• Korean Journal of Clinical Pharmacy
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• v.30 no.3
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• pp.149-160
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• 2020

Background: Basiliximab is used as an alternative to tacrolimus in patients with decreased renal function. However, studies on basiliximab as a maintenance immunosuppressant, particularly in patients with lung transplantation, are limited. Therefore, here, we investigated the efficacy and safety of basiliximab in patients with lung transplantation. Methods: Adult patients with acute kidney injury (AKI) who received lung transplantation at a single general hospital between July 1, 2014 and June 30, 2018, were selected and classified in tacrolimus and basiliximab groups. Both groups received a triple-drug regimen (tacrolimus, mycophenolate mofetil, and steroids). However, tacrolimus was discontinued in the basiliximab group when AKI occurred, and two or more repeat basiliximab doses were administered within 3 months after transplantation. The electronic medical records were analyzed retrospectively. Results: Of the 85 patients who met the selection criteria, 61 and 24 were assigned to the tacrolimus and basiliximab groups, respectively. Significant improvement in renal function was observed in the basiliximab group (p <0.001). However, there were no differences in acute and chronic rejection rates in both the groups. No difference was observed in the incidence rate of complications between the groups, except for chronic kidney disease, which showed higher incidence in the basiliximab group (25.0% vs. 4.9%; p =0.013). Conclusions: We suggest the use of basiliximab as an immunosuppressant alternative to tacrolimus in patients with acute renal failure after lung transplantation. Basiliximab demonstrated effectiveness as an immunosuppressant and improved renal function. Therefore, basiliximab can be used in patients with decreased renal function.

• Korean Journal of Clinical Pharmacy
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• v.16 no.1
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• pp.14-22
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• 2006

Purpose: To determine the short (1 year of transplant) and long-term (1-5 years of transplantation) risk factors affecting the graft and patient survival in kidney transplantation recipients. Methods: Records of 149 patients who received kidney transplantation in 1996 from Asan Medical Center were followed for 5 years retrospectively. Results: All patients initiated triple immunosuppressive therapy with cyclosporine, prednisone and azathioprine. One, two, three, four, five year patient and graft survival rates were 98.7%, 98.0%, 98.0%, 97.3%, 97.3%, and 96.6%, 95.2%, 94.6%, 92.5%, 91.8%, respectively. There were 30 cases of acute rejection (AR) and 6 cases of chronic rejection (CR) within $2.1{\pm}3.2$ months and $42.1{\pm}13.2$ months of transplantation, respectively. The risk factors for AR were donor's age older than 30 years (p=0.02) and cardiovascular disease (p=0.05). The risk factors for CR were AR (p=0.0169) and episode of complications (p=0.0330). Increasing period of dialysis (p=0.0473), episodes of AR (p<0.0001) and complication (p=0.0317) were significant factors for graft loss. Seven grafts were lost from noncompliance during 1-5 year period. The most com- mon cause of the graft loss for both periods was the graft rejection. The graft survival rate was significantly lower in patients with than without rejection episodes (77.4% vs. 90.0%, p=0.002). Conclusions: Survival rate of the graft with rejection was significantly lower. The risk factors affecting AR were donor's age older than 30years and CVD. AR and episode of complications within 1year were the risk factors for CR and graft loss.

• Journal of Industrial Convergence
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• v.21 no.11
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• pp.85-95
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• 2023

The purpose of this study is to provide evidences throught scoping review of education intervention studies for post kidney transplantation management in the kidney transplant patients in Korea. Through the search engines RISS, KISS, DB pia and Pubmed, 13 articles were selected by searching for theses and academic journals published prior to the search date of May 21, 2023. According to the study result, relevant studies were 13, and the education programs provided to kidney transplant patients were classified into 1) overall health management after transplantation, 2) self-efficacy promotion exercise program, 3) exercise therapy, 4) drug education, and 5) stress coping. Knowledge, implementation, self-efficacy, anxiety, uncertainty, stress, and quality of life were confirmed as effects of the intervention. Based on the results of this study, it is necessary to develop integrated educational materials and systematic self-management programs that can manage various health problems that may occur after kidney transplantation, and it is suggeste that research on educational interventions for kidney transplant patients in nursing.

• Journal of Korean Critical Care Nursing
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• v.8 no.1
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• pp.11-24
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• 2015

Purpose: The purpose of this study was to explore the experience of patients on the waiting list for kidney retransplantation. Methods: The data were collected by individual in-depth interviews of nine patients who were dialyzed after primary kidney graft dysfunction and were waiting for deceased donor kidney retransplantation. All interviews were audio-taped and transcribed, and were analyzed using a phenomenological method. Results: The findings included 5 theme clusters and 13 sub-themes. The 5 clusters were 'Diagnosed with chronic renal failure and dialysis: Broken daily life and crisis', 'Kidney transplantation: The only way to escape from dialysis', 'Kidney graft failure: Inevitable moving backward to hemodialysis', 'Self-management of re-dialysis patients: Growth through pain', and 'The waiting for kidney retransplantation: To try again in the hope of getting a new life'. Conclusion: This study provides a deep understanding of patients with dialysis who are waiting for deceased donor kidney retransplantation. On the basis of the findings of this study, health professionals can provide customized information and develop effective nursing interventions to improve the self-management of these patients.

• Clinical and Experimental Pediatrics
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• v.59 no.4
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• pp.202-204
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• 2016

A 15-year-old boy, who was diagnosed with Alport syndrome and end-stage renal disease, received a renal transplant from a living-related donor. On postoperative day 1, his daily urine output was 10,000 mL despite normal graft function. His laboratory findings including urine, serum osmolality, and antidiuretic hormone levels showed signs similar to central diabetes insipidus, so he was administered desmopressin acetate nasal spray. After administering the desmopressin, urine specific gravity and osmolality increased abruptly, and daily urine output declined to the normal range. The desmopressin acetate was tapered gradually and discontinued 3 months later. Graft function was good, and urine output was maintained within the normal range without desmopressin 20 months after the transplantation. We present a case of a massive polyuria due to transient deficiency of antidiuretic hormone with the necessity of desmopressin therapy immediately after kidney transplantation in a pediatric patient.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.9
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• pp.4335-4339
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• 2012

Background: Whether sirolimus is useful in the prevention of non-melanoma skin cancer (NMSC) remains unclear and we therefore performed this meta-analysis of randomized controlled trials to test the hypothesis that Sirolimus-based immunosuppression is associated with a decrease in NMSC. Methods: The main outcomes were NMSC, squamous-cell carcinoma and basal-cell carcinoma. The pooled risk ratio (RR) with its 95% confidence interval (95%CI) were used to assess the effects. Results: 5 randomized trials involving a total of 1499 patients receiving kidney transplantation were included. Patients undergoing Sirolimus-based immunosuppression had much lower risk of NMSC (RR = 0.49, 95%CI 0.32-0.76, P = 0.001). Subgroup analyses by tumor type showed that Sirolimus-based immunosuppression significantly decreased risk of both squamous-cell carcinoma (RR = 0.58, 95%CI 0.43-0.78, P < 0.001) and basal-cell carcinoma (RR = 0.56, 95%CI 0.37-0.85, P = 0.006). The quality of evidence was high for NMSC, and moderate for squamous-cell carcinoma and basal-cell carcinoma. No evidence of publication bias was observed. Conclusion: High quality evidence suggests that Sirolimus-based immunosuppression decreases risk of non-melanoma skin cancer, and Sirolimus has an antitumoral effect among kidney-transplant recipients.

• 한국생물공학회:학술대회논문집
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• 2003.10a
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• pp.347-350
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• 2003

Dialysis and renal transplantation, the current therapies for end-stage renal disease (ESRD), have many limitations including severe complications, organ shortage, and graft failure. To overcome the limitations, the present study investigated the reconstruction of renal tissue in vivo by transplanting isolated fetal renal cells using fibrin gel to the kidney of renal failure rat model. After 4 weeks from the transplantation, blood urea nitrogen(BUN) and creatinine were examined from blood samples and histological examination of the implanted tissues revealed formation of renal-like structures and restoration of renal function.

• Childhood Kidney Diseases
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• v.22 no.1
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• pp.7-11
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• 2018

Significant advances in the diagnosis and medical care of children with chronic kidney disease (CKD) are major reasons for the better survival rates of children and adolescents with CKD than the survival rates reported in previous decades. These patients are reaching adulthood, and therefore require a transition to adult medical care. This transition phase is well-recognized to be associated with considerably increased morbidities and medical problems, such as non-adherence, graft loss after transplantation, and loss to follow-up. Low adherence increases morbidity and medical complications and contributes to poorer qualities of life and an overuse of the health care system. However, these tragic outcomes may be avoidable through a structured and well-defined transition program. In the last decade, there has been increasing interest to resolve these medical and psychological problems that occur during the transfer of young adult patients from pediatric to adult renal units. The aims of a successful transition from pediatric to adult medical care include enhancing the individual development of better health-competence and stabilizing, or even improving, the state of health. This review will focus on various aspects of the transition phase of adolescents who have CKD or who underwent kidney transplantation from pediatric to adult nephrology care.

• Korean Journal of Clinical Pharmacy
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• v.29 no.1
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• pp.18-24
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• 2019

Background: Although a growing number of guidelines and clinical researches are available for immunosuppressive treatment of post-transplantation, there is no clinical practice guideline for the care of kidney transplant recipients in Korea. Selection of a researchable question is the most important step in conducting qualified guideline development. Thus, we aimed to formulate key questions for Korean guideline to aid clinical decision-making for immunosuppressive treatment. Methods: Based on previous published guidelines review, a first survey was constructed with 29 questions in the range of immunosuppressive treatments. The experts were asked to rate the clinical importance of the question using a 5-point Likert scale. The questions reached 60% or more from the first survey and additional new questions were included in the second survey. In analyzing the responses to items rated on the 9-point scale, consensus agreement on each question was defined as 75% or more of experts rating 7 to 9. Results: In the first survey, 50 experts were included. Among the 29 questions, 27 were derived to get 60% or more importance and 3 new questions were additionally identified. Through the second survey, 9 questions were selected that experts reached consensus on 75% and over of the options. Finally, we developed key questions using PICO (patient, intervention, comparison, and outcome) methodology. Conclusion: The experts reached a high level of consensus on many of key questions in the survey. Final key questions provide direction for developing clinical practice guideline in the immunosuppressive treatment of transplantation.

• Journal of Korean Academy of Nursing
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• v.47 no.4
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• pp.445-455
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• 2017

Purpose: This study was conducted to develop an Empowerment Education Program (EEP) for kidney transplant patients and to test the program's effects on uncertainty, self-care ability, and compliance. Methods: The research was conducted using a nonequivalent control group with a pretest-posttest design. The participants were 53 outpatients (experimental group: 25, control group: 28) who were receiving hospital treatment after kidney transplants. After the pre-test, patients in the experimental group underwent a weekly EEP for six weeks. The post-test was conducted immediately after, and four weeks after the program's completion in the same manner as the pre-test. For the control group, we conducted a post-test six and ten weeks after the pre-test, without and program intervention. A repeated measure ANOVA was performed to compare the change scores on main outcomes. Results: Uncertainty was significantly lower in the experimental group than in the control group, both immediately after (t=-3.84, p=<.001) and 4 weeks after (t=-4.51 p=<.001) the program, whereas self-care ability (t=5.81, p=<.001), (t=5.84, p=<.001) and compliance (t=5.07, p=<.001), (t=5.45, p=<.001) were significantly higher. Conclusion: Kidney transplant patients who underwent an EEP showed a decrease in uncertainty and an improvement in self-care ability and compliance. Thus, our findings confirmed that an EEP can be an independent intervention method for improving and maintaining the health of kidney transplant patients.