This is a case of a 56-year-old man with Castleman disease (CD) who improved after kidney transplantation (KTP). CD is an uncommon lymphoproliferative disorder that was found incidentally on biopsy during dialysis in the current patient and was followed up without further treatment. However, the lesion showed improvement after KTP. Therefore, active KTP can be considered even if CD is one of the lymphoproliferative disorders that can occur as a complication after KTP.
Biopsy ; Dialysis ; Giant Lymph Node Hyperplasia ; Humans ; Kidney Transplantation ; Kidney ; Lymphoproliferative Disorders ; Middle Aged ; Renal Dialysis

Angiotensin II type 1 receptor (AT1R) antibodies directly injure endothelial and vascular smooth muscle cells by activating transcription factors associated with proinflammatory responses. Previous studies have shown that AT1R antibodies are associated with allograft rejection and decreased graft survival in kidney transplantation. Development of enzyme-linked immunosorbent assay has facilitated semiquantitative detection of AT1R antibodies. Assessing AT1R antibodies along with donor specific human leukocyte antigen antibodies may have potential to identify patients with possible risk for allograft injury and improve overall outcomes. In this review, we summarize recent clinical studies about AT1R antibodies in kidney transplantation and provide perspectives for future research area.
Activating Transcription Factors ; Allografts ; Angiotensin II ; Angiotensins ; Antibodies ; Enzyme-Linked Immunosorbent Assay ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney ; Leukocytes ; Muscle, Smooth, Vascular ; Receptor, Angiotensin, Type 1 ; Tissue Donors ; Transplantation

Pediatric liver transplantation has evolved into an effective treatment for a variety of liver diseases in the pediatric population. Over the past 25 years, pediatric liver transplantation results in Korea have matched international standards, and Korea has become one of the most important leaders in living donor liver transplantation. This review presents the cumulative outcomes of pediatric liver transplants in Korea and highlights other concerns related to pediatric liver transplantation, particularly pediatric liver allocation policy and split liver transplantation.
Humans ; Korea ; Liver Diseases ; Liver Transplantation ; Liver ; Living Donors

Pregnancy following heart transplantation is a high-risk condition, requiring adequate maintenance of immunosuppressive drugs that enable proper graft function for optimal maternal and fetal outcomes. Here, we present the first case of successful child delivery in a patient who underwent heart transplantation in Korea. The 35-year-old female patient had become pregnant at 4 years after heart transplantation. The pregnancy progressed uneventfully, and the infant was healthy.
Adult ; Child ; Female ; Heart Transplantation* ; Heart* ; Humans ; Infant ; Korea* ; Pregnancy* ; Transplants

Induction therapy with basiliximab is widely administered after kidney transplantation to prevent acute rejection. Herein, we report a case of non-cardiogenic pulmonary edema induced by basiliximab. To the best of our knowledge, such case has not been reported to date in Korea. A 54-year-old man with polycystic kidney disease received kidney transplantation. As induction therapy, he was prescribed basiliximab. On day 4, the second dose of basiliximab was administered. The patient complained of acute hypoxia 23 hours later, which led to circulatory collapse. He was discharged 3 weeks later with stable renal function. Pulmonary edema was presumed to have been caused by increased pulmonary capillary permeability. A possible hypothesis for this event occurring after the second basiliximab injection is steroid-related effects. Non-cardiogenic pulmonary edema is a complication that might occur after basiliximab induction therapy. Physicians should be aware of this potentially life-threatening complication.
Anoxia ; Capillary Permeability ; Humans ; Kidney Transplantation ; Kidney* ; Korea ; Middle Aged ; Polycystic Kidney Diseases ; Pulmonary Edema* ; Shock

A 38-year-old man, who underwent a second kidney transplantation (KT), was admitted because of antibody-mediated rejection (AMR) complicated by BK virus-associated nephropathy (BKVAN). He was placed on hemodialysis at the age of 24 years because of membranoproliferative glomerulonephritis. At the age of 28 years, he underwent a living donor KT from his father; however, 1 year after the transplantation, he developed a recurrence of the primary glomerular disease, resulting in graft failure 2 years after the first KT. Ten years later, he received a deceased-donor kidney with a B-cell-positive-cross-match. He received 600 mg of rituximab before the KT with three cycles of plasmapheresis and immunoglobulin (0.5 g/kg) therapy after KT. During the follow-up, the first and second allograft biopsies at 4 and 10 months after KT revealed AMR with a recurrence of primary glomerular disease that was reclassified as C3 glomerulonephritis (C3GN). He received a steroid pulse, rituximab, plasmapheresis, and immunoglobulin therapies. The third allograft biopsy demonstrated that the BKVAN was complicated with AMR and C3GN. As the azotemia did not improve after repeated conventional therapies for AMR, one cycle of bortezomib (1.3 mg/m²×4 doses) was administered. The allograft function stabilized, and BK viremia became undetectable after 6 months. The present case suggests that bortezomib therapy may be applicable to patients with refractory AMR, even in cases complicated with BKVAN.
Adult ; Allografts ; Azotemia ; Biopsy ; BK Virus ; Bortezomib* ; Fathers ; Follow-Up Studies ; Glomerulonephritis* ; Glomerulonephritis, Membranoproliferative ; Graft Rejection ; Humans ; Immunization, Passive ; Immunoglobulins ; Kidney ; Kidney Transplantation ; Living Donors ; Plasmapheresis ; Recurrence ; Renal Dialysis ; Rituximab ; Transplants ; Viremia

BACKGROUND: Bortezomib has been used to treat antibody-mediated rejection (AMR) that usually develops after kidney transplantation (KT). Although it has been used in various clinical situations, it is difficult to precisely define how the drug affects the clinical course. We used bortezomib to treat eight cases of AMR that developed immediately following KT in patients who were resistant to conventional treatment. METHODS: Eight cases of refractory AMR that developed immediately after KT were treated with bortezomib on days 1, 4, 8, and 11. RESULTS: The resolution rate was 75%, and the 2-year rejection-free survival rate was 83%. Six cases underwent immunologically high-risk KT. Six recovering patients exhibited clinical improvement within 2 weeks of the first dose of bortezomib and recovered completely within 2 months. The effects of bortezomib seemed to be prolonged; only one additional rejection episode was observed. The two failed patients never exhibited any clinical improvement and progressed aggressively to graft failure soon after transplantation. Their donor specific anti-human leukocyte antigen antibody were sustained at high levels. CONCLUSIONS: Bortezomib is an effective rescue therapy in patients with AMR that developed immediately after KT.
Bortezomib* ; Graft Rejection ; Humans ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Leukocytes ; Survival Rate ; Tissue Donors ; Transplants

Deceased organ donation in Korea has increased steadily after legislation of transplantation law. Since last year, however, several obstacles resulting in a decrease in organ donation have been experienced. Among them, the reduced reporting of potential brain death from large size hospitals and reduced consent rate of medically available deceased donors are two main hurdles. The consent rate of organ donation was 41.9% in 2017 but has dropped to approximately 10% than 2016. Other strong family members overrode approximately 10% of donations initially consented by their next of kin. In addition to the medical points, difficulties in labor shortage are being experienced during donor management, testing and organ recovery in the hospital. Some end stage patients who are candidates as organ donor give up further management and decide to withdrawing life sustaining treatment, which deprive the chance of donation. Moreover, the national mortality rate of cerebrovascular and traffic accidents, which occupy a major part of brain death, have decreased over the recent 10 years. All of these events can cause a decrease in brain death development so it is important to find solutions to overcome all of them. Revising transplant law and donation system should be led by government. Efforts to increase the consent rate, procurement rate, and transplant rate and decrease the organ discard rate are all the responsibility of the medical team. Public awareness and a positive attitude towards organ donation are the most important basic requirements for increasing organ donation. A comprehensive task force team to overcome all of these problems is requested.
Accidents, Traffic ; Advisory Committees ; Brain Death ; Humans ; Informed Consent ; Jurisprudence ; Korea* ; Mortality ; Organ Transplantation ; Tissue and Organ Procurement* ; Tissue Donors ; Waiting Lists

An increasing number of pediatric patients undergo liver transplantation, and it has become an effective and definitive treatment of choice for pediatric end-stage liver disease patients. However, liver transplantation in pediatric patients differs greatly from that in older individuals with respect to not only surgical techniques, immunosuppression, and post-operative managements, but also to intraoperative anesthetic management. The present review provides an overview of the current development and clinical practices in anesthetic management of pediatric liver transplantation.
Anesthesia ; Child ; Humans ; Immunosuppression ; Liver Diseases ; Liver Transplantation* ; Liver*

Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.
Allografts ; Antibody-Dependent Cell Cytotoxicity ; B-Lymphocytes ; Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Fibrosis ; Hand ; Hepatitis B virus ; HLA Antigens ; Humans ; Liver Transplantation* ; Liver* ; Living Donors ; Middle Aged ; Tissue Donors*