ABSTRACT
Background: Transplantation among ABO blood group incompatibility was considered an absolute contraindication until recent development of successful protocols. A living-donor across ABO barriers may provide another option for end-stage kidney disease patients. Objective: To report the first case of ABO-incompatible living-donor kidney transplantation (ABOi-LKT) in Thailand. Patients and method: The kidney transplantation across ABO barriers was performed following the Japanese recommended protocol. The kidney recipient was a thirty-four years old woman with blood group-O, whereas the kidney donor was her brother with blood group A. To reduce anti-donor (anti-blood group-A antibody) blood levels, the patient underwent double filtration plasmapheresis and received an intravenous anti-CD20 monoclonal antibody. A maintenance immunosuppressive regimen was similar to the one of ABO-compatible setting. Results: The kidney allograft had immediate good function. The transplantation was uneventful, and the patient went home within two weeks. Kidney allograft biopsies were performed on a protocol-driven basis at time-zero, the first and sixth month post-transplantation. Histologic studies showed unremarkable findings. The patient is now twelve months after transplantation and has achieved excellent kidney function. Conclusion: ABOi-LKT provides an alternative treatment for end-stage kidney disease patients. A multi-center study of ABOi-LKT in Thailand is ongoing, and this may change the national policy of organ donation in the near future.
ABSTRACT
Background: The Royal College of Anesthesiologists of Thailand arranged the first national incident reports of anesthesia-related adverse events in 2007 on an anonymous and voluntary basis. Objective: To identify the incidence of perioperative non-hypoxic bradycardia in pediatric patients’ clinical course, outcome, contributing factors and its preventive strategies in the database of the Thai anesthesia incidents monitoring study (Thai AIMS). Methods: As part of the Thai AIMS, perioperative anesthesia incident reports of adverse events were collected from 51 participating hospitals across Thailand between January to June 2007. Three anesthesiologists reviewed relevant data of perioperative non-hypoxic bradycardia in pediatric patients. A descriptive statistical method was used. Results: There were 49 cases of perioperative non-hypoxic bradycardia in pediatric patients (2.4% of all 1996 incident reports or 13.4% of all incident reports from pediatric patients). Anesthesia (71%) was a major factor that related to the bradycardia, wheareas 19% and 10% were surgical and patient factors, respectively. Sixty percent of cases occurred during induction, of which 80% (24 out of 30 cases) and 10% were considered as anesthesia-related or combination of anesthesia and patient factors. Sixty percent (9 out of 15 cases) of bradycardia during the maintenance phase was surgery-related particularly in ophthalmologic surgery. Four cases (8.1%) of all bradycardia occurred during the emergence and recovery phase of which 78% was considered anesthesia-related. All bradycardia had complete recovery. Sixty-three percent of events were preventable. Major contributing factors were lack of adequate knowledge (55%) and inappropriate decision-making (22%). Conclusion: Most perioperative non-hypoxic bradycardia incidences were anesthesia-related and most common during the induction phase. Improved supervision, additional training and vigilance were suggested corrective strategies.