The understanding of genetic diversities in humans by applying the state of the art genomic technologies has been accumulated and enriched since the last decades. Even in organ transplantation, these genomic technologies have not yet been widely applied and have less impact, except Human Leukocyte Antigen (HLA) matching. Pre- and post-operative care including surgical techniques in organ transplantation has improved reducing morbidity and mortality, but there are limitations and obstacles due to personal diversities coming from genetic variation. For this reason, the therapy combined with genomic information would be promising and beneficial in organ transplantation and would expect to give a new paradigm in personalized medicine in the near future. In this review, we introduce Next Generation Sequencing (NGS) technology and summarize potential benefits of these technologies in organ transplantation.
Genetic Variation ; Genomics* ; Graft Rejection ; Humans ; Leukocytes ; Mortality ; Organ Transplantation* ; Transplants* ; Precision Medicine

PURPOSE: Liver transplantation has been accepted as the treatment for end-stage-liver diseases. However, despite the development of more powerful and selective immunosuppressive agents to improve survival following transplantation, graft rejection remains a major cause of morbidity and mortality. It is not always easy to diagnose rejection precisely at an early stage even by liver biosy, which can involve risk, especially when the recipient shows coagulation disorder. Therefore, it is important to develop noninvasive diagnostic approach that can supplement or substitute for histological examination in order to diagnose the rejection response earlier and more precisely. METHODS: In this study, as the experimental group (rejection combination strains), 30% partial liver of Dark-Agauti (DA) rat was transplanted heterotopically to Sprague-Dawly (SD) rat by microsurgical technique. As the control group, partial liver of SD rat was transplanted heterotopically to SD rat. After liver transplantation, serum inteleukin-6 (IL-6), GOT/GPT and histological findings of grafts were evaluated. RESULTS: In the experimental group, serum IL-6 was 84.6 pg/ml on postoperative 2 days, and not decreased so much, remained 28.9 pg/ml on postoperative 8 days. In the control group, serum IL-6 was 58.8 pg/ml on postoperative 2 days, after then decreased to 6.72 pg/ml. In the experimental group, serum IL-6 was already increased, in which rejection was histologically confirmed. CONCLUSION: Therefore, IL-6 may be used as the noninvasive diagnostic parameter to predict rejection of graft after liver transplantation.
Animals ; Graft Rejection ; Immunosuppressive Agents ; Interleukin-6* ; Liver Transplantation* ; Liver* ; Mortality ; Rats* ; Transplants

Graft Rejection ; Humans ; Kidney Transplantation ; mortality ; statistics & numerical data ; Patient Care

PURPOSE: The aim of this study was to analyze survival outcomes in 1,000 consecutive liver transplantations (LTs) performed at a single institution from 1993 to April 2017. METHODS: The study population was divided into 2 groups based on donor type: deceased donor LT (DDLT; n = 181, 18.1%) and living donor LT (LDLT; n = 819; 81.9%), and into 3 periods based on the number of cases (first 300 cases, middle 300 cases, last 400 cases). RESULTS: Infection was the most common cause of death, accounting for 34.8% (95 of 273). Mortality due to hepatocellular carcinoma recurrence occurred most frequently between 1 and 5 years after transplantation. Mortality rate by graft rejection was highest between 5 and 10 years after transplantation. And mortality by de novo malignancy occurred most frequently after 10 years after transplantation. The patient survival rates for the entire population at 5 and 10 years were 74.7%, and 68.6%, respectively. There was no difference in survival rate between the LDLT and DDLT groups (P = 0.188). Cause of disease, disease severity, case period, and retransplantation had a significant association with patient survival (P = 0.002, P = 0.031, P = 0.003, and P = 0.024, respectively). CONCLUSION: Surgical techniques and perioperative management for transplant patients have improved and undergone standardization. Controlling perioperative infection and managing patients with HCC as LT candidates will result in better outcomes.
Carcinoma, Hepatocellular ; Cause of Death ; Graft Rejection ; Humans ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Recurrence ; Risk Factors ; Survival Rate ; Tissue Donors

Heart transplantation is now regarded as the treatment of choice for end-stage heart failure. To improve long-term results of the heart transplantation, we analyzed causes of death relative to time after transplantation. A total of 201 consecutive patients, 154 (76.6%) males, aged > or = 17 yr underwent heart transplantation between November 1992 and December 2008. Mean ages of recipients and donors were 42.8 +/- 12.4 and 29.8 +/- 9.6 yr, respectively. The bicaval anastomosis technique was used since 1999. Mean follow up duration was 6.5 +/- 4.4 yr. Two patients (1%) died in-hospital due to sepsis caused by infection. Late death occurred in 39 patients (19.4%) with the most common cause being sepsis due to infection. The 1-, 5-, and 10-yr survival rates in these patients were 95.5% +/- 1.5%, 86.9% +/- 2.6%, and 73.5% +/- 4.1%, respectively. The surgical results of heart transplantation in adults were excellent, with late mortality due primarily to infection, malignancy, and rejection. Cardiac deaths related to cardiac allograft vasculopathy were very rare.
Adult ; Anastomosis, Surgical/methods ; Female ; Follow-Up Studies ; Graft Rejection/mortality ; Heart Transplantation/*mortality ; Humans ; Immunosuppression/methods ; Infection/mortality ; Male ; Middle Aged ; Neoplasms/mortality ; Postoperative Complications/mortality/surgery ; Survival Rate ; Transplantation/*mortality ; Treatment Outcome

Solid organ transplantation is a therapeutic option for end-stage organ diseases. However, complications including infection and graft rejection, which are related to immunosuppressive therapy, remain the major causes of morbidity and mortality following solid organ transplantation. The optimal approach to infection in solid organ transplant recipients is prevention; failing this, prompt and aggressive diagnosis and therapy are essential. In addition, the epidemiology of infections after solid organ transplantation has shifted as a result of changes in immunosuppressive strategies and improved survival. Immunosuppression must be linked with appropriate vaccinations, donor and recipient screening, patient education regarding infectious risks and lifestyle, monitoring, and antimicrobial prophylaxis.
Diagnosis ; Epidemiology ; Graft Rejection ; Humans ; Immunosuppression ; Life Style ; Mass Screening ; Mortality ; Opportunistic Infections* ; Organ Transplantation* ; Patient Education as Topic ; Tissue Donors ; Transplants* ; Vaccination

BACKGROUND: Since the time various strategies have been introduced to overcome the ABO-blood barrier including local infusion therapy (LIT), plasmapheresis and rituximab, the graft and patient survival outcome of ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) has remarkably improved. But, the need for LIT under rituximab prophylaxis should be reevaluated because of high incidence of the LIT-related complications. The aim of this study was to verify the safety and efficacy of the protocol without local infusion therapy in ABOi ALDLT. METHODS: From November 2008 to December 2010, 43 cases of ABO-incompatible adult living donor liver transplantation were performed. In all cases, the spleen was preserved. From the 1st to 20th case, LIT was employed (group I, n=20). From the 21th case onwards, LIT was eliminated from the protocol (group II, n=23). The 3-month and 1-year patient and graft survival rates were compared between the two groups. The clinical parameters including recipient, donor and graft-related factors were also compared. The graft function was assessed in each group based on the serial changes in serum AST/ALT, total bilirubin and prothrombin time. RESULTS: There was 1 case of in-hospital mortality (2.3%) among the 43 cases. Overall 3-month and 1-year patient and graft survival rate was 97.7% and 92.1% during a mean period of 11.4 +/- 0.4 (0.9~28.9) months. There was no significant difference in the 3-month and 1-year patient and graft survival rates (95.0 vs. 100% and 90.0 vs. 92.9%, P=0.60) between groups. LIT-related complications occurred in 4 patients (20.0%). One case of antibody-mediated rejection occurred in group II. Both groups showed no difference in graft function at postoperative 3rd month. CONCLUSIONS: ABOi ALDLT without splenectomy and LIT resulted in promising outcomes. Therefore, LIT can be safely eliminated from the protocol.
Adult ; Antibodies, Monoclonal, Murine-Derived ; Bilirubin ; Graft Survival ; Hospital Mortality ; Humans ; Incidence ; Liver ; Liver Transplantation ; Living Donors ; Plasmapheresis ; Prothrombin ; Rejection (Psychology) ; Rituximab ; Spleen ; Splenectomy ; Tissue Donors ; Transplants

Solid organ transplantation has been established as an accepted treatment modality for end-stage diseases. Although the prognosis for organ recipients has improved with the development of surgical technical skills and the application of newly developed immunosuppressive agents, opportunistic infections remain the major cause of death in these patients. Invasive aspergillosis is one of the most common fungal infections in solid organ transplantation, and it carries a high mortality rate. In Korea, eight sporadic cases of invasive aspergillosis after kidney or heart transplantation have been reported. Recently, we experienced five cases of invasive aspergillosis after liver or heart transplantation over a four year period. Among these five patients, three died of uncontrollable aspergillosis and one died of heart failure and graft rejection. Early diagnosis and treatment are essential for the improvement of the prognosis for invasive aspergillosis after solid organ transplantation.
Aspergillosis* ; Cause of Death ; Early Diagnosis ; Graft Rejection ; Heart Failure ; Heart Transplantation ; Humans ; Immunosuppressive Agents ; Kidney ; Korea ; Liver ; Mortality ; Opportunistic Infections ; Organ Transplantation* ; Prognosis ; Transplants*

Lung transplantation is the choice of treatment for selected patients with end-stage pulmonary disease. However, retransplantation of the lung due to primary graft failure carries a high risk of morbidity and mortality. This is a case of a 52 year old male with emphysema who continuously needed a ventilator care and a tracheostomy. He underwent a left single lung transplantation but were not able to wean from the ventilator due to primary graft failure, and therefore we decided to do a retransplantation. Bilateral sequential single lung transplantation was performed under the cardiopulmonary bypass. The patient recovered quite well and was discharged and fully active with his work. Retransplantation although it carries a high risk, is a very effective treatment in patients with primary graft failure.
Cardiopulmonary Bypass ; Emphysema ; Graft Rejection ; Humans ; Lung Diseases ; Lung Transplantation* ; Lung* ; Male ; Middle Aged ; Mortality ; Pulmonary Emphysema ; Reoperation ; Tracheostomy ; Transplants* ; Ventilators, Mechanical

BACKGROUNDWe investigated the role of 1,25-dihydroxyvitamin D3(1,25-(OH)2D3) in preventing allograft from acute rejection following orthotopic liver transplantation.

METHODSA rat orthotopic liver transplantation model was used in this study. SD-Wistar rats served as a high responder strain combination. Recipients were subjected to administration of 1,25-(OH)2D3 at dosages ranging from 0.25 microg.kg(-1).d(-1) to 2.5 microg.kg(-1).d(-1). Survival after transplantation as well as pathological rejection grades and IFN-gamma mRNA, IL-10 mRNA transcription intragraft on day 7, and day 30 post-transplantation were observed.

RESULTSAfter recipients were treated with 1,25(OH)2D3 at dosages of 0.5 microg.kg(-1).d(-1) or 1.0 microg.kg(-1).d(-1), survivals of recipients were prolonged. Ninety-five percent confidence intervals of survival were 46 - 87 days and 69 - 102 days (both P = 0.0005 vs control group), respectively. On day seven post-transplantation, relative levels of IFN-gamma mRNA transcription were 0.59 +/- 0.12 and 0.49 +/- 0.16, which was higher than the control group (P = 0.005, P = 0.003, respectively). Relative levels of IL-10 mRNA transcription were 0.83 +/- 0.09 and 0.76 +/- 0.09, which was lower than the control group (P = 0.002, P = 0.003, respectively). At a dosage of 0.5 microg.kg(-1).d(-1), the median of pathological rejection grade on day seven and on day thirty post-transplantation were 1.5 and 2.0 in comparison with the CsA-treated group (P = 0.178, P = 0.171, respectively). At a dosage of 0.5 microg.kg(-1).d(-1), the median of pathological rejection grade on day seven and day thirty post-transplantation were 1.5 and 1.5 in comparison with CsA-treated group (P = 0.350, P = 0.693, respectively).

CONCLUSIONAfter each recipient was treated with 1,25-(OH)2D3 at a dosage of (0.5 - 1.0) microg.kg(-1).d(-1), transcription of cytokine intragraft was accommodated effectively and deviated to Th2 type, resulting in alleviation of acute rejection. 1,25-(OH)2D3 can prolong survival of recipient after orthotopic liver transplantation.

Animals ; Calcitriol ; pharmacology ; physiology ; Graft Rejection ; prevention & control ; Interferon-gamma ; genetics ; Interleukin-10 ; genetics ; Liver Transplantation ; mortality ; Male ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Transcription, Genetic