Objectives: . We aimed to investigate the effects of preoperative auditory rehabilitation using hearing aids in patients with prolonged hearing deprivation. Methods: . We retrospectively enrolled 204 patients who underwent cochlear implantation surgery at age >60 years using a single university hospital database. In total, 135 patients with a duration of deafness (DoD) >10 years were divided into three groups according to perioperative hearing aid use: unaided (n=22, 16.3%), aided (n=92, 68.1%; comprising 22 ipsilateral hearing aid users and 70 bilateral hearing aid users), and contralateral-only aided (n=21, 15.5%). We identified the highest postoperative sentence recognition score (Max_S) and compared this measure across groups. Results: . Max_S was significantly higher in the DoD <10 years group than in the DoD ≥10 years group (72.38±25.74 vs. 64.09±32.29, P=0.048). Among patients with DoD ≥10 years, the aided group had significantly better Max_S than the unaided group (69.84±28.72 vs. 47.86±37.14, P=0.015). After one-to-two propensity score matching, Max_S remained significantly better in the aided group than in the unaided group (73.64±29.10 vs. 47.86±37.14, P=0.007). Conclusion . Our study demonstrated the need for hearing rehabilitation during the period of hearing deprivation, including on the ear to be implanted, regardless of whether it produced immediate improvement in hearing levels.

Patients with sensitization and blood type O experience increased waiting times for deceased-donor kidney transplantation (DDKT). While allocation benefits are needed to resolve inequity in DDKT opportunity, whether DDKT has comparable outcomes in this disadvantaged population requires further study. This study assessed these outcomes and developed a new allocation system that balances equity and utility. Methods: Patients from national and hospital cohorts from two centers in Korea were categorized as B1 to B4 (according to panel reactive antibody [PRA] positivity and ABO blood type) and A1 to A4 (based on the maximal PRA% and blood type), respectively. Competing risk and Cox regression analyses were performed to assess the effects of PRA and blood type on graft failure and mortality, respectively. Based on DDKT opportunities and posttransplant outcomes, a new scoring system for kidney allocation was developed. Results: The national and hospital cohorts included 3,311 and 819 patients, respectively, who underwent DDKT. Despite the disparities in DDKT opportunities, the graft failure rates and mortality did not differ among the different PRA and blood type groups. Furthermore, posttransplantation outcomes did not differ according to the categories with different DDKT opportunities. A new scoring system to provide additional points to disadvantaged populations was developed based on the hazard ratios for DDKT. Conclusion: A new allocation approach based on PRA and ABO blood types offers benefits to disadvantaged patients with fewer DDKT opportunities and could enhance equity without sacrificing utility in Korea, which has a long waiting time for DDKT.

Cytomegalovirus (CMV) is the most important opportunistic viral pathogen in solid organ transplant (SOT) recipients.The Korean guideline for the prevention of CMV infection in SOT recipients was developed jointly by the Korean Society for Infectious Diseases and the Korean Society of Transplantation. CMV serostatus of both donors and recipients should be screened before transplantation to best assess the risk of CMV infection after SOT. Seronegative recipients receiving organs from seropositive donors face the highest risk, followed by seropositive recipients. Either antiviral prophylaxis or preemptive therapy can be used to prevent CMV infection. While both strategies have been demonstrated to prevent CMV infection post-transplant, each has its own advantages and disadvantages. CMV serostatus, transplant organ, other risk factors, and practical issues should be considered for the selection of preventive measures. There is no universal viral load threshold to guide treatment in preemptive therapy. Each institution should define and validate its own threshold.Valganciclovir is the favored agent for both prophylaxis and preemptive therapy. The evaluation of CMV-specific cellmediated immunity and the monitoring of viral load kinetics are gaining interest, but there was insufficient evidence to issue recommendations. Specific considerations on pediatric transplant recipients are included.

Recent several reports have demonstrated that periodontitis is prevalent and adversely affects the survival in patients with chronic kidney disease (CKD) or end-stage kidney disease. However, its impact on transplant outcomes remains uncertain. Methods: This retrospective cohort study included 136 and 167 patients, respectively, who underwent living donor kidney transplantation (KT) at Seoul National University Hospital from July 2012 to August 2016 and Korea University Hospital from April 2008 to October 2018. We divided patients into three groups according to stages of periodontitis based on a new classification system. Results: Patients with severe periodontitis were older, had a higher prevalence of diabetes, a higher body mass index and C-reactive protein level, a lower cardiac output, and were more likely to be smokers, indicating its association with chronic systemic inflammation. After KT, stage IV periodontitis was independently associated with a lower incidence of acute T cell-mediated rejection, suggesting the possible effect of periodontitis on immune function. However, 1-year and 3-year estimated glomerular filtration rates were not different. Among the KT recipients followed up more than 3 years, new-onset cardiovascular disease occurred in nine patients, and coronary artery disease occurred more frequently in patients with stage IV periodontitis. However, diabetes was the independent predictor of new-onset coronary artery disease in multivariate logistic regression analysis. Conclusion: Our findings showed that periodontitis might be an important player in determining posttransplant outcomes in recipients. Further interventional trials to test whether treating periodontitis could modify transplant outcome are needed.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established.METHODS: We retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation.RESULTS: Thirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months.CONCLUSION: The high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.
Adhesives ; Diagnosis ; Dilatation ; Female ; Fistula ; Humans ; Kidney Transplantation ; Korea ; Male ; Mortality ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Reoperation ; Retrospective Studies ; Seoul ; Tomography, X-Ray Computed

BACKGROUND: Although a growing number of guidelines and clinical researches are available for immunosuppressive treatment of post-transplantation, there is no clinical practice guideline for the care of kidney transplant recipients in Korea. Selection of a researchable question is the most important step in conducting qualified guideline development. Thus, we aimed to formulate key questions for Korean guideline to aid clinical decision-making for immunosuppressive treatment. METHODS: Based on previous published guidelines review, a first survey was constructed with 29 questions in the range of immunosuppressive treatments. The experts were asked to rate the clinical importance of the question using a 5-point Likert scale. The questions reached 60% or more from the first survey and additional new questions were included in the second survey. In analyzing the responses to items rated on the 9-point scale, consensus agreement on each question was defined as 75% or more of experts rating 7 to 9. RESULTS: In the first survey, 50 experts were included. Among the 29 questions, 27 were derived to get 60% or more importance and 3 new questions were additionally identified. Through the second survey, 9 questions were selected that experts reached consensus on 75% and over of the options. Finally, we developed key questions using PICO (patient, intervention, comparison, and outcome) methodology. CONCLUSION: The experts reached a high level of consensus on many of key questions in the survey. Final key questions provide direction for developing clinical practice guideline in the immunosuppressive treatment of transplantation.
Clinical Decision-Making ; Consensus ; Kidney Transplantation ; Kidney ; Korea ; Transplant Recipients

BACKGROUND: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction. METHODS: We conducted a multicenter, prospective, non-interventional study. Patients with CHADS2 ≥ 1 and treated with VKA (started within the last 3 months) were enrolled from April 2013 to March 2014. Demographic and clinical features including risk factors of stroke and VKA treatment information was collected at baseline. Treatment patterns and international normalized ratio (INR) level were evaluated during follow-up. Time in therapeutic range (TTR) > 60% indicated well-controlled INR. Treatment satisfaction on the VKA use was measured by Treatment Satisfaction Questionnaire for Medication (TSQM) after 3 months of follow-up. RESULTS: A total of 877 patients (age, 67; male, 60%) were enrolled and followed up for one year. More than half of patients (56%) had CHADS2 ≥ 2 and 83.6% had CHA2DS2-VASc ≥ 2. A total of 852 patients had one or more INR measurement during their follow-up period. Among those patients, 25.5% discontinued VKA treatment during follow-up. Of all patients, 626 patients (73%) had poor-controlled INR (TTR < 60%) measure. Patients' treatment satisfaction measured with TSQM was 55.6 in global satisfaction domain. CONCLUSION: INR was poorly controlled in Korean NVAF patients treated with VKA. VKA users also showed low treatment satisfaction.
Atrial Fibrillation* ; Drug Interactions ; Follow-Up Studies ; Humans ; International Normalized Ratio ; Male ; Prospective Studies ; Risk Factors ; Stroke ; Thromboembolism ; Vitamin K* ; Vitamins*

OBJECTIVES: normal circadian rhythm of autonomic nervous system function stands for the daily change of sympathetic and parasympathetic modulation, which can be measured by heart rate variability (HRV). Generally, patients in the intensive care unit (ICU) are prone to sleep-wake cycle dysregulation, therefore, it may have an influence on the circadian rhythm of autonomic nervous system. This study was designed to interpret possible dysregulation of autonomic nervous system in ICU patients by using HRV. METHODS: HRV was assessed every 3 hours in 21 ICU patients during a 7-minute period. The statistical differences of HRV features between the morning (AM 6 : 00–PM 12 : 00), and the afternoon (PM 12 : 00–PM 18 : 00) periods were evaluated in time domain and frequency domain. RESULTS: Patients showed significantly increased normalized power of low frequencey (nLF), absolute power of low frequencey (LF)/absolute power of high frequencey (HF) in the afternoon period as compared to the morning period. However, normalized power of high frequency (nHF) was significantly decreased in the afternoon period. There was no statistically significant difference between the morning period and the afternoon period in the time domain analysis. CONCLUSIONS: The increased sympathetic tone in the afternoon period supports possible dysregulation in the circadian rhythm of autonomic nervous system in ICU patients. Future studies can help to interpret the association between autonomic dysregulation and negative outcomes of ICU patients.
Autonomic Nervous System* ; Circadian Rhythm* ; Critical Care* ; Heart Rate* ; Heart* ; Humans ; Intensive Care Units*

BACKGROUND: For various reasons, kidney transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) often undergo native nephrectomy in preparation for the transplantation. Simultaneous nephrectomy can result in hypotensive events perioperatively and affect transplant outcome adversely. Our aim was to evaluate the effect of simultaneous native nephrectomy (SNx) on perioperative blood pressure and graft outcome compared to non-nephrectomy (NNx) in renal transplant recipients with ADPKD. METHODS: Data regarding renal function and blood pressure were collected from 42 renal transplant recipients with ADPKD. The primary outcome was graft function over 1 year post-transplant. The secondary outcomes were patient and graft survival, postoperative hypotensive events, and blood pressure control. We compared units of anti-hypertensive medication used by transplanted ADPKD patients in the SNx and NNx groups. RESULTS: Patients with SNx during kidney transplantation showed similar rates of patient and graft survival and renal function. Although they had significantly more hypotensive events during the perioperative period (69.2% vs. 37.5% in NNx, P=0.045), no harmful influence on renal function was observed. No difference in mean blood pressure during the 1-year post-transplant period was observed between the two groups; however, the SNx group required fewer units of anti-hypertensive medication. CONCLUSIONS: SNx is a relatively safe procedure. Graft outcome in the SNx group was not inferior to that of the NNx group, and patients with SNx can have well-controlled blood pressure.
Blood Pressure* ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Nephrectomy* ; Perioperative Period ; Polycystic Kidney, Autosomal Dominant* ; Transplantation* ; Transplants*

No abstract available.