No abstract available.
Cytomegalovirus Infections/diagnosis/*etiology ; Graft Rejection/diagnosis/etiology ; Humans ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Nephritis, Interstitial/diagnosis/*etiology ; Ureteral Obstruction/diagnosis/*etiology

Bile Duct Diseases ; etiology ; pathology ; Diagnosis, Differential ; Graft Rejection ; etiology ; pathology ; Hepatic Artery ; pathology ; Humans ; Liver Transplantation ; adverse effects ; Thrombosis ; etiology ; pathology

OBJECTIVETo explore the clinical significance of early diagnose and treatment of subclinical renal allograft rejection.

METHODSNinety-six renal allograft recipients (54 male and 42 female) with normal renal function aged 17 to 58 years (mean 37.5 years) were included in this study. Early subclinical rejection was diagnosed 3 months after the transplantation by color Doppler examination.

RESULTSPatients with early subclinical rejection were given methylpredisolone followed by adjustment of immunosuppressive regimens, and no difference was observed in 3-year survival rate between these patients and those with normal renal allograft findings.

CONCLUSIONEarly diagnosis and treatment of subclinical renal allograft rejection is significant to improve renal allograft survival rate.

Adolescent ; Adult ; Aged ; Early Diagnosis ; Female ; Graft Rejection ; diagnosis ; drug therapy ; etiology ; Graft Survival ; drug effects ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; adverse effects ; methods ; Male ; Methylprednisolone ; therapeutic use ; Middle Aged ; Time Factors ; Ultrasonography, Doppler, Color

It is generally accepted that one-year post-transplant proteinuria over 0.5 gm per day has a negative impact on renal graft survival. In this study, the effects of minimal proteinuria less than 0.5 g/day were analyzed in 272 renal recipients who had survived for one year with a functioning graft. Recipients were classified by one-year posttransplant proteinuria: no proteinuria group (<0.2 g/day), minimal proteinuria group (0.2-0.5 g/day), and overt proteinuria group (> or =0.5 g/day). Recipients were followed up for 87.1+/-21 months after transplantation and 38 (13.9%) lost their graft during follow-up. Fifteen percent of patients had minimal proteinuria and 7.8% had overt proteinuria. Five-year graft survival in the minimal proteinuria group was 83.0%, and that in the overt proteinuria group was 70%, in contrast to 97.1% in the no proteinuria group (p=0.01 for trend). In a multivariate analysis, the minimal proteinuria group (relative risk [RR], 4.90; 95% confidence interval [CI], 2.09-11.46) and the overt proteinuria group (RR, 8.75; 95% CI, 3.29-23.29) had higher risks of graft failure than the no proteinuria group. Even minimal proteinuria at one year after transplantation was strongly associated with poor graft outcome. Therefore, it appears logical to consider a low level of proteinuria as a risk factor for graft survival in renal recipients.
Adult ; Female ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/*adverse effects ; Living Donors ; Male ; Nephrology/*methods ; Proteinuria/*diagnosis/etiology ; Risk ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUNDIn the past decades, the one-year graft survival of cadaveric renal allografts has been markedly improved, but their long-term survival has not kept pace. The attrition rate of renal allografts surviving after one year remains almost unchanged. The causes for late graft loss are multiple. The aim of this study was to analyze the predictive factors that impact long-term survival of grafts after kidney transplantation.

METHODSWe retrospectively analyzed 524 kidney transplantation patients who were treated in our hospital between January 1991 and January 2000, including 254 patients who had lived more than 10 years with normal graft function (long survival group), and 270 cases whose renal graft had survived less than 10 years (control group). Specifically, we analyzed 10 factors that may potentially affect graft survival by both univariate and Logistic model multivariate analyses to pinpoint the independent risk factors.

RESULTSUnivariate analyses showed that no significant differences existed in the age or gender of recipients, dialysis time, lymphotoxin levels, or cold ischemia time between the two groups. However, the ratio of delayed graft function and acute rejection, and the uric acid levels of patients in the long survival group were significantly lower than those in the control group (P < 0.01). Furthermore, we found that the concentration of cyclosporin A at one year after transplantation and the histocompatibility antigen match of donor-recipients for patients within the long survival group were significantly higher than those in the control group (P < 0.01). Furthermore, multivariate analyses showed that these four factors were independent risk factors that impact patient survival.

CONCLUSIONSThe ratios of delayed graft function and acute rejection, the concentration of cyclosporin A at one year after transplantation, and serum uric acid levels are very important factors that affect the long-term survival of renal grafts.

Adolescent ; Adult ; Female ; Graft Rejection ; diagnosis ; etiology ; Graft Survival ; physiology ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; adverse effects ; methods ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Young Adult

OBJECTIVETo analyze the kinetics of hematopoietic cell chimerism in the early period after non-myeloablative stem cell transplantation (NAST) and to investigate the correlation between molecular and hematologic assessment of engraftment or rejection.

METHODShort tandem repeat-polymerase chain reaction (STR-PCR) analysis of chimerism status was carried out in 6 patients who received NAST from HLA-matched sibling donors.

RESULTSIn 5/6 patients, the peripheral blood samples collected on the first day after allograft infusion displayed the presence of mixed chimerism. STR-PCR analysis revealed a gradual increase of the donor-specific allelic signal which became dominant over the recipient-specific allele by day +7. On day +14, hematologic chimerisms were completely donor origin. Their molecular engraftments (ME) were detected at a median time of 6 days, preceding hematologic engraftment by a median of 5 days (P > 0.05). But the sixth patient showed more than 50% host residual cells on day +7 and had no signs of ME on day +14.

CONCLUSIONIt suggested that molecular monitoring of the early dynamics of chimerism after NAST could be useful in predicting engraftment, or rejection. If the engraftment was less than 50% on day +7 and failed to get ME on day +14, the graft rejection would occur.

Adult ; Graft Rejection ; Graft vs Host Disease ; diagnosis ; etiology ; Hematopoiesis ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Kinetics ; Middle Aged ; Polymerase Chain Reaction ; Tandem Repeat Sequences ; Transplantation Chimera ; Transplantation, Homologous

BACKGROUND/AIMS: Patients who undergo repeat kidney transplantations (KTs) are considered at high risk for experiencing immunologic and non-immunologic complications. In this study, we investigated the clinical outcomes, including medical and surgical complications, of patients who underwent a third KT at our center. METHODS: Between March 1969 and December 2012, a total of 2,110 KTs were performed at the Seoul St. Mary's Hospital. Of them, we examined 11 patients who underwent a third KT, and investigated the allograft outcomes and complication rates. RESULTS: The mean follow-up duration after KT was 72.4 ± 78.3 months. The mean age at KT was 38.2 ± 8.0 years, and seven patients (63.6%) were males. Nine patients (81.8%) underwent living-donor KT. A cross-match test yielded positive results in four of the nine patients, and all underwent pretransplant desensitization therapy. After KT, three patients (27.2%) showed delayed graft function. Acute rejection developed in four patients (36.4%), and surgical complications that required surgical correction occurred in three patients. Allograft failure developed due to acute rejection (n = 3) or chronic rejection (n = 1) in four patients. Allograft survival rates at 1, 5, and 10 years were 81.8%, 42.9%, and 42.9%, respectively; however, the allograft survival rate at 5 years was > 80% in patients who underwent KT only after results of the panel reactive antibody test became available. CONCLUSIONS: Thus, a third KT procedure may be acceptable, although aggressive pretransplant immune monitoring and patient selection may be required to reduce the risks of acute rejection and surgical complications.
Acute Disease ; Adult ; Allografts ; Chronic Disease ; Delayed Graft Function/diagnosis/*etiology/therapy ; Female ; Graft Rejection/diagnosis/*immunology/therapy ; Graft Survival ; *Histocompatibility ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Patient Selection ; Reoperation ; Republic of Korea ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

This study was designed to evaluate whether sirolimus (SRL) conversion effectively improves renal function and histopathology in calcineurin inhibitor (CNI)-treated renal recipients with mild to moderate renal insufficiency. SRL conversion from CNI was performed in patients who underwent kidney transplantation from 6 months to 5 yr prior to screening. Forty-five patients were enrolled. The effect of SRL conversion on graft function was evaluated, and protocol biopsies were performed preconversion and 1 yr after conversion. Overall graft function after SRL conversion gradually improved, and the improvement in renal function was closely associated with the shorter duration of CNI exposure. When we divided the patients by the duration of CNI exposure, the patients with less than 1 yr of CNI exposure demonstrated significant improvement, but patients with a greater than 1 yr CNI exposure did not exhibit significant improvement. In contrast, protocol biopsies demonstrated no significant improvements in the modified "ah" score or other Banff scores after SRL conversion. Furthermore, the duration of CNI treatment prior to SRL conversion was not associated with histological findings 1 yr after SRL conversion. SRL conversion improved graft function in renal recipients with mild to moderate renal insufficiency, but this effect is not accompanied by histological improvement.
Adult ; Calcineurin Inhibitors/*administration & dosage ; Drug Synergism ; Female ; Graft Rejection/*etiology/*prevention & control ; Graft Survival/drug effects ; Humans ; Immunosuppressive Agents ; Kidney Transplantation/adverse effects/*methods ; Male ; Renal Insufficiency/diagnosis/*therapy ; Republic of Korea ; Severity of Illness Index ; Sirolimus/*administration & dosage ; Transplantation Tolerance/drug effects ; Treatment Outcome

BK virus-associated nephropathy (BKVAN) is one of the major causes of allograft dysfunction in kidney transplant (KT) patients. We compared BKVAN combined with acute rejection (BKVAN/AR) with BKVAN alone in KT patients. We retrospectively analyzed biopsy-proven BKVAN in KT patients from 2000 to 2011 at Seoul National University Hospital. Among 414 biopsies from 951 patients, biopsy-proven BKVAN was found in 14 patients. Nine patients had BKVAN alone, while 5 patients had both BKVAN and acute cellular rejection. BKVAN in the BKVAN alone group was detected later than in BKVAN/AR group (21.77 vs 6.39 months after transplantation, P=0.03). Serum creatinine at diagnosis was similar (2.09 vs 2.00 mg/dL). Histological grade was more advanced in the BKVAN/AR group (P=0.034). Serum load of BKV, dose of immunosuppressants, and tacrolimus level showed a higher tendency in the BKVAN alone group; however it was not statistically significant. After anti-rejection therapy, immunosuppression was reduced in the BKVAN/AR group. Renal functional deterioration over 1 yr after BKVAN diagnosis was similar between the two groups (P=0.665). These findings suggest that the prognosis of BKVAN/AR after anti-rejection therapy followed by anti-BKV therapy might be similar to that of BKVAN alone after anti-BKV therapy.
Acute Disease ; Adult ; Antiviral Agents/therapeutic use ; BK Virus/*physiology ; Creatinine/blood ; Female ; *Graft Rejection/diagnosis/virology ; Humans ; Immunosuppressive Agents/administration & dosage ; Kidney/*virology ; Kidney Diseases/pathology/surgery/*virology ; *Kidney Transplantation ; Male ; Middle Aged ; Polyomavirus Infections/drug therapy/*etiology/pathology ; Retrospective Studies ; Tacrolimus/administration & dosage ; Time Factors ; Transplantation, Homologous/adverse effects ; Tumor Virus Infections/drug therapy/*etiology/pathology

The optimal immunosuppressive strategy for renal transplant recipients at high immunologic risk remains a topic of investigation. This prospective single arm pilot study was undertaken to evaluate the safety and efficacy of a combined tacrolimus and sirolimus regimen in recipients at immunological high risk and to compare outcomes with a contemporaneous control group received tacrolimus and mycophenolate mofetil. Patients that received a renal allograft between 2010 and 2011 at high risk (defined as panel reactive antibodies > 50%, 4 or more human leukocyte antigen mismatches, or retransplantation) were enrolled. All patients received basiliximab induction and corticosteroids. A total of 28 recipients treated with tacrolimus and sirolimus were enrolled in this study and 69 recipients were retrospectively reviewed as a control group. The sirolimus group showed a higher, but not statistically significant, incidence of biopsy proven acute rejection and a lower glomerular filtration rate than the control group. Furthermore, sirolimus group was associated with significant increases in BKV infection (P = 0.031), dyslipidemia (P = 0.004), and lymphocele (P = 0.020). The study was terminated prematurely due to a high incidence of adverse events. A de novo tacrolimus/sirolimus combination regimen may not be an ideal choice for recipients at high immunological risk.
Adult ; Drug Therapy, Combination/methods ; Female ; Graft Rejection/diagnosis/*etiology/*prevention & control ; Humans ; Immunocompromised Host ; Immunosuppressive Agents/administration & dosage/adverse effects ; Kidney Transplantation/*adverse effects ; Longitudinal Studies ; Male ; Middle Aged ; Sirolimus/*administration & dosage/adverse effects ; Survival Rate ; Tacrolimus/*administration & dosage/adverse effects ; Treatment Outcome