BACKGROUND: Using long-term (more than 30 years) data from a single center, this retrospective study evaluated changes of independent risk factors affecting renal allograft survival by transplant era. METHODS: Of 3,000 cases of kidney transplantation, 2,708 (90.3%), including their follow-up observations, were reviewed. Transplant era was classified according to immunosuppressive regimens as either early group (transplant serial No. 1~1,500) or recent group (transplant serial No. 1,501~3,000). RESULTS: There was a significant difference observed in pre-transplant clinical manifestations between the early and recent groups. The number of elderly recipients and donors, number of deceased donors, and cases related to pre-transplant diabetes, pre-emptive transplantation, and retransplantation were differed relative to transplant era. The short- and long-term graft survival rate of the recent group improved significantly, and the effect of human leukocyte antigen mismatching and living donor type disappeared in the recent group. Moreover, pre-emptive transplantation and retransplantation were effective only in the recent group. However, non-immunological factors such as elderly recipients and donors, and immunologic factors such as episodes of acute rejection and types of immunosuppressive regimen were persistent independent risk factors affecting graft survival rate. CONCLUSIONS: According to the retrospective survival analysis of a large number of recipients in a single center, risk factors for kidney transplant patients differed by transplant era. However, the independent risk factors associated with elderly recipients and donors (non-immunologic), and episodes of acute rejection, and types of immunosuppressive regimen (immunologic) persisted regardless of transplant era.
Aged ; Follow-Up Studies ; Graft Survival ; Humans ; Immunologic Factors ; Kidney ; Kidney Transplantation ; Leukocytes ; Living Donors ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplantation, Homologous ; Transplants

PURPOSE: To detect early arteriovenous fistula (AVF) dysfunction, we have developed a new method of intra-access total pressure (pT), and static pressure (pS) measurements. The purpose of this study is to assess the relationship between intra-access pressure and vascular stricture in order to establish the clinical validity of the method. METHODS: Total 46 of native AVFs were enrolled. They were measured intra-access pS and pT monthly. In initial angiography, 6 of 10 inflow stricture (As), 6 of 7 outflow stricture (Vs) and 2 having both lesions were taken PTA (percutaneous angioplasty) and compared pressure and ratio changes. If delta p (pT-pS) decreased more than 10% over 3 months or pT/MAP (mean arterial pressure) ratio dropped more than 10% over 3 months with below 0.8, then the patients were referred to angiography. Thirtyone patients were performed final angiography, and we compared the results with those of initial angiography. RESULTS: Although pT/MAP ratio and delta p were increased after PTA, there was no statistical significance in 6 As (+) patients (p>0.05). Six Vs (+) and 2 AS (+) and Vs (+) patients' delta p were increased significantly (p<0.05). Two As (+) and 5 Vs (+) were detected with delta p or pT/MAP ratio change. However, 2 Vs (+) were unable to be detected with delta p, but detected only by final angiography. Among 15 As (-) and Vs (-) patients in both initial and final angiography, pT and MAP were not reproducible (pI<0.4), but pS and delta p showed intermediate reproducibility (pI>0.45). CONCLUSION: Intra-access stricture could be detected with pT/MAP ratio and delta p change. However, more careful MAP and pT measurement should be recommended for accurate diagnosis.
Angiography ; Arteriovenous Fistula ; Constriction, Pathologic ; Fistula ; Humans ; Renal Dialysis

Appendiceal bleeding is a kind of lower gastrointestinal bleeding. For treatment, it is essential to identify the location of the lower gastrointestinal tract bleeding. Appendiceal bleeding has some diagnostic difficultie. It is a very rare condition, and colonoscopy shows only the appendiceal orfice. Recently, multidetector computed tomography has increasingly been used in the diagnostic evaluation of most vascular diseases. Herein, we report the case of an appendiceal bleeding diagnosed by using abdominal multidetector computed tomography, and we present a the literature.
Appendix* ; Colonoscopy ; Hemorrhage* ; Lower Gastrointestinal Tract ; Multidetector Computed Tomography* ; Vascular Diseases

PURPOSE: To detect the dysfunction of arteriovenous fistula (AVF) early, we have developed a new method to calculate the intra-vascular conduit flow rate based on the Bernoulli's theory. However, this method has limitation on detection of inflow stenosis. For detection of both in- and out-flow stenosis, we tried to measure intra-access static (pS) and total pressure (pT), and compared with angiographic findings. METHODS: From a total of 46 cases of native AVFs, of at least 3 months of construction, intra-access pS and pT were measured, before starting hemodialysis. deltap (pT-pS) and pT/mean arterial pressure (MAP) ratio were calculated, and compared with angiographic findings. RESULTS: Among 37 patients without outflow stenosis (Vs) in fistulogram, 10 patients with inflow stenosis (As) had significantly lower pT/MAP ratio and deltap than those without As patients (p<0.005). Among 34 patients without As, deltap was significantly lower in 7 patients with Vs than those 27 patients without Vs (p=0.001). CONCLUSION: pT/MAP ratio was correlated with As, and deltap reflects Vs in angiography. The measurement of pS and pT might be useful to predict inflow and outflow stenosis of AVFs.
Angiography ; Arterial Pressure ; Arteriovenous Fistula* ; Constriction, Pathologic ; Humans ; Renal Dialysis*

PURPOSE: We have already reported on a new method to calculate the intra-vascular conduit flow rate based on Bernoulli's theory for maintaining surveillance of the arteriovenous fistula (AVF) function. To assess the clinical validity of our methods, we examined a trend analysis on the calculated flow rate in hemodialysis vascular conduits. METHODS: From a total of 27 cases of native AVFs that were at least 3 months after construction, we measured the AVF flow rate (Q(D)) with Doppler ultrasonography first. When Q(D) was below 600 ml/min, a fistulogram was taken. The intra-vascular conduit static pressure (ps) was measured, and the flow rate (Q(a)) was calculated every month with using the mean arterial pressure. The patients with a decreased Q(a) of more than 10% over 3 months were referred for a diagnostic fistulogram. RESULTS: Twenty-seven AVFs were studied after 29.5+/-28.5 (4~120) months of operation. The mean Q(D) was 980.6+/-501.6 (144~2,230) ml/min. In 6 patients who showed a Q(D) less than 600 ml/min, 4 pathologic lesions were found on the diagnostic fistulogram: juxta-anastomosis stenosis (n=3) and a draining venous stenosis (n=1). Three patients who showed a Q(a) decrement were confirmed as having a draining venous stenosis. However, any unpredictable thrombosis with proximal stenosis (n=2) couldn't be detected. CONCLUSION: Q(a) represents the narrowing of the draining vein of an internal AVF. However, arterial or venous narrowing that is proximal to the arterial puncture site couldn't be detected with the calculated intra-conduit flow rate. The development of new methods that can detect proximal vascular stenosis and that can be used in combination with our method is anticipated in the near future.
Arterial Pressure ; Arteriovenous Fistula* ; Constriction, Pathologic ; Humans ; Punctures ; Renal Dialysis* ; Thrombosis ; Ultrasonography, Doppler ; Veins

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.
Arm ; Arteriovenous Fistula* ; Follow-Up Studies ; Forearm* ; Humans ; Kidney Failure, Chronic ; Male ; Ocimum basilicum* ; Renal Dialysis ; Transplants ; Veins*

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.
Arm ; Arteriovenous Fistula* ; Follow-Up Studies ; Forearm* ; Humans ; Kidney Failure, Chronic ; Male ; Ocimum basilicum* ; Renal Dialysis ; Transplants ; Veins*

Surgery for the inflammatory abdominal aortic aneurysm (IAAA) is a technically challenging procedure and it's associated with increased morbidity and mortality. Injuries of the vena cava, the duodenum, the left ureter and the renal vein are common in an operation for IAAA. Herein, we report 2 cases of ligation of the left renal vein during repair of the IAAA. Cases: The 1st case was a 75- year-old male patient, who had an abrupt onset of abdominal pain and a pulsatile abdominal mass. An 8.5 cm sized IAAA and left hydronephrosis were detected via CT angiogram. During the operation, the left renal vein was mobilized and then divided to gain access to the aneuysmal neck. We couldn't reconstruct the divided left renal vein. On the follow-up CT scan, the left renal vein drained into the left paravertebral plexus, and no renal congestion was demonstrated. The 2nd patient was a 72-year-old male who experienced sudden abdominal pain and a growing pulsatile mass on the abdomen. A huge IAAA 10.5 cm in diameter was detected in CT scan. During the repair of IAAA, the left renal vein was divided and ligated to expose the neck of the aneurysm. The divided left renal vein was anastomosed to the splenic vein in an end-to-side fashion instead of performing direct reconstruction. On follow-up CT scan, neither left renal congestion nor significant increment of the portal venous flow was noted. The two patients were doing well at the 15th and 10th postoperative month, respectively.
Abdomen ; Abdominal Pain ; Aged ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Duodenum ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Humans ; Hydronephrosis ; Ligation* ; Male ; Mortality ; Neck ; Renal Veins* ; Splenic Vein ; Tomography, X-Ray Computed ; Ureter

PURPOSE: Previously, we developed a new method to calculate the flow rate in the hemodialysis vascular conduit based on Bernoulli's theory for surveillance of the arteriovenous fistula (AVF) function. However, the calculated flow rate would be different from the true flow rate because due to various factors. To compare the true flow rate, with intra- conduit pressure, and the calculated flow rate, an ex vivo experimental model was developed. METHODS: The arterial end of the vascular conduit was connected to a saline-filled bottle, with the venous end connected to a flow meter to control the flow rate. By monitoring the change in the true flow rate (Q) with the flow meter, each arterial and venous static pressure (pA, pV) and total pressure (pT) were observed. Using these parameters, the intra-conduit flow rates (QA, QV) were calculated by Bernoulli's equation. Finally, we compared the pA or pV with Q, and calculated the difference between the QA or QV and Q. RESULTS: There were no statistical differences between any of the pressure measurement during the 5 consecutive 5 experiments (P<0.05). The static pressure (pA or pV) was closely correlated with Q (pA, R2=0.950, P=0.000; pV, R2= 0.952, P=0.000). The calculated flow rate (QA or QV) was not in complete in accord with Q, but was closely correlated (QA, R2=0.961, P=0.000; QV, R2=0.961, P=0.000). CONCLUSION: The pressure measurement and calculated flow rate indicate the nature of the true flow rate in the vascular conduit.
Arteriovenous Fistula ; Models, Theoretical* ; Renal Dialysis

PURPOSE: In the analysis of risk factors affecting the renal graft survival and graft function, time-dependent effect of each risk factor should be differentiated from net effect of risk factor. We attempted to analyze the impact of immunologic and/or non-immunologic risk factors on the graft function and survival after renal transplantation among the recipients having same immunologic risks at the time of transplantation. METHODS: Three hundred ninety recipients who underwent haplotype matched living related donor kidney transplantation and have been regularly followed-up were retrospectively evaluated in a single center. All recipients were treated with cyclosporine-based double or triple regimens. The graft function was evaluated by serum creatinine (Scr) level and 24 hours urinary excretion of protein every year until 5 years after transplantation. The donor kidney weight/ recipient body weight ratio (KW/BW), donor age/ recipient age ratio (DA/RA), donor-recipient sex (D-R sex) relationship, and episodes of acute rejection (AR) within 1 year were regarded as the potential risk factors affecting the graft survival and function in this study. Kaplan-Meier method and Cox proportional-hazard model were used for survival analysis. ANOVA to evaluate time-point difference of graft function, and repeated measures ANOVA to evaluate the yearly difference of graft function were used. RESULTS: Only the episode of AR was a significant risk factor affecting the graft survival. However, each non-immunologic risk factors (KW/BW, DA/RA, D-R sex) and AR episode persistently showed statistically significant impact on Scr level until 5 years after transplantation. Recipients having lowest KW/BW (1st Q KW/BW) and highest DA/RA (4th Q DA/RA) had experienced accelerated increment of Scr level from 4th year after transplantation. From 3rd year after transplantation, there is a significant correlation between the numbers of non-immunologic risk factor the recipients having had and yearly increment of Scr level. However, episode of AR didn't influence the annual slope of Scr level even 4th year after transplantation. CONCLUSIONS: Non-immunologic risk factors had an detrimental effect on renal graft function, especially from 3rd year after transplantation. To have a better long-term graft function, non-immunologic risk factors should be considered from the time of live donor evaluation for transplantation. From the early period of transplantation, the recipients should be aware of the negative impact of overweight in terms of graft function and other metabolic derangement.
Body Weight ; Creatinine ; Graft Survival* ; Haplotypes* ; Humans ; Kidney ; Kidney Transplantation ; Living Donors* ; Overweight ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplantation* ; Transplants*