Search

IntroductionABO-incompatible (ABOi) kidney transplantation (KT) has become an important option to overcome organ shortage. Plasmapheresis/rituximab-based desensitization therapy has successfully reduced anti-ABO antibody levels and suppressed antibody-mediated rejection (AMR) in ABOi KT. However, high titers of anti-ABO antibodies in some patients are refractory to standard desensitization, leading to loss of KT opportunities or AMR.MethodsEculizumab treatment was used an adjunctive therapy to rescue high-titer ABOi KT patients refractory to plasmapheresis/rituximab-based desensitization. Molecular phenotypes of allograft biopsies and cellular phenotypes of peripheral blood mononuclear cells of eculizumab group were compared with those of control groups using the Banff Human Organ Transplant gene panel and flow-cytometric analysis, respectively.ResultsThe initial titers of anti-ABO antibodies in the two patients were 1:512 and >1:1024; the final pre-transplant titers after desensitization were 1:128 and 1:64. Both patients received eculizumab from KT day to two or four weeks post-KT and maintained stable renal function up to one-year post-transplantation without overt infection, despite early episodes of probable AMR or borderline T cell-mediated rejection. Molecular phenotype analysis revealed that gene expression patterns in the ABOi KT with eculizumab group overlapped with those in the ABOi KT with AMR group more than in the ABOi KT without AMR group, except for complement pathway-related gene expression. Anti-ABO antibody titers decreased to low levels 1–3 months post-transplant in the eculizumab group in parallel with decreasing anti-B-specific B cells.ConclusionsShort-term eculizumab therapy is promising for rescuing ABOi KT recipients with high anti-ABO antibody titers refractory to plasmapheresis-based desensitization therapy.

Abstract Death with a functioning graft is important cause of graft loss after kidney transplantation. However, little is known about factors predicting death with a functioning graft among kidney transplant recipients. In this study, we evaluated the association between post-transplant creatinine-cystatin C ratio and death with a functioning graft in 1592 kidney transplant recipients. We divided the patients into tertiles based on sex-specific creatinine-cystatin C ratio. Among the 1592 recipients, 39.5% were female, and 86.1% underwent living-donor kidney transplantation. The cut-off value for the lowest creatinine-cystatin C ratio tertile was 0.86 in males and 0.73 in females. The lowest tertile had a significantly lower 5-year patient survival rate and was independently associated with death with a functioning graft (adjusted hazard ratio 2.574, 95% confidence interval 1.339–4.950, P

Abstract Cardiovascular disease remains a leading cause of morbidity and mortality after kidney transplantation (KT). Although statins reduce cardiovascular risk and have renal benefits in the general population, their effects on KT recipients are not well-established. We studied the effects of early statin use (within 1-year post-transplantation) on long-term outcomes in 714 KT recipients from the Korean cohort study for outcome in patients with KT. Compared with the control group, statin group recipients were significantly older, had a higher body mass index, and had a higher prevalence of diabetes mellitus. During a median follow-up of 85 months, 74 graft losses occurred (54 death-censored graft losses and 20 deaths). Early statin use was independently associated with lower mortality (hazard ratio, 0.280; 95% confidence interval 0.111–0.703) and lower death-censored graft loss (hazard ratio, 0.350; 95% confidence interval 0.198–0.616). Statin therapy significantly reduced low-density lipoprotein cholesterol levels but did not decrease the risk of major adverse cardiovascular events. Biopsy-proven rejection and graft renal function were not significantly different between statin and control groups. Our findings suggest that early statin use is an effective strategy for reducing low-density lipoprotein cholesterol and improving patient and graft survival after KT.

Owing to the massive expansion and intermittent nature of renewable power, green hydrogen production, storage, and transportation technologies with improved economic returns need to be developed. Moreover, the slowness of the dehydrogenation reaction is a primary barrier to the commercialization of liquid organic hydrogen carrier (LOHC) technology. The present study focused on increasing the speed of dehydrogenation, resulting in the proposal of a triple-loop dehydrogenation system comprising reaction, heating, and chilling loops. The reactor has a rotating cage containing a packed bed of catalyst pellets, which is designed to enhance both heat and mass transfer by helping to detach precipitated hydrogen bubbles from the catalyst surface. In addition, the centrifugal force aids in isolating the gas phase from the LOHC liquid. A dehydrogenation experiment was conducted using the reaction and chilling loops, which revealed that the average hydrogen production rate during the first hour was 52.6 LPM (liter per minute) from 26.3 L of perhydro-dibenzyl-toluene with 1.5 kg of 0.5 wt% Pt/Al2O3 catalyst. This was approximately 48% more than the value predicted with the reaction kinetics measured with a small-scale plug flow dehydrogenation reactor with less than 1.0 g of 5.0 wt% Pt/Al2O3 catalyst. The concept, construction methods, and results of the preliminary gas infiltration, flow visualization, and reactor pumping experiments are also described in this paper.

Objectives: The risk factors for late-onset Pneumocystis jirovecii pneumonia (PCP) after liver transplantation (LT) have not been well studied. We aimed to analyze the clinical features preceding PCP in LT recipients that would guide individualized prophylaxis. Methods: Among 742 patients who underwent LT and routine PCP prophylaxis from January 2009 through December 2019 at Severance Hospital, 27 patients developed PCP. We conducted a retrospective case-control study matching each patient with four controls and analyzed the risk factors for late-onset PCP. Results: After 6 months, post-transplant PCP cases increased steadily with an overall incidence of 6.36 cases per 1000 patient-year. The PCP-related mortality was 37.0%. In the multivariate analyses, age at LT ≥65 years (odds ratio [OR], 13.305; 95% confidence interval [CI], 2.507-70.618; P = 0.002), cytomegalovirus infection (OR, 5.390; 95% CI, 1.602-18.132; P = 0.006), steroid pulse therapy (OR, 6.564; 95% CI, 1.984-21.719; P = 0.002), hepatocellular carcinoma recurrence (OR, 18.180; 95% CI, 3.420-96.636; P = 0.001), and lymphocytopenia (OR, 3.758; 95% CI, 1.176-12.013; P = 0.026) were independently associated with PCP. Conclusion: Late-onset PCP after routine prophylaxis after LT remains a lethal infection and is associated with age ≥65 years at LT, cytomegalovirus infection, steroid pulse therapy, hepatocellular carcinoma recurrence, and lymphocytopenia. Targeted prophylaxis considering these risk factors could improve the prevention of this potentially lethal complication.

This study aimed to determine the prevalence and predictors of oral, ocular, or dermal e-liquid exposure and subsequent outcomes (becoming sick, going to the hospital) in the US. We examined survey data from the Population Assessment of Tobacco and Health Study Wave 5 (2018-2019). The analytic sample included US youth (aged 12-17 years), young adults (aged 18-24 years), and older adults (aged ≥ 25 years) who reported e-cigarette use in the past 12 months. We first determined the prevalence of self-reported e-liquid exposure (in the mouth, skin, or eyes), subsequently "becoming sick" from the exposure, and "going to the hospital" after the exposure. We also examined associations between these outcomes and the device type used (refillable tank /mod system, replaceable prefilled cartridges, disposable/ other device type). E-liquid exposure was reported by 25% of youth (aged 12-17 years), 25% of young adults (aged 18-24 years), and 19% of older adults (aged≥ 25 years). Among individuals reporting e-liquid exposure, subsequent sickness was reported by 10% of youth11% of young adults, and 14% of older adults, and "going to the hospital" was reported by 3.5% of youth, 2.7% of young adults, and 6.8% of older adults. Among young adults, the use of a refillable tank /mod system was associated with higher odds of e-liquid exposure (aOR = 2.2, 95% CI = 1.2, 4.1) than the use of other device types, including disposables. The findings suggest that, at a minimum, e-cigarettes/e-liquids may need warning labels that state the risks of e-liquid exposure and packaging regulations that promote device and bottle designs that minimize e-liquid spills.

Abstract De novo donor-specific antibody (dnDSA) is associated with a higher risk of kidney graft failure. However, it is unknown whether preemptive treatment of subclinical dnDSA is beneficial. Here, we assessed the efficacy of high-dose intravenous immunoglobulin (IVIG) and rituximab combination therapy for subclinical dnDSA. An open-label randomized controlled clinical trial was conducted at two Korean institutions. Adult (aged ≥ 19 years) kidney transplant patients with subclinical class II dnDSA (mean fluorescence intensity ≥ 1000) were enrolled. Eligible participants were randomly assigned to receive rituximab or rituximab with IVIG at a 1:1 ratio. The primary endpoint was the change in dnDSA titer at 3 and 12 months after treatment. A total of 46 patients (24 for rituximab and 22 for rituximab with IVIG) were included in the analysis. The mean baseline estimated glomerular filtration rate was 66.7 ± 16.3 mL/min/1.73 m2. The titer decline of immune-dominant dnDSA at 12 months in both the preemptive groups was significant. However, there was no difference between the two groups at 12 months. Either kidney allograft function or proteinuria did not differ between the two groups. No antibody-mediated rejection occurred in either group. Preemptive treatment with high-dose IVIG combined with rituximab did not show a better dnDSA reduction compared with rituximab alone. Trial registration : IVIG/Rituximab versus Rituximab in Kidney Transplant With de Novo Donor-specific Antibodies (ClinicalTrials.gov Identifier: NCT04033276, first trial registration (26/07/2019).

Abstract While most living kidney donors experience good outcomes and high rates of satisfaction, kidney donation can increase the risk of gestational hypertension or preeclampsia. However, pregnancy outcomes in non-white donors are limited. We conducted a nationwide cohort study of 112 living kidney donors and 672 matched healthy non-donors using the Korean National Health Insurance Claims Database. Donors and healthy non-donors were matched according to age, year of cohort entry, residency, income, number of pregnancies, and the time to the first pregnancy after cohort entry. We assessed pregnancy outcomes of live kidney donors compared with matched healthy non-donors using the nationwide database. Gestational hypertension or preeclampsia was more common in kidney donors than in non-donors (8.9% vs. 1.8%; adjusted odds ratio, 2.68; 95% confidence interval, 1.11–6.50). However, the incidence of severe gestational hypertension or preeclampsia that required antihypertensive medication was comparable (2.7% vs. 0.9%; P = 0.121). The time from donation to delivery within 5 years and primiparity were risk factors for preeclampsia in donors. Low birth weight, stillbirth, and ectopic pregnancy were not significantly different between the two groups. Maternal death occurred in two non-donor cases, but none occurred in donors compared to non-donors. Our findings indicate that kidney donors are associated with an increased risk of gestational hypertension or preeclampsia than matched healthy non-donors. However, the probabilities of serious maternal and fetal outcomes remained low and are not increased significantly after kidney donation.

Abstract Tacrolimus is the mainstay of immunosuppression in liver transplantation to prevent rejection. However, the clinical use of tacrolimus is complicated by its narrow therapeutic window and significant intra-patient variability (IPV). High tacrolimus IPV is associated with overexposure and adverse effects, including malignancy. The effects of tacrolimus IPV in liver transplant recipients with and without hepatocellular carcinoma (HCC) are unknown. We investigated the association between tacrolimus IPV and transplant outcomes in 636 liver transplant patients. Tacrolimus IPV was determined by calculating the coefficient of variance (CV) of outpatient tacrolimus trough levels from 3 to 12 months after transplantation. High tacrolimus IPV was defined as CV > 30%. Patients were grouped according to tacrolimus IPV and HCC status. Among 636 liver transplant patients, 349 had HCC and 287 had no HCC. Overall survival in HCC patients was significantly reduced with high tacrolimus IPV (P

Introduction: The COVID-19 pandemic has significantly disrupted the entire healthcare system, resulting in unmet needs for medical care (e.g., delayed or forgone care) among patients with cancer. Methods: Using 2020 National Health Interview Survey data, we examined the prevalence of unmet healthcare needs and whether the self-reported experience of having delayed or forgone healthcare is associated with increased emergency services use and hospitalizations. A multivariable logistic regression model was used to assess the associations between unmet healthcare needs because of COVID-19 and emergency services use and hospitalization, controlling for potential confounding. All analysis was conducted in March and April 2022. Results: Among 2,386 study participants living with cancer (representing 25.6 million U.S. adults), 33.7% reported having unmet healthcare needs because of the COVID-19 pandemic. The prevalence of unmet healthcare needs was higher among younger cancer survivors and those with higher education. In the adjusted analysis, cancer survivors with unmet healthcare needs were 31% more likely to report any emergency services use (adjusted OR=1.31, 95% CI=1.05, 1.65) than those without. Having unmet healthcare needs was not significantly associated with hospitalization (p=0.465). Conclusions: Our findings highlight the unmet need for cancer care because of the pandemic and potential adverse health outcomes.

BackgroundThe proliferation of e-cigarette content on YouTube is concerning because of its possible effect on youth use behaviors. YouTube has a personalized search and recommendation algorithm that derives attributes from a user’s profile, such as age and sex. However, little is known about whether e-cigarette content is shown differently based on user characteristics. ObjectiveThe aim of this study was to understand the influence of age and sex attributes of user profiles on e-cigarette–related YouTube search results. MethodsWe created 16 fictitious YouTube profiles with ages of 16 and 24 years, sex (female and male), and ethnicity/race to search for 18 e-cigarette–related search terms. We used unsupervised (k-means clustering and classification) and supervised (graph convolutional network) machine learning and network analysis to characterize the variation in the search results of each profile. We further examined whether user attributes may play a role in e-cigarette–related content exposure by using networks and degree centrality. ResultsWe analyzed 4201 nonduplicate videos. Our k-means clustering suggested that the videos could be clustered into 3 categories. The graph convolutional network achieved high accuracy (0.72). Videos were classified based on content into 4 categories: product review (49.3%), health information (15.1%), instruction (26.9%), and other (8.5%). Underage users were exposed mostly to instructional videos (37.5%), with some indication that more female 16-year-old profiles were exposed to this content, while young adult age groups (24 years) were exposed mostly to product review videos (39.2%). ConclusionsOur results indicate that demographic attributes factor into YouTube’s algorithmic systems in the context of e-cigarette–related queries on YouTube. Specifically, differences in the age and sex attributes of user profiles do result in variance in both the videos presented in YouTube search results as well as in the types of these videos. We find that underage profiles were exposed to e-cigarette content despite YouTube’s age-restriction policy that ostensibly prohibits certain e-cigarette content. Greater enforcement of policies to restrict youth access to e-cigarette content is needed.

Minimally invasive surgery reduces perioperative pain and morbidity, facilitating rapid recovery. However, the field of kidney transplantation has lagged in this regard, its customary open surgical techniques going nearly unchanged until recently. Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. In Korea, the first RKT performed (November 2019) involved a 30-year-old man (body mass index, 22 kg/m2) with end-stage hypertensive nephrosclerosis. A left donor kidney from his 28-year-old sister was successfully transplanted using the daVinci Robotic Surgical System. Transperitoneal regional hypothermia (Vattikuti Urology Institute-Medanta technique) was also implemented across the main periumbilical incision (up to 6 cm). Total operative time was 260 minutes (cold ischemia, 34 minutes; rewarming, 54 minutes), with 50 mL of blood loss. There was immediate graft function, unencumbered by surgical complications (e.g., postoperative bleeding, leakage, or lymphocele). The patient was discharged on postoperative day 8, with serum creatinine at 1.27 mg/dL. RKT with regional hypothermia may be a viable, minimally invasive intervention that is safe and effective in select patients, showing good surgical results.

Purpose This study aimed to apply MR elastography (MRE) to achieve in vivo evaluation of the elastic properties of thigh muscles and validate the feasibility of quantifying the elasticity of normal thigh muscles using MRE. Materials and Methods This prospective study included 10 volunteer subjects [mean age, 32.5 years, (range, 23–45 years)] who reported normal activities of daily living and underwent both T2-weighted axial images and MRE of thigh muscles on the same day. A sequence with a motion- encoding gradient was used in the MRE to map the propagating shear waves in the muscle. Elastic properties were quantified as the shear modulus of the following four thigh muscles at rest; the vastus medialis, vastus lateralis, adductor magnus, and biceps femoris. Results The mean shear modulus was 0.98 ± 0.32 kPa and 1.00 ± 0.33 kPa for the vastus medialis, 1.10 ± 0.46 kPa and 1.07 ± 0.43 kPa for the vastus lateralis, 0.91 ± 0.41 kPa and 0.93 ± 0.47 kPa for the adductor magnus, and 0.99 ± 0.37 kPa and 0.94 ± 0.32 kPa for the biceps femoris, with reader 1 and 2, respectively. No significant difference was observed in the shear modulus based on sex (p < 0.05). Aging consistently showed a statistically significant negative correlation (p < 0.05) with the shear modulus of the thigh muscles, except for the vastus medialis (p = 0.194 for reader 1 and p = 0.355 for reader 2). Conclusion MRE is a quantitative technique used to measure the elastic properties of individual muscles with excellent inter-observer agreement. Age was consistently significantly negatively correlated with the shear stiffness of muscles, except for the vastus medialis.

Abstract High intra-patient variability (IPV) of tacrolimus trough concentrations is increasingly recognized as a predictor of poor long-term outcomes in kidney transplant. However, there is a lack of information regarding the association between tacrolimus IPV and graft outcomes according to immunological risk. We analyzed tacrolimus IPV using the coefficient of variability from months 6–12 after transplantation in 1080 kidney transplant recipients. Patients were divided into two immunological risk groups based on pre-transplant panel reactive antibodies and donor-specific antibodies. High immunological risk was defined as panel reactive antibodies ≥ 20% or the presence of donor-specific antibodies. The effects of tacrolimus IPV on graft outcomes were significantly different between low and high immunological risk patients. A multivariable Cox regression model confirmed that high tacrolimus IPV was an independent risk factor for graft failure in the high risk group (HR, 2.90; 95% CI, 1.42–5.95, P = 0.004). In the high risk group, high tacrolimus IPV was also significantly associated with increased risk of antibody-mediated rejection (P = 0.006). In contrast, death-censored graft survival and antibody-mediated rejection in the low immunological risk group was not significantly different by tacrolimus IPV. High tacrolimus IPV significantly increases the risk of graft failure and antibody-mediated rejection in patients with high immunological risk.

Abstract Serum bilirubin, a potent endogenous antioxidant, has been associated with decreased risks of cardiovascular disease, diabetes, and kidney disease. However, the effects of serum bilirubin on kidney transplant outcomes remain undetermined. We analyzed 1628 patients who underwent kidney transplantations between 2003 and 2017. Patients were grouped into sex-specific quartiles according to mean serum bilirubin levels, 3–12 months post-transplantation. Median bilirubin levels were 0.66 mg/dL in males and 0.60 mg/dL in females. The intra-individual variability of serum bilirubin levels was low (9%). Serum bilirubin levels were inversely associated with graft loss, death-censored graft failure, and all-cause mortality, independent of renal function, donor status, and transplant characteristics. Multivariable analysis revealed that the lowest serum bilirubin quartile was associated with increased risk of graft loss (HR 2.64, 95% CI 1.67–4.18, P

Purpose Melanoma is a potentially fatal cutaneous malignancy and regional lymph node (LN) metastases are the most important predictors of mortality. This study aimed to analyze clinical features and risk factors of complications associated with inguinal LN dissection (LND) to establish treatment protocols. Methods This single-center retrospective study (2000 to 2018) consisted of patients who underwent inguinal area sentinel LN biopsy (SLNB) or LND due to malignant melanoma. Risk factors and outcomes were analyzed. Results One hundred patients underwent SLNB alone (n=67; patients with negative SLNB), complete LND (CLND) after positive SLNB (n=19), or radical LND without SLNB (n=14). Five-year overall survival and disease-free survival rates among these groups were 87.3%, 57.4%, and 61.9%, and 59.0%, 22.7%, and 28.1%, respectively. The complication rate in the SLNB alone group was lower than the other groups (22.4% vs. 47.4% and 35.7%, respectively; P=0.048). Seroma was the most common complication in the SLNB alone group (15.0%); lymphedema was most common in the CLND after SLNB group (21.1%). Multivariate analysis of risk factors for postoperative complications found the hazard ratio for body mass index >28 kg/m2 was 4.376 (95% confidence interval [CI], 1.243–15.401; P=0.022). The hazard ratio for LND (including CLND after SLNB and radical LND without SLNB) was 3.263 (95% CI, 1.248–8.529; P=0.016). Conclusion Inguinal LND is a higher risk procedure compared to SLNB and other sites for postoperative complications, irrespective of meticulous surgical techniques. More studies are needed to establish treatment protocols (e.g., observation vs. CLND after a positive SLNB result) and the risks and benefits in Asian populations.

Background : The coronavirus disease 2019 (COVID-19) has forced healthcare systems to reduce transplant activities in order to preserve resources and minimize the risk of nosocomial transmission. Although transplantation societies around the world have proposed interim recommendations, little is known about the safety of transplant surgery under pandemic conditions and how transplant medicine should move forward after the peak of the pandemic. Methods : We describe our experiences regarding the continuation of living and deceased donor transplantation under infection control measures during the COVID-19 outbreak in South Korea. We reviewed consecutive liver and kidney transplantations at Severance Hospital and analyzed national transplantation activities in South Korea. Results : Transplantation activities with living and deceased donors remained stable during the COVID-19 outbreak compared to the same period in 2019. We performed 94 transplantations (58 kidney, 35 liver, and 1 simultaneous liver-kidney) during the COVID-19 outbreak. Twenty-five patients underwent desensitization therapy prior to transplant (nine ABO-incompatible kidney, eight human leukocyte antigen-incompatible kidney, and eight ABO-incompatible liver). No transplant recipients in our center contracted COVID-19. In South Korea, national transplant activities with living and deceased donors remained stable in 2020 compared to 2019. Conclusions: Organ transplantation during pandemics appears to be feasible with appropriate infection prevention measures.

Introduction Males have a higher prevalence of waterpipe tobacco smoking (WTS) than females in most Eastern Mediterranean Region (EMR) countries, with a smaller gender gap than that of cigarette smoking. The objective of this study was to determine gender differences among university students with respect to WTS initiation, smoking behavior, tobacco flavors, and expenditure on WTS, in four EMR countries. Methods A cross-sectional online survey was conducted based on convenient samples of ever waterpipe smokers among university students in four EMR countries (Egypt, Jordan, Occupied Palestinian Territories, and the United Arab Emirates) in 2016. The total samples included 2470 participants. Study participants were invited through flyers, university portals, emails and Facebook, followed by emails with links to the internet survey. Results Females (80.4%) were more likely than males (66.4%, p

Background : Living donors are the major source of kidneys in countries with a shortage of deceased donors. Kidney donation after careful donor selection is generally accepted as a safe procedure, but the physiologic consequences after donor nephrectomy are not fully verified. In this study we retrospectively reviewed the renal function of the residual kidney in living donors. Methods : Post-nephrectomy laboratory data of 1,175 living donors (60.7%) from 1,933 living donors who received uninephrectomy from January 1999 to December 2017 at Yonsei University, Severance Hospital, Korea were retrospectively collected. Post-nephrectomy renal function was monitored by the relative ratio of estimated glomerular filtration rate (e-GFR; pre-nephrectomy e-GFR ratio vs. post-nephrectomy e-GFR) that was calculated by the Modification of Diet in Renal Disease formula. Results : During 36.3±37.6 months of mean follow-up, two cases (0.17%, 2/1,175) of renal failure developed. The mean e-GFR decreased to 64.3±14.2 mL/min/1.73 m2 immediately after nephrectomy from 99.2±19.9 mL/min/1.73 m2 of the pre-nephrectomy e-GFR. Early decrement of e-GFR was prominent in male and obese donors (body mass index >25 kg/m2, P0.05). Conclusions: Our data showed that long-term compensation of the renal function after nephrectomy occurs independently of preoperative donor characteristics.

Graft-versus-host disease (GVHD) is rare complication after simultaneous pancreas-kidney transplantation (SPK). Here, we present a rare case of GVHD that developed in a SPK recipient. A 38-year-old female patient with end-stage renal disease due to type 1 diabetes mellitus underwent SPK from a deceased female donor. Four months after transplantation, she was readmitted with fever and abdominal pain and computed tomography revealed a retroperitoneal abscess. While being treated for the retroperitoneal abscess by percutaneous drainage and antibiotics, the patient developed skin rash and diarrhea. A skin biopsy performed at the time showed vacuolization and peri-venular lymphocytic infiltration compatible with GVHD. High-dose steroids resulted in complete remission of GVHD, and the patient was discharged after 2 weeks of treatment. This case demonstrates that early diagnosis of GVHD followed by timely treatment may led to a favorable outcome, and cautions that GVHD can occur in SPK patients.

BackgroundValve regurgitation can decrease with resolution of hemodynamic loads on the left ventricle (LV) after kidney transplantation (KT). We aimed to investigate the natural course of left-side valve regurgitation after KT and factors associated with progression.MethodsAmong patients who underwent KT in two tertiary centers, 430 (224 men, mean age 50 ± 13 years) were examined by echocardiography within 3 months before KT and between 6 and 36 months after KT. Mitral regurgitation (MR) and aortic regurgitation (AR) were graded according to the current guidelines. Regression was defined as a decrease in regurgitation by one or more steps, and progression was an increase in one or more steps after KT. Clinical and echocardiographic factors associated with progression of MR and AR were analyzed.ResultsMild or greater MR was observed in 216 (50%) patients before KT, and mild or greater AR was observed in 99 (23%). During the follow-up period of 23.4 ± 9.9 months, most patients experienced regression or no change in regurgitation after KT, but 34 patients (7.9%) showed MR progression and 37 (8.6%) revealed AR progression. Patients who showed MR progression were more likely to receive a second KT, have mitral annular calcifications, and show a smaller decrease in LV end-systolic dimension. Patients who showed AR progression were more likely to have persistent hypertension after KT, aortic valve calcifications, and a smaller reduction of LV end-systolic dimension.ConclusionsRisk factors for progression of MR after KT include a second KT, MAC and a smaller decrease in LV end-systolic dimension after KT. Risk factors for progression of AR include valve calcification, persistent hypertension and a smaller decrease in LV end-systolic dimension after KT. Further echocardiographic surveillance and risk factor management after KT are warranted in these patients.

Abstract Background Despite the obvious survival benefit compared to that among waitlist patients, outcomes of positive crossmatch kidney transplantation (KT) are generally inferior to those of human leukocyte antigen (HLA)-compatible KT. This study aimed to compare the outcomes of positive complement-dependent cytotoxicity (CDC) crossmatch (CDC + FC+) and positive flow cytometric crossmatch (CDC-FC+) with those of HLA-compatible KT (CDC-FC-) after successful desensitization. Methods We retrospectively analyzed 330 eligible patients who underwent KTs between June 2011 and August 2017: CDC-FC- (n = 274), CDC-FC+ (n = 39), and CDC + FC+ (n = 17). Desensitization protocol targeting donor-specific antibody (DSA) involved plasmapheresis, intravenous immunoglobulin (IVIG), and rituximab with/without bortezomib for positive-crossmatch KT. Results Death-censored graft survival and patient survival were not different among the three groups. The median estimated glomerular filtration rate was significantly lower in the CDC + FC+ group than in the compatible group at 6 months (P

Abstract Sensitized patients received desensitization therapy with rituximab for kidney transplantation. However, the impact of rituximab dose on hepatitis B virus (HBV) reactivation is unknown. Patients who underwent living donor kidney transplantation between 2008 and 2016 were grouped according to rituximab dose (control vs. standard-dose rituximab [375 mg/m2] vs. reduced-dose rituximab [200 mg/body]) for comparison of HBV reactivation. A total of 336 hepatitis B surface antigen (HBsAg)-negative/antibody to hepatitis B core antigen (anti-HBc)-positive patients underwent kidney transplantation, of whom 91 (27.1%) received rituximab for desensitization (57 standard-dose and 34 reduced-dose rituximab). During the study period, eight patients experienced HBV reactivation (three in the control group, five in the standard-dose group). In the standard-dose group, four patients experienced hepatitis flare, and one patient died due to hepatic failure. No HBV reactivation occurred in the reduced-dose group. Standard-dose rituximab significantly decreased hepatitis B surface antigen antibody titer (anti-HBs; −99.8 IU/L) at 12 months, compared with reduced-dose rituximab (−20.1 IU/L) and control (−39.1 IU/L, P = 0.017). Standard-dose rituximab (HR, 10.60; 95% CI, 2.52–44.60; P = 0.001) and anti-HBs

We demonstrated the relationships between elemental carbon (EC) and EC fractions during evolved gas analysis (EGA) for PM2.5 sampled at KOREATECH from 29 March 2018 to 12 May 2018. The EC concentrations were compared to the concentrations of equivalent black carbon to confirm that the level of EC concentrations analyzed in this study was valid. Among various EC fractions and their combination, EC1+EC3 fractions were best correlated with the EC concentrations. Especially, dominant EC fraction was related with the dependence of carbon oxidation quantity on the oxidation temperature. We also examined the relationships between pyrolytic carbon (PyC) and EC concentration with respect to the split time. PyC was correlated with the split time in the phase of oxygen-helium mixture. PyC was close to zero for the split time in the helium phase. It is novel, as far as the authors know, that the correlation between PyC and the split time under NIOSH 5040 protocol was reported with regard to EGA. We believe that our study helps to identify what causes uncertainty in the quantification of PyC.

Abstract The effect of delayed graft function (DGF) recovery on long-term graft outcome is unclear. The aim of this study was to examine the association of DGF recovery status with long-term outcome. We analyzed 385 recipients who underwent single kidney transplantation from brain-dead donors between 2004 and 2015. Patients were grouped according to renal function at 1 month post-transplantation: control (without DGF); recovered DGF (glomerular filtration rate [GFR] ≥ 30 mL/min/1.73 m2); and incompletely recovered DGF group (GFR

Abstract Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients. The aim of this study was to evaluate risk factors for PJP in kidney transplantation recipients. We conducted a retrospective analysis of patient data from 500 consecutive kidney transplants performed at Severance Hospital between April 2011 and April 2014. Eighteen kidney transplantation recipients (3.6%) were diagnosed with PJP. In the univariate analysis, acute graft rejection, CMV infection, use of medication for diabetes mellitus, and lowest lymphocyte count were associated with PJP. Recipients who experienced acute graft rejection (odds ratio [OR] 11.81, 95% confidence interval [CI] 3.06–45.57, P

BACKGROUND:Limited information exist on tobacco and e-cigarette use patterns in cancer survivors. The purpose of this study is to report on use patterns in cancer survivors compared with non-cancer participants from the Population Assessment of Tobacco and Health (PATH) Study. METHODS:Sociodemographic data and tobacco product use were analyzed for 32,244 adult participants from the PATH Study in 2013-2014 by cancer status and age. Logistic regression examined the patterns of and factors associated with tobacco use by cancer status. RESULTS:Overall, cancer survivors represented 7.1% (n = 1,527) of participants, were older, and had a higher proportion of females and non-Hispanic whites than non-cancer participants. In cancer survivors, current and former cigarette smoking was reported in 12.7% and 32.9% respectively, compared with 18.5% and 19.0% in non-cancer adults. Current e-cigarette use was reported by 3.8% of survivors compared with 5.7% of non-cancer participants. Dual tobacco use was reported by 25.0% and poly use by 6.9% of cancer survivors who currently smoked. All other forms of current tobacco use were individually reported by

Background: Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. However, data on the feasibility and safety of performing RKT by surgeons with a lack of prior minimally invasive surgery (MIS) experience are limited. The authors aimed to evaluate the surgical and functional results of RKT and present the learning curves (LC) of RKT by a single surgeon with no prior experience in MIS. Materials and methods: This was a retrospective study of all RKT performed between November 2019 and April 2023 at Severance Hospital in Seoul, South Korea. The authors analyzed surgical and functional outcomes, as well as complication rates of RKT in comparison to open kidney transplantation (OKT). The authors evaluated LCs using the cumulative summation method to describe the number of cases associated with the competency of a single surgeon. Results: A total of 50 patients who underwent RKT and 104 patients who underwent OKT were included in this study. In RKT group, the median surgical console time was 193 min (interquartile range, 172-222) and the median vascular anastomoses time was 38 min (35-44). Total operation time was 323 min (290-371) and rewarming time was 62.5 min (56.0-70.0) in RKT group compared to 210 min (190-239) and 25 min (21-30), respectively, in OKT group. Despite extended surgical durations with a robotic technique, both groups had comparable intraoperative and postoperative outcomes, as well as renal function. Estimated blood loss and posttransplant hospital stays were significantly lower in RKT group than in OKT group. LC analysis of RKT by the single surgeon revealed that surgical competence was achieved after 15 cases. Conclusion: Even if surgeons do not have prior experience with MIS, they can rapidly overcome the LC and safely perform RKT with adequate preparation and acquisition of basic robotic surgical techniques. [ABSTRACT FROM AUTHOR]

Background E-cigarettes are frequently promoted on social media and portrayed in ways that are attractive to youth. While the COVID-19 pandemic significantly affected people’s lives, less is known about how the pandemic influenced e-cigarette-related marketing and information on social media. This study examined how e-cigarettes were portrayed on youtube, one of the most popular social media platforms during the COVID-19 pandemic. Methods We searched for combinations of search terms related to e-cigarettes (e.g., “electronic cigarette” and “vape”) and COVID-19 (e.g., “corona” and “COVID”) in July of 2021. To be included in analyses, videos must be: uploaded after February 1, 2020, in English, related to e-cigarettes and COVID-19, and less than 30 min in length. We conducted a content analysis of included videos, coding for uploader characteristics, what e-cigarette products were showcased, and specific themes that intersected between e-cigarettes and COVID-19. Results We examined N = 307 videos and found that N = 220 (73.6%) discussed the health effects of e-cigarette use on COVID-19, followed by videos on how COVID-19 affects e-cigarette sales (N = 40, 12.9%), face mask-related videos (N = 16, 5.1%; e.g., vape tricks including masks) and instructional videos (N = 10, 3.2%; e.g., sanitizing vape devices during COVID-19). Instructional videos had the highest number of likes (Median = 23; IQR = 32) and comments (Median = 10; IQR = 7). Conclusions Our findings support the need for continuous surveillance and research on novel vaping-related content in reaction to policies and events, such as the global pandemic. More research is needed to understand the impact of this content on young people’s perceptions and use of e-cigarettes. [ABSTRACT FROM AUTHOR]

Patients with end stage kidney disease (ESKD) and a previous acute myocardial infarction (AMI) have less access to KT. Data on ESKD patients with an AMI history who underwent first KT or dialysis between January 2007 and December 2018 were extracted from the Korean National Health Insurance Service. Patients who underwent KT (n = 423) were chronologically matched in a 1:3 ratio with those maintained on dialysis (n = 1,269) at the corresponding dates, based on time-conditional propensity scores. The 1, 5, and 10 years cumulative incidences for all-causemortality were 12.6%, 39.1%, and 60.1%in the dialysis group and 3.1%, 7.2%, and 14.5% in the KT group. Adjusted hazard ratios (HRs) of KT versus dialysis were 0.17 (95% confidence interval [CI], 0.12-0.24; p < 0.001) for mortality and 0.38 (95% CI, 0.23-0.51; p < 0.001) for major adverse cardiovascular events (MACE). Of the MACE components, KT was most protective against cardiovascular death (HR, 0.23; 95% CI, 0.12-0.42; p < 0.001). Protective effects of KT for all-cause mortality and MACE were consistent across various subgroups, including patients at higher risk (e.g., age >65 years, recent AMI [<6 months], congestive heart failure). KT is associated with lower all-cause mortality and MACE than maintenance dialysis patients with a prior AMI. [ABSTRACT FROM AUTHOR]