There are no guidelines to establish the indications and contraindications for a simultaneous heart and kidney transplantation. We report our single-institutional experience with simultaneous heart and kidney transplantation.Retrospective chart review.Between 1995 and 2006, 13 patients with co-existing end-stage heart and renal failure underwent simultaneous heart and kidney transplantation at the authors' hospital. Heart failure was secondary to dilated cardiomyopathy in five patients, ischemic cardiomyopathy in three, cardiac allograft vasculopathy in two, and congenital heart disease, cardiac allograft failure, and acute myocarditis each in one. Renal failure was secondary to glomerulonephritis in six patients, heart failure in two, cyclosporine nephropathy in three, hypertension in one, and systemic lupus erythematosus in one. Eight patients were in UNOS status IA and five patients in UNOS status II before transplantation. The 30-day mortality rate and in-hospital mortality rate were 15% and 38%. Of eight patients in UNOS status IA, seven patients have lived beyond 30 days and three (38%) beyond 1 year. Of five patients in UNOS status II, four patients have lived beyond 30 days and four (80%) beyond 1 year. Patients in UNOS status IA had high rates of previous cardiac surgery, cardiac allograft rejection, and major renal allograft complications.Although simultaneous heart and kidney transplantation continues to be a viable option for patients with co-existing end-stage heart and renal failure, the results do not match those of isolated heart transplantation. The clinical outcomes were not satisfactory in UNOS status IA patients with previous cardiac surgery.
Aims Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long- term mortality and end -stage renal disease (ESRD) is unknown. Methods and Results We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all–cause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long–term composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI). Conclusion Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.
Abstract Background and Objective: Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasing. Only a few studies of MRSA infective endocarditis have been conducted, and none have reported its risk factors. We sought to determine the host-related risk factors for infective endocarditis in patients with nosocomial MRSA bacteremia. Setting: A 2,000-bed, university-affiliated, tertiary-care hospital. Patients: Thirty-one patients with nosocomial MRSA infective endocarditis between October 1996 and May 2003. Design: A retrospective chart review was conducted. Data were compared with those from a control group of patients with nosocomial MRSA bacteremia. Logistic regression was used to identify independent risk factors for nosocomial infective endocarditis. Results: Compared with patients who had nosocomial MRSA bacteremia and no infective endocarditis, patients who had infective endocarditis had a higher incidence of chronic liver disease and a lower incidence of immunodeficiency. The risk of developing infective endocarditis was approximately 10% for patients with nosocomial MRSA bacteremia. Conclusion: Patients with MRSA bacteremia and underlying chronic liver disease were prone to infective endocarditis. ( Infect Control Hosp Epidemiol 2005;26:654-657 )
In vivo imaging of insulin metabolism is realized by T.-M. Liu, P.-T. Chou and co-workers using synthesized human insulin–Au nanodots (NDs). Benefiting from its efficient red to near infrared emission, deep tissue subcellular uptake of insulin–Au NDs can be evaluated with a nonlinear optical microscope. On page 2103, insulin-Au NDs permeate into lipid droplets (LDs) of adipocytes, and enlarged ones in type II diabetes mice have a higher adjacent/LD concentration contrast. Human clinical samples show similar trends in patients with diabetes and coronary artery diseas
Combined heart and kidney transplantation (CHRT) has been an acceptable therapeutic option with a lower allograft rejection rate than isolated heart or kidney transplantation. Herein we present a patient who received CHRT using a single donor at a medical center in 1995. This is the first case of CHRT in Taiwan. After ten years follow up, no renal rejection but one episode of cardiac rejection has been noted. Cardiac function and renal function have remained normal. We reviewed the literature about immunology and post-transplantation complications of CHRT. In conclusion, CHRT is a feasible procedure for patients with end-stage cardiac and renal failure. This patient, with only one episode of rejection has attained long-term survival with fair cardiac and renal function.
Donor shortage and improved medical treatment of heart failure increase the prevalence of patients with extreme right ventricular failure and ascites to heart transplantation. The clinical outcome of heart transplantation in these patients has rarely been reported. Here, we sought to evaluate the clinical outcome of heart transplantation in patients with extreme right ventricular failure and refractory ascites.Data were collected by retrospective chart review.Between 1993 and 2005, 12 patients with extreme right ventricular failure and refractory ascites underwent orthotopic heart transplantation at the authors' hospital. The causes of heart failure were congenital heart disease in four patients, dilated cardiomyopathy in two patients, rheumatic heart disease in two patients, coronary artery disease in two patients, and restrictive cardiomyopathy and transplant coronary artery disease each in one patient. Eight of 12 patients had previous cardiac operation. The findings of preoperative abdominal sonography were massive ascites in all patients, congestive liver in 11 patients, and probably cardiac cirrhosis in 1 patient. One patient underwent combined heart and kidney transplantations. There were six in-hospital deaths: bleeding in three patients and multiple organ failure in three patients. Major postoperative complications occurred in 10 patients: renal failure requiring dialysis in 9, bleeding requiring reoperation in 8 patients. Patients with previous cardiac operation had a higher mortality rate (5/7 vs 1/5).Heart transplantation in patients with extreme right ventricular failure and refractory ascites was associated with high mortality and morbidity. The presence of previous cardiac operation implied even poor prognosis.
Emergency surgery for acute type A aortic dissection (AAAD) was usually avoided or denied in octogenarians because of high surgical mortality. Refined surgical techniques and improved postoperative care have led to an improved in-hospital outcome. However, a significant number of operative survivors suffered from postoperative complications and had compromised quality of life. We sought to assess the clinical outcome of emergency surgery using a standard conservative approach in octogenarians with AAAD.From 2004 to 2021, 123 patients underwent emergency surgery for AAAD by one surgeon using a standard conservative approach with right subclavian artery cannulation, no aortic cross-clamp, selective antegrade cerebral perfusion, moderate systemic hypothermia, reinforced sandwich technique, and a strategy of limited aortic resection. Hospital and late outcomes were assessed in patients with age >80 years.Eighteen patients (15%) were octogenarians with seven males (39%) and median age of 82 years (range, 80-89). Hypertension was present in six patients (33%). None had diabetes mellitus, Marfan, or bicuspid aortic valve. Dissection was intramural hematoma in six (33%) and DeBakey type I in 15 patients (83%). Cardiac tamponade with shock was present in seven patients (39%). Ascending aortic grafting was performed in 17 patients, and additional hemiarch replacement in one patient. The hospital mortality rate was 17% (3/18). Fourteen patients (82%) were alive and well at discharge.Emergency surgery for AAAD using a standard conservative approach showed an improved outcome in octogenarians. The majority of patients could return home with an acceptable living.
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