• Title/Summary/Keyword: Liver Transplantation

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Comparison of Anxiety, Depression, and Quality of Life between Organ Transplant Candidates and Recipients (장기이식 대기자와 수혜자의 불안, 우울 및 삶의 질 비교)

  • Cha, Ji-Eun;Yi, Myung-Sun
    • Korean Journal of Adult Nursing
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    • v.24 no.3
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    • pp.284-293
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    • 2012
  • Purpose: The aim of this study was to compare the levels of anxiety, depression, and quality of life (QOL) among kidney or liver transplant candidates and recipients. Methods: A cross-sectional descriptive design was utilized. The 160 subjects were recruited and assigned to three different conditions: awaiting transplant group; post-transplantation (TPL) group within less than one year of surgery; and post-TPL group with one year and no more than two years post surgery. The levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale. The level of quality of life was measured by the Medical Outcomes Study Short Form-36 version 2. Results: The anxiety score was significantly higher in the waiting group compared with the 1~2 years post TPL group. The depression score was significantly higher in the waiting group compared with the post TPL groups. The QOL was significantly lower in the waiting group compared with the post TPL groups. Conclusion: Our results show a high prevalence of anxiety and depression and a marked reduction in the QOL in transplant candidates compared to the recipients. This study indicates that the group waiting for transplants may have unmet needs during that time period. Health professionals should be encouraged to attend to the psychological distress of the transplant candidates in order to improve their quality of life.

Studies on the Experimental Heart and Heart-Lung Transplantation in the Mongrel Dogs for the Purpose of Clinical Application (임상적용을 위한 한국산 잡견에서의 실험적 심장및 심폐 이식술)

  • 이정렬
    • Journal of Chest Surgery
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    • v.25 no.5
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    • pp.458-468
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    • 1992
  • With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.

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T Lymphocyte Development and Activation in Humanized Mouse Model

  • Lee, Ji Yoon;Han, A-Reum;Lee, Dong Ryul
    • Development and Reproduction
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    • v.23 no.2
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    • pp.79-92
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    • 2019
  • Humanized mice, containing engrafted human cells and tissues, are emerging as an important in vivo platform for studying human diseases. Since the development of Nod scid gamma (NSG) mice bearing mutations in the IL-2 receptor gamma chain, many investigators have used NSG mice engrafted with human hematopoietic stem cells (HSCs) to generate functional human immune systems in vivo, results in high efficacy of human cell engraftment. The development of NSG mice has allowed significant advances to be made in studies on several human diseases, including cancer and graft-versus-host-disease (GVHD), and in regenerative medicine. Based on the human HSC transplantation, organ transplantation including thymus and liver in the renal capsule has been performed. Also, immune reconstruction of cells, of the lymphoid as well as myeloid lineages, has been partly accomplished. However, crosstalk between pluripotent stem cell derived therapeutic cells with human leukocyte antigen (HLA) mis/matched types and immune CD3 T cells have not been fully addressed. To overcome this hurdle, human major histocompatibility complex (MHC) molecules, not mouse MHC molecules, are required to generate functional T cells in a humanized mouse model. Here, we briefly summarize characteristics of the humanized mouse model, focusing on development of CD3 T cells with MHC molecules. We also highlight the necessity of the humanized mouse model for the treatment of various human diseases.

Folic acid inhibits necrosis and apoptosis in ischemic and reperfusion induced injury in rat liver

  • Chattopadhyay, Pronobesh;Shukla, Gunjan;Wahi, Arun Kumar
    • Advances in Traditional Medicine
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    • v.9 no.1
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    • pp.67-73
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    • 2009
  • Temporary clamping of the portal triad is a common strategy to minimize bleeding during liver transplantation. Increasing evidences suggests that oxygen derived free radicals and reintroduction of oxygen in ischemic tissue lead to ischemic and reperfusion injury (I/R) and lead to apoptosis and necrosis. Adult Wistar rat subjected to 60 min of partial liver ischemia followed by three hour reperfusion. Eighteen Wister rats were divided into sham-operated control group (I) (n = 6), ischemia and reperfusion group (II) (n = 6), folic acid treated group (1 mg/kg body weight/daily by oral route for 7 days before induced ischemia reperfusion maneuver) (III) (n = 6). Apoptotic and necrotic hepatocytes, mitochondrial antioxidant enzymes were measured. Liver injury was assessed by alanine transaminases (ALT), aspartate transaminases (AST), liver histopathology and electron microscopy. An ischemic and reperfusion hepatocellular injury was indicated by increased serum-ALT, AST, histopathology and electron microscopy studies. Apoptotic and necrotic cells were increased which was revealed by flow cytometry in I/R group. Pre- treatment with folic acid significantly decreased serum -ALT, AST levels, apoptotic and necrotic cells after 1 h ischemia followed by 3 h of reperfusion. Histopathology and TEM studies showed markedly diminished hepatocellular injury in folic acid pretreated rats during the hepatic I/R, which reached a level comparable to saline-treated rat of sham operated group. On the basis of our findings it may be concluded that folic acid afforded significant protection from necrosis and apoptosis in I/R injury.

A Case of Mesenchymal Hamartoma Associated with Biliary Atresia (담도 폐쇄증 환아에서 우연히 발견된 간엽 과오종 1례)

  • Choi, Kyung-Dan;Seo, Jeong-Kee;Shin, Eon-Woo;Ko, Jae-Sung;Kim, Woo-Sun;Park, Young-Su;Kang, Kyung-Hoon;Chi, Je-Geun
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.4 no.1
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    • pp.113-119
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    • 2001
  • Mesenchymal hamartoma is an uncommon benign tumor usually found in childhood, especially during the first two years of life. The tumor consists of a solid component and multiple cyst. Without treatment, these lesions can grow to an enormous size. We experienced a case of mesenchymal hamartoma which was found incidentally, in a 8 month old girl who had ascending cholangitis after Kasai operation due to biliary atresia. On abdominal ultrasonography and CT, there was a well-defined homogeneous small echogenic mass in the right lobe of the liver with cirrhosis. Five months later, she underwent liver transplantation. Gross picture of the resected liver showed a dark greenish pigmented solid mass in the right lobe of the cirrhotic liver. Microscopic findings showed reactive mesenchyma and epithelial overgrowth.

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Inhibition of Tumor Formation and Changes in Hepatic Enzyme Activities by Kimchi Extracts in Sarcoma-180 Cell Transplanted Mice

  • Hur, Young-Mi;Kim, So-Hee;Park, Jong-Won;Park, Kun-Young
    • Preventive Nutrition and Food Science
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    • v.5 no.1
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    • pp.48-53
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    • 2000
  • Inhibitory effects of the methanol extract, hexane extract, methanol soluble fraction (MSF) and juice from 3 weeks fermented Kimchi on the tumor formation in sarcoma-180 cell transplanted mice were studied. Effects of the solvent extracts and juice of the Kimchi on the levels of lipid peroxide, glutathione, and the enzyme activities of the liver were also investigated in normal and sarcoma-180 cell transplanted mice. At 32 days following trans-plantation, MSF reduced the tumor formation by 54% compared with the control group, resulting in the smallest tumor weight. Lipid peroxided content in liver increased by the transplantation of sarcoma-180 cells. However, it decreased when MSF of Kimchi was treated to the mice. MSF also suppressed xanthine oxidase activity in cytosol of the liver cells in mice transplanted by sarcoma-180 cells. Kimchi extracts had no inhibitory effect on hepatic aminopyrine-N-demethylase activity in sarcoma-180 cell transplanted or normal mice. Methanol extract and hexane extract of Kimchi slightly increased hepatic glutathione contents in sarcoma-180 treated mice. The injection of MSF from Kimchi markedly increased glutathione levels in the liver of sarcoma-180 treated mice. The injection of MSF from Kimchi markedly increased glutathione levels in the liver of sarcoma-180 treated mice compared to the controls. The MSF recovered the activities of hepatic glutathione reductase and glutathione S-transferase that decreased by the injection of sarcoma-180 cells. These results showed that MSF of Kimchi could suppress the growth of tumors, inhibiting lipid peroxide production and xanthine oxidase activity, in mice. We also suggested that Kimchi extract might play an important role in the prevention of cancer by enhancement of the glutathione level itself as well as via glutathione reductase and glutathione S-transferase.

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Clinical Practice Guidelines for Hepatocellular Carcinoma: Current and Future Perspectives (간암 진료가이드라인의 현재와 전망)

  • Bo Hyun Kim;Joong-Won Park
    • Journal of Digestive Cancer Research
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    • v.4 no.1
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    • pp.21-28
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    • 2016
  • Hepatocellular carcinoma (HCC) is rather unique. Most of HCC patients have underlying chronic liver diseases with or without cirrhosis and the prognosis of HCC depends on the liver function, as well as the tumor extent. Non-invasive diagnosis of HCC can be made with certain risk factors and specific imaging findings (e.g. hypervascularity). Patients with HCC can receive surgical resection, radiotherapy, and systemic chemotherapy as other solid malignancies. HCC has more treatment options such as liver transplantation, transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). A variety of practice guidelines for HCC has been published by many academic societies. Different healthcare systems and availability of resources also affect the practice guidelines; therefore, practice guidelines have similarities and dissimilarities. Herein, we review the current status of practice guidelines for HCC and future perspectives for the improvement of guidelines are also discussed.

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Clinical Pharmacology of Mycophenolic Acid as Immunosuppressant in Organ Transplaantation

  • Kang, Ju-Seop;Lee, Joo-Won;Jhee, Ok-Hwa;Om, Ae-Son;Lee, Min-Ho;Shaw, Leslie M.
    • Biomolecules & Therapeutics
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    • v.13 no.2
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    • pp.65-77
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    • 2005
  • Present article reviews about clinical pharmacology of mycophenolic acid (MPA), the active form of mycophenolate mofetil (MMF), as widely used component of immunosuppressive regimens in the organ transplantation field. MMF, used alone or concomitantly with cyclosporine or tacrolimus, has approved in reducing the incidence of acute rejection and has gained widespread use in solid organ such as kidney, heart and liver transplantation. The application of MPA and development of MMF has shown a considerable impact on immunosuppressive therapy for organ transplantation as a new immunosuppressive agent with different mechanism of action from other drugs after early 1990s. In particular aspect, use of MMF, a morpholinoethyl ester of MPA, represented a significant advance in the prevention of organ allograft rejection as well as allograft and patient survival. In considering MMF clinical data, it is important to note that there is a strong correlation between high MPA area under curve(AUC) values and a low probability of acute allograft rejection. Individual trials have shown that MMF is generally well tolerated and revealed that MMF decreased the relative risk of developing chronic allograft rejection compared with azathioprine. Recent clinical investigations suggested that improved effectiveness and tolerability will results from the incorporation of MPA therapeutic drug monitoring into routine clinical practice, providing effective MMF dose individualization in renal and heart transplant patients. Therefore, MMF has a selective immunosuppressive effect with minimal toxicity and has shown to be more effective that other agents as next step of immunosuppressive agents and regimens that deliver effective graft protection and immunosuppression along with a more favorable side effect.

Kinetics of IFN-${\gamma}$ and IL-17 Production by CD4 and CD8 T Cells during Acute Graft-versus-Host Disease

  • Ju, Ji-Min;Lee, Hakmo;Oh, Keunhee;Lee, Dong-Sup;Choi, Eun Young
    • IMMUNE NETWORK
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    • v.14 no.2
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    • pp.89-99
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    • 2014
  • Graft-versus-host disease (GVHD) is a fatal complication that occurs after allogeneic hematopoietic stem cell transplantation. To understand the dynamics of CD4 and CD8 T cell production of IFN-${\gamma}$ and IL-17 during GVHD progression, we established a GVHD model by transplanting T cell-depleted bone marrow (TCD-BM) and purified T cells from B6 mice into irradiated BALB.B, creating an MHC-matched but minor histocompatibility (H) antigen-mismatched transplantation (B6 ${\rightarrow}$ BALB.B GVHD). Transplantation-induced GVHD was confirmed by the presence of the appropriate compositional changes in the T cell compartments and innate immune cells in the blood and the systemic secretion of inflammatory cytokines. Using this B6 ${\rightarrow}$ BALB.B GVHD model, we showed that the production of IFN-${\gamma}$ and IL-17 by CD4 T cells preceded that by CD8 T cells in the spleen, mesenteric lymph node, liver, and lung in the BALB.B GVHD host, and Th1 differentiation predated Th17 differentiation in all organs during GVHD progression. Such changes in cytokine production were based on changes in cytokine gene expression by the T cells at different time points during GVHD development. These results demonstrate that both IFN-${\gamma}$ and IL-17 are produced by CD4 and CD8 T cells but with different kinetics during GVHD progression.

Overexpression of CXCL2 inhibits cell proliferation and promotes apoptosis in hepatocellular carcinoma

  • Ding, Jun;Xu, Kangdi;Zhang, Jie;Lin, Bingyi;Wang, Yubo;Yin, Shengyong;Xie, Haiyang;Zhou, Lin;Zheng, Shusen
    • BMB Reports
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    • v.51 no.12
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    • pp.630-635
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    • 2018
  • C-X-C motif chemokine ligand 2 (CXCL2) is a small secreted protein that exhibits a structure similar to the proangiogenic subgroup of the CXC chemokine family. Recently, accumulating evidence suggests that chemokines play a pivotal role in cancer progression and carcinogenesis. We examined the expression levels of 7 types of $ELR^+$ CXCLs messenger RNA (mRNA) in 264 clinical samples. We found that CXCL2 expression was stably down-regulated in 94% of hepatocellular carcinoma (HCC) specimens compared with paired adjacent normal liver tissues and some HCC cell lines. Moreover, CXCL2 overexpression profoundly attenuated HCC cell proliferation and growth and induced apoptosis in vitro. In animal studies, we found that overexpressing CXCL2 by lentivirus also apparently inhibited the size and weight of subcutaneous tumours in nude mice. Furthermore, we demonstrated that CXCL2 induced HCC cell apoptosis via both nuclear and mitochondrial apoptosis pathways. Our results indicate that CXCL2 negatively regulates the cell cycle in HCC cells via the ERK1/2 signalling pathway. These results provide new insights into HCC and may ultimately lead to the discovery of innovative therapeutic approaches of HCC.