Erratum to "Assessment of Deceased Donor Kidneys Using a Donor Scoring System" by Bang K, et al. (Yonsei Med J 2010;51:870-876)

No abstract available.

Erratum to "Assessment of Deceased Donor Kidneys Using a Donor Scoring System" by Bang K, et al. (Yonsei Med J 2010;51:870-876)

No abstract available.

Suitability of the IDMS-traceable MDRD equation method to estimate GFR in early postoperative renal transplant recipients.

BACKGROUND/AIMS: Accurate measurement of glomerular filtration rate (GFR) is critical for the management of kidney transplant recipients. Comparison of creatinine and cystatin C in renal transplant recipients gave conflicting results. We aimed to compare the performance of creatinine- and cystatin C-based equations and creatinine clearance in 102 early postoperative Korean renal transplant patients. METHODS: We measured (51)Cr-EDTA clearance using a 2-compartment model and considered this the reference GFR. Then, we estimated GFR using 13 creatinine- and 7 cystatin C-based equations. Serum creatinine value was calibrated to isotope-dilution mass spectrometry (IDMS). RESULTS: The mean reference GFR was 76.77 +/- 17.01 ml/min/1.73 m(2). The IDMS-traceable MDRD (IDMS-MDRD) equation had the highest accuracy (94.12 within 30% of the reference; 99.02 within 50% of the reference) with a bias of 0.33 ml/min/1.73 m(2) and a precision of 12.57 ml/min/1.73 m(2). The Mayo Clinic equation also performed well (92.16% within 30% of the reference; 99.02% within 50% of the reference; bias: -0.19 ml/min/1.73 m(2)). As for cystatin C-based equations, the Filler equation had the least bias (0.03 ml/min/1.73 m(2)) but low accuracy (78.43% within 30% of the reference). CONCLUSIONS: We conclude that the IDMS-MDRD equation provided the best estimate of GFR in our early postoperative Korean renal transplant patients.

Assessment of Deceased Donor Kidneys Using a Donor Scoring System

PURPOSE: Marginal grafts should be used more actively in Asian countries where deceased donor transplantation is unpopular. We modified a quantitative donor scoring system proposed by Nyberg and his colleagues and developed a donor scoring system in order to assess the quality of deceased donor grafts and their prognostic value as an initial effort to promote usage of marginal donors. MATERIALS AND METHODS: We retrospectively evaluated 337 patients. RESULTS: A scoring system was derived from six donor variables [age, 0-25; renal function, 0-4; history of hypertension, 0-4; Human Leukocyte Antigen (HLA) mismatch, 0-3; body weight, 0-1; cause of death, 0-3 points]. Donor grafts were stratified by scores: grade A, 0-10; grade B, 11-20; grade C, 21-30; and grade D, 31-40 points. Donor grades significantly correlated with estimated glomerular filtration rate (eGFR) at 6 months (A, 64.0 mL/min/1.73 m2; B, 57.0 mL/min/1.73 m2; C, 46.8 mL/min/1.73 m2; p < 0.001). The five-year graft survival rate was also lower in grade C than grade A (74% vs. 93%, p = 0.002). Donors in grade C and D were regarded as marginal donors. The proportion of marginal donors was much lower in Korea, compared with data from the United Network for Organ Sharing (15.2% vs. 29%). CONCLUSION: Considering the scarcity of deceased donor kidneys and the relatively better graft outcome with lower grade-donors in Korea, it is worth increasing the usage of marginal grafts.

Lack of association between small dense low-density lipoprotein levels and coronary artery disease in chronic hemodialysis patients.

BACKGROUND/AIMS: Small, dense low-density lipoprotein (sd-LDL) is a newly recognized risk factor for coronary artery disease (CAD) in the general population. This study was performed to evaluate the relationship between sd-LDL, and CAD and cardiovascular risk factors such as other lipid profiles and hemostatic factors, in patients with chronic hemodialysis (CHD). METHODS: Thallium single-photon emission computed tomography (SPECT) was performed to evaluate for CAD in 126 CHD patients. Coronary angiography was performed in patients with positive thallium SPECT. CHD patients were classified into CAD and non-CAD group. LDL subfractions, other lipid profiles, and hemostatic factors were measured. RESULTS: The proportion of sd-LDL, and mean LDL size did not differ between CHD patients and healthy controls. Twenty-eight CHD patients had CAD by thallium SPECT and coronary angiography. The proportion of sd-LDL and mean LDL size did not differ between CAD and non-CAD patients. Age, diabetes mellitus presentation and high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher, and prealbumin and apolipoprotein A1 levels were significantly lower, in the CAD group (p < 0.05). The proportion of sd-LDL was positively correlated with triglyceride levels (p < 0.001), apolipoprotein B (p < 0.05) and fibrinogen (p < 0.05). CONCLUSION: This study showed that sd-LDL is not increased in CHD patients and is not associated with CAD in such patients.

[Outcome of intensive medical treatments in patients with infected severe necrotizing pancreatitis].

BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.

Skin necrosis after a low-dose vasopressin infusion through a central venous catheter for treating septic shock.

This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter.