Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 5 Articles
Background: No study has specifically investigated the duration of continuous renal replacement therapy (CRRT) in\npatients who experienced acute kidney injury during extracorporeal membrane oxygenation (ECMO) support.\nHowever, there are concerns that prolonged CRRT may be futile.\nMethods: We conducted a retrospective population-based cohort study using Taiwan National Health Insurance\nResearch Database data collected between January 1, 2007 and December 31, 2013. Patients who received ECMO\nand CRRT during the study period were included. We divided patients into three groups based on the duration of\nCRRT received: less than equal to 3 days, 4-6 days, and Greater than equal to 7 days. The outcomes were all-cause mortality, end-stage renal disease,\nventilator dependency, and readmission rate.\nResults: There were 247, 134 and 187 patients who survived the hospitalization in the CRRT for less than equal to3 days, 4-6 days\nand > 7 days respectively. Survival after discharge did not differ significantly between CRRT for 4-6 days vs. less than equal to 3 days\n(adjusted hazard ratio [aHR] 1.16, 95% confidence interval [CI] 0.85-1.57), between CRRT for > 7 days vs. less than equal to 3 days\n(aHR 1.001, 95% CI 0.73-1.38) and between CRRT for > 7 days vs. 4-6 days (aHR 0.87, 95% CI 0.62-1.22). The patients\nwho received CRRT for Greater than equal to7 days had a higher risk of ESRD than did those who received CRRT for less than equal to3 days (adjusted\nhazard ratio [aHR] 3.46, 95% confidence interval [CI] 1.47-8.14) and for 4-6 days (aHR 3.10, 95% CI 1.03-9.29). The\nincidence of ventilator dependence was higher in the patients with CRRT Greater than equal to7 days than in those with less than equal to3 days (aHR\n2.45, 95% CI 1.32-4.54). The CRRT Greater than equal to7 days group also exhibited a higher readmission rate than did the 4-6 days\nand less than equal to 3 days groups (aHR 1.43, 95% CI 1.04-1.96 and aHR 1.67, 95% CI 1.13-2.47, respectively).\nConclusions: Our study found similar long-term survival but increased ESRD and ventilator dependency among\nECMO patients who underwent CRRT for Greater than equal to7 days. These results offer reason to be concerned that this aggressive\nlife support may maintain patient survival but do so at the cost of long-term disabilities and a lower quality of life....
Background. Damage to the endothelium has been established as a key pathological process in lung transplantation and ex vivo\nlung perfusion (EVLP), a new technology that provides a platform for the assessment of injured donor lungs. Damage to the lung\nendothelial glycocalyx, a structure that lines the endothelium and is integral to vascular barrier function, has been associated with\nlung dysfunction. We hypothesised that endothelial glycocalyx shedding occurs during EVLP and aimed to establish a porcine\nmodel to investigate the mechanism underlying glycocalyx breakdown during EVLP. Methods. Concentrations of endothelial\nglycocalyx breakdown products, syndecan-1, hyaluronan, heparan sulphate, and CD44, were measured using the ELISA and\nmatrix metalloproteinase (MMP) activity by zymography in the perfusate of both human (n =9) and porcine (n =4) lungs\nundergoing EVLP. Porcine lungs underwent prolonged EVLP (up to 12 hours) with perfusion and ventilation parameters\nrecorded hourly. Results. During human EVLP, endothelial glycocalyx breakdown products in the perfusate increased over time.\nIncreasing MMP-2 activity over time was positively correlated with levels of syndecan-1 (r =0.886; p =0.03) and hyaluronan\n(r =0.943; p =0.02). In the porcine EVLP model, hyaluronan was the only glycocalyx product detectable during EVLP (1 hr: 19\n(13-84) vs 12 hr: 143 (109-264) ng/ml; p =0.13). Porcine hyaluronan was associated with MMP-9 activity (r =0.83; p =0.02) and\nalso with dynamic compliance (r =0.57; p =0.03). Conclusion. Endothelial glycocalyx products accumulate during both porcine\nand human EVLP, and this accumulation parallels an accumulation of matrix-degrading enzyme activity. Preliminary evidence in\nour porcine EVLP model suggests that shedding may be related to organ function, thus warranting additional study....
OBJECTIVES: In recent years, the percentage of heart transplantation (HT)\nwith short/medium-term assistance devices has increased. This study aims at\nanalyzing primary graft failure and in-hospital mortality according to the\ntype of care. MATERIAL AND METHODS: From January 2013 to December\n2017 all patients undergoing urgent HT with circulatory/ventricular assistance\nwere retrospectively and consecutively recruited. Combined transplants, retransplantations\nand pediatric transplants were excluded. The sample was divided\nin 10 groups according to the type of shot/medium term assistance devices.\nRESULTS: A total of 53 patients were recruited, 79% men, average age............................
Albuminâ??bilirubin (ALBI) grade is defined using the ALBI score, which is calculated based\non total serum bilirubin and albumin. This study aimed to evaluate the diagnostic ability of the\nALBI score for determining hepatic fibrosis stage and transplant-free survival in primary biliary\ncholangitis (PBC) patients. A total of 181 Japanese patients with biopsy-proven or serologically\ndiagnosed PBC were enrolled. The pathological stage was assessed using the Scheuer classification.\nThe ALBI score differentiated fibrosis in stage 4 from that of 3 in the biopsy-proven cohort (p < 0.05).\nWith an ALBI score cut-off value of -1.679, the sensitivity and specificity were 100% and 91.1%,\nrespectively, with a likelihood ratio of 12.3 to differentiate stage 4 from stages 1â??3. The ALBI score at\nthe beginning of ursodeoxycholic acid (UDCA) prescription correlated with the two prognostic scores\ncalculated after 1-year UDCA treatment. Kaplanâ??Meier analysis showed that the baseline ALBI score\ndifferentiated liver transplant-free survival (p < 0.05). The ALBI score presented a greater hazard\nratio for transplant-free survival than aspartate aminotransferase-to-platelet ratio index (APRI) in\nCox proportional hazard model. In conclusion, ALBI score indicates pathological stage in Japanese\nPBC patients and scores before UDCA prescription predict better liver transplant-free survival,\nwhich correlated well with the two major prognostic scores. The prognosis-predicting ability of the\nALBI score might surpass that of APRI....
Background: Bacteraemia of the donor is not considered to be contraindication of organ procurement. On the\nother hand, infection of solid organ transplant recipients remains to be a major cause of their morbidity and\nmortality. When using organs from bacteraemic donors, individual risks need to be assessed and the appropriate\nantibiotic treatment applied.\nCase presentation: In this case series we report several serious donorâ??derived infectious complications in four out\nof five recipients of different organs from one single donor in the early posttransplant period. Donor-transmitted\nmulti-drug resistant strains of Escherichia coli and Klebsiella pneumonia was confirmed by both serologic and\nmolecular testing.\nConclusions: To prevent donor-derived infections, careful microbiological screening followed by targeted antibiotic\ntreatment is essential. Although such complications can never by completely prevented, a high index for potential\nbacterial infection in organ donors and transplant recipients should be routinely employed....
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