Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background: Alcoholic liver disease (ALD) includes a wide clinical spectrum from acute alcoholic hepatitis to severe cirrhosis and/or hepatocellular carcinoma. Until now, there has been no report revealing the bleeding tendency of ALD compared to other diseases in liver transplantation (LT). Thus, we analyzed blood loss and transfusion amounts during operation according to the etiologies of liver disease and model for end-stage liver disease (MELD) score. Methods: Out of 874 recipients who underwent LT, a total of 146 patients were excluded by our exclusion criteria. We compared 728 recipients’ baseline characteristics, operation time, blood loss, and transfusion amounts between ALD and nonALD according to MELD score. Results: The number of patients in the ALD group was 130 (17.9%), and 598 (82.1%) in the non-ALD group. The ALD group showed younger age, higher MELD score, and a higher proportion of deceased donor LT than the non-ALD group. Intraoperative blood loss and transfusions of red blood cells (RBCs), fresh frozen plasma, and platelets were significantly higher in the ALD group. When stratified by MELD score (cut-off: 20), ALD patients in both high and low MELD subgroups demonstrated greater blood loss and RBC transfusion requirements, even when international normalized ratio and platelet counts were similar. In multivariate logistic regression analysis, ALD was a significant risk factor for massive transfusion (odds ratio 1.813, 95% confidence interval 1.158–2.840, p=0.009). Conclusion The ALD group showed increased bleeding tendency than the non-ALD group during LT, irrespective of MELD score. This suggests that transplant surgeons should anticipate greater blood loss and ensure adequate transfusion resources during LT for ALD patients.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.