Long-term Outcomes of Post-transplant Diabetes Mellitus in Renal Transplant Recipients / 대한이식학회지

PURPOSE: Post-transplant diabetes mellitus (PTDM) is believed to cause serious complications. PTDM might be one of the important risk factors of cardiovascular death after renal transplantation. Because the consequence of PTDM is expected to take long time, long-term follow-up is necessary. We performed this study not only to define the prevalence and risk factors of PTDM but also to define the long-term clinical impact of PTDM. METHODS: Among 508 patients who had received renal transplantation at Seoul National University Hospital between July 1969 and December 1995, 431 patients were included. Patients were grouped into PTDM and non-DM groups. The clinical characteristics were compared between two groups. RESULTS: Mean follow-up duration was 121.9 months (2~346 months). PTDM was developed in 68 (15.8%) patients. Recipient age at transplantation (P=0.004), family history of DM (P=0.000) and obesity (P= 0.000) were significant risk factors in multivariate analysis. Complications of PTDM such as cerebrovascular disease (CVD, P=0.040), ischemic heart disease (IHD, P=0.040), and infection (p=0.044) were significantly more frequent in PTDM group. The frequency of chronic allograft nephropathy (CAN) was not different between two groups. Although graft survival rate was not affected by PTDM, patient survival rate was significantly lower in PTDM group (P=0.002). CONCLUSION: PTDM increased complication rates such as CVD, IHD and infection. PTDM seemed not to affect graft survival, but to worsen the patient survival rate.

Clinical Study of Endovenous Laser Treatment in Short Saphenous Vein Varicosity

PURPOSE: With regard to the selection of varicose treatment, conventional therapy such as stripping and ligation has became unpopular but the selection of endovenous radiofrequency coagulations (RF) or endovenous laser treatment (EVLT) of the greater saphenous varicose vein have increased as they are more convenient for patient. Mipiphlebectomy (MP) and sclerotherapy (SC) have also been welcome due to the advantages of less scaring and a rapid return to work. Therefore, varicose vein of the greater saphenous vein (GSV) and its tributaries are well controlled by new modalities, such as RF, EVLT, MP and SC, but those of the short saphenous vein (SSV) are difficult to control because of the many tributaries and perforating veins. A new modality with a simultaneous EVLT +/-MP combination for the treatment of SSV varicosities has been used. METHOD: 27 cases of SSV varicosities in 24 patients, between Feb 2002 and May 2004, were included in this study. The series of patients were followed up for recurrence of varisose vein, SSV recanalization and complications. RESULT: The patients were grossly examined postoperatively, and doppler were checked, and the varicose recurrence rates at 1, 3 and 6 months were found to be 0, 7.4 (2/27) 25.9% (7/27), espectively, the Doppler SSV recanalization rates at 1, 3 and 6 months were 0, 0 and 11.1% (3/27) and tributaries recurrence rates were 0, 7.4 (2/27) and 14.8% (4/27) with recurrence controlled by MP or SC, or observed for progression only. Most patients (93.6%) were satisfied with our treatment modality, and complications, such as pain, hematoma and swelling were controlled within 1 month, with 3 cases of tingling sensation of calf that subsided spontaneously. CONCLUSION: The control of SSV varicosities wes a little hard due to the many recurrences after surgery or EVLT alone. In our study, the cases of SSV varicosity alone were collected, and combination therapy, such as EVLT with miniphlebectomy, wes effective, as indicated by the relatively few recurrences, and even in these recurrence cases, additional postoperative MP or SC was enough for patient's satisfaction.