Objective: To evaluate the safety and effectiveness of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis. Methods: Six patients with AF and end-stage renal disease(ESRD)on long term hemodialysis who underwent LAAO from March 2017 to March 2021 in Beijing Anzhen Hospital were enrolled. Baseline characteristics such as age, sex, types of arrhythmia, stroke and bleeding score, and continuous dialysis time were collected. Four patients underwent LAAO, two patients underwent the combined procedure of catheter ablation and LAAO. Perioperative treatment and serious complications were recorded. Transesophageal echocardiography was repeated at 45 days and 60 days after the procedure. Telephone follow-up was conducted at 3, 6 and 12 months after the procedure, and every 6 months thereafter. Thromboembolism and major bleeding events and survival were evaluated. Results: The average age was (66.7±17.0) years old, and 5 were male (5/6). There were 4 patients with paroxysmal AF (4/6), and 2 patients with persistent AF (2/6). The mean CHA₂DS₂-VASc score was (4.8±1.5), and the HAS-BLED score was (3.5±1.4). The duration of hemodialysis was 2.6 (1.1, 8.3) years. Successfully Watchman implantation was achieved in all patients. There were no severe perioperative complications, and no device related thrombosis or leaks were observed by transesophageal echocardiography. During a mean of 22.0 (12.0, 32.0) months follow-up, there was no thromboembolism or major bleeding events. A total of 2 patients died, one from sudden cardiac death, and another one from heart failure. Conclusions: LAAO may be a safe and effective therapeutic option for prevention of thromboembolism in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis, further studies with larger patient cohort are needed to confirm our results.
Aged ; Aged, 80 and over ; Atrial Appendage/surgery* ; Atrial Fibrillation/surgery* ; Echocardiography, Transesophageal ; Humans ; Kidney Failure, Chronic/therapy* ; Male ; Middle Aged ; Renal Dialysis ; Stroke ; Thromboembolism ; Treatment Outcome

BACKGROUND: Cardiovascular diseases of chronic dialysis patients are often undertreated because of their higher surgical risk. This study aimed to assess mortality and morbidity after open heart surgery in chronic dialysis patients compared to those with normal renal function and identify risk factors for postoperative outcomes. METHODS: We retrospectively analyzed 2,432 patients who underwent open heart surgery from 2002 to 2017 and collected data from 116 patients (38 patients on dialysis and 78 age-, sex-, and diabetes mellitus status-matched control patients with normal kidney function). We assessed comorbidities, New York Heart Association (NYHA) class, laboratory data, surgical methods, and postoperative outcomes. RESULTS: The dialysis group had more comorbidities, higher NYHA classes, and greater need for urgent surgeries compared to the control group. They exhibited significantly higher postoperative mortality (18.4% vs. 2.6%, P = 0.005) and more overall complications (65.8% vs. 25.6%, P < 0.001). Dialysis itself significantly increased relative risk for in-hospital mortality after adjustment. EuroSCORE II was not as useful as in the general population. Multivariate logistic regression analysis demonstrated that total (adjusted odds ratio [AOR], 10.7; P = 0.029) and in-hospital death risk (AOR, 14.7; P = 0.033), the durations of postoperative hospitalization (AOR, 4.6; P = 0.034), CRRT (AOR 36.8; P = 0.004), and ventilator use (AOR, 7.6; P = 0.022) were significantly increased in the dialysis group. CONCLUSION: The dialysis group exhibited a higher risk for mortality and overcall complications after open heart surgery compared to the patients with normal renal function. Therefore, the benefit of surgical treatment must be balanced against potential risks.
Cardiovascular Diseases ; Comorbidity ; Diabetes Mellitus ; Dialysis ; Heart ; Hospital Mortality ; Hospitalization ; Humans ; Kidney ; Kidney Failure, Chronic ; Logistic Models ; Mortality ; Odds Ratio ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Thoracic Surgery ; Ventilators, Mechanical

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered.
Altruism ; Health Policy ; Humans ; Kidney ; surgery ; Kidney Failure, Chronic ; surgery ; Kidney Transplantation ; methods ; Living Donors ; Nephrectomy ; Quality Improvement ; Singapore ; Tissue Donors ; Tissue and Organ Harvesting ; Tissue and Organ Procurement

PURPOSE: Recently, bortezomib has been used to treat antibody-mediated rejection (AMR) refractory to conventional treatment such as plasmapheresis, intravenous immunoglobulin, and rituximab. The authors aimed to describe their experiences when bortezomib was used to treat refractory AMR. MATERIALS AND METHODS: Eleven refractory AMR episodes treated with bortezomib were included in this study. The patients received one or two cycles of bortezomib (1.3 mg/m2) on days 1, 4, 8, and 11. RESULTS: Bortezomib effectively reduced antibodies against various targets, including human leukocyte antigen (HLA) class I and II, ABO blood group antigen, and angiotensin II type 1 receptor. Antibodies were depleted or reduced significantly in eight AMR episodes. Overall, there was a significant improvement in the mean estimated glomerular filtration rate (eGFR) at 3 months after therapy (36.91+/-22.15 mL/min/1.73 m2) versus eGFR at time of AMR diagnosis (17.00+/-9.25 mL/min/1.73 m2; p=0.007). All six early-onset AMR episodes (within 6 months post-transplantation) showed full recovery of allograft function. Additionally, three of the five late-onset AMR episodes (>6 months post-transplantation) showed improved allograft function. CONCLUSION: Anti-humoral treatment based on bortezomib might be an effective strategy against refractory AMR caused by various types of antibodies. Notably, this treatment could be more effective in early-onset AMR than in late-onset AMR.
Adolescent ; Adult ; Antibodies, Monoclonal/therapeutic use ; Antineoplastic Agents/*therapeutic use ; Boronic Acids/therapeutic use ; Bortezomib/*therapeutic use ; Female ; Graft Rejection/*drug therapy/*prevention & control ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Immunologic Factors/therapeutic use ; Isoantibodies ; Kidney Failure, Chronic/*surgery ; *Kidney Transplantation ; Male ; Middle Aged ; Plasmapheresis ; Pyrazines/administration & dosage ; Transplantation, Homologous

Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management.
Diagnostic Imaging ; Female ; Humans ; Kidney Failure, Chronic/*surgery ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Postoperative Complications/diagnosis/*radiography ; Quality of Life ; Survival Rate

OBJECTIVETo analyze the factors relevant to success rate of arteriovenous fistula (AVF) plasty in children who need maintenance hemodialysis and to provide predictor of the success of operation.

METHODTotally 62 patients who had arteriovenous fistula plasty operation for maintenance of hemodialysis in our hospital treated during June 2007 to April 2014 were enrolled into this study, 41 were male, and 21 female, median age of surgery was 11 years and 9 months (age range was 5 y 8 m to 16 y 2 m). The proportions of primary diseases were: chronic glomerulonephritis 29% (18), kidney abnormality and dysplasia 27% (17). These 62 cases were divided into 2 groups: the success group and the failure group according to whether there were tremble and vascular murmur on the surgery site 1 week after the surgery. Factors like sex, choice of operation side, choice of operation vessel, anesthesia, urine protein, model of vascular suture line, age of surgery, inner diameter of anastomotic stoma, hemoglobin (Hb), platelet (Plt), hematocrit (Hct), coagulation function (prothrombin time, PT, fibrinogen, Fib, activated partial thromboplastin time, APTT), creatinine (Scr), Ca²⁺, left ventricular ejection fraction (LVEF), blood pressure (before, during and after surgery) were collected retrospectively. Student's t test and chi-square tests were used to analyze the differences of the factors between 2 groups. Those factors which were statistically significant in t test and chi-square test were taken into multi factor logistic regression analysis.

RESULT(1) Average time interval from final diagnosis of ESRD to surgery was 30.8 days. (2) Relevant factors of operation success rate: anesthesia (χ² = 5.531, P=0.026), preoperative serum cholesterol (CHO) (t=-2.069, P=0.043), mean systolic blood pressure in the afternoon before operation (t=2.154, P=0.042), systolic blood pressure when the operation was finished (t=2.199, P=0.032) were related to the success rate of AVF operation in the t test and chi-square test. Multi factors logistic regression analysis showed systolic blood pressure measured when the operation was finished was a dependent protective factor of the surgery (OR=0.962, P=0.040, 95% CI=0.926-0.998). When the systolic blood pressure at the end of operation elevated 1 mmHg (1 mmHg=0.133 kPa), the failure rate of the surgery would be 0.962 times.

CONCLUSIONThe time interval from final diagnosis of ESRD to surgery was 30.8 days, it was much shorter than 6-12 months which was suggested by 2006 NKF-KDOQI vascular access guideline. As dependent protective factor of success rate, the systolic blood pressure at the end of operation was suggested to be the predictor of successful operation. And the higher systolic blood pressure at the end of operation may increase the success rate of operation.

Adolescent ; Arteriovenous Fistula ; surgery ; Blood Coagulation Tests ; Blood Pressure ; Child ; Child, Preschool ; Female ; Humans ; Kidney Failure, Chronic ; surgery ; Male ; Partial Thromboplastin Time ; Renal Dialysis ; Ventricular Function, Left

No abstract available.
Adult ; Female ; Graft Rejection/immunology/*prevention & control ; Graft Survival ; *Hematopoietic Stem Cell Transplantation ; Humans ; *Immune Tolerance ; Immunosuppressive Agents/therapeutic use ; Kidney Failure, Chronic/diagnosis/*surgery ; *Kidney Transplantation ; Living Donors ; Siblings ; Time Factors ; *Transplantation Chimera ; Treatment Outcome

Aortic Aneurysm, Thoracic ; complications ; diagnostic imaging ; Aortography ; Contrast Media ; adverse effects ; Coronary Artery Bypass ; Cross Infection ; diagnostic imaging ; Fatal Outcome ; Female ; Humans ; Iohexol ; adverse effects ; Kidney Failure, Chronic ; complications ; Male ; Middle Aged ; Postoperative Complications ; diagnostic imaging ; ST Elevation Myocardial Infarction ; surgery ; Sepsis ; etiology ; Stevens-Johnson Syndrome ; etiology ; Surgical Wound Dehiscence ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy. MATERIALS AND METHODS: This retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes. RESULTS: The underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension. CONCLUSION: Transarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.
Adult ; Aged ; Angiomyolipoma/therapy ; Arteriovenous Malformations/therapy ; Child ; Embolization, Therapeutic/adverse effects/*methods ; Female ; Graft Rejection/therapy ; Hematuria/etiology ; Humans ; Infarction/etiology ; Kidney/blood supply ; Kidney Diseases/surgery/*therapy ; Kidney Failure, Chronic/therapy ; Kidney Neoplasms/therapy ; Male ; Middle Aged ; Nephrectomy/adverse effects/*methods ; *Renal Artery/abnormalities ; Retrospective Studies ; Young Adult

PURPOSE: Currently, insufficient data exist to evaluate the relationship between angiographic late loss (LL) and long-term clinical outcome after drug-eluting stent (DES) implantation. In this study, we hypothesized that angiographic LL between 0.3 and 0.6 mm correlate with favorable long-term clinical outcomes. MATERIALS AND METHODS: Patients were enrolled in the present study if they had undergone both DES implantation in single coronary vessel and a subsequent follow-up angiogram (n=634). These individuals were then subdivided into three groups based on their relative angiographic LL: group I (angiographic LL <0.3 mm, n=378), group II (angiographic LL between 0.3 and 0.6 mm, n=124), and group III (angiographic LL >0.6 mm, n=134). During a 5-year follow-up period, all subjects were tracked for critical events, defined as any cause of death or myocardial infarction, which were then compared among the three groups. RESULTS: Mean follow-up duration was 63.0+/-10.0 months. Critical events occurred in 25 subjects in group I (6.6%), 5 in group II (4.0%), and 17 in group III (12.7%), (p=0.020; group I vs. group II, p=0.293; group II vs. group III, p=0.013). In a subsequent multivariate logistic regression analysis, chronic renal failure [odds ratio (OR)=3.29, 95% confidence interval (CI): 1.48-7.31, p=0.003] and long lesion length, defined as lesion length >28 mm (OR=1.88, 95% CI: 1.02-3.46, p=0.042) were independent predictors of long-term critical events. CONCLUSION: This retrospective analysis fails to demonstrate that post-DES implantation angiographic LL between 0.3 and 0.6 mm is protective against future critical events.
Adult ; Aged ; Angiography/*methods ; Coronary Artery Disease/*surgery ; Coronary Vessels/surgery ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic/complications ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Percutaneous Coronary Intervention/methods ; Prosthesis Failure ; Retrospective Studies ; Time Factors ; Treatment Outcome