The field of organ transplantation has undergone a continual evolution to become the standard treatment for patients with end-stage diseases in diverse organs including the kidney, liver, pancreas, intestine, heart, and lung diseases. The efforts to increase organ donation and clinical studies along with basic researches are very important for the progress of transplantation medicine. This review is focused on "What's new in transplantation surgery and medicine", addressing the current hot issues on the attempts at organ shortage, recent findings on antigen recognition, improved immunosuppressive strategies, and finally recent advancements in kidney and liver transplantation.
Heart ; Humans ; Intestines ; Kidney ; Liver ; Liver Transplantation ; Lung Diseases ; Organ Transplantation ; Pancreas ; Tissue and Organ Procurement ; Transplantation ; Transplants

Bone Marrow Transplantation ; Corneal Transplantation ; Heart Transplantation ; Humans ; Kidney Transplantation ; Liver Transplantation ; Lung Transplantation ; Organ Transplantation ; Poisoning ; etiology ; surgery

During the year of 1996, total 1,013 solid organ transplantations were performed at 38 centers in Korea: 941 kidney transplantation at 36 centers, 48 liver transplantation at 13 centers, 20 heart transplantation at 7 centers, 2 pancreas transplantation at 2 centers, and 2 lung transplantation at 2 centers. (Kidney) There were 941 kidney transplantations including 42 retransplantations. Living related donors were 544 (57.8%), living unrelated donors were 286 (30.4%), and cadaver donors were 111 (11.8%). Twenty centers of 36 performed kidney transplantation less than 20 cases. Numbers of donors and recipients were the most at 4th decade group. Cadaver donor kidneys were procured at the same transplant center in 97 (87.4%). Multiorgan procurement technique was used in 39 cases. The most common cause of donor death was traffic accident (57.4%). Chronic GN was the most frequent disease in recipient nephropathy (36.9%). Three antigen mismatch of HLA was the most frequent group (43.1%). Cadaver donor transplantation was performed within 12 hours of cold ischemia time in 86.5%. Triple regimen immunosuppression was used in 65.4%. Acute rejection occurred in 217 cases. Overall recovery rate with antirejection therapies was 70.9%. Among 941 patients, 17 patients succumbed with 0.5% of operative mortality. Graft loss was 37 (3.9%.). (Liver) There were 48 liver transplantations including 1 retransplantation. Living related partial liver transplantation was performed in 19 (39.6%). Donors were the most frequent in the third decade group. Recipients were the most frequent in the first decade group. Cadaver donor liver was obtained from the same transplant center in 20 (69.0%). The most frequent cause of hepatic failure was chronic viral hepatitis (22) in adult and biliary atresia (13) in child. Status 3 was the most common medical status of recipient. Cadaver donor liver transplantation was performed within 12 hours of cold ischemia time in 86.2%. Triple regimen immunosuppression was used in 64.6% and FK506 based regimen in 20.8%. Acute rejection occurred in 12 cases. Overall recovery rate with antirejection therapies were 71.4%. Among 48 patients, 17 were dead with 31.3% of operative mortality. (Heart) There were 20 heart transplantations. Donors were the most frequent in the third decade group. Recipients were the most frequent in the fourth decade group. Heart was obtained from the same transplant center in 9 (45%). The most frequent cause of heart failure was idiopathic cardiomyopathy (14). All heart transplantations were performed within 4 hours of cold ischemia time. Triple regimen immunosuppression was used in 95%. Acute rejection occurred in 5 cases with 100% recovery rate. Among 20 patients, 5 were dead with 10% of operative mortality. (Pancreas) There were two pancreas transplantations. One was juvenile diabetes patient and the other was adult onset diabetes patient. Both were simultaneous pancreas-kidney transplantations. Both were obtained by multiorgan procurement technique, one at the same transplant center and the other was shared. Cold ischemia time was less than 4 hours and quadruple immunosuppression was performed in all. One of them died and one living patient does not need insulin treatment. (Lung) The first case of lung transplantation was performed in 1996 and two lung transplantations were performed. One was single lung transplantation and the other was double lung transplantation. Causes of lung disease were idiopathic pulmonary fibrosis and lymphangioadenomyomatosis each. Both lungs were procuredat the same transplant center with multiorgan harvest technique. Cold ischemia time was less than 4 hours and quadruple immunosuppression was performed in all. Both were dead with 50% operative mortality. Kidney transplantation showed comparable results to those of western countries, however, other organ transplantations seem to need more time periods for the good results.
Accidents, Traffic ; Adult ; Biliary Atresia ; Cadaver ; Cardiomyopathies ; Child ; Cold Ischemia ; Heart ; Heart Failure ; Heart Transplantation ; Hepatitis ; Humans ; Idiopathic Pulmonary Fibrosis ; Immunosuppression ; Insulin ; Kidney ; Kidney Transplantation ; Korea* ; Liver ; Liver Failure ; Liver Transplantation ; Lung ; Lung Diseases ; Lung Transplantation ; Mortality ; Organ Transplantation* ; Pancreas ; Pancreas Transplantation ; Tacrolimus ; Tissue Donors ; Transplants* ; Unrelated Donors

During the last 30 years, major organ transplantation has become popular, even in Korea, such as kidney, liver, etc. After the successful clinical cardiac transplantation in Korea, many cases of cardiac transplantation are being performed in some centers. But lung transplantation has a lot of obstacles, especially donor shortage and decreased tolerability of the lung to ischemia-reperfusion injury. Usually it was considered that the maximum safety margin of ischemic time in lung transplantation was about 4 to 6 hours. So, many investigators have tried to develop better preservation methods and experimental model for evaluation of effectiveness in those various methods. But most of those methods had several drawbacks in clinical and experimental settings. So we developed an easily-controllable, reliable, and inexpensive experimental model of isolated rabbit lung block. Using these model, we evaluated its effectiveness and reliability for the experiment of ischemia-reperfusion injury in lung transplantation.
Heart Transplantation ; Humans ; Ischemia* ; Kidney ; Korea ; Liver ; Lung Transplantation ; Lung* ; Models, Theoretical* ; Organ Transplantation ; Reperfusion Injury ; Research Personnel ; Tissue Donors ; Transplantation ; Transplants

BACKGROUNDThe University of Wisconsin colloid based preserving solution (UW solution) is the most efficient preserving solution for multiorgan transplantation. Unfortunately, unavailability of delayed organ preserving solutions hindered further progression of cardinal organ transplantation in China. In this study, we validated an organ preserving Changzheng Organ Preserving Solution (CZ-1 solution) and compared it with UW solution.

METHODSA series of studies were conducted on how and how long CZ-1 solution could preserve the kidneys, livers, hearts, lungs and pancreas of New Zealand rabbits and SD rats. Morphology of transplanted organs was studied by visible microscopy and electron microscopy; biochemical and physiological functions and the survival rate of the organs during prolonged cold storage were studied.

RESULTSThere was no significant difference between CZ-1 and UW solutions in preserving the kidneys, livers, hearts or lungs of rabbits; kidneys, livers, intestinal mucosa or pancreases of SD rats or five deceased donors' testicles. In some aspects, such as preserving rabbits' hearts, rats' intestinal mucosa and pancreases, the effect of CZ-1 solution was superior to UW solution. CZ-1 could safely preserve kidneys for 72 hours, livers for 24 hours, hearts for 18 hours and lungs for 8 hours for SD rats. Twelve kidneys preserved in cold CZ-1 solution for 22 - 31 hours were transplanted successfully and the mean renal function recovery time was (3.83 +/- 1.68) days.

CONCLUSIONSCZ-1 solution is as effective as UW solution for organ preservation. The development of CZ-1 solution not only reduces costs and improves preservation of organs, but also promotes future development of organ transplantation in China.

Adenosine ; pharmacology ; Allopurinol ; pharmacology ; Animals ; China ; Glutathione ; pharmacology ; Heart ; drug effects ; physiology ; Heart Transplantation ; methods ; Insulin ; pharmacology ; Intestine, Small ; drug effects ; physiology ; Kidney ; drug effects ; physiology ; Kidney Transplantation ; methods ; Liver ; drug effects ; physiology ; Liver Transplantation ; methods ; Lung ; drug effects ; physiology ; Lung Transplantation ; methods ; Male ; Organ Preservation ; economics ; methods ; Organ Preservation Solutions ; pharmacology ; Pancreas ; drug effects ; physiology ; Pancreas Transplantation ; methods ; Pharmaceutical Solutions ; pharmacology ; Rabbits ; Raffinose ; pharmacology ; Testis ; drug effects ; physiology

China ; Heart Transplantation ; pathology ; Humans ; Kidney Transplantation ; pathology ; Liver Transplantation ; pathology ; Organ Transplantation ; pathology ; Tissue and Organ Procurement

BACKGROUND: It is well known that skin cancer and precancerous disease develop more frequently in patients undergoing solid organ transplantation than normal populations in the normal population in Western countries. However, to date, the clinical and demographic features of skin cancer and precancerous disease after solid organ transplantation are not established in Asian countries. We evaluated the clinical and demographic features of primary skin cancer and precancerous lesions after solid organ transplantation and compared these with the trends observed in Western countries. METHODS: We retrospectively reviewed the medical records of patients who underwent kidney, liver, heart, and lung transplantation between January 1995 and April 2017 and who developed skin cancer or precancerous lesions after transplantation. The various lesions observed were squamous and basal cell carcinoma, malignant melanoma, Kaposi sarcoma, Bowen's disease, and actinic keratosis. RESULTS: We identified 4604 patients who received organ transplant. The mean age of patients was 44.8 years (male, 64.6%; female, 35.4%), and the sum of the person-year of observation time was 31,024 person-years. The incidence rate per 100,000 person-years was 29.01 for squamous cell carcinoma, 19.34 for basal cell carcinoma, 6.45 for malignant melanoma 3.22 for Kaposi sarcoma, and 74.17 for Bowen's disease and actinic keratosis. The incidence rate per 100,000 person-years was the highest in patients undergoing heart transplantation (610.50), followed by those who underwent kidney transplantation (136.54) and liver transplantation (90.15). Koreans showed lower incidence rates than those observed in Westerners. CONCLUSION: The incidence of primary skin cancer and precancerous lesions after solid organ transplantation in Koreans was lower than that in Westerners. Squamous cell carcinoma was the most common skin cancer in patients undergoing solid organ transplantation and the incidence rate of skin cancer and precancerous lesions was the highest in patients undergoing heart transplantation.
Asian Continental Ancestry Group ; Bowen's Disease ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Female ; Heart ; Heart Transplantation ; Humans ; Incidence* ; Keratosis, Actinic ; Kidney ; Kidney Transplantation ; Korea* ; Liver ; Liver Transplantation ; Lung Transplantation ; Medical Records ; Melanoma ; Organ Transplantation* ; Retrospective Studies ; Sarcoma, Kaposi ; Skin Neoplasms* ; Skin* ; Transplants*

Heart transplantation remains the definitive surgical solution for Stage D heart failure. There have been impressive developments in lung transplantation also. This review is focused on the recent advancements in the field of heart and lung transplantation and the current status of thoracic organ transplantation in Korea. Future directions of thoracic organ transplantation are discussed.
Heart ; Heart Failure ; Heart Transplantation ; Korea ; Lung ; Lung Transplantation ; Organ Transplantation ; Transplants

No abstract available.
Facial Pain* ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Organ Transplantation

AIMS: This study was done to develop an ethical guideline for organ transplatation, a life-saving treatment which helps improve the quality of life. METHODS: This study begins with a survey of the Korean current state of affairs concerning organ transplantation. This study used a survey questionnaire and received responses from 31 hospitals out of 45 hospitals where organ transplantation are being done. After this survey, followed by a discussion of ethical considerations in arranging organ transplants. Before proposing an ethical guideline, this study discusses a series of interesting ethical issues in transplanting(both living and cadaveric)organs including ethical foundations of organ transplantation, distributive justice and matters of donor's consent in organ transplatation. RESULTS: The foremost research for this study boils down to a survey paper titled, "An Analysis of the Current State of Affairs Concerning Organ Transplantation and Ethical Considerations in Domestic and International Hospitals." Based upon data collected from various hospitals, this work analyzes items, such as the frequency and types of organs transplanted in a hospital, the existence of organ transplant coordinator, the performance of the hospital ethics committee, and ethical considerations in obtaining consents from the living donor. Although thousands of organs are annually transplanted in domestic hospitals, virtually none of them are found to meet ethically proper standards. The paper points out the need to institutionalize a nationwide cadaveric organ distribution organization like UNOS(United Network for Organ Sharing) in the U.S., and proposes to stretch out the national health insurance to extensively cover transplanting expenses. "The Ethical Foundation of Organ Transplantation", the author counts three key ethical principles in organ transplantation: the principle of respect for autonomy; the principle of beneficence; and the principle of justice. He argues that in cases of living donor no principle should take precedence over the principle of respect for autonomy and thus it is very important for a hospital to obtain the donor's consent. As for cadaveric organ transplantation, he holds reservation because he is worried that serious shortage of organs for transplantation in conjunction with pure utilitarian considerations could change the definition of death so that the brain death gains more popularity than ever. In addition, the author claims that the proponent of organ transplantation must distinguish the moral dimension of the discussion from the legal one because otherwise she would hardly be able to defend herself from the slippery slope argument against organ transplantation. This paper concludes with a note that we must implement restrictions to avoid undesired effects if organ transplantation could ever be justified. "A Discussion of Distributive Justice in Organ Transplantation" comprises two parts. The first half delineates above mentioned ethical principles in the context of organ transplantation, while the second half goes generally over the UNOS Point System. This work is focused entirely upon cadaveric organ transplants, because the vast majority of organs available for transplants comes from cadavers and the number is still increasing. The UNOS allocates cadaveric organs based upon both medical and justice criteria. Following are summaries of the UNOS policy on organ distribution. Every potential recipient of organ transplants must be listed on the UNOS computer system waiting list. Allocation of cadaveric kidneys consider factors such as waiting time, six antigen match, panel reactive antibody, blood group and age. The UNOS Point System allocates livers to the local patients first, followed by regional and national patients respectively, in order to limit ischemic time. A recipient of liver transplant belongs to one of five(0~4) medical status levels where status 4 is the most medically urgent. At the regional and national levels pancreas are allocated first to patients with excellent HLA matches, while at the local level waiting time is the sole factor. The intestinal organ allocation system is based on two(1~2) patient status codes, ABO blood type identity and time waiting. In heart or lung tranplants ischemic time seriously matters. "A Biomedical Study of Informed Consent from the Organ Donor" investigates several topics: the relevance of the principle of respect for autonomy as the basic principle of informed consent; how the autonomy of the organ donor to be respected; and the role of the hospital ethics committee in obtaining informed consent from the donor. The author finds the principle of respect for patient's autonomy not sufficient for the basic principle of the living donor's informed consent because there is some danger in which the patient may be left uncared-for, and thus she suggests that the principle of nonmaleficence and the principle of care also be considered. That the principle of respect for autonomy turns out not sufficient even for cadaveric organ donation, and so judgment based upon the best interest of the deceased may seem appropriate for people from some special groups. A medical team must make efforts to identify the donor's competence and voluntariness, i.e., preconditions of informed consent. All the relevant medical information should be disclosed to the living donor. Once the donor makes a judgment, medical experts should respect the donor's decision. This article puts an emphasis on the role of the hospital ethics committee in such activities as identifying donor's voluntariness, confirming the disclosure, and evaluating the minority's benefit. The last work in this paper, "A Moral Theological Investigation of the Presumed Consent in Organ Transplantation" talk about Principium Riflexum(the principle of reflection) in an attempt to explain the possibility that we may harvest cadaveric organs from the deceased who while alive had never expressed their wishes concerning organ donation. To apply the principle in the context of presumed consent, the author, a Catholic priest, introduces two elements of the principle. Probabilismus allows us to feel free to choose when we face dubious matters(in dubio libetas), and by the rule of selection we are justified in choosing whatever our consciousness mandates. He takes both elements to support the presumed consent of the deceased because he believes the good that people may contribute to their neighbors by donating organs would obviously override opposing reasons. Although the author argues for the presumed consent from the deceased, he does not overlook the family grief in donating the cadaveric organs. He concludes with a suggestion that we should work to keep the public aware of cadaveric organ donation and to form public opinions education should play a key role. CONCLUSION: Researcher suggest an Ethical Guideline for Organ Transplantation as our study conclusion. 1) Body organs may be transplanted to protect the health and well-being of the patient, but not for the medical or scientific research. 2) Body organs may be taken for transplantation, only with the consent from the donor. In cases of cadaveric donors who have left no formal consent in the lifetime, they are to be presumed to refuse to donate body organs. 3) In principle, cadaveric transplantation is preferred. Living donors are limited to competent adults who have blood ties with the patient, e.g., parents, children, or siblings of the patient. However, reversible tissue like bone marrows donation may be an exception to this limitation. In particular, no living donors may be put under inappropriate pressure or influences. Body organs may be taken from the living donor only if based upon sufficient and easy-to-understand information provided, the donor voluntarily consents after (s)he deliberately balances benefits against harm. 4) Under no circumstances human bodies, organs, or tissues may be sold or purchased for transplantation. A physician should not participate in any transplanting operations if (s)he becomes to know that the transplant has been obtained through a transaction. 5) Recipients of organs for transplantation should be determined in accordance with the principle of justice on the allocation of limited medical resources. 6) When a vital, single organ is to be transplanted, the death of the donor shall have been determined by at least one physician other than the recipient's physician. 7) Transplant procedures of body organs should be undertaken (a) only by physicians who possess special medical knowledge and technical competence developed through special training, study, and laboratory experience and practice, and (b) in medical institutions with adequate facilities. 8) All decision procedures in transplanting body organs should be objective, open to parties involved, kept accurately on record, and maintained for a given period of time.
Adult ; Beneficence ; Bioethics* ; Bone Marrow ; Brain Death ; Cadaver ; Child ; Computer Systems ; Consciousness ; Disclosure ; Education ; Ethics ; Ethics Committees, Clinical ; Foundations ; Furunculosis ; Grief ; Heart ; Human Body ; Humans ; Informed Consent ; Judgment ; Kidney ; Liver ; Living Donors ; Lung ; Mental Competency ; National Health Programs ; Organ Transplantation* ; Pancreas ; Parents ; Presumed Consent ; Public Opinion ; Quality of Life ; Surveys and Questionnaires ; Siblings ; Social Justice ; Tissue and Organ Procurement ; Tissue Donors ; Transplants* ; Waiting Lists ; Wedge Argument