This study examined the potential moderating effects of insulin resistance and dietary inflammatory index (DII) on the relationship between body mass index (BMI) and peak postprandial glucose levels in patients with prediabetes and type 2 diabetes. Methods: A retrospective analysis was conducted, using integrated nutritional data from a diabetes management program for patients with prediabetes and type 2 diabetes who used continuous glucose monitoring (CGM). Data from 17 patients, including 408 meal records, were analyzed. The energy-adjusted DII (E-DII) was calculated, and peak postprandial glucose was matched for each meal. Statistical tests analyzed differences and relationships between variables. Hayes' SPSS PROCESS macro version 4.0 was used to identify the moderating effects. Results: Peak postprandial glucose levels varied significantly among E-DII subgroups (p < .026) and were positively correlated with insulin resistance (rho = .30, p = < .001) and E-DII (rho = .14, p = .004). Insulin resistance and E-DII had a multiple additive moderating effect on the relationship between BMI and peak postprandial glucose levels in glucose-controlled patients (F = 12.22, p < .001), explaining 21.6% of the variance. Conclusion: Higher E-DII scores, which indicated a more pro-inflammatory diet, were associated with increased glucose levels, especially for patients who were overweight and mildly obese. Patients with obesity who received insulin therapy had varied postprandial glucose levels depending on their insulin resistance status. These findings highlight the importance of tailored dietary interventions, inflammation management, and CGM to improve obesity-related glucose regulation.

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.

This study examined the potential moderating effects of insulin resistance and dietary inflammatory index (DII) on the relationship between body mass index (BMI) and peak postprandial glucose levels in patients with prediabetes and type 2 diabetes. Methods: A retrospective analysis was conducted, using integrated nutritional data from a diabetes management program for patients with prediabetes and type 2 diabetes who used continuous glucose monitoring (CGM). Data from 17 patients, including 408 meal records, were analyzed. The energy-adjusted DII (E-DII) was calculated, and peak postprandial glucose was matched for each meal. Statistical tests analyzed differences and relationships between variables. Hayes' SPSS PROCESS macro version 4.0 was used to identify the moderating effects. Results: Peak postprandial glucose levels varied significantly among E-DII subgroups (p < .026) and were positively correlated with insulin resistance (rho = .30, p = < .001) and E-DII (rho = .14, p = .004). Insulin resistance and E-DII had a multiple additive moderating effect on the relationship between BMI and peak postprandial glucose levels in glucose-controlled patients (F = 12.22, p < .001), explaining 21.6% of the variance. Conclusion: Higher E-DII scores, which indicated a more pro-inflammatory diet, were associated with increased glucose levels, especially for patients who were overweight and mildly obese. Patients with obesity who received insulin therapy had varied postprandial glucose levels depending on their insulin resistance status. These findings highlight the importance of tailored dietary interventions, inflammation management, and CGM to improve obesity-related glucose regulation.

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.

This study examined the potential moderating effects of insulin resistance and dietary inflammatory index (DII) on the relationship between body mass index (BMI) and peak postprandial glucose levels in patients with prediabetes and type 2 diabetes. Methods: A retrospective analysis was conducted, using integrated nutritional data from a diabetes management program for patients with prediabetes and type 2 diabetes who used continuous glucose monitoring (CGM). Data from 17 patients, including 408 meal records, were analyzed. The energy-adjusted DII (E-DII) was calculated, and peak postprandial glucose was matched for each meal. Statistical tests analyzed differences and relationships between variables. Hayes' SPSS PROCESS macro version 4.0 was used to identify the moderating effects. Results: Peak postprandial glucose levels varied significantly among E-DII subgroups (p < .026) and were positively correlated with insulin resistance (rho = .30, p = < .001) and E-DII (rho = .14, p = .004). Insulin resistance and E-DII had a multiple additive moderating effect on the relationship between BMI and peak postprandial glucose levels in glucose-controlled patients (F = 12.22, p < .001), explaining 21.6% of the variance. Conclusion: Higher E-DII scores, which indicated a more pro-inflammatory diet, were associated with increased glucose levels, especially for patients who were overweight and mildly obese. Patients with obesity who received insulin therapy had varied postprandial glucose levels depending on their insulin resistance status. These findings highlight the importance of tailored dietary interventions, inflammation management, and CGM to improve obesity-related glucose regulation.

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.

This study examined the potential moderating effects of insulin resistance and dietary inflammatory index (DII) on the relationship between body mass index (BMI) and peak postprandial glucose levels in patients with prediabetes and type 2 diabetes. Methods: A retrospective analysis was conducted, using integrated nutritional data from a diabetes management program for patients with prediabetes and type 2 diabetes who used continuous glucose monitoring (CGM). Data from 17 patients, including 408 meal records, were analyzed. The energy-adjusted DII (E-DII) was calculated, and peak postprandial glucose was matched for each meal. Statistical tests analyzed differences and relationships between variables. Hayes' SPSS PROCESS macro version 4.0 was used to identify the moderating effects. Results: Peak postprandial glucose levels varied significantly among E-DII subgroups (p < .026) and were positively correlated with insulin resistance (rho = .30, p = < .001) and E-DII (rho = .14, p = .004). Insulin resistance and E-DII had a multiple additive moderating effect on the relationship between BMI and peak postprandial glucose levels in glucose-controlled patients (F = 12.22, p < .001), explaining 21.6% of the variance. Conclusion: Higher E-DII scores, which indicated a more pro-inflammatory diet, were associated with increased glucose levels, especially for patients who were overweight and mildly obese. Patients with obesity who received insulin therapy had varied postprandial glucose levels depending on their insulin resistance status. These findings highlight the importance of tailored dietary interventions, inflammation management, and CGM to improve obesity-related glucose regulation.

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.

Purpose: We conducted a randomized prospective trial (KLASS-07 trial) to compare laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. In this interim report, we describe short-term results in terms of morbidity and mortality. Methods: and Methods: The sample size was 442 participants. At the time of the interim analysis, 314 patients were enrolled and randomized. After excluding patients who did not undergo planned surgeries, we performed a modified per-protocol analysis of 151 and 145 patients in the LADG and TLDG groups, respectively. Results: The baseline characteristics, including comorbidity status, did not differ between the LADG and TLDG groups. Blood loss was somewhat higher in the LADG group, but statistical significance was not attained (76.76±72.63 vs. 62.91±65.68 mL; P=0.087). Neither the required transfusion level nor the operation or reconstruction time differed between the 2 groups. The mini-laparotomy incision in the LADG group was significantly longer than the extended umbilical incision required for specimen removal in the TLDG group (4.79±0.82 vs. 3.89±0.83 cm; P<0.001). There were no between-group differences in the time to solid food intake, hospital stay, pain score, or complications within 30 days postoperatively. No mortality was observed in either group. Conclusions Short-term morbidity and mortality rates did not differ between the LADG and TLDG groups. The KLASS-07 trial is currently underway.

Background and Objectives: The number of sensitized heart failure patients on waiting lists for heart transplantation (HTx) is increasing. Using the Korean Organ Transplantation Registry (KOTRY), a nationwide multicenter database, we investigated the prevalence and clinical impact of calculated panel-reactive antibody (cPRA) in patients undergoing HTx. Methods: We retrospectively reviewed 813 patients who underwent HTx between 2014 and 2021. Patients were grouped according to peak PRA level as group A: patients with cPRA ≤10% (n= 492); group B: patients with cPRA >10%, <50% (n=160); group C patients with cPRA ≥50% (n=161). Post-HTx outcomes were freedom from antibody-mediated rejection (AMR), acute cellular rejection, coronary allograft vasculopathy, and all-cause mortality. Results: The median follow-up duration was 44 (19–72) months. Female sex, retransplantation, and pre-HTx renal replacement therapy were independently associated with an increased risk of sensitization (cPRA ≥50%). Group C patients were more likely to have longer hospital stays and to use anti-thymocyte globulin as an induction agent compared to groups A and B. Significantly more patients in group C had positive flow cytometric crossmatch and had a higher incidence of preformed donor-specific antibody (DSA) compared to groups A and B. During follow-up, group C had a significantly higher rate of AMR, but the overall survival rate was comparable to that of groups A and B. In a subgroup analysis of group C, post-transplant survival was comparable despite higher preformed DSA in a desensitized group compared to the non-desensitized group. Conclusions Patients with cPRA ≥50% had significantly higher incidence of preformed DSA and lower freedom from AMR, but post-HTx survival rates were similar to those with cPRA <50%. Our findings suggest that sensitized patients can attain comparable post-transplant survival to non-sensitized patients when treated with optimal desensitization treatment and therapeutic intervention.