Long-term results of orthotopic heart transplantation vary among different institutions. The purpose of the present study was to assess the factors, which might affect long-term survival and complications. Between November 1992 and July 2003, 112 heart transplantations (M/F=89: 23) were performed. The standard technique was used in the first 57 patients and the bicaval technique in the latter 55 patients. Indications for transplantation in decreasing order of frequency were dilated cardiomyopathy (75%), ischemic cardiomyopathy (7%), and others (18%). The mean follow up duration was 51.8 +/- 31.3 months with 98 patients remaining alive. Preoperatively, all patients were either in NYHA functional class III or IV. Postoperatively, all patients showed improvement to functional class II or I, except 3 patients that remained in NYHA class III. The mean number of rejection cases within the first year was 0.6 +/- 0.8, with humoral rejection noted in 3 cases. The graft vascular disease (GVD) -free survival at 3 and 5 years was 96% and 83%, respectively. The 7-year survival after heart transplantation was 84%. There were 16 deaths, of which infection (n=4) was the most common followed by rejection (n=3), and malignancy (n=2). The present long-term results, were relatively superior to those seen in western countries. The relatively low GVD-free survival rate is thought to have contributed. The complications encountered after transplantation were mostly immunosuppressive drug related, suggesting further potentials for improvement in long-term survival.
Adult ; Female ; Follow-Up Studies ; Graft Rejection/epidemiology ; *Heart Transplantation/mortality ; Humans ; Incidence ; Kidney/blood supply ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Vascular Diseases/epidemiology

OBJECTIVETo investigate the risk factors of transplant renal artery stenosis (TRAS).

METHODSThe clinical records of 26 patients undergoing renal transplantation in our hospital between 2000 and 2005 were retrospectively analyzed, whose final diagnosis of TRAS was established on the basis of arteriographic findings. A case-control group of 52 post-renal transplantation patients were sampled by stratified randomization, whose blood pressure and renal graft function were without complications of avascularity or urinary passage. The two groups were matched for the operation time, gender, age, primary diseases, blood type, PRA and HLA matching and use of immunosuppressants. Possible events related to TRAS such as cold ischemia time, acute rejection, delayed graft function and approaches of arterial anastomosis were compared.

RESULTSFifteen patients (57.7%) with TRAS had a history of acute rejection episode, 7 (26.9%) had delayed graft function, both rates of which were higher than those in the control group (P<0.05). The cold ischemic time and type of arterial anastomosis showed no significant effect on TRAS occurrence (P>0.05).

CONCLUSIONSPost-transplant renal artery stenosis is closely associated with acute rejection and delayed graft function but not with the cold ischemic time or the type of arterial anastomosis.

Adult ; Case-Control Studies ; China ; epidemiology ; Delayed Graft Function ; complications ; Female ; Graft Rejection ; complications ; Humans ; Kidney Transplantation ; adverse effects ; Male ; Middle Aged ; Renal Artery Obstruction ; epidemiology ; etiology ; Retrospective Studies ; Risk Factors

OBJECTIVE: To introduce clinical experience for living-related donor kidney transplantation (LDKT) by reviewing LDKT clinical data. METHODS: A total of 158 patients underwent LDKT. Expect for 7 patients donated by their spouses, the others had blood relationship donors. Donor-recipient HLA matching showed 2 patients had 5-loci mismatch, 5 with 4-loci mismatch, 88 with 3-loci mismatch, 50 with 2-loci mismatch, 12 with 1-loci mismatch, the other 1 with 0-loci mismatch. All of the 158 donors underwent open nephrectomy, 35 of whom donated the right kidneys and the other 123 donated the left kidneys. Triple immunosuppressive regimen consisted of calcineurin inhibitors or FK506, MMF or AZa, and steroid. RESULTS: All donors were healthy after the operation. All donors were followed up for 6 to 12 months and blood exams showed that inosine levels were normal. The longest kidney transplant functional survival time was 10 years to up June 2008. The one year patient/graft survival rate was 95.5%. Delayed graft function (DGF) occurred in 5 patients, 4 of whom recovered in 2-5 weeks. Five patients died, 4 of whom died of post-operational pulmonary infection within 3-5 months, with no transplantational complications. The other one died of pulmonary bleeding during dialysis while treating for DGF. One patient received a second deceased kidney transplant because of hyperacute rejection during the surgery. Five developed acute rejection 1 month after the operation (incidence rate 3.16%), 4 of whom were cured by administration of methylprednisolone, and the other one returned to dialysis because of renal toxicity of cyclosporine. Three patients had positive chronic rejection, 2 of whom lost graft function in 1.5-3.5 years. Eight patients developed pulmonary infection and 4 of them were cured. CONCLUSION Sufficient LDKT pre-operational assessment, satisfactory tissue matching and reduced ischemia time may result in lower incidence of DGF, acute rejection and higher patient/graft survival rate. In LDKT, importance should also be attached to the prevention of DGF and graft rejection. Rational dosage of immunosuppressants is advocated to prevent secondary infective complications. Donor specifications and all around evaluation of the living-related donors should also be emphasized to minimize the harm to the donors. Long term follow-up is also essential to ensure donors' post-operational healthy life.
Adolescent ; Adult ; Aged ; China ; epidemiology ; Family ; Female ; Graft Rejection ; epidemiology ; Graft Survival ; immunology ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Living Donors ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Solid organ transplantation is a therapeutic option for end-stage organ diseases. However, complications including infection and graft rejection, which are related to immunosuppressive therapy, remain the major causes of morbidity and mortality following solid organ transplantation. The optimal approach to infection in solid organ transplant recipients is prevention; failing this, prompt and aggressive diagnosis and therapy are essential. In addition, the epidemiology of infections after solid organ transplantation has shifted as a result of changes in immunosuppressive strategies and improved survival. Immunosuppression must be linked with appropriate vaccinations, donor and recipient screening, patient education regarding infectious risks and lifestyle, monitoring, and antimicrobial prophylaxis.
Diagnosis ; Epidemiology ; Graft Rejection ; Humans ; Immunosuppression ; Life Style ; Mass Screening ; Mortality ; Opportunistic Infections* ; Organ Transplantation* ; Patient Education as Topic ; Tissue Donors ; Transplants* ; Vaccination

OBJECTIVETo summarize the experiences in high-risk renal transplant recipients for ketter long-term survival.

METHODSFrom April 1991 to December 2008, a total of 921 kidney recipients with high-risk factors were divided into six groups as following: (1) pediatric patients (< 18 years old) (GI, n = 34); (2) retransplant recipients (GII, n = 169); (3) high sensitized patients (PRA> 30% or peak PRA > 50%)(GIII, n = 35); (4) elderly recipients (> 60 years old) (GIV, n = 297); (5) diabetic patients (GV, n = 112); (6) patients with HBV/HCV infection or HBV/HCV carrier (GVI, n = 274). Each group was compared to a control of 807 recipients without any above risk factor for patient and graft survival at 1, 3 and 5 years. Incidences of acute rejection (AR), chronic rejection (CR) and complication were analyzed and compared respectively between the studied subjects and the control group as well.

RESULTSCompared with the control group, patient/graft survivals were lower in GII, GIII and GVI (all P < 0.05), GIV had worse patient survival (P < 0.05); AR and CR incidences were greater in GI and GIII (all P < 0.05); GIV, GV and GVI had more complications.

CONCLUSIONSThis study suggests the benefits for long-term outcome in high-immunological risk renal transplant recipients of low acute selection incidence rate, and reduction of complication incidences is the key to long term results for non-immunological high risk recipients.

Adolescent ; Adult ; Aged ; Child ; Female ; Graft Rejection ; epidemiology ; Graft Survival ; Humans ; Kidney Transplantation ; statistics & numerical data ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome ; Young Adult

The disparity between patients awaiting transplantation and available organs forced many patients to go overseas to receive a transplant. Few data concerning overseas transplantation in Korea are available and the Korea Society for Transplantation conducted a survey to evaluate the trend and outcome of overseas transplantation. The survey, conducted on June 2006, included 25 hospitals nationwide that followed up patients after receiving kidney transplant (KT) or liver transplant (LT) overseas. The number of KT increased from 6 in 2001 to 206 in 2005 and for LT from 1 to 261. The information about overseas transplant came mostly from other patients (57%). The mean cost for KT was dollar 21,000 and for LT dollar 47,000. Patients were admitted for 18.5 days for KT and 43.4 days for LT. Graft and patient survival was 96.8% and 96.5% for KT (median follow up 23.1 months). Complication occurred in 42.5% including surgical complication (5.3%), acute rejection (9.7%) and infection (21.5%). Patient survival for LT was 91.8% (median follow up 21.2 months). Complication occurred in 44.7% including 19.4% biliary complication. Overseas KT and LT increased rapidly from 2001 to 2005. Survival of patients and grafts was comparable to domestic organ transplantation, but had a high complication rate.
Graft Rejection/complications ; Graft Survival ; Humans ; Kidney Transplantation/adverse effects/economics/trends ; Liver Transplantation/adverse effects/economics/trends ; Organ Transplantation/adverse effects/economics/*trends ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

The disparity between patients awaiting transplantation and available organs forced many patients to go overseas to receive a transplant. Few data concerning overseas transplantation in Korea are available and the Korea Society for Transplantation conducted a survey to evaluate the trend and outcome of overseas transplantation. The survey, conducted on June 2006, included 25 hospitals nationwide that followed up patients after receiving kidney transplant (KT) or liver transplant (LT) overseas. The number of KT increased from 6 in 2001 to 206 in 2005 and for LT from 1 to 261. The information about overseas transplant came mostly from other patients (57%). The mean cost for KT was dollar 21,000 and for LT dollar 47,000. Patients were admitted for 18.5 days for KT and 43.4 days for LT. Graft and patient survival was 96.8% and 96.5% for KT (median follow up 23.1 months). Complication occurred in 42.5% including surgical complication (5.3%), acute rejection (9.7%) and infection (21.5%). Patient survival for LT was 91.8% (median follow up 21.2 months). Complication occurred in 44.7% including 19.4% biliary complication. Overseas KT and LT increased rapidly from 2001 to 2005. Survival of patients and grafts was comparable to domestic organ transplantation, but had a high complication rate.
Graft Rejection/complications ; Graft Survival ; Humans ; Kidney Transplantation/adverse effects/economics/trends ; Liver Transplantation/adverse effects/economics/trends ; Organ Transplantation/adverse effects/economics/*trends ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

INTRODUCTIONThe status of heart transplantation in Singapore is reviewed in this article.

MATERIALS AND METHODSThe database of 40 consecutive heart transplantations from July 1990 through December 2007 is reviewed retrospectively. The data is compared with the 2008 registry data of the International Society for Heart and Lung Transplantation (ISHLT).

RESULTSThe average age of recipients was 45.3 years. Ages ranged from 14 to 64 years. Ischaemic cardiomyopathy (52.5%) and dilated cardiomyopathy (42.5%) were the major indications. From 1990 to 1999, 50% of the donors sustained brain death from road traffic accident, 25% from cerebrovascular accident and 25% from falling from height, whereas the cause of brain death in the donors from 2000 to 2007 was 33%, 47% and 9.5%, respectively. The average donor age increased from 28.3 to 38.1 years. The significant morbidities in the recipients were hypertension, cytomegalovirus (CMV) infection, cardiac allograft vasculopathy and renal dysfunction. Thirtytwo required treatment for hypertension. 67.5% developed CMV disease requiring treatment. Cardiac allograft vasculopathy was diagnosed in 10. Rising creatinine levels reaching over 2.5 mg/dL was seen in 7. Three required renal dialysis. Epstein-Barr virus related lympho proliferative disorder occurred in 2 patients. One patient developed adenocarcinoma of stomach. The 30-day mortality was 10% and half life was 10 years. Cardiac allograft vasculopathy and sepsis caused 41.7% of mortality each. 11.7% of the mortality was due to cerebrovascular accident.

CONCLUSIONThe status of heart transplantation in Singapore is comparable to the ISHLT registry data. Transplant provides excellent early survival of 80%; however, the expected half life is around 10 years after cardiac transplantation. The late mortality is mainly caused by cardiac allograft vasculopathy (CAV) and renal failure. More effort and research needs to be directed towards these issues to improve the long-term results.

Adolescent ; Adult ; Cytomegalovirus Infections ; Female ; Graft Rejection ; epidemiology ; Heart Failure ; etiology ; physiopathology ; surgery ; Heart Transplantation ; mortality ; utilization ; Humans ; Immunosuppression ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Tissue and Organ Procurement ; Transplantation, Homologous ; Young Adult

OBJECTIVETo analyze the clinical characteristics of living-related kidney transplantation (LRKT).

METHODSFrom January, 2004 to December, 2008, 175 LRKT were performed including 63 cases (36%) of parent-child relations and 49 cases (28%) of sibling relations between the recipients and donors. Out of 175 donors, 52 were 50 years old or above, 4 had microscopic hematuria (including 2 with also hypertension), 2 had kidney stone, and 2 had high body mass index (BMI). Zero-point graft biopsy was performed in 59 donors, and abnormalities were found in 15 of them. The recipients were at the age of 33-/+10.5 years, and the primary diseases are mainly dominant glomerular nephritis (72.6%, 127/175), and with a few cases of diabetes (4%, 7/175) and hypertensive nephropathy (4%, 7/175).

RESULTSSerum creatinine of the donors was 102-/+22.5 micromol/L at 7 days postoperatively, and 92-/+19.1 micromol/L at one month. One recipient died of severe pulmonary infection. Two recipients underwent graft nephrectomy due to anastomotic stenosis with concomitant acute graft rejection and renal arterial embolism. The one-year survival rates of the patients and grafts were 99.3% and 98.2%, respectively. The incident rates of accelerated rejection and acute rejection were 1.1% and 14.9%, respectively. Other complications included impaired liver function (22.3%), infection (9.7%) and leucopenia (4.6%). The renal arterial stenosis occurred in 2.3% (4/175) of the recipients.

CONCLUSIONSThe recipients of living-related and cadaveric kidney transplant have different primary kidney disease spectrums. Differential diagnosis and treatment of acute rejection and renal artery or anastomotic stenosis can be of vital importance. Marginal donor kidneys with appropriate inclusion criteria can be safely used for transplantation. With good short-term patient and graft survival, LRKT needs further study to evaluate its long-term effect.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; epidemiology ; Family ; Female ; Glomerulonephritis ; surgery ; Graft Rejection ; epidemiology ; Humans ; Kidney Transplantation ; adverse effects ; Living Donors ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo study the incidence, etiology, outcome, and risk factors of early (is less than or equal to 30 days) pulmonary infection following adult-to-adult living donor liver transplantation (AALDLT).

METHODSMedical records of 108 AALDLT without pre-operative respiratory disease from 2005 to 2008 were retrospective to evaluate the incidence, etiology, outcome, and risk factors of pulmonary infection following AALDLT. Univariate analysis was used to determine relative risk factors leading to postoperative pneumonia, and significant factors (P less than 0.05) were then used for multivariate logistic regression analysis.

RESULTSThe incidence of pneumonia was 22.2 % (n = 24 ); etiology including bacteria (n = 23, 21.3%), gram negative bacteria account for 78.3%, fungi (n = 4, 3.7%) and virus (n = 1, 0.9%), 4 patients were coinfection by bacteria and fungi; 6 among 24 patients (25%) and 4 out of the other 84 patients (4.76%) died early following the AALDLT, respectively (x2 = 6.850, P = 0.009). In univariate analysis, intraoperative volume of whole blood/packed red blood cells transfusion (P less than 0.01), intraoperative volume of fresh frozen plasma transfusion (P = 0.001), total volume of intraoperative transfusion (P = 0.015), mechanical ventilation (P less than 0.01), intensive unit care (ICU) stay (P = 0.012) and acute rejection (P = 0.001) are of statistical significance. Multivariate logistic regression showed only mechanical ventilation (P = 0.023) and acute rejection (P = 0.026) are independent factors predicting pneumonia.

CONCLUSIONGram negative bacteria is the main etiology for pneumonia following AALDLT which has high morbidity and mortality; mechanical ventilation and acute rejection are independent risk factors.

Adult ; Female ; Graft Rejection ; epidemiology ; Gram-Negative Bacterial Infections ; epidemiology ; mortality ; Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Incidence ; Liver Transplantation ; adverse effects ; methods ; mortality ; Living Donors ; Lung Diseases ; epidemiology ; microbiology ; mortality ; Male ; Middle Aged ; Pleural Effusion ; epidemiology ; Pneumonia ; epidemiology ; microbiology ; mortality ; Postoperative Complications ; epidemiology ; Regression Analysis ; Retrospective Studies ; Risk Factors ; Transfusion Reaction ; Young Adult