Transfusion-related acute lung injury and treatment with high-flow oxygen therapy in a pediatric patient: a case report

Transfusion-Related Acute Lung Injury (TRALI) is an immune-inflammatory lung pathology that manifests within the first 6–72 hours after administration of blood products. However, due to reduced awareness of TRALI, it continues to be an underreported and often underdiagnosed complication of transfusion therapy. We report a case of a 6-year-old girl with myelodysplastic syndrome and TRALI developed in the first hour after platelet transfusion. Diagnosis of TRALI is based on the exclusion of etiologic factors such as volume overload and cardiogenic pulmonary edema following transfusion. Symptoms responded to high-flow oxygen therapy, so intubation was not attempted and full recovery was achieved. © 2021 Sociedade Brasileira de AnestesiologiaThis Article was presented as an oral presentation at the 22nd International Intensive Care Symposium in Istanbul-Turkey on May 03-04, 2019

Posttranplant Urinary Tract Infection Rates and Graft Outcome in Kidney Transplantation for End-Stage Renal Disease Due to Reflux Nephropathy Versus Chronic Glomerulonephritis

Sahutoglu, Tuncay/0000-0003-2015-4421; sevinc, mustafa/0000-0003-2804-4884; Seyahi, Nurhan/0000-0001-7427-618XWOS: 000383528700033PubMed: 27569945Background. the goal of this study was to evaluate posttransplant urinary tract infection (UTI) rates and graft outcome in kidney transplantation for end-stage renal disease (ESRD) due to vesicoureteral reflux (VUR)-related reflux nephropathy (RN) versus chronic glomerulonephritis (CGN). Methods. A total of 62 patients with ESRD who underwent kidney transplantation for VUR-related RN (VUR-RN group, n = 31; mean +/- standard deviation age, 34.1 +/- 6.0 years; 58.1% female) or CGN (CGN group, n = 31; mean age, 34.2 +/- 6.8 years; 71.0% male) at our unit between January 1996 and January 2011 were included in this retrospective study. Baseline recipient and donor characteristics, renal replacement therapy, posttransplant data on serum creatinine levels, graft outcome, and UTIs were recorded. Posttransplant UTIs and graft outcome were compared between the VUR-RN and CGN groups, as well as between patients with and without pretransplant nephrectomy in the VUR-RN group. Results. the frequency of overall (72 vs 18 of 90; P =.05) UTI episodes was significantly higher in the VUR-RN group than in the CGN group; Escherichia coli (64.2%) was the most common pathogen. the VUR-RN and CGN groups were similar in terms of 1-year (100.0% for each), 5-year (95.8% vs 96.8%), and 10-year (82.0% vs 96.8%) graft survival. VUR-RN patients with and without nephrectomy were similar in terms of 1-year (100.0% for each), 5-year (91.7% vs 85.7%), and 10-year (81.5% vs 85.7%) graft survival. Conclusions. Our findings indicate kidney transplantation is a safe and effective option in ESRD patients with RN secondary to VUR. It resulted in high 1-year, 5-year, and 10-year graft survival rates

Comparative Analysis of Outcomes of Kidney Transplantation in Patients With AA Amyloidosis and Chronic Glomerulonephritis

Sahutoglu, Tuncay/0000-0003-2015-4421;WOS: 000383528700025PubMed: 27569937Background. Amyloid A (AA) amyloidosis is a multisystemic, progressive, and severe disease. Renal involvement is a prominent feature of the disease, and the outcome of patients on dialysis is poor. We aimed to analyze the outcomes of kidney transplantation in patients with AA amyloidosis in comparison with chronic glomerulonephritis (CGN). Methods. Charts of patients who underwent kidney transplantation between 1988 and 2012 were reviewed; 41 patients with AA amyloidosis were identified, and 41 age-and sex-matched control patients with chronic CGN were included. Baseline characteristics, immunosuppressive regimens, and transplantation-related outcomes were retrieved using a standardized form. Results. the mean follow-up period was 70.9 +/- 44.9 months. the 10-year patient survival was found to be significantly worse in the AA amyloidosis group (62.5%) compared to CGN group (100%) (P =.008). During the follow-up period, three of the 41 patients (9.7%) died of sepsis and one patient died of cardiac complications in the amyloidosis group, whereas there was no patients were lost in the CGN group. the first-year, fifth year, and tenth-year mean graft survival rates, acute and chronic rejections, and mean creatinine levels at last visits were not significantly different between the groups. Proteinuria >1 g/d, cytomegalovirus and tuberculosis infections, and rhabdomyolysis were recorded at a significantly higher rate in patients with amyloidosis. Conclusion. As compared to patients with CGN, patients with AA amyloidosis had a lower patient survival; equal graft survival and rejection rates; and higher risks of developing proteinuria, cytomegalovirus and tuberculosis infections, and rhabdomyolysis

Treatment of Pump Thrombosis With Low Dose Thrombolytic Therapy in Heartware HVAD Left Ventricular Assist Devices: Single Center Experience

38th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT) -- APR 11-14, 2018 -- Nice, FRANCEWOS: 000429934300132Int Soc Heart & Lung Transplanta

Heartmate 3 versus Heartmate 2: Is New Always Better ?

38th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT) -- APR 11-14, 2018 -- Nice, FRANCEWOS: 000430727300080Int Soc Heart & Lung Transplanta

Short-term Results of Heartmate 3 Ventricular Assist Device Implantation for End-Stage Heart Failure

WOS: 000398017900044PubMed ID: 28340840Objective. To report our initial experience with Heartmate 3 ventricular assist device (HM3) in cases with end-stage heart failure (ESHF). Methods. Charts of 8 ESHF patients who underwent HM3 implantation in our clinic from January to June 2016 (group 1) and 16 patients who underwent HM2 implantation during 2015 (group 2) were reviewed retrospectively. Demographics as well as pre and early postoperative medical data were noted and statistically analyzed between the 2 groups. Results. No statistical difference was found in age or sex distribution between groups (P >.05). Mean Interagency Registry for Mechanically Assisted Circulatory Support scores were 2.13 +/- 0.99 and 3.38 +/- 0.72 in groups 1 and 2, respectively (P =.020). Mean cardiopulmonary bypass time, and chest tube drainage fluid volume and blood product requirement during intensive care unit (ICU) stay were 64.0 +/- 13.9 minutes, 1,112.5 +/- 516.7 mL, and 318.8 +/- 271.2 mL, respectively, in group 1 and 89.0 +/- 33.3 minutes, 2,081.3 +/- 1,696.0 mL, and 1,118.8 +/- 1,010.8 mL in group 2 (P =.027, P =.019, and P =.040, respectively). Need for surgical revision and early mortality were not evident for group 1, although 4 cases (25.0%) required revision surgery, and early mortality was seen in 3 cases (18.8%) in group 2 (P =.121 and P =.190, respectively). Mean durations of ICU stay and total postoperative hospitalization were 5.9 +/- 2.0 and 18.3 +/- 5.5 days, respectively in group 1 and 6.2 +/- 4.3 and 18.0 +/- 6.9 days in the surviving 13 patients of the group 2 (P =.645 and P =.697, respectively). Conclusions. With its shorter implantation time and reduced blood product requirement in the early postoperative period, the HM3 system was found to be safe and effective in ESHF treatment

Can eculizumab be discontinued in aHUS? Case report and review of the literature

Nephrolog

Anesthetic Management for Left Ventricular Assist Device Implantation Without Using Cardiopulmonary Bypass: Case Series

WOS: 000357066800064PubMed ID: 26093752Purpose. Ventricular assist devices are an alternative to medical treatment in patients with hemodynamic disturbances related to acute or chronic congestive heart failure. In this case series, we present our anesthesia management for implantation of left ventricular assist device (LVAD) with thoracotomy. Method. Sixteen patients with end-stage heart failure undergoing LVAD implantation via thoracotomy between November 2012 and August 2014 were analyzed prospectively. Preoperative characteristics, intraoperative hemodynamic and respiratory parameters, use of anesthetic and blood products, and durations of mechanical ventilation, hospital, and intensive care stays were recorded. Results. Sixteen patients (mean age, 54.6 +/- 13 years) were investigated. Single-lung ventilation was applied to 2 patients. Cardiopulmonary bypass (CPB) was required in 5 patients. Intraoperative ketamine, midazolam, fentanyl, and rocuronium requirements were 112 +/- 63 mg, 5.5 +/- 3.5 mg, 438 +/- 187 mu g, and 179 +/- 49 mg, respectively. Requirements of fresh donor blood, fresh frozen plasma, and thrombocyte and erythrocyte suspension were 1.19 +/- 1, 1 +/- 0.8, 0.44 +/- 0.5, and 0.25 +/- 0.7 U, respectively. Durations of mechanical ventilation, intensive care unit, and hospital stay were 46 53 hours, 8.2 +/- 6.6 days, and 20.5 +/- 11.6 days, respectively. Twelve patients were discharged from hospital with full recovery and 2 patients died; 2 patients are still receiving treatment in the hospital. Conclusion. A left thoracotomy approach can be used without CPB, because it reduces the incidences of pump complications and blood transfusion. In addition, this case series showed that the implantation of LVAD by thoracotomy can be implemented securely with single-lumen endotracheal tube without single-lung ventilation