONCLUSION: The recovery of body water distribution after KT starts with reduction of ECF within the 1st month. Serum creatinine and proteinuria are related to the recovery. No significant difference according to dialysis modality was found. Further study with larger sample size is necessary to confirm these findings.

Association of Transforming Growth Factor-beta1 and Vascular Endothelial Growth Factor Gene Polymorphisms with Chronic Allograft Nephropathy and Graft Survival in Korean Renal Transplant Recipients / 대한신장학회지

PURPOSE: Transforming growth factor-beta1 (TGF-beta1) has been associated with the promotion of renal allograft interstitial fibrosis and thereby chronic allograft nephropathy (CAN). Vascular endothelial growth factor (VEGF) has been shown to contribute to cytoprotection of the graft after kidney transplantation. We investigated the influence of single nucleotide polymorphisms (SNPs) of the TGF-beta1 (C-509T and T869C) and the VEGF gene (C-2578A and C405G) on graft survival and the development of CAN. METHODS: Genotyping was carried out using a real-time polymerase chain reaction which was performed on the LightCycler480 in 221 Korean renal transplant recipients and 148 healthy controls. According to the presence of CAN or chronic calcineurin inhibitor nephrotoxicity, the recipients were separated into the CAN (n=21) and the No CAN (n=200) groups. RESULTS: The genotype frequencies of the SNPs were in Hardy-Weinberg equilibrium. The distributions of genotypes and alleles did not differ between recipients and controls. No significant differences were observed in the genotype distributions and allele frequencies between the CAN and the No CAN groups. The frequencies of haplotypes were not significantly different between the two groups, either. There were no statistically significant effects of TGF-beta1 and VEGF gene polymorphisms on graft survival. CONCLUSION: This study did not show any statistically significant effects of four selected SNPs of the TGF-beta1 and the VEGF genes on the development of CAN and graft survival in Korean renal transplant recipients.

Comparison of defect size measured by transthoracic and transesophageal echocardiography with balloon occlusive diameter measured during transcatheter closure of atrial septal defect / 소아과

PURPOSE: Accurate measurement of defect size is important in transcatheter closure of atrial septal defect (ASD). We performed this study to analyze the difference between the measured ASD size and balloon occlusive diameter (BOD) by transthoracic (TTE) or transesophageal echocardiography (TEE). METHODS: We investigated 78 patients who underwent transcatheter closure of ASD. The defect size and the distance between the surrounding structures were measured by TTE and TEE. The BOD was measured by TEE during cardiac catheterization. Clinical characteristics and echocardiographic data were compared and analyzed. RESULTS: The difference between BOD and diameter by TTE was 4.8+/-3.6 mm on short axis view, 5.4+/-3.2 mm on long axis view. The difference between BOD and diameter by TEE was 3.6+/-2.2 mm on short axis view, 4.2+/-3.1 mm on long axis view. The difference between BOD and the diameter of defects on TTE, TEE had statistically significant positive correlations with the age of the patients, distance between the, defect and posterior atrial septal wall, the distance between the defect and the mitral valve leaflet, and the diameter of defects and the length of the atrial septum on TTE (P<0.05). CONCLUSION: BOD of ASD can be estimated by the diameter on TTE and TEE. BOD is expected to measure larger, depending on the size of defects, the distance from surrounding structures and the location of defects on echocardiography. Our data offers important information on details of transcatheter ASD closure which can be helpful in predicting suitability and judging the procedural appropriateness during the procedure.

Late aortic root dilatation and aortic regurgitation in repaired tetralogy of fallot / 소아과

PURPOSE: Aortic valve or aortic root (AoRo) replacement is occasionally required because of AoRo dilatation and aortic regurgitation (AR) in repaired tetralogy of Fallot (TOF). We evaluated AoRo size and possible factors associated with its hemodynamic nature in patients with repaired TOF. METHODS: We investigated 130 repaired TOF patients more than 15 years of age who followed-up by echocardiography from January 2002 to December 2003. Of 130 patients, we identified 17 patients with AoRo dilatation, which was defined as ratio of expected AoRo size by standard nomogram (AoRo ratio) >1.5 (dilator group), and 113 TOF controls, with AoRo ratio <1.5 (non-dilator group). RESULTS: Mean indexed AoRo size (mm/m2) in the first echo was 24+/-3.2 in the dilator group and 18+/-3.4 in the non-dilator group (P<0.0001). AoRo rate of change (mm/year) from the first to latest echo study was 1.6+/-3.8 in dilator group and 0.05+/-1.6 in the non dilator group (P=0.0021). Patients from the dilator group showed a higher prevalence of pulmonary atresia (P=0.031) and a history of aortopulmonary shunt before repair (P=0.048), moderate to severe AR (P=0.0065), and increased left ventricular end-diastolic dimensions (P=0.003). Conclusions:A subset of patients late after TOF repair may show progressive dilatation of AoRo. To identify and prevent long-term sequelae in this patient group, regular follow-up and speculation about AoRo after TOF repair is recommended.

Comparison of Cardiovascular Risk Profiles and Graft Function between Cyclosporin A-based and Tacrolimus-based Immunosuppression in Renal Transplant Recipients / 대한신장학회지

PURPOSE: Tacrolimus (TAC) may be less unfavorable than cyclosporin A (CsA) on cardiovascular morbidity and mortality in renal transplant recipients, but well controlled studies are insufficient. METHODS: In this prospective randomized controlled study, fifty seven consecutive renal transplant recipients were treated with CsA-based (CsA, MMF and steroid, CsA group: n=27) or TAC-based (TAC, MMF and steroid, TAC group: n=30) immunosuppressive regimens by randomized ratio of 1:1. In the baseline (pre-operation), 1, 3, and 6 months after transplantation, several cardiovascular risk factors and graft function were evaluated. RESULTS: There were no significant differences in the renal function, glucose regulation, the incidence of acute rejection and post-transplant diabetes mellitus for the post-transplant 6 months between the two groups. The blood pressure of the CsA group was maintained higher than TAC group through 6 months after transplantation even though the number of antihypertensive drugs in the CsA group was significantly higher at 3 and 6 month after transplantation. The lipid profiles except oxidized LDL were similar, but oxidized LDL level was significantly higher for the post-transplant 6 months in the CsA group (p<0.05). There were no significant differences in levels of fibrinogen, PAI-I, t-PA, hs-CRP, homocysteine, spot urine TGF-beta a and beta ig-h3, but the uric acid level was significantly higher in the CsA group (p<0.05). CONCLUSION: This study demonstrates that TAC tends to have a beneficial effect on cardiovascular risk profiles, with regard to BP and atherogenic properties of serum lipids in early post-transplant period.

Reappraisal of the predictive factors for postoperative pulmonary complications after general anesthesia / 대한내과학회지

BACKGROUND: As our population in Korea ages, more postoperative pulmonary complications (PPCs) have recently developed. There have been several studies about the predictive factors for PPC, but any consensus has not been established. In this study, we reappraised the predictive factors for PPC after general anesthesia in a population from Gyeong-ju, which was composed of elderly people. METHODS: We retrospectively investigated the incidence and predictive factors for PPC in 84 patients who underwent general anesthesia. We investigated gender, age, height, weight, BMI, smoking, underlying disease, underlying respiratory disease, malignancy, the laboratory findings (hemoglobin, albumin, arterial O2 saturation) and the pulmonary function tests of the patients. RESULTS: 84 patients were initially enrolled into the study, and PPC developed in 31 (36%) patients. The mean age of the enrolled patients was 66.515.1 years-old, so it shows the trend of an aging society. Three predictive factors were revealed that are independently associated with the PPC: site of operation (OR, 8.3), underlying disease (OR, 9.9) and serum albumin (OR, 4.0). CONCLUSIONS: Among the statistically meaningful predictive factors, underlying disease and operation site are well known from previous studies, but the albumin level<3.5 g/dL is also meaningful, which is higher than the previous reference level. It implies that the patient with a albumin level 3.0~3.5 g/dL can be classified into the high risk group. Therefore, we should recognize that it is necessary to apply more strict reference levels in an aging population to reduce the incidence of PPC.