• 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.

• 한국임상수의학회지
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• 제24권4호
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• pp.522-528
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• 2007

A 3-year-old male Maltese dog(weighing 2.5 kg) was referred with an excessive movement of mandible and depression. Comprehensive diagnostic investigation revealed an end-stage of renal disease with secondary hyperparathyroidism. The renal allograft was performed after the condition of dog was stabilized by hemodialysis and medical treatment. After transplantation, the renal function of this dog was returned to normal. thereafter, the dog died suddenly without apparent clinical signs. The subsequent pathological studies revealed the actual etiology of death was not clearly identified However acute pancreatitis caused by abrupt introduction of food after prolonged luting might be involved in the etiology. This case study showed the necessity of pancreatic function test in postoperative management after renal transplantation.

• 대한이식학회지
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• 제28권3호
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• pp.135-143
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• 2014

Background: Kidney injury molecule-1 (KIM-1) is known as a good ancillary marker of acute kidney injury (AKI) and its expression has also been observed in acute rejection and chronic graft dysfunction. We tested usefulness of KIM-1 as an indicator of acute and chronic renal graft injury by correlating KIM-1 expression with renal graft function and histology. Methods: A total of 133 zero-time biopsies and 42 follow-up biopsies obtained within 1 year posttransplantation were selected. Renal tubular KIM-1 staining was graded semiquantitatively from 0 to 3 and the extent of staining was expressed as the ratio of KIM-1 positive/CD10 positive proximal tubules using Image J program. Results: KIM-1 was positive in 39.8% of zero-time biopsies. KIM-1 positive cases were predominantly male and had received grafts from donors with older age, deceased donors, and poor renal function at the time of donation, compared with KIM-1 negative cases. KIM-1 expression showed correlation with delayed graft function and acute tubular necrosis. In comparison of KIM-1 expression between stable grafts (n=23) and grafts with dysfunction (n=19) at the time of repeated biopsy, the intensity/extent of KIM-1 staining and renal histology at zero-time did not differ significantly between the two groups. Histologically, KIM-1 expression was significantly increased with both acute and chronic changes of glomeruli, tubules and interstitium, peritubular capillaritis, and arteriolar hyalinosis. Conclusions: KIM-1 can be used as an ancillary marker of AKI and a nonspecific indicator of acute inflammation and tubulointerstitial fibrosis. However, KIM-1 expression at zero-time is not suitable for prediction of long-term graft dysfunction.

• 대한이식학회지
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• 제31권4호
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• pp.170-176
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• 2017

We need to establish an informative guideline to increase inter-institutional and inter-observer reproducibility of renal transplant diagnosis, and to improve the diagnostic ability of pathologists in Korea. A first nation-wide survey for renal transplant pathology was conducted by Renal Pathology Study Group of the Korean Society of Pathologists in 2016, to provide the continued excellence in the transplantation pathology laboratory, and to improve the diagnostic ability for the best treatment of transplant patients. This survey revealed the significant variations in scale, work load and biopsy indications for the renal transplant pathology in various institutions in Korea. The Banff classification were used by all institutions for the diagnosis of renal transplant pathology, but different formats were used: most institutions (70%) used the "2013 Banff classification" while the others were using "2007 Banff classification" (20%) or even older formats. In daily diagnostic practice of the renal allografts, difficulties that pathologists encounter were quite diverse due to different environments they work in. Most respondents agreed that standardized diagnostic practice guidelines, regular education on renal transplant pathology and convenient ways of consultation are further needed. We are currently working toward the enhancement of the expertise of renal pathologists and to increase inter-institutional and inter-observer reproducibility by 1) development of a set of virtual slides of renal allograft biopsies for the training, 2) validation and gathering expert's consensus on the core variables of rejection diagnosis by using virtual slides, and 3) continued education by the developed virtual slide atlas.

• Biomolecules & Therapeutics
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• 제13권2호
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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.

• Journal of Chest Surgery
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• 제38권9호
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• pp.656-659
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• 2005

뮤코르진균증은 비교적 드문 질환으로 면역이 저하된 환자에게 있어서 치명적인 기회감염을 일으킨다. 감염은 주로 혈액암, 만성 신부전, 당뇨 환자나 장기이식을 받은 환자에게 일어난다. 저자들은 조절되지 않은 당뇨를 동반한 신장이식을 받은 환자에서 발생한 폐뮤코르진균증을 암포테리신과 함께 수술적 절제를 통해 성공적으로 치료하였다.

• Clinical and Experimental Pediatrics
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• 제54권8호
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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.

• Childhood Kidney Diseases
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• 제6권2호
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• pp.131-141
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• 2002

목적 : 아시아 각 국가들간의 소아 신이식 성적은 많은 수준 차이가 존재하고, 몇몇 선두그룹을 제외하고 전체적으로 서구에 비하여 많이 뒤떨어지는 것은 사실이지만 소아 신이식 성적에 영향을 미치는 관련 조건들이 서로 비슷한 경향을 가지고 있기에, 아시아 각국의 소아 신이식 경험의 축적과 관련 자료의 비교분석이 앞으로 신이식성적의 향상에 있어 서구의 자료보다 더욱 많은 도움을 줄 수 있을 것이고, 이번 조사를 계기로 이러한 공동 연구의 바탕이 될 수 있는 국가별 신이식 등록사업과 국가간 자료 교환 사업의 활성화가 원활하게 이루어지기를 기대하여 본 연구를 시작하게 되었다. 대상 및 방법 : 이식현황에 대한 자료수집은 아시아 각국의 소아신장학회에 보낸 설문과 각국에서 보내온 여러 다른 기준과 형식의 자료를 총괄하여 시행하였고 총 11개국이 본 조사에 참여하였으며 우리나라 국내 소아 신이식 현황은 KONOS(Korean Network for Organ Sharing)의 자료와 국내 최대 신이식 증례를 보유하고 있는 2개 단일기관의 자료를 기준으로 알아보았다. 결과 : 아시아 각국의 소아 신이식 상황을 비교한 결과 매년 시행되는 소아 신이식례의 숫자는 해마다 증가하고 있으며 현재 아시아에서 소아 신이식이 가장 활발하게 이루어지고 있는 한국, 일본의 경우 최근3년간 연간 40-50례 정도가 시행되고 있다. 소아 신이식 등록사업은 한국, 일본, 싱가폴, 홍콩, 말레이시아 등에서 시행되고 있으나 서구에 비하여 참여도가 낮고, 체계적인 자료수집과 추가자료의 보충과정의 미비로 신이식 전반에 걸친 완벽한 국가적 소아 신이식 통계의 보유가 어렵고, 국가간의 자료를 수시로 교환하여 비교할 수 있는 통일된 프로그램의 운용은 더욱 생각하기 어려운 실정이다. 결론 : 통일된 프로토콜이 아닌 부분적으로 수집된 자료이지만 이번 아시아 각국의 소아 신이식 자료의 비교 연구는 아시아 신이식 현 수준을 파악하고 이식성적의 향상을 위한 등록사업과 자료교환사업의 필요성을 촉구하는데 충분히 도움이 될 수 있을 것으로 생각되었다.

• 한국임상수의학회지
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• 제22권4호
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• pp.322-327
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• 2005

보체의존성 세포독성반응(CDC)을 이용한 DLA class I교차 반응의 실험방법을 정립함으로써 개의 동종 신장이식 후 초기에 발생되는 초급성 거부반응을 억제하는데 응용하고자 븐 실험을 실시하였다. 체중(약 5kg)과 연령(약 1년령)이 유사한 잡종견을 대상으로 적혈구 교차 반응을 실시하여 상호 음성인 7마리를 실험에 사용하였다. 혈액형이 동일한 개체를 대상으로 CDC검사를 실시하였으며, Anti-dog serum, Hank's balanced salt solution (HBSS), 그리고 자가 혈청을 각각 양성 음성 그리고 자가 대조 혈청으로 이용하였다. Class I보체와 반응시킨 후 에오신으로 염색하여 고정한 다음 위상차 현미경 100배율에서 조사하였다. 국제 Cytotoxicity scoring system에 의하려 죽은 세포가 $20\%$ 이상이면 양성으로 평가하였다. CDC 결과 동일 혈액형 군에서 상호 음성이 나온 경우를 대상으로 상호 동종이식을 실시하여 초급성 거부반응의 발생 정도를 평가하였다. 혈액형이 1.2 B인 4두 중 1두는 자가항체를 가지고 있었다. CDC 결과 동일 혈액형 군에서 각각 1쌍이 상호 음성을 나타내었고, 혈액형이 다른 1쌍에서도 상호 음성이 관찰되었다. 혈액형이 동일하고 CDC음성인 2쌍 4두를 대상으로 상호 신장 이식을 한 결과 4마리 모두 초급성 거부반응이 나타나지 않았다. 이 실험에서 확립한 DLA교차 방법은 동종 이식에서 초급성 거부반응을 억제하는데 효과적인 방법이며, 향후 개의 동종 장기 이식에서 조직적합성 평가를 위해 응용될 수 있을 것이라 사료된다.