A Kundakci

Early Postoperative Acute Kidney Injury Among Pediatric Liver Transplant Recipients

Introduction Acute kidney injury after pediatric liver transplantation (LT) is a serious complication associated with increased morbidity and mortality. There are few data regarding the incidence, risk factors and outcome of KDIGO (Kidney Disease Improving Global Outcomes) based AKI after pediatric LT. The aim of the study was to evaluate children with AKI in the early postoperative period using KDIGO criteria and to compare patients with and without AKI to determine incidence, risk factors and clinical outcomes. Material and Methods In this retrospective cohort study, the medical records of all patients aged <16 years undergoing LT from April 2007 to April 2017 was reviewed. AKI was defined according to KDIGO criteria based on serum creatinine and urine output. Recorded data included demographic features and perioperative variables. Results and Discussion A total of 117 pediatric liver transplant recipients were analyzed. The mean age of transplantation was 6.1 ± 5.4 years and 69 (59%) were male. Postoperative AKI was seen in 39 (35.8%) children of which 21 (19.3%) had AKI stage 1, 12 (11%) stage 2, 6 (5.5%) stage 3. When compared with children who did not have AKI, preoperative aPTT values (38.9 ± 9.4 seconds vs 45.7 ± 19.3 seconds, p=0.02), intraoperative lactate levels at the end of surgery (5.2 ± 3.3 mmol/L vs 6.9 ± 4.0 mmol/L, p=0.004) andneed for open abdomen (2.9% vs 15.4%, p=0.01) were significantly higher in those children who had AKI. The mean calculated Model for End-Stage Liver Disease and Pediatric End-Stage Liver Disease Scores, intraoperative blood and fluids administered during the intraoperative period were similar in both groups. Logistic regression analysis revealed that preoperative high aPTT levels (odds ratio (OR), 1.043; 95% confidence interval (CI), 1.006-1.082; p=.02), intraoperative end of surgery lactate levels (OR, 1.151; 95%CI, 1.021-1.297; p=.02) and need for open abdomen (OR, 0.162; 95%CI, 0.031-0.845; p=.03) were independent risk factors for AKI. Renal replacement therapy was initiated in 12.8% of children with AKI. Length of ICU stay was significantly longer in children who developed AKI (7.1 ± 8.5 days vs 4.4 ± 5.4 days, p=0.04). Duration of mechanical ventilation and length of hospital stay were similar between the groups. In-hospital mortality was significantly higher in children with AKI (12.8% vs 1.4%, p=.01). Conclusion Our results suggest that based on KDIGO criteria early postoperative AKI occur in 35.8% of pediatric liver transplant recipients with an increased risk of mortality. Preoperative high aPTT levels, intraoperative high end of surgery lactate levels and need for open abdomen are associated with AKI after pediatric LT.

0986. The effect of eritoran on the severity of lung injury in two different rat lung injury models

Toll like receptors (TLR) play an important role in noninfectious problems in critically ill patients. The central role of TLR4 in sepsis has been clearly demonstrated. However, the role of TLR as a therapeutic target in acute respiratory distress syndrome (ARDS) has not been studied. The goal of this study is to compare the effects of eritoran, a TLR4 antagonist, on severity of ARDS in two different (pulmonary versus extrapulmonary) ARDS rat models. Forty rats were randomized to sham (n=8), extrapulmonary control (n=8), extrapulmonary eritoran (n=8), pulmonary control (n=8), and pulmonary eritoran (n=8) groups. Intestinal ischemia-reperfusion (I/R) via ligation of superior mesenteric artery was used to induce the extrapulmonary ARDS model. Intratracheal instillation of hydrochloric acid was used for the pulmonary ARDS model. Rats received either eritoran 100 µg/kg or an equal volume of placebo solution. Serum tumor necrosis factor- α (TNF-α), interleukin-1β (IL-1β), and IL-6; lung tissue malondialdehyde (MDA), glutathione (GSH), and myeloperoxidase (MPO) levels; lung histopathologic examination; arterial partial oxygen pressure (pO2); and lung wet-to-dry weight ratio (w/d) measurements were used to compare and evaluate the severity of lung injury between the groups. TLR-4 and nuclear factor-κB (NF-κB) gene expressions were determined from lung tissue using polymerase chain reaction technique. Compared to its control group, extrapulmonary eritoran group exhibited significantly less severe lung injury, as indicated by lower mean values for MDA (p 0.05 for all). However, mean values for MPO (p 0.05). However, compared to pulmonary control group the expression of TLR-4 gene was significantly less pronounced in the pulmonary eritoran group (p< 0.05). In conclusion eritoran reduced the severity of lung injury both in pulmonary and extrapulmonary ARDS models. This effect of eritoran was more pronounced in the I/R lung injury model.

Cerrahi Yoğun Bakım Ünitesinde Çok İlaca Dirençli Acinetobacter Baumannii Enfeksiyonunun Ön Belirleyicileri: Retrospektif Bir Analiz

Tel.: +90 312 212 68 68/1172-4 Faks: +90 312 212 15 83 E-pos ta: acamkiran@gmail.com Geliş Tarihi/Received: 24.02.2011 Kabul Tarihi/Accepted: 19.08.2011 Amaç: Günümüzde hastane kaynaklı enfeksiyonlarda sık rastlanan bir etken olan çok ilaca dirençli Acinetobacter baumannii (ÇİD-A. baumannii) artmış morbidite ve mortalite ile ilişkilidir. Bu çalışmada cerrahi yoğun bakım hastalarında ÇİD-A. baumannii enfeksiyonu için ön belirleyicilerin belirlenmesi amaçlandı. Materyal ve Metod: Ocak 2008 ile Ağustos 2010 tarihleri arasında cerrahi yoğun bakım ünitesinde izlenen hastaların verileri retrospektif olarak tarandı. Çok ilaca dirençli A. baumannii enfeksiyonu olan hastalar ve kontrol grubunu oluşturan aynı dönemde yoğun bakımda izlenen ancak ÇİD-A. baumannii enfeksiyonu olmayan hastaların yaş, cinsiyet, Acute Physiology and Chronic Health Evaluation II (APACHE II) skoru, Glasgow koma skoru, yandaş hastalıkları, yoğun bakım ünitesine yatış nedeni, ameliyat olanların ameliyat türleri, uygulanan invazif işlemler (entübasyon, arteriyel, santral venöz ve üriner kateterizasyonlar), renal replasman tedavi gereksinimi, üreme yeri, sistem yetmezlikleri, hospitalizasyon ve yoğun bakım ünitesinde kalış süresi, laktat seviyesi ve beyaz küre sayısı kaydedildi. Bulgular: Araştırılan dönem içerisinde 25 hastada ÇİD-A. baumannii enfeksiyonu saptandı. Çok ilaca dirençli A. baumannii enfeksiyonu olmayan eşleştirilmiş kontrol grubu (n=25) ile karşılaştırıldığında enfeksiyonu olan grupta ortalama APACHE II skoru daha yüksek (p=0,001) ve solunum sistemi hastalığı (p=0,03), açık yara bulunması (p=0,002), mekanik ventilasyon ihtiyacı (p=0,005) ve ÖZET SUMMARY