• Childhood Kidney Diseases
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• 제12권1호
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• pp.23-29
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• 2008

Kidney allograft transplantation is the most effective method of renal replacement for end stage renal disease patients. Still, it is another kind of 'disease', requiring immunosuppression to keep the allograft from rejection(allograft immune reaction). Immune system of the allograft recipient recognizes the graft as a 'pathogen (foreign or danger)', and the allograft-recognizing commanderin-chief of adaptive immune system, T cell, recruits all the components of immune system for attacking the graft. Proper activation and proliferation of T cell require signals from recognizing proper epitope(processed antigen by antigen presenting cell) via T cell receptor, costimulatory stimuli, and cytokines(IL-2). Thus, most of the immunosuppressive agents suppress the process of T cell activation and proliferation.

• 한국임상수의학회지
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• 제22권4호
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• pp.439-443
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• 2005

Rejection is one of the life-threatening complications after organ transplantation. An eight-month-old, intact male, mixed breed dog was presented with acute rejection after renal allograft. The heterotopic renal transplantation with bilateral nephrectomy was performed in the dog. The triple drug protocol for immunosuppression was applied for prevention of the acute rejection. Postoperative care was done according to the transplantation protocol of VMTH, Kangwon National University. The dog was euthanized when the serum creatinine concentration exceeded 5 mg/dL followed by tile signs of illness. The transplanted kidney was enlarged. The renal cortex lesions were characterized by necrosis of the renal tubules and the glomeruli. Interstitial lesions were characterized by hemorrhage and severe infiltration of lymphoid cells. Intrarenal arteries showed necrosis of the walls and infiltration of perivascular lymphoid cells. In immunohistochemical (IHC) findings, infiltration of the CD4 and the CD8 positive T lymphocytes was examined. In this case, acute rejection was shown by humoral and cellular immunity on the basis of histopathologic and IHC evaluation.

• 응용통계연구
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• 제11권2호
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• pp.205-219
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• 1998

신장이식 수술을 받은 114명의 환자를 대상으로 이식 수술 후에 나타나는 신기능 부전에 영향을 미치는 인자들을 밝히기 위한 통계분석을 실시하였다. 신기능의 변화는 혈청 크레아터닌값을 통해 조사하였고 각 환자들로부터 이식 후 1년에서 5년 사이의 혈청 크레아티닌값을 평균 3개월 간격으로 반복적으로 측정하였다. 크레아티닌의 역수값에 영향을 미치는 인자를 조사하기 위해 반복측정 자료 분석에 사용되는 회귀 모형을 사용하였다. 본 논문에서는 이러한 반복측정자료의 분석 시에 발생하는 상관행렬의 선택에 관한 통계 적 인 문제 점 들을 고찰해 보았다.

• Kidney Research and Clinical Practice
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• 제37권4호
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• pp.414-417
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• 2018

Disseminated adenovirus infection can result in high mortality and morbidity in immunocompromised patients. Here, we report the case of a 10-year-old renal allograft recipient who presented with hematuria and dysuria. Adenovirus was isolated from his urine. His urinary symptoms decreased after intravenous hydration and reduction of immunosuppressants. However, 2 weeks later he presented with general weakness and laboratory tests indicated renal failure necessitating emergency hemodialysis. Adenovirus was detected in his sputum; therefore, intravenous ganciclovir and immunoglobulin therapy were initiated. Renal biopsy revealed diffuse necrotizing granulomatous tubulointerstitial nephritis compatible with renal involvement of the viral infection. Adenovirus was detected in his serum. Despite cidofovir administration for 2 weeks, adenovirus was also detected in the cerebrospinal fluid, resulting in generalized tonic-clonic seizure. The patient died 7 weeks after the onset of urinary symptoms. Adenovirus should be considered in screening tests for post-renal transplantation patients who present with hemorrhagic cystitis.

• Childhood Kidney Diseases
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• 제11권2호
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• pp.152-160
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• 2007

목 적 : 이식신 생검은 이식신 기능 이상의 원인, 거부반응의 정도, 예후 등을 확인하는데 도움이 된다. 그러나 이식신의 조직학적 변화가 신피질에 고르게 분포하지 않는 경우를 흔히 보게 된다. 따라서 본 연구는 이러한 이식신 생검에서의 잠재적인 표본추출의 오류를 평가하기 위하여 시행되었다. 방법 : 569개의 이식신 생검 표본 중에서 Banff criteria에 준하는 급성 거부반응을 보이고 있으며, 신피막부터 수질까지의 전 층을 포함하고 있는 신생검 표본 26개를 조사하였다. Banff criteria를 변형하여 조직의 변화를 간질성 염증(0-3+), 부종(0-3+), 요세관간질염(0-3+)으로 구분하여 급성거부반응의 등급을 표면 피질, 깊은 피질과 피질에 근접한 수질층 각각을 비교하여 조직학적 분석을 시행하였다. 결과 : 간질성 염증(P=0.019), 부종(P=0.023), 요세관 거부등급(P=0.019)에서 깊은 피질에서 표면 피질에 비해 급성 거부반응의 정도가 심하였다. 결론 : 이식신의 급성 거부반응을 진단하기 위하여 신생검을 실시 할 경우 깊은 피질이 포함되지 않으면 급성 거부반응을 과소 평가 할 수 있으므로 주의해야 할 것으로 사료된다.

• 대한두경부종양학회지
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• 제24권1호
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• pp.64-68
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• 2008

Purpose：The chronic use of immunosuppressive therapy in transplant recipients can increase the long-term risk of carcinoma. The aim of this study was to determine the incidence, biological behaviors, and treatment outcomes in PTC(papillary thyroid carcinoma) in renal allograft recipients. Material and Methods：The present study examined the incidence and biological behavior of PTCs in RA recipients. A total of 1,739 RA patients treated between January 1986 and December 1999 were followed-up for a median 137(84-238) months. During the follow-up period, 129(7.4%) recipients were identified as having posttransplant malignancies. Of those, 12(0.7%) had PTCs, and these comprised six male and six female patients with a median age of 41(23-57) years. Results：Nine cases(incidentalomas) were diagnosed based on ultrasonography(US) screening. Eight of those nine were TNM stage I, and two of the three clinical carcinomas were TNM stage IVa. During a median follow-up of 94(18-159) months, two(16.7%) PTC patients developed loco-regional recurrence, but no patients showed distant metastasis. Posttransplant PTC showed no gender bias, and was often associated with aggressive lymphatic metastasis. However, most incidentalomas showed a favorable treatment outcome. Conclusion：In conclusion, routine surveillance of the thyroid gland using US screening is recommended to ensure early detection, treatment and favorable prognosis in RA patients with PTC.

• Clinical and Experimental Pediatrics
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• 제64권2호
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• pp.49-59
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• 2021

Since the initial International Society of Heart Lung Transplantation registry was published in 1982, the number of pediatric heart transplantations has increased markedly, reaching a steady state of 500-550 transplantation annually and occupying up to 10% of total heart transplantations. Heart transplantation is considered an established therapeutic option for patients with end-stage heart disease. The long-term outcomes of pediatric heart transplantations were comparable to those of adults. Issues affecting long-term outcomes include acute cellular rejection, antibody-mediated rejection, cardiac allograft vasculopathy, infection, prolonged renal dysfunction, and malignancies such as posttransplant lymphoproliferative disorder. This article focuses on medical issues before pediatric heart transplantation, according to the Korean Network of Organ Sharing registry and as well as major problems such as graft rejection and cardiac allograft vasculopathy. To reduce graft failure rate and improve long-term outcomes, meticulous monitoring for rejection and medication compliance are also important, especially in adolescents.

• 대한핵의학회지
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• 제37권3호
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• pp.199-201
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• 2003

A 38-year-old woman with end stage renal disease received a living related donor-renal transplant to the right iliac fossa. She developed anuria a week later Tc-99m $MAG_3$ renal scintigraphy demonstrated no perfusion, uptake, or excretion of the radioactive tracer from the renal transplant. The expected area of the renal allograft appeared as a photopenic area with increased rim activity. The gallbladder and bowel activities were observed on delayed images at 24 hours. There was no blood flow within the renal artery on renal doppler examination. This case shows total absence of perfusion and function in the infarcted renal transplant with extrarenal excretion of Tc-99m $MAG_3$ caused by acute renal artery thrombosis.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2006년도 추계학술대회 및 정기총회
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• pp.49-49
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• 2006

• 한국임상약학회지
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• 제13권1호
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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.