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

• Journal of Chest Surgery
• /
• v.33 no.4
• /
• pp.338-341
• /
• 2000

Renal transplant recipients who received immunosuporessive agent are in high risk of development Kaposi's sarcoma. In Korea a few report of Kaposi's sarcoma has been pubilshed but any report of intrathoracic Kaposi's sarcoma provedn by open lung biopsy has not been pulbilshed until now. We report a case of intrathoracic Kaposi's sarcoma developed in a 25 year old Korean man, who had been operated renal transplantation due to end stage renal disease and received cyclosporine and prednisolone as immunosuppessive agent, without any other organ involvment and was proven by open lung biopsy. Although discontinuation of immunosuppressive agent, temporary symptomatic and radilolgic improvement were observed, he died 11 days later after open lung biopsy because of intractable resiratory failure.

• Journal of Periodontal and Implant Science
• /
• v.30 no.3
• /
• pp.609-619
• /
• 2000

Cyclosporin A(CsA) is now widely used to treat organ transplant recipients. But CsA has various short-and long-term side effects. Especially, gingival hyperplasia is not easy to resolve since its nature is still unknown. This study discusses the pathogenesis of CsA-induced gingival hyperplasia on the basis of data obtained from light and electron microscopic studies of biopsis from patients on CsA treatment after kidney transplantation. Light microscopically, the multilayered squamous epithelium showed an irregular surface of parakeratosis and deep invaginations in the subepithelial tissue. At lamina propria, we observed bundles of irregularly arranged collagen fiber, some fibroblasts, numerous capillary vessels and a large diffuse infiltration of plasma cells. Ultrastructurally, many fibroblasts, collagen fibers, collagen fibrils were present in lamina propria. On the basis of the data collected, we propose that the morphological features of the dimensional increase in gingival tissue associated with CsA treatment in kidney transplant patients may be considered proliferative fibroblasts, collagen fibers, collagen fibrils in lamina propria.

• Clinical and Experimental Pediatrics
• /
• v.59 no.6
• /
• pp.252-255
• /
• 2016

Purpose: Pneumocystis jirovecii pneumonia occurs in various immunocompromised patients. Despite the prophylaxis strategies in clinical practice, certain patients develop P. jirovecii pneumonia. This study was performed to investigate pediatric cases with P. jirovecii pneumonia in a single center. Methods: We identified pediatric patients younger than 19 years with microbiologically confirmed P. jirovecii pneumonia from January 2000 to February 2014. A retrospective chart review was performed. Results: Fifteen episodes of P. jirovecii pneumonia in 14 patients were identified with median age of 8.3 years (range, 0.4-18.6 years). Among these patients, 11 patients had hematology-oncology diseases, 2 had primary immunodeficiency disorders (one with severe combined immunodeficiency and the other with Wiskott Aldrich syndrome), 1 had systemic lupus erythematosus and 1 received kidney transplant. Four patients were transplant recipients; 1 allogeneic and 2 autologous hematopoietic cell transplant and 1 with kidney transplant. The median absolute lymphocyte count at the diagnosis of P. jirovecii pneumonia was $5,156cells/mm^3$ (range, $20-5,111cells/mm^3$). In 13 episodes (13 of 15, 86.7%), patients were not receiving prophylaxis at the onset of P. jirovecii pneumonia. For treatment, trimethoprim/sulfamethoxazole was given as a main therapeutic agent in all 15 episodes. Steroid was given in 9 episodes (60%). Median treatment duration was 15 days (range, 4-33 days). Overall mortality at 60 days was 35.7% (5 of 14). Conclusion: Majority of our patients developed P. jirovecii pneumonia while not on prophylaxis. Continuous efforts and more data are needed to identify high risk patients who may get benefit from P. jirovecii pneumonia prophylaxis.

• Childhood Kidney Diseases
• /
• v.12 no.2
• /
• pp.133-142
• /
• 2008

For solid organ transplant, ABO blood type of donor and recipient should be compatible in principle. Recent improvement of immunosuppressant made HLA typing not so important while no-mismatch transplant still shows the longest graft survival. PRA(panel reactive antibody) test is to screen and identify recipients with HLA sensitization. When solid organ transplant is scheduled, cross-match test of donor cell and recipient serum should be performed and positive result of cross-match prohibits transplantation. Donor specific antibody(DSA) test can predict the severity of recipient immune reaction against donor organ. Today's mainstay of allograft immunosuppressant regimen is triple therapy of steroid, calcineurin inhibitor(cyclosporine, tacrolimus), azathioprine or mycophenolate mofetil(MMF). Antibody induction using Thymoglobulin or anti-IL-2 receptor antibody(basiliximab or daclizumab) is frequently practiced as well.

• Archives of Plastic Surgery
• /
• v.48 no.6
• /
• pp.703-713
• /
• 2021

The field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread application of VCAs is the side effect profile associated with the current immunosuppressive regimen, which can cause a wide array of complications such as infection, malignancy, and even death. Significant concerns remain regarding whether the treatment outweighs the risk. The potential solution to this dilemma would be achieving VCA tolerance, which would allow recipients to receive allografts without significant immunosuppression and its sequelae. Promising tolerance protocols are being studied in kidney transplantation; four major trials have attempted to withdraw immunosuppressive treatment with various successes. The common theme in all four trials is the use of radiation treatment and donor cell transplantation. The knowledge gained from these trials can provide valuable insight into the development of a VCA tolerance protocol. Despite similarities, VCAs present additional barriers compared to kidney allografts regarding tolerance induction. VCA donors are likely to be deceased, which limits the time for significant pre-conditioning. VCA donors are also more likely to be human leukocyte antigen-mismatched, which means that tolerance must be induced across major immunological barriers. This review also explores adjunct therapies studied in large animal models that could be the missing element in establishing a safe and stable tolerance induction method.

• Korean Journal of Adult Nursing
• /
• v.20 no.6
• /
• pp.895-904
• /
• 2008

Purpose: This study analyzes the trends of nursing researches about organ donation and transplantation, and recommends the direction of future nursing studies in Korea. Methods: Ninety-nine researches based upon organ donation and transplantation in Korea were analyzed by descriptive statistics. Results: Among them 58 papers were master's theses and 9 were doctoral dissertations. Articles about organ beneficiaries were seventy. The 47 articles among them were for kidney transplantation. By the types of research design, there were 73 quantitative studies, 19 qualitative studies, and 9 methodological studies. In correlation studies, the quality of life of subjects were evaluated the association with stress, social support, self-efficacy, and compliance. In experimental studies, the independent variables were self efficacy promotion exercise, steroid medication, educational programs regarding an organ transplantation and a brain death, DanJeon breathing exercise, and telephone counseling. The methods of qualitative studies were based on the grounded theory, phenomenology, interpretive phenomenology, and ethnography. The dominant concepts of qualitative researches were experiences of a decision-making of donors and of recipients for organ transplantation. Conclusion: Descriptive surveys or correlation studies were predominant on the nursing research about organ transplantation. Qualitative studies were conducted to some extent. It is recommended to conduct clinically applicable interventional researches with the experimental design.

• Childhood Kidney Diseases
• /
• v.4 no.1
• /
• pp.77-83
• /
• 2000

Purpose: Pregnancy in transplanted mother is considered as a high-risk pregnancy, and significant incidences of prematurity and low-birthweight(LBW) infants have been reported. The objective of this study is to examine the outcome of pregnancy in transplanted mothers and to evaluate the current growth status in their children. Patients and Methods: We retrospectively reviewed 54 pregnancies in 40 kidney recipients until June 1999. Outcomes of pregnancy were reviewed and assessment of the current growth status in children was performed. Results: 54 pregnancies in 40 recipients were identified; 22 ended in termination of pregnancy because of unwanted pregnancy or therapeutic purposes. And of the other 32, 29 livebirths resulted in 28 recipients. The mean age of conception was $30.3{\pm}3.8$ years, with a mean interval from transplantation to conception of $35.9{\pm}23.2$ months. All patients were maintained on immunosuppressive regimens. Incidence of drug-treated hypertension(HTN) prior to pregancy was $52\%$, HTN during pregnancy, $48\%$; preeclampsia, $41\%$; urinary tract infection, $48\%$; oligohydramnios $4\%$; and no rejection during pregnancy and up to 3month post delivery. Of the 29 liveborn infants, prematurity(<37wk) occurred in $52\%$, LBW(<2500g) in $62\%$, VLBW(<1500g) in $7\%$ and $48\%$ born intrauterine growth retardation(IUGR). Mean gestational age was $36.3{\pm}3.0\;wk$; a mean birthweight, $2.23{\pm}0.6\;kg$; a mean birth-height, $45.1{\pm}3.6cm$. Current mean height standard deviation score (height SDS) was $0.29{\pm}0.91$ and mean weight SDS was $0.62{\pm}1.34$. Only one child($4\%$) under 1 year of age was below 10 percentile in height. Most of children had no medical problems except for 4 children; cleft palate(1), tuberous sclerosis(1), essential hematuria(1), and one child expired due to sepsis. Conclusion: This study showed similar incidence of premaure birth($57\%$) and low birth weight infants($62\%$), but lower incidence of spontaneous abortion($5.6\%$) was observed and compared to other studies. Postnatal growth in majority of children($96\%$) achieved catch-up growth before 1 year. Present study supports a more optimistic view of pregnancy in renal transplant mother and normal growth in their children.

• Childhood Kidney Diseases
• /
• v.18 no.1
• /
• pp.18-23
• /
• 2014

Purpose: The pharmacokinetics of tacrolimus, one of the most widely used immunosuppressive drugs, are known to vary by sex, age, and ethnicity during pediatric transplantation. This study assessed the pharmacokinetic characteristics and associated factors of tacrolimus in Korean children receiving a kidney transplant. Methods: We retrospectively reviewed the pharmacokinetic data (therapeutic dose, trough level, clearance, and half-life) of 9 children who were given tacrolimus as one of their initial immunosuppressive drugs after kidney transplantation. In addition, we compared the findings to data from 10 adult kidney transplant recipients. Results: The mean age of our pediatric patients was 13.9 years, and the maleto- female ratio was 4:5. The mean dose of tacrolimus was $0.19{\pm}0.14$ mg/kg/day. The mean dose of tacrolimus for males was $0.23{\pm}0.12$ mg/kg/day, which was significantly higher than the dose for females ($0.16{\pm}0.14$ mg/kg/day). The trough level was not significantly different between both groups. The clearance rate of tacrolimus for males was also significantly higher than females. Although the dosage of tacrolimus for patients over the age of 12 years was lower ($0.18{\pm}0.13$ vs. $0.21{\pm}0.16$ mg/kg/day) and the trough level was higher ($8.2{\pm}4.5$ vs. $7.2{\pm}4.2$ mg/mL) than that for patients under the age of 12 years, there was no significant difference between them. However, there were significant differences between children and adults in dose, clearance, and half-life of tacrolimus. Conclusion: Out study suggests that the pharmacokinetics of tacrolimus tends to vary with sex and age. Therefore, large-scale prospective studies are required to verify the proper therapeutic dosage of tacrolimus in Korean children.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.6 no.1
• /
• pp.78-95
• /
• 1999

The grafting of a kidney has been found to be the best medical treatment for patients who have renal insufficiency failure, but the patients still have experienced much trouble and apprehension. This study was done to further nursing theory developing for patients who have has a kidney graft from another person. The research method followed grounded theory methodology of Strauss and Corbin. The subjects were three female and four male patients. This study done befween Oct. 1997 and Mar. 1998. All of the subjects were interviewed by the author. Interview were done by the long interview technique and observation. In the process of data analysis, 'heart-boiling' was found to be the core phenomenon. The results were composed to 101 concepts. These concepts were grouped into nineteen categories, and then to twelve categories. There were 12 super-class categories as follows ; 'pain', 'heart-boiling', 'experience of dialysis', 'term of admission to a hospital', 'support of other person', 'dependence on God', 'direction', 'negative reaction', 'positive reaction', 'comfortable', 'lacking', 'acceptance'. In this process, 14 hypotheses were derived from the categories as follows ; (1) The more experience with dialysis that the patients have, the stronger the heart-boiling will tend to be. (2) The less experience with dialysis the patients have, the weaker the heart-boiling will tend to be. (3) The longer admission to hospital the patients have, the stronger the heart-boiling will be. (4) The shorter the admission to hospital the patients have, the weaker the heart-boiling will be. (5) The weaker the intense-grief is, the more positive the reaction to heart-boiling the patients wll have. (6) The stronger the intense-grief is, the more negative the reaction to heart-boiling the patients will have. (7) The stronger the support of other persons that the patients have, the more positive the reaction to heart-boiling the patients will have. (8) The weaker the support of other person that the patients have, the more negative the reaction to heart-boiling the patients will have. (9) The stronger the dependence on God that the patients have, the mure positive reaction to heart-boiling the patients will have. (10) The weaker the dependence on God that the patients have, the more negative reaction to heart-boiling the patients will have. (11) The more positive thoughts that the patients have, the more positive reaction to heart-boiling the patinets will have. (12) The more negative thoughts that the patients have, the more negative reaction to heart-boiling the patients will have. (13) The more positive reaction the patients have, the more free from heart-boiling the patients tend to be. (14) The more negative reaction the patients have, the less free from heart-boiling the patients tend to be. From the analysis of observed data and comparing each class, I concluded that there are four formula relation types between reaction of patients and heart-boiling. (1) If patients have the experience of dialysis, have a long term admission to hospital, are strong in heart-boiling, depend on God, have positive thoughts and another's strong support, they experience release by positive reaction to the intense-grief. (2) If patients have the experience of dialysis, have a short term admission to hospital, are weak in heart-boiling, do not depend on God, have negative thoughts, and have few supports from others, they experience attachment to heart-boiling though a negative reaction. (3) If patients have the experience of dialysis, have a long term admission to hospital, are strong in heart-boiling, do not depend on God, and have negative thoughts, they experience attachment to heart-boiling through negative reaction in spite of support from another. (4) If patients have the experience of dialysis, have a long term admission into hospital, are strong in heart-boiling and satisfaction is low, but they have positive thoughts, then they experience acceptance and harmony through the positive reaction to heart-boiling. The results of this study are expected to help the way nurses care for patients who have had a kidney graft from another.