• Title/Summary/Keyword: allograft transplantation

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Disseminated adenovirus infection in a 10-year-old renal allograft recipient

  • Lee, Bora;Park, Eujin;Ha, Jongwon;Ha, Il Soo;Cheong, Hae Il;Kang, Hee Gyung
    • Kidney Research and Clinical Practice
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    • v.37 no.4
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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.

Evolving Indication of Meniscal Allograft Transplantation (진화하고 있는 동종 반월연골판 이식술의 적응증)

  • Lee, Bum-Sik;Bin, Seong-Il;Kim, Taehyung
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.3
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    • pp.200-209
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    • 2020
  • The first human meniscal allograft transplantations (MATs) were performed 30 years ago. In the early era, candidates were limited to patients who have favorable joint conditions. MAT is currently indicated for patients with post-meniscectomy symptoms, such as compartmental pain or effusion after a subtotal or total meniscectomy. The current indication for MAT is being expanded to other patients who were not indicated previously. The present article reviews how the indications of MAT have changed over the years.

Rehabilitative goals for patients undergoing lung retransplantation

  • Massimiliano Polastri;Robert M. Reed
    • Journal of Yeungnam Medical Science
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    • v.41 no.2
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    • pp.134-138
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    • 2024
  • Lung retransplantation (LRT) involves a second or subsequent lung transplant (LT) in a patient whose first transplanted graft has failed. LRT is the only treatment option for irreversible lung allograft failure caused by acute graft failure, chronic lung allograft dysfunction, or postoperative complications of bronchial anastomosis. Prehabilitation (rehabilitation before LT), while patients are on the waiting list, is recognized as an essential component of the therapeutic regimen and should be offered throughout the waiting period from the moment of listing until transplantation. LRT is particularly fraught with challenges, and prehabilitation to reduce frailty is one of the few opportunities to address modifiable risk factors (such as functional and motor impairments) in a patient population in which there is clearly room to improve outcomes. Although rehabilitative outcomes and quality of life in patients receiving or awaiting LT have gained increased interest, there is a paucity of data on rehabilitation in patients undergoing LRT. Frailty is one of the few modifiable risk factors of retransplantation that is potentially preventable. As such, it is imperative that professionals involved in the field of retransplantation conduct research specifically exploring rehabilitative techniques and outcomes of value for patients receiving LRT, because this area remains unexplored.

Changes in Immunogenicity of Preserved Aortic Allograft (보존된 동종동맥편 조직의 면역성 변화에 관한 연구)

  • 전예지;박영훈;강영선;최희숙;임창영
    • Journal of Chest Surgery
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    • v.29 no.11
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    • pp.1173-1181
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    • 1996
  • The causes of degenerative changes in allograft cardiac valves are not well known to this day. Today's preserved allografts possess highly viable endothelial cells and degeneration of allografts can be facilitated by immune reaction which may be mediated by these viable cells. To test the antigenicity of endothelial cells, pieces from aortic wall were obtained from fresh and cryo-preserved rat allograft. Timings of sampling were prior to sterilization, after sterilization, after 1, 2, 7, 14 days of fresh preservation and cryopreservation. Endothelial cells were tested by immunohistochemical methods using monoclonal antibodies to MHC class I(MRC OX-18), class II(MRC OX-6) and ICAM-1 antigens. After transplantation of each group of aortic allograft at the subcutaneous layers of rats, population of CD4$^{+}$ T cell and CD8$^{+}$ T cell were analyzed with monoclonal antibodies after 1, 2, 3, 4, 6 and 8 weeks. MHC class I expression was 23.95% before preservation and increased to 35.53~48.08% after preservation(p=0.0183). MHC Class II expression was 9.72% before preservation and 10.13~13.39% after preservation(P=0.1599). ICAM-1 expression was 15.02% before preservation and increased to 19.85~35.33% after preservation(P=0.001). The proportion of CD4$^{+}$ T-cell was 42.13% before transplantation. And this was 49.23~36.8% after transplantation in No treat group (p=0.955), decreased to 29.56~32.80% in other group(p=0.0001~0.008). In all the groups, the proportion of CD8$^{+}$ T-cell increased from 25.57% before transplantation to 42.32~58.92% after transplantation(p=0.000l~0.0002). The CD4$^{+}$/CD8$^{+}$ ratio decreased from 1.22~2.28 at first week to 0.47~0.95 at eighth week(p=0.0001). The results revealed that the expression of MHC class I and ICAM-1 in aortic allograft endothelium were increased but that of MHC class II were not changed, despite the different method of preservation. During 8 weeks after transplantation of aortic allograft, the subpopulations of CD4$^{+}$ T cell were not changed or only slightly decreased but those of CD8$^{+}$ T cell were progressively increased.ely increased.

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The effect of the freeze dried bone allograft and gel/putty type demineralized bone matrix on osseous regeneration in the rat calvarial defects (백서 두개골 결손부에서 동결건조골과 gel/putty 형 탈회골기질의 골재생효과)

  • Kim, Deug-Han;Hong, Ji-Youn;Pang, Eun-Kyoung
    • Journal of Periodontal and Implant Science
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    • v.39 no.3
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    • pp.349-358
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    • 2009
  • Purpose: This study was aimed to evaluate the effect of the Freeze Dried Bone Allograft and Demineralized Bone Matrix on osseous regeneration in the rat calvarial defects. Methods: Eight mm critical-sized calvarial defects were created in the 80 male Sprague-Dawley rats. The animals were divided into 4 groups of 20 animals each. The defects were treated with Freeze Dried Bone Allograft($SureOss^{TM}$), Demineralized Bone Matrix($ExFuse^{TM}$ Gel, $ExFuse^{TM}$ Putty), or were left untreated for sham-surgery control and were evaluated by histologic and histomorphometric parameters following a 2 and 8 week healing intervals. Statistical analysis was done between each groups and time intervals with ANOVA and paired t-test. Results: Defect closure, New bone area, Augmented area in the $SureOss^{TM}$, $ExFuse^{TM}$ Gel, $ExFuse^{TM}$ Putty groups were significantly greater than in the sham-surgery control group at each healing interval(P < 0.05). In the New bone area and Defect closure, there were no significant difference between experimental groups. Augmented area in the $ExFuse^{TM}$ Gel, $ExFuse^{TM}$ Putty groups were significantly greater than $SureOss^{TM}$ group at 2weeks(P < 0.05), however there was no significant difference at 8 weeks. Conclusions: All of $SureOss^{TM}$, $ExFuse^{TM}$ Gel, $ExFuse^{TM}$ Putty groups showed significant new bone formation and augmentation in the calvarial defect model.

Treatment of steroid-resistant pediatric nephrotic syndrome

  • Kang, Hee-Gyung
    • Clinical and Experimental Pediatrics
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    • v.54 no.8
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    • pp.317-321
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    • 2011
  • Children who suffer from steroid-resistant nephrotic syndrome (SRNS) require aggressive treatment to achieve remission. When intravenous high-dose methylprednisolone fails, calcineurin inhibitors, such as cyclosporine and tacrolimus, are used as the first line of treatment. A significant number of patients with SRNS progress to end-stage renal disease if remission is not achieved. For these children, renal replacement therapy can also be problematic; peritoneal dialysis may be accompanied by significant protein loss through the peritoneal membrane, and kidney allograft transplantation may be complicated by recurrence of SRNS. Plasmapheresis and rituximab were initially used for treatment of recurrent SRNS after transplantation; these are now under consideration as rescue therapies for refractory SRNS. Although the prognosis of SRNS is complicated and unfavorable, intensive treatment in the early stages of the disease may achieve remission in more than half of the patients. Therefore, timely referral of pediatric SRNS patients to pediatric nephrology specialists for histological and genetic diagnosis and treatment is highly recommended.

The Effect of Platelet-Rich Plasma on Allograft Transplantation after Curettage in Benign Bone Tumor (양성 골 종양의 소파술 후 실시한 동종골 이식에서 혈소판 풍부 혈장 투여의 효과)

  • Kim, Jae-Do;Kim, Ji-Youn;Jang, Su-Jin;Chung, So-Hak;Jung, Gu-Hee
    • The Journal of the Korean bone and joint tumor society
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    • v.16 no.1
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    • pp.8-13
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    • 2010
  • Purpose: This study was performed to evaluate the effi ciency of Platelet-rich plasma (PRP) for acceleration of bone healing process on allograft transplantation after curettage in benign bone tumor. Materials and Methods: From December 2007 to February 2009, twenty-one patients who had benign bone tumor and underwent allograft transplantation after curettage were evaluated. Mean follow-up period was 14.6 months (range, 12-26 months). We compared with 13 cases of PRP group and 8 cases of non-PRP group in terms of size of lesion, bone resorption, amount of applied PRP and complications. The mean age at surgery was 23.6 years (range, 4-73 years). The most common diagnosis was simple bone cyst (7) followed by enchondroma (4), giant cell tumor (3), undifferentiated benign bone tumor (3) and so on. Results: The mean size of lesion was 33.5 $cm^3$ (range, 2.3-181.9 $cm^3$) (29.4 $cm^3$ in PRP group and 40.2 $cm^3$ in non-PRP group). The mean volume of injected PRP was 7.4 cc (range, 3-12 cc). Bone union started at 3.0 months (range, 1.5-5.8 months) in PRP group and 5.3 months (range, 4-8 months) in non-PRP group. Three cases for each group were excluded due to recurrence and pathologic fracture. One patient had febrile episode 3 weeks later after surgery which subsided with antibiotics. Conclusion: The PRP could accelerate bone union in allograft transplantation after curettage of benign bone tumor. Furthermore, we expect that PRP can accelerate bone union in fracture or non-union.

The Clinical Results of Meniscus Allograft Transplantation - Comparison between medial, Lateral, Isolated and Combined Procedure Groups - (동종 반월상 연골 이식술의 임상적 결과 - 내측과 외측 및 동반 손상의 유무에 따른 비교 -)

  • Cho, Seung-Mok;Yoon, Kyoung-Ho;Lee, Jung-Hwan;Bae, Dae-Kyung;Song, Sang-Jun;Kang, Chang-Min
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.1
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    • pp.28-33
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    • 2009
  • Purpose: To compare the clinical outcomes after meniscus allograft transplantation between lateral and medial or isolated and combined procedure groups. Materials and Methods: Of the patients who had undergone arthroscopic meniscal allograft transplantation between Dec. 1997 and Jun. 2007, 52 patients were available for retrospective evaluation. Patients were grouped into lateral(33 cases) and medial(19 cases) transplant groups as well as those with isolated(18 cases) and combined(34 cases) procedure. The average age was 34.2 years and the mean follow-up period was 42.2 months. Postoperative range of motion (ROM), visual analog scale (VAS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner score, patient's subjective satisfaction, $2^{nd}$ look arthroscopy and MRI were evaluated retrospectively. Results: Mean postoperative ROM was $130.3^{\circ}$. The VAS showed an improvement from 5.96 to 3.05 at the last follow up. IKDC subjective score and Lysholm score also showed an improvement from 46.5 to 64.5 and from 61.9s to 79.58 respectively. Tegner score was improved from 2.9 to 3.6. Overall, 61.5% of patients reported they were completely or mostly satisfied with procedure. There were no significant differences noted between lateral and medial groups as well as isolated and combined groups. In 2nd look arthroscopy, 10 of 18 cases showed good pheripheal healing and there were 6 cases of partial and 2 of complex tear. We observed graft subluxation or extrusion in 12 of 16 cases who were evaluated with follow-up MRI. Conclusion: Meniscus allograft transplantation alone or in combination with other procedure showed an improvement in knee pain and clinical score. But there were no significant difference between lateral and medial groups or isolated and combined procedure groups.

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Review of two immunosuppressants: tacrolimus and cyclosporine

  • HyunJong Lee;Hoon Myoung;Soung Min Kim
    • 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.