Tibial sided Anterolateral Ligament Injuries are Associated with Poor Healing and Residual Pivot Shift Testing Following Anterior Cruciate Ligament Reconstruction.

PURPOSE: ; to investigate if tibial sided anterolateral ligament (ALL) injuries are associated with poor healing and residual pivot shift. METHODS: ; Patients who underwent anterior cruciate ligament reconstructions within postinjury 6 weeks from January 2008 to March 2021 were included. They had concomitant ALL injury confirmed by preoperative magnetic resonance imaging (MRI) and were followed minimum 20 months. Preoperative ALL injury was graded by the Muramatsu classification and postoperative ALL healing were graded by a modification of the Lee classification (good, partial, and non-visualized). The patients were allocated to an improved group (IG) and an unimproved group (UG) based on a comparison of pre- and postoperative MRI. ALL tear site, postoperative knee stability, Lysholm score, and Tegner activity scale (PROs) were compared between the two groups. RESULTS: ; 128 patients were enrolled. 94.5 % patients achieved the minimal clinically important difference (MCID) for PROs, respectively. The ALL was torn at the femoral side in 46.9% patients, at mid-substance in 31.2.%, and at tibial side in 21.9%, Preoperatively, 86 (67.2%) patients had a partial tear and 42 (32.8%) patients had a complete tear. Based on the postoperative MRI appearances, 38 (29.7%) and 90 (70.3%) patients were allocated to the IG and UG, respectively. The tibial side tears were significantly frequent in UG (p= .032). Pivot shift showed a significantly higher incidence in UG than IG (p=.004). Lachman test and PROs did not differ between the two groups. CONCLUSIONS: ; Tibial-sided ALL tears occurred in 18.7% of the UG compared to 3.2% of the IG, and 45.6% of the UG had a postoperative grade 1 or 2 pivot shift, compared to 15.8% of the IG. Percentages of patients with the MCID for PROs did not differ between the two groups. However, the clinical relevance is limited by a high transfer bias.

Liver Transplantation from Brain-Dead Donors with Hepatitis B or C in South Korea: A 2014-2020 Korean Organ Transplantation Registry Data Analysis.

BACKGROUND According to the current guidelines for liver transplantation (LT) of brain-dead donors with hepatitis B or C virus (HBV or HCV) in Korea, grafts from hepatitis B surface antigen (HBsAg)(+) or HCV antibody (anti-HCV)(+) donors must be transplanted only to HBsAg(+) or anti-HCV(+) recipients, respectively. We aimed to determine the current status and outcomes of brain-dead donor LT with HBV or HCV in Korea. MATERIAL AND METHODS This retrospective observational study included all LTs from brain-dead donors in the Korean Organ Transplantation Registry between April 2014 and December 2020. According to donor hepatitis status, 24 HBV(+), 1 HCV(+), and 1010 HBV(-)/HCV(-) donors were included. RESULTS Baseline/final model for end-stage liver disease score (MELD) for HBV(+), HCV(+), and HBV(-)/HCV(-) were 22.4±9.3/27.8±7.8, 16/11, and 33.0±15.4/35.5±7.1, respectively. MELD score of HBV (+) were lower than those of HBV(-)/HCV(-) (P<0.01). Five-year graft and patient survival rates of HBV(+) and HBV(-)/HCV(-) recipients were 81.7%/85.6%, and 76.6%/76.7%, respectively (P=0.73 and P=0.038). One-year graft and patient survival rates of HCV (+) graft recipients were both 100%. CONCLUSIONS No differences in graft and patient survival rates between HBV(+) and HBV(-)/HCV(-) groups were observed. Although accumulating the results of transplants from HBV (+) or HCV(+) grafts to HBV(-) or HCV(-) recipients is not possible owing to domestic regulations, Korea should conditionally permit transplantations from HBV(+) or HCV(+) grafts to HBV(-) or HCV(-) recipients by considering the risks and benefits based on foreign studies. Thereafter, we can accumulate the data from Korea and analyze the outcomes.

Kidney Transplantation From Brain-Dead Donors With Hepatitis B or C in South Korea: A 2015 to 2020 Korean Organ Transplantation Registry Data Analysis.

BACKGROUND: According to the current Center for Korean Network for Organ Sharing guidelines for kidney transplantation from brain-dead donors with hepatitis B or C infection, organs from hepatitis B surface antigen-positive (HbsAg+) or anti-hepatitis C virus-positive (HCV+) donors can only be transplanted into HBsAg+ or anti-HCV+ recipients. We aimed to confirm the status and the outcomes of kidney transplantation from brain-dead donors with hepatitis B or C virus in Korea. METHODS: This retrospective study included all kidney transplantations from brain-dead donors in the Korean Organ Transplantation Registry database between January 2015 and June 2020, divided into 3 groups according to donor hepatitis status. Finally, kidney transplantations from 80 HBV+, 12 HCV+, and 2013 HBV-/HCV- donors were included. RESULTS: No statistically significant differences were observed in the recipient characteristics and the transplant outcomes except the waiting time (HBV+ to HBV-/HCV-, P < .001; HCV+ to HBV-/HCV-, P = .10; HBV+ to HCV+P = .95). Five-year graft survival rates of the HBV+, HCV+, and HBV-/HCV- recipients were 95%, 83%, and 85%, respectively (HBV+ to HCV+, P = .22; HCV+ to HBV-/HCV-, P = .81; HBV+ to HBV-/HCV-, P = .02). Five-year patient survival rates of the HBV+, HCV+, and HBV-/HCV- recipients were 95%, 100%, and 76%, respectively (HBV+ to HCV+, P = .61; HCV+ to HBV-/HCV-, P = .13; HBV+ to HBV-/HCV-, P < .001). CONCLUSION: HBV+/HCV+ brain-dead donor kidney transplantation outcomes were comparable to HBV-/HCV-. South Korea should consider conditionally permitting transplantation from HBV+ or HCV+ donors to HBV- or HCV- recipients to accumulate new data and conduct further studies.

First Organ Donation after Circulatory Death Following Withdrawal of Life-sustaining Treatment in Korea: a Case Report.

In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist. The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of "no-touch time," circulatory death was declared. Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.

Organ Donation from Donors with Hepatitis B or C in South Korea: A 2013-2017 Nationwide Data Analysis.

BACKGROUND The number of organ donations from hepatitis B virus (HBV) or hepatitis C virus (HCV)-positive donors is gradually increasing; however, the current status of organ donation from brain-dead donors with hepatitis in South Korea has not been analyzed. This study aimed to analyze this. MATERIAL AND METHODS In total, 9210 potential brain deaths were reported in South Korea from January 2013 to December 2017, of which 333 were hepatitis carriers (HBV, n=246; HCV, n=87). Based on the data from the Korean Network for Organ Sharing and Korea Organ Donation Agency, 2460 completion of transplantations from brain-dead donors have been performed, of which 71 were hepatitis carriers (HBV, n=60; HCV, n=11). RESULTS There were 60 and 11 transplantations from HBV- and HCV-positive brain-dead donors, respectively. The main reasons for organ transplantation failure were recipient's refusal (n=90), unsuitability as donors (n=80), non-brain death (n=45), and cardiac death (n=20). There were 71 and 31 kidney and liver donations, respectively; the average number of organs donated by HBV-positive donors was higher than that donated by HCV-positive donors. HBV-positive donors donated more hearts and livers than HCV-positive donors. CONCLUSIONS There are few organ donations from brain-dead donors with hepatitis B or C which led to transplantation completion in South Korea, and the main reasons for failure are recipient's refusal to receive organs from donors with hepatitis and unsuitability for donation due to active viral conditions. To promote organ transplantations from donors with hepatitis B and C virus, we could consider 3 strategies: 1) reducing recipient's refusal rates by educating recipients and their families on the outcomes of organ donation from hepatitis carriers, 2) establishing treatment protocols for infection management after organ transplantations from HBV/HCV brain-dead donors, and 3) increasing the relevant experience of medical staff.

Organ donation after controlled circulatory death (Maastricht classification III) following the withdrawal of life-sustaining treatment in Korea: a suggested guideline.

The "Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life" was enacted in February 2018 in Korea. Therefore, we suggest a Korean guideline for organ donation after circulatory death (DCD) category III after the withdrawal of life-sustaining treatment (WLST). Implementation of WLST includes stopping ventilation, extubation, discontinuation of inotropics and vasoconstrictors, cessation of continuous renal replacement therapy, and cessation of extracorporeal membrane oxygenation. Medical staff involved in organ procurement or transplantation surgery cannot participate in the WLST process. Following cardiac arrest, 5 minutes of "no touch time" should pass, after which circulatory death can be declared. The procurement team can enter the room after the declaration of death. The final procurement decision is made after the surgeon visually checks the organ condition. DCD category III activation in Korea will help increase organ donation and reduce the demand-supply mismatch of organ transplantation.