• Journal of Chest Surgery
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• v.36 no.2
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• pp.101-104
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• 2003

Although lung transplantation has been accepted as the most effective treatment for end-stage pulmonary emphysema, it is not only very hard to find a donor but also to obtain a relatively healthy lung. Furthermore, it is more difficult to match the size of the allograft, considering the height, the weight, and the size of the thoracic cage. The single lung transplatations for the end-stage emphysema have been more commonly performed than bilateral lung transplantation due to the shortage of the donors and the long-term survival rate of the single lung transplantations has shown no reasonable difference compared with that of the bilateral lung transplantationh. Recently, the functional criteria based on a comparison of predicted TLCs(Total Lung Capacities) of the donor and recipient according to height, sex and age, have been accepted at a more suitable.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.6
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• pp.311-323
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• 2023

Immunosuppressants are vital in organ transplantation including facial transplantation (FT) but are associated with persistent side effects. This review article was prepared to compare the two most used immunosuppressants, cyclosporine and tacrolimus, in terms of mechanism of action, efficacy, and safety and to assess recent trials to mitigate their side effects. PubMed and Google Scholar queries were conducted using combinations of the following search terms: "transplantation immunosuppressant," "cyclosporine," "tacrolimus," "calcineurin inhibitor (CNI)," "efficacy," "safety," "induction therapy," "maintenance therapy," and "conversion therapy." Both immunosuppressants inhibit calcineurin and effectively down-regulate cytokines. Tacrolimus may be more advantageous since it lowers the likelihood of acute rejection, has the ability to reverse allograft rejection following cyclosporine treatment, and has the potential to reinnervate nerves. Meanwhile, graft survival rates seem to be comparable for the CNIs. To avoid nephrotoxicity, various immunosuppressants other than CNIs have been studied. Despite averting nephrotoxicity, these medications show increases in acute rejection or other types of adverse effects compared to CNIs. FT has been a topic of interest for oral and maxillofacial surgeons, and the postoperative usage of immunosuppressants is crucial for the long-term prognosis of FT. As contemporary transplantation regimens incorporate novel medications along with CNIs, further research is required.

• Annals of Surgical Treatment and Research
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• v.95 no.5
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• pp.278-285
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• 2018

Purpose: We investigated the clinical outcomes of deceased donor kidney transplantation (KT) using kidneys with terminal acute kidney injury (AKI). Methods: Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 brain dead donors. According to the expanded criteria donor (ECD) and AKI network criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & standard criteria donor (SCD) (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); and group IV: AKI & ECD (n = 38). Results: The incidence of delayed graft function (DFG) was significantly higher in patients with AKI than it was in the non-AKI group (P = 0.008). There were no significant differences among the 4 groups in graft survival (P = 0.074) or patient survival (P = 0.090). However, the long-term allograft survival rate was significantly lower in group IV than it was in other groups (P = 0.024). Conclusion: Allografts from deceased donors with terminal AKI had a higher incidence of DGF than did those from donors without AKI. However, there is no significant difference in graft and patient survival rates among the groups. So, the utilization of renal grafts from ECDs with terminal AKI is a feasible approach to address the critical organ shortage.

• Korean Circulation Journal
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• v.54 no.6
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• pp.325-335
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• 2024

Background and Objectives: The number of sensitized heart failure patients on waiting lists for heart transplantation (HTx) is increasing. Using the Korean Organ Transplantation Registry (KOTRY), a nationwide multicenter database, we investigated the prevalence and clinical impact of calculated panel-reactive antibody (cPRA) in patients undergoing HTx. Methods: We retrospectively reviewed 813 patients who underwent HTx between 2014 and 2021. Patients were grouped according to peak PRA level as group A: patients with cPRA ≤10% (n= 492); group B: patients with cPRA >10%, <50% (n=160); group C patients with cPRA ≥50% (n=161). Post-HTx outcomes were freedom from antibody-mediated rejection (AMR), acute cellular rejection, coronary allograft vasculopathy, and all-cause mortality. Results: The median follow-up duration was 44 (19-72) months. Female sex, re-transplantation, and pre-HTx renal replacement therapy were independently associated with an increased risk of sensitization (cPRA ≥50%). Group C patients were more likely to have longer hospital stays and to use anti-thymocyte globulin as an induction agent compared to groups A and B. Significantly more patients in group C had positive flow cytometric crossmatch and had a higher incidence of preformed donor-specific antibody (DSA) compared to groups A and B. During follow-up, group C had a significantly higher rate of AMR, but the overall survival rate was comparable to that of groups A and B. In a subgroup analysis of group C, post-transplant survival was comparable despite higher preformed DSA in a desensitized group compared to the non-desensitized group. Conclusions: Patients with cPRA ≥50% had significantly higher incidence of preformed DSA and lower freedom from AMR, but post-HTx survival rates were similar to those with cPRA <50%. Our findings suggest that sensitized patients can attain comparable post-transplant survival to non-sensitized patients when treated with optimal desensitization treatment and therapeutic intervention.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.713-722
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• 1996

Poor long term patient survival (60% at 2 years) in lung allograft recipients are mainly due to rejection and complications associated with the use of nonspecific immunosuppressants. Better means to achieve waft acceptance is desperately needed. 1 have investigated whether mixed allogeneic chimerism in the form of bone marrow stem cell engraftment would induce donor-specific tolerance for lung allografts. Fisher (F344) and Wistar Forth (WF)rats were lethally irradiated (1100c0y) and reconstituted with a mixture of T-cell depleted syngeneic and allogeneic bone marrow (F344+WFIWF, ACI +F344- F344). After Mixed chimerism was documented by peripheral blood Ipnphocyte typing at 28 days, orthotopic left single lung transplantation was performed, using donor-s ecific or third party allografts. No immunosuppressants were administered. Graft rejection was monitored by chest rentgenography, and con- firmed by histology Mixed chimeric rats accepted lung allografts permanently, and it was not strain specific effect. Tolerance was all or none phenomenon which had nothing to do with the percentage of chimerlsm. Mixed chimeras rejected third party allografts in less than 10 days, a time course similar to that of unmanipulated controls. No acute or chronic rejection was observed in donor specific grafts more than 150 days posttransplant. These data suggest that mixed chimerism in the form of bone marrow stem cell engraftment results in stable, systemic donor-specific transplantation tolerance for lung allografts.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.385-392
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• 2008

Purpose: The most effective methods of harvesting, preparing, and injecting autologous fat grafts have been inconsistent and conflicting. With its limitation as resorption in fat grafting, handling various techniques affect adipocyte survival, and is crucial to optimizing its long-term survival. To improve graft survival, re-implantation of cryopreserved adipocytes was developed. In addition, adipocytes do not induce immune rejection in response to non-self lymphocytes in a mixed lymphocyte reaction. The purpose of this study is to analyze the changes in cryopreserved adipocytes so as to determine the most efficient long-term storage period, and to analyze the changes in cryopreserved allografted adipocytes so as to determine the efficacy of cryopreserved adipocytes allografting. Methods: Fat tissues were harvested from the inguinal and retroperitoneal fat pad of mice. After the centrifugation of the harvested fat tissues, they were disintegrated with collagenase. The adipocytes were obtained by centrifugation of the disintegrated fat tissues. The adipocytes were treated as follows: (1) They were examined for weight and then frozen at $-20^{\circ}C$(n=25). For four months, each five frozen samples were taken and examined for weight and histologic changes in the 1st week, the 1st month, the 2nd month, the 3rd month, and the 4th month, respectively. (2) The adipocytes were immediately frozen at $-20^{\circ}C$(n=125). For four months, five frozen samples were taken, and allografted in the same time period as above. Finally, for four months, five cryopreserved allografted adipocytes were taken and examined for histologic changes in the same time period as above. Results: (1) Significant weight changes and histologic findings with inflammatory and destructive changes were observed in the cryopreserved adipocytes in three months. (2) Significant fat necrotic changes in the histologic changes with Hematoxylin and eosin stain were observed in the cryopreserved allografted adipocytes since the first week, independent of the freezing period. Conclusion: The study results show that the adipocytes that were cryopreserved for more than three months underwent obvious weight reductions and necrotic changes, and the adipocytes that were allografted without freezing were viable for four months, but the cryopreserved allografted adipocytes had obvious necrotic changes since the first week regardless of the freezing period.

• Journal of Periodontal and Implant Science
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• v.37 no.2
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• pp.277-286
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• 2007

The edentulous posterior maxilla generally provides a limited amount of bone height because of atrophy of the ridge and pneumatization of the maxillary sinus, Maxillary sinus augmentation is one of the surgical techniques for reconstruction of the severely resorbed posterior maxilla. The purpose of this study was to evaluate the survival rate of implants and the long-term changes of graft height after maxillary sinus augmentation by lateral window approach. From September 1996 to July 2004, maxillary sinus augmentation with mixed grafts of autograft, allograft, xenograft and alloplast were performed on 45 patients and 100 implants were placed. We evaluated the survival rate of implants and the changes of BL(bone length)/IL(implant length) according to time using panoramic radiographs. The survival rate of implants was 91.0% for follow-up period. The mean reduction of graft heights was 0.34mm(3.0%) for 6 months and 1.22mm(1O.66%) for 3 years after augmentation. The total mean BL/IL was $1.34{\pm}0.21$ during 5 year observation period after augmentation and decreased slightly over time. The result means that graft materials were stable above the implant apex. BL/ILs of 1stage procedure were significantly decreased at 1-2 year, 3-4 year after augmentation and no statistically significant changes were observed in those of 2 stage procedure. The graft materials of both procedures were stable above the implant apex. No statistically significant changes of BL/IL were observed in the grafts combined with low amount of autogenous bone or without autogenous bone. The graft materials of both groups were stable above the implant apex. The results indicated that the placement of dental implants with maxillary sinus augmentation showed predictable clinical results and the grafts combined with low amount of autogenous bone or without autogenous bone had long-term resistance to resorption in maxillary sinus.

• 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 Yeungnam Medical Science
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• v.33 no.2
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• pp.150-154
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• 2016

Hepatitis C virus (HCV) infection is present in a high proportion of patients with kidney transplantation. Compared with uninfected kidney transplant recipients, HCV infected kidney recipient have higher prevalence of liver disease and worse allograft survival after transplantation. Interferon monotherapy before transplantation is standard therapy for HCV-infected kidney transplant candidates. If HCV infection is discovered after transplantation, interferon monotherapy is considered due to the limited critical situation. However, in this patient, who was a kidney recipient, HCV infection was treated after kidney transplantation with peginterferon-${\alpha}$ and rivabirin. As a result, the patient achieved sustained virologic response.

• Journal of Chest Surgery
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• v.49 no.4
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• pp.258-263
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• 2016

Background: The advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position. Methods: This is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (<60 years) and organ donors who were not suitable for heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months). Results: Aortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were $80.0%{\pm}7.3%$ and $60.8%{\pm}10.1%$, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were $92.3%{\pm}5.2%$, $68.9%{\pm}10.2%$, and $50.3%{\pm}13.6%$, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were $91.7%{\pm}8.0%$, $41.7%{\pm}14.2%$, and $25.0%{\pm}12.5%$, respectively. Conclusion: Homografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis.