Journal of Military Pharmaco-medicine

FACTORS AFFECTING THE VARIATION OF TACROLIMUS LEVELS IN KIDNEY TRANSPLANT PATIENTS AT VIET DUC UNIVERSITY HOSPITAL

Objectives: To analyze usage characteristics and Tacrolimus (TAC) trough level variability over time, and to analyze some factors affecting the intra-patient variability in TAC exposure in the first year after kidney transplantation. Methods: A retrospective, descriptive study was conducted based on medical records of patients who underwent kidney transplantation and had regular follow-up at the Department of Kidney Diseases and Dialysis, Viet Duc University Hospital, from January 1, 2019 to June 30, 2023. Results: 274 medical records of 274 kidney transplant patients were included. Dosage, trough concentrations, and intra-individual variability (IPV) of TAC trough concentrations tended to decrease over time. Logistic regression analysis revealed factors associated with high IPV (CV > 30%) in the first month after transplantation including concomitant use of azole antifungal agents non-continuously vs. continuously use vs. no use (OR = 16.51; p < 0.001); concomitant use of diltiazem non-continuously vs continuously use or no use (OR = 2.92; p = 0.002); factors during the 2 - 6 month period included hematocrit (OR = 0.86; p = 0.001) and mean C0/D ratio (OR = 1.41; p < 0.001); during the 6 - 12-month period, switching between twice-daily and once-daily formulations compared to no switching was associated (OR = 1.17; p = 0.004). Conclusion: TAC trough levels IPV decrease over time after transplantation. High IPV of TAC levels includes concomitant use of azole antifungal and diltiazem agents non-continuously; hematocrit and switching between twice-daily and once-daily formulations.

STUDY ON CHANGES IN LEFT VENTRICULAR STIFFNESS BY SPECKLE TRACKING ECHOCARDIOGRAPHY IN PATIENTS WITH END-STAGE CHRONIC KIDNEY DISEASE BEFORE AND AFTER KIDNEY TRANSPLANTATION

Vu Thu Ha Pham, Nguyen Thi Thu Ha

Objectives: To investigate the change in left ventricular stiffness by speckle tracking echocardiography (STE) in patients with end-stage chronic kidney disease (ESKD) before and after kidney transplantation.Methods: A prospective, cross-sectional descriptive study was conducted on 63 patients with ESKD who underwent kidney transplantation at Military Hospital 103 from October 2024 to April 2025. All patients were followed up 1 month after transplantation. Results: There was no significant difference in DWS before and after kidney transplantation. Left ventricular stiffness after kidney transplantation decreased significantly compared to before transplantation. Left ventricular stiffness after transplantation in the hemodialysis group increased significantly compared to the emptive treatment group when assessed by both tissue doppler (TDI) and STE. There was no difference in DWS after transplantation between the two treatment groups. Left ventricular stiffness after transplantation in the hemodialysis group > 12 months was significantly higher than that < 12 months when assessed by both TDI and STE. Conclusion: 1 month after kidney transplantation, left ventricular stiffness measured by 3 methods (DWS and E/e’/LVEDV and E/LASr/LVEDV) tended to improve, reflecting a reduction in myocardial stiffness. Factors such as pre-transplant treatment and duration of dialysis may also affect left ventricular stiffness.

SOME CHARACTERISTICS OF INTRA-PATIENT VARIABILITY OF TACROLIMUS CONCENTRATIONS POST-KIDNEY TRANSPLANTATION

Cuong Nguyen Van, Khoa Nguyen Viet, Hoang Nguyen Huy, Quý Kiên Trương

Objectives:To investigate Tacrolimus's (TAC) concentration and intra-patient variability of Tacrolimus concentrations and analyze its relationship with some clinical and subclinical characteristics in patients after kidney transplantation from the 7th to the 12th month. Methods: A retrospective, prospective, cross-sectional descriptive study was conducted on 108 patients who were evaluated for the coefficient of variation of TAC concentration based on the quantification of TAC trough concentrations at the 7th to the 12th month post-kidney transplantation. The distribution of drug concentration variation was based on the quartile principle. Results: The median IPV of the study group from 7th to 12th month was 19.0%, with a minimum of 6.84% and a maximum of 57.84%. The proportion of patients with high IPV was 13.9%. IPV was not significantly associated with age, sex, eGFR, MMF dose, hemoglobin concentration, and post-transplant proteinuria, with p > 0.05. IPV was associated considerably with TAC trough concentrations at months 8, 9, and 10; p < 0.05. IPV was significantly related to TAC trough concentrations at months 8, 9, and 10; p < 0.05. Conclusion: The IPV of the study group during the 6 months (7th to 12th) fluctuated significantly and was significantly related to trough concentrations at months 8, 9, and 10.

INVESTIGATION OF PLASMA GLUCAGON-LIKE PEPTIDE-1 LEVELS IN KIDNEY TRANSPLANT RECIPIENTS

Tien Son Nguyen, Dung Thị Thùy Nguyễn, Viet Thang Le, Minh Nui Nguyen

Objectives: To investigate plasma glucagon-like peptide-1 (GLP-1) levels in kidney transplant recipients.Methods:A cross-sectional descriptive study was conducted on 81 kidney transplant recipients and 53 age- and sex-matched healthy controls at Military Hospital 103 from October 2021 to December 2023. Plasma GLP-1 concentrations were quantified in kidney transplant recipients and compared to the control group.Results:The median plasma GLP-1 concentration in kidney transplant recipients was 8.82 pmol/L, which was significantly lower than that of the control group (10.7 pmol/L, p < 0.001). A 8.6% reduction in GLP-1 levels was observed in the post-transplant group. In kidney transplant recipients, plasma GLP-1 levels demonstrated a negative correlation with age, the time after transplantations, insulin sensitivity (HOMA-S), and a positive correlation with insulin resistance (HOMA2-IR), p < 0.05. Insulin is an independent predictive factor for reducing plasma GLP-1, with OR = 0.578, p < 0.05. Conclusion:Plasma GLP-1 levels were decreased in kidney transplant recipients, with a reduction rate of 8,6%.

SURVEY OF THE CHARACTERISTICS OF TACROLIMUS TROUGH CONCENTRATIONS IN KIDNEY TRANSPLANT RECIPIENTS OVER ONE YEAR POST-TRANSPLANT AT MILITARY HOSPITAL 103

Objectives: To investigate the characteristics of tacrolimus (TAC) trough concentrations (C0) and their associations with selected clinical and laboratory parameters in kidney transplant recipients over one year post-transplantation. Methods: A cross-sectional descriptive study was conducted on 532 kidney transplant recipients over one year post-transplant, all receiving an immunosuppressive regimen containing TAC, from January 2024 to September 2024. Data on TAC dosing, C0, and relevant clinical and laboratory parameters were collected for descriptive analysis and association testing. Results: The proportion achieving target TAC C0 levels was 73.68% (392/532 patients), with 1.32% above and 25.00% below the recommended range. Post-transplant duration was significantly associated with abnormal TAC C0 levels (OR = 1.167, p < 0.001). Conclusion: The majority of kidney transplant recipients, over one year post-transplant, achieved TAC C0 within the recommended range. Post-transplant duration was the only factor significantly associated with abnormal C0 levels.

EVALUATION OF CHANGES IN PERIPHERAL BLOOD CELL INDICES, NEUTROPHIL TO LYMPHOCYTE RATIO, AND PLATELET TO LYMPHOCYTE RATIO DURING THE FIRST SIX MONTHS POST-TRANSPLANT IN KIDNEY TRANSPLANT RECIPIENTS AT MILITARY HOSPITAL 103

Thi Thu Ha Nguyen, Van Duc Nguyen, Phuc Kham Hoang

Objectives:To investigate changes in peripheral blood cell indices, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)in pre-kidney transplant and during the first six months post-transplant. Methods: A combined retrospective and prospective, descriptive study was conducted on 258 kidney transplant recipients at Military Hospital 103 (01/2022 - 4/2025).Clinical characteristics and complete blood counts were collected and analyzed. Results: RBC, hemoglobin, and hematocrit increased from the first month post-transplant; anemia prevalence decreased from 82.6% pre-transplant to 15.5% at 6 months. Platelet counts rose from 218.61 ± 70.3 to 231.98 ± 60.41 G/L (p < 0.05), lymphocytes from 1.55 ± 0.69 to 1.75 ± 0.81 G/L (p < 0.05), while NLR declined from 3.07 (2.26 - 4.45) to 2.72 (1.93 - 3.75) (p < 0.05). Conclusion: Peripheral blood indices improved within 6 months after transplantation, and regular monitoring facilitates early complication detection and timely therapeutic adjustment.

RESEARCH ON QUALITY OF LIFE USING THE SF-36 QUESTIONNAIRE IN KIDNEY TRANSPLANT RECIPIENTS

Objectives: To evaluate the quality of life (QoL) of kidney transplant recipients. Methods: A prospective, cross-sectional descriptive study was conducted on 172 kidney transplant recipients followed up at the Military Hospital 103. QoL was assessed using the SF-36 questionnaire. Results: The mean SF-36 score was 70.94 ± 15.32; the physical health component was 69.67 ± 17.51; and the mental health component was 72.21 ± 16.01. Overall, 48.8% of patients had SF-36 scores > 75, 39.5% scored 50 - 75, and 11.6% scored 25 - 50; no patients had scores < 25. Patients with BK, CMV, HBV, HCV infections, hypertension, diabetes, a history of acute rejection therapy, or elevated serum creatinine had significantly lower SF-36 scores (p < 0.05). No difference was observed between male and female patients (p > 0.05). Conclusion: Kidney transplant recipients achieved a fairly good QoL. Viral infections (BK, CMV, HBV, HCV), comorbid conditions (hypertension, diabetes), acute rejection, and reduced graft function were associated with decreased QoL.

INVESTIGATION OF THE ASSOCIATION BETWEEN INSULIN RESISTANCE AND SOME CHARACTERISTICS IN PATIENTS WITH NEW-ONSET DIABETES AFTER KIDNEY TRANSPLANTATION

Dung Thị Thùy Nguyễn, Viet Thang Le, Minh Nui Le, Tien Son Nguyen

Objectives: To investigate insulin resistance status and its association with some characteristics in patients with new-onset diabetes after kidney transplantation (NODAT). Methods: A cross-sectional descriptive study was conducted on 81 patients with untreated NODAT and 53 age- and sex-matched healthy controls at Military Hospital 103 from October 2021 to December 2023. Clinical and laboratory characteristics were collected, and insulin resistance indices were calculated using the HOMA2 model, including insulin resistance (HOMA2-IR), insulin sensitivity (HOMA2-S), and β-cell function (HOMA2-B). Results: The median HOMA2-IR in the NODAT group was 0.95, which was significantly higher than that of the control group (0.7); p < 0.001. In contrast, both HOMA2-S and HOMA2-B were markedly reduced in the NODAT group compared to the control group (p < 0.001). Among NODAT patients, the prevalence of elevated HOMA2-IR, decreased HOMA2-S, and impaired HOMA2-B was 18.5%, 19.8%, and 27.2%, respectively. Patients with increased HOMA2-IR or reduced HOMA2-S exhibited significantly greater waist circumference, higher mean BMI, with those without these abnormalities, and the rate of increased HOMA2-IR was significant with OR 6,08 and 7,0, respectively (p < 0.05). Conclusion: Insulin resistance in NODAT patients is associated with increased waist circumference and higher BMI,

ASSESSMENT OF ANEMIA CHARACTERISTICS DURING THE FIRST SIX MONTHS AFTER KIDNEY TRANSPLANTATION AND ASSOCIATED FACTORS IN PATIENTS UNDERGOING KIDNEY TRANSPLATATION AT MILITARY HOSPITAL 103

Bá Nghĩa Phan, Lê Việt Thắng, Nguyen Thi Thu Ha

Objectives: To evaluate the prevalence of anemia during the first six months after kidney transplantation and its association with selected clinical and paraclinical characteristics in patients undergoing kidney transplantation. Methods: A combined retrospective and prospective study was conducted on 258 patients who successfully underwent kidney transplantation between January 2022 and January 2025 at Military Hospital 103. Anemia prevalence was assessed at 1 week, 1 month, 3 months, and 6 months post-transplant. Results: The prevalence of anemia progressively decreased from 92.24% at 1 week to 68.6% at 1 month, 39.53% at 3 months, and 23.26% at 6 months. Most cases were mild normocytic normochromic anemia; polycythemia was observed in 5.04% of patients. At 6 months post-transplant, female patients and those with an estimated glomerular filtration rate (eGFR) < 60 mL/min had significantly lower hemoglobin levels compared with other groups (p < 0.05). Patients’ age and post-transplant eGFR were independent predictors of anemia, with odds ratios of 0.97 and 0.96, respectively (p < 0.05). Conclusion: Anemia was highly prevalent during the first six months after kidney transplantation, although the prevalence decreased over time. At 6 months, anemia persisted in 23.26% of patients and was associated with female sex, reduced eGFR, and older age.

TISSUE-ORGAN DONATION IN BRAIN DEATH OR CIRCULATORY DEATH: RESULTS OF THE ALLOCATION ACTIVITIES AT CHO RAY HOSPITAL

Objectives: To survey tissue-organ donation activities from brain death or circulatory death at Cho Ray Hospital from June 2024 to July 2025. Methods: A retrospective study on the allocation activities of tissue-organ donation and transplantation was conducted from June 2014 - July 2025. The activities consist of three separate branches with closely coordinated processes: The donor management branch, the patient on the waitlist management branch, and the media branch. Results: The allocation activities of tissue-organ donation and transplantation at Cho Ray Hospital achieved the following results: The donor management branch received 42 donors. The patient on the waitlist management branch received 183 patients. The media branch includes many articles to popularize knowledge about tissue-organ donation and transplantation. Conclusion: To develop the tissue-organ donation and transplantation program from brain-death or circulatory death that ensures transparency and fairness, the coordination system must have a clinical pathway, a strict and clear coordination process between specialties to ensure the scientific integrity and compliace with the ethics and law.

EMERGENCY LIVER TRANSPLANTATION IN A PATIENT WITH HEPATITIS B VIRUS-RELATED CIRRHOSIS COMPLICATED BY HEPATORENAL SYNDROME: A CLINICAL CASE REPORT

Nga Nguyen Thi, Hoa Do Thanh, Loi Hoang Quoc, Hoang Nguyen Huy, Quý Kiên Trương

Objectives: To present a clinical case of hepatitis B virus-related (HBV) cirrhosis that developed hepatorenal syndrome - acute kidney injury (HRS-AKI), managed with hemodialysis, plasma exchange, and subsequent liver transplantation; and to discuss diagnostic challenges, therapeutic strategies, and renal function recovery after transplantation. Methods: A case report was conducted on a patient with HRS-AKI who underwent emergency liver transplantation. Results: A 41-year-old male with cirrhosis due to chronic HBV infection, with poor treatment adherence, was admitted in a state of altered consciousness, ascites, and oliguria. Laboratory findings revealed severe progressive hepatic dysfunction and renal impairment. The patient was diagnosed with HRS-AKI after exclusion of other causes of acute kidney injury. Vasoconstrictor therapy and albumin infusion were unsuccessful, necessitating continuous renal replacement therapy and plasma exchange. Emergency liver transplantation was performed 10 days after admission. Five days post-transplant, liver function recovered significantly, and renal function gradually improved, eliminating the need for further dialysis. Conclusion: This case demonstrates that emergency liver transplantation is a life-saving option for patients with HRS-AKI unresponsive to medical therapy. It further highlights the importance of early diagnosis and timely referral to a transplant center.

EVALUATION OF POSTOPERATIVE CRITICAL CARE OUTCOMES AFTER LIVING-DONOR KIDNEY TRANSPLANTATION AT MILITARY HOSPITAL 175

Objectives: To describe clinical and paraclinical characteristics and to evaluate complications during postoperative critical care after living donor kidney transplantation at Military Hospital 175. Methods: A retrospective, descriptive study was conducted on 50 patients who underwent living donor kidney transplantation at the Surgical ICU of Military Hospital 175, including patients ≥ 18 years who underwent kidney transplantation from July 2023 to June 2025. Results: the mean age was 42.3 ± 12.1 years; 68% patients were male; the mean BMI was 21.35 ± 2.52 kg/m². Most patients had chronic comorbidities and prolonged pre-transplant dialysis. No severe respiratory complications occurred postoperatively. Vasopressor support was required in 2% of cases. Hypertension requiring treatment was observed in 86% of cases. Early postoperative polyuria and electrolyte disturbances occurred but resolved quickly; serum urea and creatinine levels approached near-normal values by day 3. Complications were observed in 12% of patients (n = 6), including postoperative bleeding requiring reoperation (n = 2), lymphocele (n = 2), and acute rejection (n = 2). Conclusion: Living donor kidney transplantation carries considerable complication risks during the post-resuscitation period. Close postoperative monitoring is essential for timely detection and intervention to optimize outcomes.

URETEROURETEROSTOMY OF THE TRANSPLANTED KIDNEY TO THE NATIVE URETER IN A RECIPIENT WITH DISUSED ATROPHIC BLADDER: A CLINICAL CASE REPORT

Thi Diem Hoang, Ngoc Son Do, Nguyen The Cuong

Patients on long-term hemodialysis often have a disused atrophic bladder, which poses a significant challenge for the reconstruction of the urinary pathway in kidney transplantation. We report the first case at our center in which a recipient with a disused atrophic bladder (capacity 30mL) underwent uretero-ureteral anastomosis. After 29 months of follow-up, graft function remained stable, the bladder showed good capacity expansion > 290mL, and only mild pelvicalyceal dilatation of the graft kidney (6 - 9mm) was observed, without intervention or hydronephrosis of the native kidney. Uretero-ureteral anastomosis should be considered in patients with a disused atrophic bladder to expand kidney transplantation opportunities for long-term dialysis patients.

EARLY RESULTS OF RIGHT LAPAROSCOPIC LIVING DONOR NEPHRECTOMY USING A SUBCOSTAL MINI-LAPAROTOMY AND LATERAL CLAMPING OF THE INFERIOR VENA CAVA

Nguyen Phu Viet, Nguyễn Nhật An, Cao Quyết Thắng, Đào Văn Nhật, Anh Tuan Nguyen

Objectives: To evaluate the early outcomes of right laparoscopic donor nephrectomyusing a subcostal mini-incision and lateral clamping of the inferior vena cava. Methods: A prospective study was conducted on 60 living kidney donors who underwent surgery at Military Hospital 103 from January 2024 to May 2025. Results: The mean age was 34.5 ± 16.7 years (22 - 59); the mean BMI was 23.7 ± 4.3. 10 cases had 2 renal arteries, and 6 had 2 renal veins. No major intraoperative complications were recorded. The average blood lost was 56.1 ± 34.01mL. The mean operative time was 90.1 ± 21.2 minutes (range 72 - 120). Urine output was observed immediately in 58/60 grafts. Graft function normalized in 59 recipients after 3 weeks. 1 patient had delayed function with discharge creatinine of 140 μmol/L. Conclusion: Right laparoscopic donor nephrectomy using a subcostal mini-incision and lateral IVC clamping is safe, feasible, and effective.

EVALUATION OF RESULTS DURING THE FIRST 3 MONTHS AFTER KIDNEY TRANSPLANTATION AT MILITARY HOSPITAL 175

Objectives: To evaluate the outcomes during the first 3 months after kidney transplantation at Military Hospital 175. Methods: A prospective, observational,descriptive study was conducted on 70 patients (68 from living donors, 2 from brain-dead donors) who underwent kidney transplantation from July 2023 to July 2025. Follow-up period was the first 3 months after transplantation. Results: 100% patients had immediate urine output at the operating table, with stable urine volumes observed after 1 month, and most patients achieved normalization of blood urea and creatinine levels after the first postoperative week, which remained stable after 3 months. The overall complication rate was 21.15%, including 2.85% postoperative bleeding, 4.2% perirenal lymphocele, 4.2% acute rejection, and 5.7% urinary tract infection. All complications were managed successfully. Conclusion: Preliminary results demonstrate that kidney transplantation yields favorable outcomes. All patients achieved good graft function after 3 months, with a moderate complication rate (21.15%) that was effectively treated.

INITIAL OUTCOMES OF LIVER TRANSPLANTATION USING CLASSIC TECHNIQUE WITH VENA CAVA RECONSTRUCTION AT VIETDUC UNIVERSITY HOSPITAL

Objectives:To evaluate the efficacy and safety of the modified classic liver transplantation technique, focusing on optimized clamp release sequence, in patients undergoing liver transplantation at VietDuc University Hospital.Methods:A retrospective study was conducted on 17 patients undergoing liver transplantation from October 2024 to April 2025 at VietDuc University Hospital. Parameters were evaluated, including clinical and laboratory characteristics, operative time, blood loss, blood transfusion, early post-operative outcomes, and 90-day mortality rate.Results:The mean operative time was 366.5 ± 59.9 minutes, warm ischemia time was 24.8 ± 5.0 minutes, and median blood loss was 1,200mL. Medical complications (infections) occurred in 29.4%, 17.6% had post-reperfusion syndrome. The 90-day mortality rate was 11.8% (2 cases), with no instances of acute rejection or delayed graft function recorded.Conclusion:The modified classic liver transplantation demonstrates feasibility, with short warm ischemia time, reduced blood loss, and acceptable complication rates. Further studies with larger sample sizes and longer follow-up periods are needed to assess long-term efficacy.

APPLICATION OF THE CLAVIEN-DINDO CLASSIFICATION IN ASSESSING SURGICAL COMPLICATIONS IN BRAIN-DEAD DONOR KIDNEY TRANSPLANT FROM 2010 - 2024

Objectives:To describe surgical complications following kidney transplantation and their corresponding management, classified according to the Clavien-Dindo scale. Methods: A retrospective, descriptive study was conducted on 213 kidney transplant cases between 2010 and 2024. Surgical complications and their management were recorded and classified according to the Clavien-Dindo system. All patients had complete medical records documenting surgical complications and treatment methods. Results: Surgical complications occurred in 27 out of 213 patients. Distribution by Clavien-Dindo grade was as follows: Grade II (2 cases), grade IIIa (9 cases), grade IIIb (15 cases), and grade V (1 case). There were no grade I, IVa, or IVb complications reported. Management primarily focused on vascular and urological complications, including ureteroneocystostomy reconstruction, ureteropyelostomy with the native ureter, and intraoperative management of arterial anastomotic stenosis using intraoperative flushing techniques. Postoperative and long-term graft function remained stable. Conclusion: Surgical complications after kidney transplantation were predominantly grade IIIa - IIIb, with most requiring invasive interventions. Early detection and timely management are crucial.

INITIAL OUTCOMES OF TRANSPERITONEAL LAPAROSCOPIC LIVING DONOR NEPHRECTOMY AT MILITARY HOSPITAL 175

Objectives: To evaluate the initial outcomes of transperitoneal laparoscopic nephrectomy at Military Hospital 175. Methods:A prospective, descriptive studywas conducted on 60 cases of living donor nephrectomy using the transperitoneal laparoscopic approach from June 2023 to June 2025. The variables were assessed, including clinical and paraclinical characteristics, operative time, estimated blood loss, intraoperative and postoperative complications, and postoperative donor renal function. Results: 100% of laparoscopic nephrectomies were successfully performed. The mean donor age was 35.4 years, with an average BMI of 23.08 kg/m². Left kidneys were harvested in 47 cases and right kidneys in 13 cases; 43 donors had a single renal artery, while 17 had two. The mean operative time was 168.72 minutes, and the average warm ischemia time was 4.67 minutes; blood loss was minimal. The harvested kidneys had intact anatomy, and all grafts produced immediate urine output in the operating room. One case experienced postoperative bleeding at the trocar site, requiring intervention. Conclusion:Transperitoneal laparoscopic donor nephrectomy is a safe and effective technique for living kidney donation.