BACKGROUND: Continuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significantly high mortality rate. To aid in the management of these high-risk patients, we evaluated the risk factors for mortality in CVVHDF-treated hypotensive AKI patients. METHODS: We studied 67 patients with AKI and hypotension who were treated with CVVHDF from February 2008 to August 2010. We reviewed patient characteristics and laboratory parameters to evaluate the risk factors for 90-day mortality. RESULTS: Of the 67 enrolled patients (male:female=42:25; mean age=69+/-14 years), 18 (27%) survived until 90 days after the initiation of CVVHDF. There was no significant difference in survival rates according to the etiology of AKI [hypovolemic shock 2/10 (20%), cardiogenic shock 4/20 (20%), septic shock 12/37 (32%)]. Univariate analysis did show significant differences between survivors and non-survivors in the frequency of ventilator use (44% vs. 76%, respectively; P=0.02), APACHE II score (29+/-7 vs. 34+/-7, respectively; P=0.01), SOFA score (11+/-4 vs. 13+/-4, respectively; P=0.03), blood pH (7.3+/-0.1 vs. 7.2+/-0.1, respectively; P=0.03), and rate of urine output <500mL for 12hours (50% vs. 80%, respectively; P=0.03). A multivariate Cox proportional hazards model showed that a urine output <500mL for 12hours was the only significant risk factor for 90-day mortality following CVVHDF treatment (odds ratio=2.1, confidence interval=1.01-4.4, P=0.048). CONCLUSION: A urine output <500mL for 12hours before the initiation of CVVHDF is an independent risk factor for 90-day mortality in hypotensive AKI patients treated with CVVHDF.
Acute Kidney Injury ; APACHE ; Dialysis ; Hemodiafiltration ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Proportional Hazards Models ; Renal Replacement Therapy ; Risk Factors ; Shock ; Shock, Cardiogenic ; Shock, Septic ; Survival Rate ; Survivors ; Ventilators, Mechanical

BACKGROUND: Since the first successful kidney transplantation from a brain death donor (BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell (PRBC) to maintain the hematocrit between 25~35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.
Age Distribution ; Brain Death* ; Brain* ; Chungcheongnam-do ; Dobutamine ; Erythrocytes ; Female ; Heart ; Hematocrit ; Humans ; Kidney ; Kidney Transplantation ; Liver ; Male ; Motor Vehicles ; Myocardium ; Organ Transplantation ; Retrospective Studies ; Tissue and Organ Procurement ; Tissue Donors* ; Transplants

BACKGROUND: The heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in human was done in 1967 and the first case in Korea was performed in November, 1992. Since the first case in 1992, more than 25 cases have been performed in Korea. The purpose of this study is to evaluate the early results and the follow-up course of 9 cases of heart transplantation done in Asan Medical Center. METHODS: Total 9 patients had orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The No. of male patients was 7 and the average age of 9 patients was 41 years old(20-51). The preoperation status was status I in 5 patients and status II in 4 patients. The mean follow-up duration was 9.5 months(2-26). All patients are alive till now. RESULTS: 1) The blood type was identical in 6 and compatible in 3 patients. 2) The original heart disease was dilated cardiomyopathy in 7, ischemic cardiomyopathy in 1 and giant cell myocarditis in 1 patient. 3) IgG Ab for CMV was positive in all recipients and donors and igM Ab for CMV was positive in only one reipient. The serial cultures for CMV shell vial method have been negative till now. 4) HLA cross matching for recipient and donor was done in 8 cases and the results were all negative for T-cell and B-cell. Among 6 loci of A, B and DR, one locus was matched in 4 cases and 2 loci was matched in 2 cases. 5) The No. of acute allograft rejection per case was average 3.7(1-6) and the No. of acute allograft rejection requiring treatment was average 1.4(1-3) per case. The time interval from operation to the first acute rejection requiring treatment was 40 days(5-60). Acute humoral rejection was supected strongly in 1 case and was successfully treated. 6) The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 15%(10-24) to 59%(45-70%) after heart transplantation. 7) Temporary pacing was needed in 2 parients over24 hours but normal sinus rhythm was appeared within 7 day in all cases. One patient had permanent pacemaker due to complte AV block appeared 140 days after heart transplantaion. CONCLUSION: The heart transplantation of Asan Medical Center is on developing stage but the early result is comparable to that of well established center in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in parients with terminal heart failure.
Allografts ; Atrioventricular Block ; B-Lymphocytes ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Chungcheongnam-do ; Echocardiography ; Follow-Up Studies ; Giant Cells ; Heart Diseases ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Male ; Myocarditis ; Stroke Volume ; T-Lymphocytes ; Tissue Donors