Clinical Parameters of Donor and Early Graft Function in Cadaveric Kidney Transplantation / 대한내과학회지

BACKGROUND: Kidney transplantation from cadaveric donor is increasing in KOREA. Knowledge of donor factors that can influence early graft function should be an important guideline in determining the suitability of a donor kidney for transplantation. METHOD: From June 1989 to August 1995, sixty patients with end-stage renal disease underwent kidney transplantation from thirty-two cadaver donors in Asan Medical Center. In this study, we reviewed the clinical characteristics of the cadaver donors including vital sign, urine output, serum creatinine, amounts of vasopressor needed, as well as the cause of brain death and evaluated the effect of these parameters on the early post-transplantation graft function (up to 6 months). RESULTS: The data are given as median (range). The donors had been admitted for 40 hours (12-177) before nephrectomy. During admission, the lowest systolic blood pressure was 85mmHg (60-130). Platelet count was 112 X 10(3)/L (11-270 X 10(3)). Hour urine output was 447ml/h (212-937). These parameters did not have significant effects on the early post-transplantation graft function of our patients. Fifteen of thirty two donors had peak serum creatinine higher than 1.4mg/dl (mean 1.9mg/dl, range 1.5-3.6mg/dl) with serum creatinine 1.5mg/dl (1.5-2.0) at the time of nephrectomy. The declining tendency and lowest level of serum creatinine after renal transplantation in patients who received kidneys from donor with peak serum creatinine higher than 1.4mg/dl was not different from those in patients who received kidney with normal function. CONCLUSION: The transient hypotension or acute reversible mild to moderate deterioration of renal function in cadaver donor does not seem to have significant effect on the early post-transplantation graft function if underlying organic renal disease could be ruled out by careful history taking and clinical evaluation.

Usefulness of Intravenous Iron Supplement During Recombinant Human Erythropoietin(rHuEPO) Therapy in Hemodialysis(HD) Patients / 대한신장학회잡지

Compared with iron dextran, iron chondroitin sulfate(ICS) is much cheaper and has better bioavailability. To evaluate the efficacy and safety of ICS in maintenance HD patients, i.v. ICS was given to 37 HD patients [20 M, 17 F, median age 51 years, median duration of HD 21 months] whose ferritin(Fer)or=100microgram/L and TFS>or=20% [Group II, 8 M, 7 F]. The patients had taken oral iron [227+/-73mg/day(mean+/-SD)] before this study. All patients received 120mg i.v. ICS weekly for 1 month. Then, ICS dosage was adjusted to 40-120mg/week depending on Hb, Fer and TFS in the following 3 months. Hb, Fer, TFS, rHuEPO dose and side effects were monitored monthly. The results were as follows : 1) I.v. iron therapy produced a significant rise in Hb(8.3+/-0.9g/dL to 9.7+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(95+/-50U/kg/wk to 69+/-28U/kg/wk; P<0.05), a significant increase in serum ferritin levels(162+/-149microgram/L to 472+/-255microgram/L; P<0.01) and TFS(24+/-13% to 41+/-18%; P<0.05). 2) In group 1, i.v. iron therapy produced a significant rise in Hb(8.5+/-1.1g/dL to 9.9+/-0.9g/dL; P< 0.01), a significant reduction in rHuEPO dose(87+/-45U/kg/wk to 69+/-27U/kg/wk; P<0.05), increased serum ferritin levels(90+/-48microgram/L to 379+/-186microgram/L; P<0.01) and TFS(18+/-9% to 36+/-16%; P<0.05). 3) In group 2, i.v. iron therapy produced a significant rise in Hb(8.1+/-0.6g/dL to 9.3+/-0.9g/dL; P<0.01), a significant reduction in rHuEPO dose(108+/-55U/kg/ wk to 69+/-31U/kg/wk; P<0.05) and increased serum ferritin levels(274+/-185microgram/L to 602+/-287microgram/L; P< 0.01) with a tendency of increase in TFS(35+/-13% to 41+/-18%; P=0.06). 4) No significant side effect was observed. 5) An annual cost reduction of 221 US dollars per patient was expected. In conclusion, ICS is an effective and safe intravenous iron preparation in HD patients.

An Anesthetic Experience ef Myasthenia Gravis with Thymoma / 대한마취과학회지

Myasthenia gravis is a rare disease entity in Korea, and its occurrence with a thymoma is even rarer. Myasthenia gravis has offered many difficult problems for the anesthesiologist because it affects respiratory muscles frequently and perioperative management of these patients is difficult. The authors aensthetized a patient with myasthenia gravis and thymoma. We report this experience with a brief literature review.