Influence of Donor's Renal Function on the Outcome of Living Kidney Transplantation: 10-Year Follow-up

PURPOSE: With the improved surgical techniques and immunosuppression available today, conventional prognostic factors have taken on less significance. Accordingly, the native renal function of the donor is thought to be more important. Thus, we analyzed the prognostic significance of the donor's renal function as assessed by 24-hour urine creatinine clearance on kidney graft survival for 10 years after living kidney transplantation. MATERIALS AND METHODS: From January 1998 to July 2000, 71 living kidney transplantations were performed at a single institution. From among these, 68 recipients were followed for more than 6 months and were included in the present analysis. We analyzed kidney graft survival according to clinical parameters of the donor and the recipient. RESULTS: Mean follow-up duration of recipients after living kidney transplantation was 115.0+/-39.4 months (range, 10 to 157 months), and 31 recipients (45.6%) experienced kidney graft loss during this time period. Estimated mean kidney graft survival time was 131.8+/-6.2 months, and 5-year and 10-year kidney graft survival rates were estimated as 88.2% and 61.0%, respectively. Donor's mean 24-hour urine creatinine clearance (Ccr) before kidney transplantation was 122.8+/-21.2 ml/min/1.73 m2 (range, 70.1 to 186.6 ml/min/1.73 m2). The 10-year kidney graft survival rates for cases stratified by a donor's Ccr lower and higher than 120 ml/min/1.73 m2 were 39.0% and 67.2%, respectively (p=0.005). In univariate and multivariate analysis, donor's Ccr was retained as an independent prognostic factor of kidney graft survival (p=0.001 and 0.005, respectively). CONCLUSIONS: Donor's 24-hour urine Ccr before living kidney transplantation was an independent prognostic factor of kidney graft survival. Therefore, it should be considered before living kidney transplantation.

Factors Affecting Osteoporosis Following Renal Transplantation

PURPOSE: Chronic renal failure is known to occur with many disturbances in calcium metabolism including osteoporosis, bone decalcification, osteitis fibrosa cystica, and parathyroid hyperplasia. Renal transplantation may benefit the patients with chronic renal failure by reversing these disturbances, but it can also have deleterious effects on the bone. Osteoporosis remains one of the most frequent and serious complications after renal transplantation. The aim of this retrospective study is to evaluate the factors affecting osteoporosis after renal transplantation. METHODS: Bone mineral density (BMD) was measured a median 46 months (range 1~121) after renal transplantation in 118 of 274 patients between March 1991 and May 2002. At the time of bone examination, sex, age, duration of dialysis before transplantation, posttransplantation period, cumulative doses of prednisone, number of rejection, serum levels of cyclosporine, BUN, Cr, Ca, P, alkaline phosphatase (ALP), osteocalcin, urine levels of deoxypyridinoline, and cumulative doses of prednisone were measured. RESULTS: Duration between renal transplantation and BMD measurement (Ed-confirm this addition) was longer, and cumulative doses of prednisone were higher in patients whose lumbar vertebrae BMD was osteoporotic with statistical significance (P=0.023 and P=0.011, respectively). Longer duration between renal transplantation and BMD measurement and higher cumulative doses of prednisone were also seen in patients whose femoral neck BMD was osteoporotic, but without a statistical significance (P=0.186 and P=0.184, respectively). Cyclosporine level did not correlate well with either lumbar vertebrae or femoral neck BMD (P=0.800 and P=0.474). Nor did other factors show a statistically significant correlation. CONCLUSION: Our data indicated that longer duration between renal transplantation and BMD measurement and higher cumulative doses of prednisone were the statistically significant factors affecting patients with osteoporotic BMD at the lumbar vertebrae and femoral neck. To prevent osteoporosis after renal transplantation, it is important to restrict the cumulative doses of prednisone as early as possible following renal transplantation.

A Clinical Analysis of 195 Cases of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the newest treatment modality to be introduced for the management of the gallstone disease and is gaining rapid acceptance elsewhere. Despite its rapid and widespread acceptance, early data suggest that some complications and limitations are common when compared to standard cholecystectomy. The aim of this study was to identify problems in laparoscopic cholecystectomy and the reasons for secondary or operative conversion. From August 1991 to December 1994, 195 consecutive patients were treated with laparoscopic cholecystectomy at the Department of General Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University. The results were as follows; 1) The most prevalent age group was the 5th decade (24.6%) and the sex ratio (M : F) was 1 : 1.4. 2) The most common symptom was right upper quadrant pain (66.2%). 3) The majority (66.7%) of the admitted patient came to our hospital within 6 months of the onset of symptoms. 4) The number of patients with previous abdominal operations was 44 patients (22.6%), and the most common operation was an appendectomy (8.2%). 5) The patients with associated diseases were 124 patients (63.6%), gastritis being noted in 35 patients (17.9%). 6) The preoperative diagnostic rate was 96% by abdominal ultrasonography and 23.6% by ERCP 7) The average operative time was 103 minutes. 8) The most frequent operative finding was adhesion (72.3%). 9) The mean period of hospitalization after operation was 3.5 days. 10) The most dominant type in pathologic classification was chronic cholecystitis (86.7%). 11) The number of conversions to an open cholecystectomy was 14 (7.2%). 12) Among 195 patients, complications were noted in 10 patients (5.1%) : bile leakage from the bile duct or the liver bed(3 patients), bile duct injury (2 patients), subphrenic abscess (2 patients), atelectasis (1 patient), wound hematoma (1 patient), and drain site bleeding (1 patient).

Pendred's syndrome: a report of 5 case

No abstract available.