scholarly journals Transfusion Status in Liver and Kidney Transplantation Recipients—Results from Nationwide Claims Database

2020 ◽  
Vol 9 (11) ◽  
pp. 3613
Author(s):  
Boyoung Park ◽  
Junghyun Yoon ◽  
Han Joon Kim ◽  
Yun Kyung Jung ◽  
Kyeong Geun Lee ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Mortality Rate ◽  
Deceased Donor ◽  
Sociodemographic Factors ◽  
Fresh Frozen Plasma ◽  
Transfusion Rate ◽  
Solid Organ ◽  
Kidney Recipients ◽  
Fresh Frozen ◽  
Liver And Kidney

Background: This study analyzed the status and trends of transfusion and its associated factors among liver and kidney transplantation recipients. Methods: A total of 10,858 and 16,191 naïve liver or kidney transplantation recipients from 2008 to 2017 were identified through the National Health Insurance Service database. The prescription code for transfusion and the presence, number, and amount of each type of transfusion were noted. The odds ratios and 95% confidence intervals were determined to identify significant differences in transfusion and blood components by liver and kidney transplantation recipient characteristics. Results: In this study, 96.4% of liver recipients and 59.7% of kidney recipients received transfusions related to the transplantation operation, mostly platelet and fresh frozen plasma. Higher perioperative transfusion in women and declining transfusion rates from 2008 to 2017 were observed in both liver and kidney recipients. In liver recipients, the transfusion rate in those who received organs from deceased donors was much higher than that in those who received organs from living donors; however, the mortality rate according to transfusion was higher only in recipients of deceased donor organs. In kidney recipients, a higher mortality rate was observed in those receiving transfusion than that in patients without transfusion. Conclusions: In Korea, the transfusion rates in liver and kidney recipients were relatively higher than those in other countries. Sociodemographic factors, especially sex and year of transplantation, were associated with transfusion in solid organ recipients, possibly as surrogates for other causal clinical factors.

scholarly journals Capillary leak syndrome and disseminated intravascular coagulation after kidney transplantation in a patient with hereditary angioedema - A case report -

2021 ◽  
Vol 16 (1) ◽  
pp. 75-80
Author(s):  
Jeong Wook Park ◽  
Jinyoung Seo ◽  
Sang Hun Kim ◽  
Ki Tae Jung
Keyword(s):  
Kidney Transplantation ◽  
Disseminated Intravascular Coagulation ◽  
Hereditary Angioedema ◽  
Treatment Options ◽  
Deceased Donor ◽  
Fresh Frozen Plasma ◽  
Capillary Leak Syndrome ◽  
Capillary Leak ◽  
Intravascular Coagulation ◽  
Fresh Frozen

Background: Hereditary angioedema (HAE) is a rare disease caused by the deficiency of C1 esterase inhibitor. HAE has a risk of life-threatening complications such as capillary leak syndrome (CLS) and disseminated intravascular coagulation (DIC).Case: A 42-year-old man with HAE presented for deceased-donor kidney transplantation. Prophylactic fresh frozen plasma (FFP) was given before surgery because of the risk of edema development. With careful management during anesthesia, there were no problems during surgery. However, generalized edema, hypotension, hypoalbuminemia, massive drainage of serosanguineous fluids from the intraabdominal space, and DIC occurred on the day after surgery. CLS was suspected and sustained hypotension with generalized edema became worse despite treatment with albumin, danazol, FFP, and vasoactive drugs. The patient’s condition worsened despite intensive care and he died due to shock.Conclusions: The anesthesiologist should prepare for the critical complications of HAE and prepare the appropriate treatment options.

scholarly journals Bacterial and Fungal Co-infections with SARS-CoV-2 in Solid Organ Recipients, A Retrospective Study

2021 ◽  
Author(s):  
Mojtaba Shafiekhani ◽  
Zahra Shekari ◽  
Arash Boorboor ◽  
Zahra Zare ◽  
Sara Arabsheybani ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Binary Logistic Regression ◽  
Risk Groups ◽  
Solid Organ ◽  
Binary Logistic Regression Model ◽  
Kidney Recipients ◽  
Susceptible Patient ◽  
Liver And Kidney ◽  
Vancomycin Resistant

Abstract Background SARS-CoV-2, a novel corona virus, has caused clusters of fatal pneumonia worldwide. Immune compromised patients are among the high risk groups with poor prognosis of the disease. The presence of bacterial or fungal co-infections with SARS-CoV-2 is associated with increased mortality.Methods The electronic data of the liver and kidney recipients, hospitalized in COVID-19 intensive care unit in an 8-month period in 2020 were retrospectively assessed. The documented bacterial or fungal infections alongside with outcome and risk factors were recorded and analyzed by binary logistic regression model and multivariate analyses.Results Sixty-Six liver and kidney recipients were included this study. Twenty one percent of the patients had at least one episode of co-infection during their COVID-19 course. Bacterial and fungal co-infections contributed to a significantly higher mortality. Urine and sputum were the most common sites of pathogen isolation (45.45 % and 36.36%; respectively). The majority of infections were caused by vancomycin- resistant Enterococci (30%). Escherichia coli stood in the next position with 23.3%. Prior hospitalization and high does corticosteroid use were associated with co-infections (p=0<0.001 and p=0.02; respectively.)Conclusions Bacterial and fungal co-infections with COVID-19 are more prevalent on solid organ recipients compared to the general population. Prior hospitalizations and use of broad-spectrum antimicrobial agents leads to emergence of multi-drug resistant pathogens in this susceptible patient population. Early detection and treatment of co-infections as well as antibiotic stewardship is recommended in solid organ recipients.

SP787SELECTIVE PLASMA EXCHANGE IN ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION: EFFICACY OF PARTIAL SUBSTITUTION WITH FRESH FROZEN PLASMA

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Toshihide Naganuma ◽  
Yoshiaki Takemoto ◽  
Ako Hanaoka ◽  
Junji Uchida ◽  
Tatsuya Nakatani
Keyword(s):  
Kidney Transplantation ◽  
Plasma Exchange ◽  
Fresh Frozen Plasma ◽  
Partial Substitution ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Urinary Biomarkers α-GST and π-GST for Evaluation and Monitoring in Living and Deceased Donor Kidney Grafts

2019 ◽  
Vol 8 (11) ◽  
pp. 1899 ◽  
Author(s):  
Shadi Katou ◽  
Brigitta Globke ◽  
M. Haluk Morgul ◽  
Thomas Vogel ◽  
Benjamin Struecker ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Rejection Sensitivity ◽  
Deceased Donor ◽  
Urine Samples ◽  
Kidney Graft ◽  
Donor Kidney ◽  
Kidney Recipients ◽  
Deceased Donor Kidney ◽  
Brain Dead

The aim of this study was to analyze the value of urine α- and π-GST in monitoring and predicting kidney graft function following transplantation. In addition, urine samples from corresponding organ donors was analyzed and compared with graft function after organ donation from brain-dead and living donors. Urine samples from brain-dead (n = 30) and living related (n = 50) donors and their corresponding recipients were analyzed before and after kidney transplantation. Urine α- and π-GST values were measured. Kidney recipients were grouped into patients with acute graft rejection (AGR), calcineurin inhibitor toxicity (CNI), and delayed graft function (DGF), and compared to those with unimpaired graft function. Urinary π-GST revealed significant differences in deceased kidney donor recipients with episodes of AGR or DGF at day one after transplantation (p = 0.0023 and p = 0.036, respectively). High π-GST values at postoperative day 1 (cutoff: >21.4 ng/mg urine creatinine (uCrea) or >18.3 ng/mg uCrea for AGR or DGF, respectively) distinguished between rejection and no rejection (sensitivity, 100%; specificity, 66.6%) as well as between DGF and normal-functioning grafts (sensitivity, 100%; specificity, 62.6%). In living donor recipients, urine levels of α- and π-GST were about 10 times lower than in deceased donor recipients. In deceased donors with impaired graft function in corresponding recipients, urinary α- and π-GST were elevated. α-GST values >33.97 ng/mg uCrea were indicative of AGR with a sensitivity and specificity of 77.7% and 100%, respectively. In deceased donor kidney transplantation, evaluation of urinary α- and π-GST seems to predict different events that deteriorate graft function. To elucidate the potential advantages of such biomarkers, further analysis is warranted.

scholarly journals Bacterial and Fungal Co-infections with SARS-CoV-2 in Solid Organ Recipients, A Retrospective Study

2022 ◽  
Author(s):  
Mojtaba Shafiekhani ◽  
Zahra Shekari ◽  
Arash Boorboor ◽  
Zahra Zare ◽  
Sara Arabsheybani ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Binary Logistic Regression ◽  
Risk Groups ◽  
Solid Organ ◽  
Binary Logistic Regression Model ◽  
Kidney Recipients ◽  
Susceptible Patient ◽  
Liver And Kidney ◽  
Vancomycin Resistant

Abstract Background SARS-CoV-2, a novel corona virus, has caused clusters of fatal pneumonia worldwide. Immune compromised patients are among the high risk groups with poor prognosis of the disease. The presence of bacterial or fungal co-infections with SARS-CoV-2 is associated with increased mortality. Methods The electronic data of the liver and kidney recipients, hospitalized in COVID-19 intensive care unit in an 8-month period in 2020 were retrospectively assessed. The documented bacterial or fungal infections alongside with outcome and risk factors were recorded and analyzed by binary logistic regression model and multivariate analyses. Results Sixty-Six liver and kidney recipients were included this study. Twenty one percent of the patients had at least one episode of co-infection during their COVID-19 course. Bacterial and fungal co-infections contributed to a significantly higher mortality. Urine and sputum were the most common sites of pathogen isolation (45.45 % and 36.36%; respectively). The majority of infections were caused by vancomycin- resistant Enterococci (30%). Escherichia coli stood in the next position with 23.3%. Prior hospitalization and high does corticosteroid use were associated with co-infections (p=0<0.001 and p=0.02; respectively.)Conclusions Bacterial and fungal co-infections with COVID-19 are more prevalent in solid organ recipients compared to the general population. Prior hospitalizations and use of broad-spectrum antimicrobial agents lead to emergence of multi-drug resistant pathogens in this susceptible patient population. Early detection and treatment of co-infections as well as antibiotic stewardship is recommended in solid organ recipients.

Incident TTP: Plasmapheresis Therapy-Related Complications Are Common.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1254-1254
Author(s):  
Anaadriana Zakarija ◽  
Kathryn R. McCaffrey ◽  
Nicholas Bandarenko ◽  
Dilip Pandey ◽  
John Cursio ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Laboratory Data ◽  
Venous Access ◽  
The United States ◽  
Fresh Frozen Plasma ◽  
Solid Organ ◽  
Cell Transplant ◽  
Replacement Fluid ◽  
Fresh Frozen ◽  
And Gender

Abstract Background: Plasmapheresis is the mainstay of therapy for thrombotic thrombocytopenic purpura (TTP). Due to the significant mortality associated with TTP if left untreated and the effectiveness of therapy, plasmapheresis may be instituted before the diagnosis is clearly established. Our case-control study of incident TTP allowed us to evaluate the incidence of complications in cases treated at multiple sites across the United States. Methods: The SERF-TTP study is a NHLBI-funded 15-site study to identify 300 cases of incident TTP and 600 age and gender-matched community controls. Each case of incident TTP is identified upon referral for therapeutic plasma exchange (TPE). Exclusion criteria include solid organ or allogeneic stem cell transplant, anti-neoplastic therapy, or metastatic adenocarcinoma. Epidemiologic information, laboratory data, and plasma samples are collected from both patients and controls. In addition, information is collected about volume of TPE, frequency, type of replacement fluid, duration of TPE, adverse reactions associated with TPE, and concurrent therapy. Results: To date, 11 sites across the US have IRB approval, and 50 cases have been identified. Data are available for the first 32 patients, whose mean age is 41.9 years. All patients underwent TPE, a number of which received more than one type of replacement fluid. The majority of patients received fresh frozen plasma (FFP): 60.0% FFP, 46.7% cyroprecipitate poor plasma, and 16.7% albumin. Additionally, 63.3% of patients received concurrent corticosteroid therapy. The mean number of treatment days prior to the achievement of platelet count &gt; 150,000 per microliter was 9.7 (range 0–43 days). Overall survival was 90.0%. Adverse reactions were observed in 53.3% of patients (16/30). The most frequently observed toxicity was an allergic reaction in 40% (12/30) of patients, followed by citrate-related toxicity in 30% (9/30) of patients. No patients experienced an anaphylactic reaction. 16.7% of cases (5/30) had venous access complications, most frequently a catheter-associated thrombosis (3/5). In addition, one patient had a significant hemorrhage associated with venous access, which required treatment in intensive care. Conclusions: Preliminary data from this cohort of patients suggest that adverse reactions are commonly seen in incident TTP patients undergoing TPE; the most frequent are allergic reactions to plasma. This highlights the need for development of reliable diagnostic criteria for TTP so patients are not exposed to the risks of TPE unnecessarily.

A Review of Goal-Directed Cardiopulmonary Bypass Management in Pediatric Cardiac Surgery

2018 ◽  
Vol 9 (5) ◽  
pp. 565-572 ◽  
Author(s):  
Ravi Medikonda ◽  
Chin Siang Ong ◽  
Rajeev Wadia ◽  
Dheeraj Goswami ◽  
Jamie Schwartz ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Central Venous Oxygen Saturation ◽  
Fresh Frozen Plasma ◽  
Transfusion Rate ◽  
Goal Directed Therapy ◽  
Perfusion Flow ◽  
Venous Oxygen Saturation ◽  
Fresh Frozen ◽  
Improve Patient

Cardiopulmonary bypass perfusion management significantly affects postoperative outcomes. In recent years, the principles of goal-directed therapy have been applied to the field of cardiothoracic surgery to improve patient outcomes. Goal-directed therapy involves continuous peri- and postoperative monitoring of vital clinical parameters to tailor perfusion to each patient’s specific needs. Closely measured parameters include fibrinogen, platelet count, lactate, venous oxygen saturation, central venous oxygen saturation, mean arterial pressure, perfusion flow rate, and perfusion pulsatility. These parameters have been shown to influence postoperative fresh frozen plasma transfusion rate, coagulation state, end-organ perfusion, and mortality. In this review, we discuss the recent paradigm shift in pediatric perfusion management toward goal-directed perfusion.

scholarly journals Vacuum-assisted venous drainage in adult cardiac surgery: a propensity-matched study

2019 ◽  
Author(s):  
Sizhe Gao ◽  
Yongnan Li ◽  
Xiaolin Diao ◽  
Shujie Yan ◽  
Gang Liu ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Blood Product ◽  
Venous Drainage ◽  
Fresh Frozen Plasma ◽  
Gravity Drainage ◽  
Transfusion Rate ◽  
Fresh Frozen ◽  
Hospital Deaths ◽  
Frozen Plasma

Abstract OBJECTIVES Conventional cardiopulmonary bypass with gravity drainage leads inevitably to haemodilution. Vacuum-assisted venous drainage (VAVD) utilizes negative pressure in the venous reservoir, allowing active drainage with a shortened venous line to reduce the priming volume. The goal of this study was to analyse the efficacy and safety of VAVD. METHODS Data on 19 687 patients (18 681 with gravity drainage and 1006 with VAVD) who underwent cardiac operations between 1 January 2015 and 31 January 2018 were retrospectively collected from a single centre. Propensity matching identified 1002 matched patient pairs with VAVD and gravity drainage for comparison of blood product transfusion rate, major morbidities and in-hospital mortality rates. RESULTS The blood transfusion rate of the VAVD group was lower than that of the gravity drainage group (28.1% vs 35% for red blood cells, 13% vs 18% for fresh frozen plasma and 0.1% vs 1.8% for platelets; P = 0.0009, 0.0020 and <0.0001, respectively). The mean difference (95% confidence interval) between the groups for red blood cells, fresh frozen plasma and platelets was −6.9% (−11.0% to −2.8%), −5.0% (−8.1% to −1.8%) and −1.7% (−2.5% to −0.9%), respectively. No difference was observed regarding the major morbidities of cerebrovascular accidents, acute kidney injury, hepatic failure and perioperative myocardial infarction and the in-hospital deaths between the 2 groups. CONCLUSIONS VAVD was associated with a reduction in blood product transfusions, and an increase in the risk of major morbidities and in-hospital deaths of the VAVD group was not observed.

scholarly journals Invasive Fungal Diseases in Kidney Transplant Recipients: Risk Factors for Mortality

2020 ◽  
Vol 9 (6) ◽  
pp. 1824 ◽  
Author(s):  
Hyeri Seok ◽  
Kyungmin Huh ◽  
Sun Young Cho ◽  
Cheol-In Kang ◽  
Doo Ryeon Chung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Acute Rejection ◽  
Bacterial Infection ◽  
Kidney Transplant ◽  
Deceased Donor ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Related Mortality

Background: Invasive fungal disease (IFD) is common in solid organ transplant (SOT) recipients and contributes to high morbidity and mortality. Although kidney transplantation (KT) is a commonly performed SOT, data on the risk factors for IFD-related mortality are limited. Methods: A 1:2 retrospective case-control study was performed in an experienced single center in the Republic of Korea. We reviewed the electronic medical records of patients with IFD after KT between February 1995 and March 2015. Results: Of 1963 kidney transplant recipients, 48 (2.5%) were diagnosed with IFD. The median interval from KT to IFD diagnosis was 172 days. Invasive aspergillosis (IA) was the most common, followed by invasive candidiasis (IC). Diabetes mellitus (DM) (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.34–10.31, p = 0.011) and acute rejection (OR 3.41, 95% CI 1.41–8.21, p = 0.006) were associated with IFD development. In the subgroup analyses, concomitant bacterial infection was associated with IC development (OR 20.10, 95% CI 3.60–112.08, p = 0.001), and delayed graft function was associated with IA occurrence (OR 10.60, 95% CI 1.05–106.84, p = 0.045). The 12-week mortality rate in all patients was 50.0%. Mortality rates were significantly higher in older patients (adjusted hazard ratio (aHR) 1.06, 95% CI 1.02–1.11, p = 0.004), or those with DM (aHR 2.61, 95% CI 1.02–6.68, p = 0.044), deceased donor transplantation (aHR 2.68, 95% CI 1.03–6.95, p = 0.043), lymphocyte-depleting antibody usage (aHR 0.26, 95% CI 0.08–0.80, p = 0.019), acute rejection (aHR 0.38, 95% CI 0.15–0.97, p = 0.044), and concomitant bacterial infection (aHR 8.76, 95% CI 1.62–47.51, p = 0.012). Conclusions: A total of 50% of IFD cases occurred six months or later after transplantation. The IFD-related mortality rate was high in kidney transplant recipients despite the low incidence. DM and acute rejection were associated with high mortality, as well as IFD development. As old age, deceased donor transplantation, lymphocyte-depleting antibody usage, and concomitant bacterial infection are risk factors for IFD-related mortality, efforts for its early diagnosis and appropriate treatment are required.

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