• Clinics in Shoulder and Elbow
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• v.19 no.2
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• pp.84-89
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• 2016

Background: The purpose of this study was to assess the results of arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Methods: From November 2009 to April 2011, 12 patients underwent arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Patients were followed for an average of 33.9 months. Clinical outcome was evaluated preoperatively and postoperatively using the mean University of California, Los Angeles (UCLA) score and the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging (MRI) was performed postoperatively at an average of 6.5 months. Results: At a mean follow-up of 33.9 months (range, 25 to 42 months), 11 out of 12 patients were satisfied with their procedure. Patients showed significant improvement in their mean modified UCLA score from 15.9 preoperatively to 29.4 postoperatively (p=0.001). The mean KSS score improved from 45.6 preoperatively to 80.5 postoperatively (p=0.002). In MRI studies, 9 out of 12 patients had full incorporation of the graft into the native rotator cuff remnant. To date, there has been no intraoperative or postoperative complication from the graft procedure, such as infection or allograft rejection, in any patient. Conclusions: Arthroscopic bridging repair using a human dermis allograft can be considered as an option in treatment of select cases of massive irreparable rotator cuff tears, resulting in high patient satisfaction.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2006.11a
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• pp.49-49
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• 2006

• Korean Journal of Clinical Pharmacy
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• v.13 no.1
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• pp.1-4
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• 2003

Cyclosporine (CsA) has become well established as a potent immunosuppressive agent in the renal transplantation. However, therapy is complicated by large intraindividual and interindividual variability in pharmacokinetics of CsA and frequent undesirable clinical outcomes such as graft rejection and nephrotoxicity. The objective of this study was to determine the CsA trough blood concentrations that were associated with acute graft rejection and renal toxicity in renal transplant patients. Also, the ability of the current recommendation of therapeutic range for CsA to prevent graft rejections and CsA-associated renal toxicity was assessed. The clinical courses of the patients on CsA as an immusuppressive agent for preventing the graft rejection with renal ransplantation performed at Seoul National University Hospital from January 1995 to September 1998 were retrospectively reviewed. Total of 78 patients were included and three of them were retransplantation cases. Twenty-two acute episodes of rejection were identified, but only 16 episodes were clinically significant. Of these all the episodes occurred during the first month after transplantation except one. Mean daily doses of CsA were $427.2\pm72.1,\;352.6\pm56.8,\;308.62\pm48.3\;and\;268.47.1\;mg$ at posttransplant 1, 3, 6, and 12 months, respectively. Mean CsA whole blood though levels were $259.8\pm36.2,\;238.5\pm39,\;200.8\pm45.8\;and\;161.9\pm25.8\;ng/ml$ at posttransplant 1, 3, 6 and 12 months, respectively. Mean daily doses/weight were $7.9\pm1,\;6.4\pm1,\;5.3\pm0.7\;and\;4.6\pm0.7\;mg/kg$ at posttransplant 1, 3, 6 and 12 months, respectively. CsA doses decreased significantly as months progressed (p<0.001). During the first month after transplantation, only $12.5\%$ of the patients in rejection group had CsA concentration in therapeutic range, and 87.5, 93.8, and $100\%$ were within the therapeutic range at posttransplant 3, 6, and 12 months, respectively. These results suggested that CsA concentrations of $250\sim300\;ng/ml$ might be appropriate for preventing the acute rejection during the first posttransplant month.

• Korean Journal of Transplantation
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• v.32 no.4
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• pp.108-112
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• 2018

Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.73-76
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• 2010

Cardiac allograft vasculopathy (CAV) is a major factor that limits the long-term survival after cardiac transplantation. Because the main feature of CAV is a diffuse stenosis that predominantly develops in the distal arteries, reperfusion therapy has shown poor outcomes. The results of cardiac retransplantation for CAV are better than that for acute resection and the survival is identical to that of patients who undergo primary transplantation. We describe a case of performing cardiac retransplantation in a 28 year-old male patient with refractory CAV and who underwent primary transplantation due to dilated cardiomyopathy 8 years previously.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.367-372
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• 2008

Purpose: Prevention of acute rejection in skin allografts without continuous immunosuppression lacks reports in worldwide literature. Needs for chronic immunosuppression preclude the use of tissue allograft as a routine surgical reconstructive option. Recently dendritic cells(DC) gained considerable attention as antigen presenting cells that are also capable of immunologic tolerance induction. This study assesses the effects of alloantigen-pulsed dendritic cells in induction of survival increase in a rat skin allograft model. Methods: Recipient-derived dendritic cells were harvested from rat whole blood and cultured with GM-CSF(200 ng/mL) and IL-4(8 ng/mL) for 2 weeks. Then donor-specific alloantigen pulsed dendritic cells were reinjected into tail vein before skin graft. The rat dorsal skin allografts were transplanted in 5 subgroups. Groups: I) untreated, II) anti-lymphocyte serum(ALS, 0.5 mL), III) FK-506(2 mg/kg), IV) DCp, VI) DCp and FK-506. Graft appearance challenges were assessed postoperatively. Results: The group V(DC and FK-506 treated) showed longest graft survival rate(23.5 days) than other groups; untreated(5.8 days), ALS(7.2 days), FK-506 (17.5 days), DCp(12.2 days). Conclusion: Donor antigen pulsed host dendritic cell combined with short-term immunosuppression prolong skin allograft survival and has potential therapeutic application for induction of donor antigen specific tolerance.

• Radiation Oncology Journal
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• v.4 no.1
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• pp.15-20
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• 1986

From 1979 to 1984, 39 local allograft irradiations were given to 29 patients: 10 irradiations were administered for prevention and 29 for reversal of acute rejection of transplanted kidney. Three doses of 150 cGy every other day were combined with high-dose of methylprednisolone pulse (1 gm/day) for 3 days. For prevention of acute rejection, local irradiation was delivered on the days 1, 3, and 5 after the transplantation, and for reversal, irradiation started after the diagnosis of acute rejection. Eight out of 10 patients irradiated for prevention had acute allograft rejection, and, what is more, there was no surviving graft at 15 months after transplantation. Reversal of acute rejection was achieved in $71\%$. When the pre-irradiation level of serum creatinine was below $5.5mg\%$, the reversal rate was $93\%$, but above $5.5mg\%$ the reversal rate was only $17\%$ (p<0.01). Reirradiation after failure was not successful. Among 15 reversed patients, $7(47\%)$ had subsequent rejection (s). The functional graft survivals at 6 month, 1, 2, and 3 year were $70\%,\;65\%,\; 54\%,\;and\;54\%$, respectively. Therapeutic irradiation resulted in better graft survival when serum creatinine was below $5.5mg\%$ (p<0.001) or when irradiation started within 15 days after the diagnosis of acute rejection (p<0.001).

• Journal of Chest Surgery
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• v.38 no.9 s.254
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• pp.595-600
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• 2005

Background: Colchicine with its immunosupressive properties has been used with benefcial effects in autoimmune disease, such as Gout, etc. Whether colchicine, by virtue of the above property, could attenuate the process of cardiac allograft rejection in the rats is investigated in this report. Material and Method: We compared the untreated group (Control, n=6), Cyclosporin A group (10 mg/kg, daily, n=20), and Colchicine derivative group (Colchicine 40 ${\mu}g$/kg, n=20) of cardiac allografts in the rats. Result: In the untreated control group (n=6), all of 6 rats showed rejection within 3 weeks after cardiac allograft. In the cyclosporin A group (n=20), cyclosporin A (10 mg daily oral dose) was administered at a 10 mg daily oral dose and promoted long-term survival (over 100 days). The cyclosporin A group had one mortality at the 18th post-operative day due to infection. Furthermore, in the Colchicine derivatives group (n=20) with a daily IP (Intra Peritoneum) dose (40 ug/kg/day), we observed long-term survival.(> 100 days), except for one rat that died of an anesthetic problem (respiratory failure) at the 9th post-operative day. Conclusion: Experiments have also been performed to evaluate whether the effect of colchicine derivatives allowed prolonged survival of cardiac allografts compared with the cyclosporin A administration group in the rats.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.984-988
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• 1999

Background: Donor-specific blood transfusion(DSBT) before organ transplantation has been demonstrated to prolong allograft survival; the mechanism of this effect has remained unclear. Only a few researches have been performed on this subject in our country. Material and Method: To investigate the effect of DSBT, we selected 5 donor recipient combinations using rats of pure strain such as PVG, ACI, and LEW. One ml of donor whole blood was transfused to each recipient through the femoral vein 7 days prior to transplantation. The donor heart was transplanted to the recipient's abdominal vessels heterotopically using modified Ono and Lindsey's microsurgical technique. Five transplantations were done for each combination. Postoperatively, donor heart beat was palpated everyday through the recipent's abdominal wall. Rejection was defined as complete cessation of donor heart beat. Result: The allogeneic heart grafts transplanted from PVG strain to ACI strain(PVG ACI) without DSBT were acutely rejected(mean survival 10.2 days). With pretransplant DSBT, the cardiac allografts in PVG ACI and LEW PVG combinations survived indefinitely(more than 100 days), those in ACI PVG combination survived 12 to 66 days(mean 31.8 days), those in PVG LEW survived 8 to 11 days(mean 10.0 days), and those in ACI LEW survived 7 to 9 days(mean 8.0 days). In brief, DSBT prior to heart transplantation was definitely effective in PVG ACI and LEW PVG combinations and moderately effective in ACI PVG combination, but not effective in PVG LEW and ACI LEW combinations. Conclusion: DSBT prior to heart transplantation showed variable effects, but might prolong cardiac allograft survival indefinitely in some donor recipient strain combinations. The mechanism of this effect should be further investigated.

• Archives of Reconstructive Microsurgery
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• v.4 no.1
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• pp.9-15
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• 1995

Free vascularized composite tissue transfer is more frequently underwent for reconstruction of complicated tissue defects with the recent advance of microsurgery. But postoperative result was not satifactory because of donor site morbidity, flap bulkiness and cosmetic problem. So would no longer be a problem if we can obtain the exact donor tissue required for the recipient site as allotransplantation and designing the flap. Allotransplantation has been resolved with the recent development of immunosuppressive agents, while reconstruction has made great progress with the refinement of microsurgical techniques in the last 20 years. The final sucess or failure of the operative procedure in transplantation is so utterly dependent no the availability of strategies that can control the immune system effectively, selectively, safely to allow allotransplantation of a nonvital body part. 1 used 2 strains of rats, BUF and LEW, for the limb allotransplantation as a composite tissue transfer. The primary goal of this program is to improve results in clinical transplantation by accelerating the transformation of new immunological knowledge into useful medicine. Two of the most promising new immunosuppressive compounds are FK-t06(FK) and rapamycin(RPM). Both drugs are antibiotic macrolide fungal fermentation products that presumably suppress the immune system in ways similar to cyclosporin(CyA). This study shows that two new immunosuppressive drugs compare the immunosuppressive activity and effectiveness of FK-506 and RPM for prevention of the limb allograft rejection in the rat. Additional experiments investigate the dose, route of administration and histologic findings. These data demonstrates that rapamycin is far more potent and effective than FK-506 when both compounds are administered by the intraperitoneal route, as well as prolonged graft survival significantly in a dose-route dependent manner. These results lead to the view that vascularized allograft composite tissue transfer can become a reality with the expectation of possible future application in reconstructive surgery of humans.