No abstract available.
Peritoneal Dialysis, Continuous Ambulatory*

No abstract available.
Animals ; Liver* ; Rats*

No abstract available.
Child* ; Humans ; Kidney Transplantation*

No abstract available.
Kidney Transplantation* ; Urinary Diversion*

Antibody-mediated rejection (ABMR) is associated with poor renal allograft survival. It shows poor response to conventional treatment with plasmapheresis, rituximab, and intravenous immunoglobulin. Bortezomib, a proteasome inhibitor used for treatment of multiple myeloma, has recently been reported as a treatment alternative for recipient desensitization and ABMR. A 58-year-old man was diagnosed with mixed-type ABMR with donor specific antibodies and acute T cell-mediated rejection early after kidney transplantation. Conventional therapy was administered, including antithymocyte globulin, plasmapheresis, and rituximab; however, his condition was found to be refractory to these antihumoral therapies. Following administration of bortezomib, his serum creatinine level returned to baseline with stable graft function. His serum creatinine level remains stable at 1.3 mg/dL at 10 months posttransplantation. Bortezomib is effective for treatment of refractory ABMR following kidney transplantation.
Allografts ; Antibodies ; Antilymphocyte Serum ; Bortezomib ; Creatinine ; Humans ; Immunoglobulins ; Kidney Transplantation ; Kidney* ; Middle Aged ; Multiple Myeloma ; Plasmapheresis ; Proteasome Inhibitors ; Rituximab ; Tissue Donors ; Transplantation* ; Transplants

Conversion of immunosuppressants to sirolimus, an inhibitor of mammalian target of rapamycin, is a useful treatment option for prevention of the adverse events of immunosuppressants such as calcineurin inhibitor in renal transplantation recipients. In addition, sirolimus has been improving the quality of life and increasing the survival of patients with renal transplantation by decreasing immunosuppression-related malignancies, particularly skin cancer. However, complete remission of skin squamous cell carcinoma after renal transplantation only by conversion to sirolimus has not been well reported, although its preventive effect on skin cancer is well known. We report on a 72-year-old male with squamous cell carcinoma in his nasal cavity consequent to renal transplantation, which was treated completely with the conversion of cyclosporine to sirolimus without surgical removal or chemotherapy.
Aged ; Calcineurin ; Carcinoma, Squamous Cell* ; Cyclosporine ; Drug Therapy ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Male ; Nasal Cavity* ; Quality of Life ; Sirolimus* ; Skin ; Skin Neoplasms

BACKGROUND: The United Network for Organ Sharing developed the continuous kidney donor risk index (KDRI) for measurement of the spectrum of risk associated with the various factors known to influence graft failure. This study was conducted in order to validate the KDRI in assessment of deceased donor kidney in Koreans. METHODS: Patients (n=404) who underwent kidney transplants performed at five transplantation centers from 2000 to 2010 were studied retrospectively. The distribution of the KDRI of donor kidneys was calculated and the distribution of kidney donors by standard criteria donor (SCD)/expanded criteria donor (ECD) and KDRI was compared. The KDRI were divided into five groups: <0.8, 0.8~1.0, 1.0~1.2, 1.2~1.4, and > or =1.4. Graft function and graft survival among KDRI groups were analyzed. RESULTS: The mean KDRI was 1.01 (range, 0.55~1.88). More than 90% of donors had KDRI <1.4. The distribution of kidneys by KDRI groups was 22.8%, 32.7%, 27.5%, 9.9%, and 7.2%, respectively. Among kidneys with KDRI <0.8, 10.5% were ECD, whereas all of the kidneys with KDRI > or =1.4 were ECD. The estimated GFR at one-year in the KDRI groups was 72.2, 65.8, 63.2, 69.1, and 47.1 mg/dL, respectively. Graft function was significantly lower in those with KDRI > or =1.4 (P<0.001). Five-year graft survival in the KDRI groups was 91.6%, 92.2%, 91.3%, 94.1%, and 56.4%, respectively. Graft survival was also significantly lower in those with KDRI > or =1.4 (P=0.001). CONCLUSIONS: The KDRI is a useful tool for estimation of posttransplant outcomes in the Korean population. The KDRI can be used by physicians as an additional assessment tool to assist in the decision making process regarding donor organ selection.
Decision Making ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation* ; Retrospective Studies ; Tissue Donors* ; Transplants

BACKGROUND: Kidney transplantation is the most effective treatment in patients with chronic kidney disease. Recently, the survival rate of kidney allografts has been markedly increased by the development of immunosuppressants. According to research reports published in Symphony in 2007 and 2009, low dose tacrolimus/mycophenolate mofetil (MMF) showed better results than cyclosporin/MMF in renal function and rejection. METHODS: We compared patient survival rate, graft survival rate, incidence of rejection, and metabolic complications in two groups of patients who received immunosuppressants with either tacrolimus/MMF/steroid or cyclosporin/MMF/steroid. All patients underwent kidney transplants at Keimyung University Dongsan Medical Center between January 1997 and December 2003 with follow-up over 10 years. RESULTS: A total of 180 patients were included in the research (117 patients were treated with tacrolimus/MMF/steroid and 63 patients with cyclosporin/MMF/steroid). The incidence rate of acute rejection was higher in the cyclosporin/MMF/steroid group; however, the difference was not statistically significant. In the case of metabolic complications, new onset diabetes after transplantation was more frequent in the tacrolimus/MMF/steroid group. The cyclosporin/MMF/steroid group appeared to have a higher rate of hypertension and hyperlipidemia. CONCLUSIONS: Overall, no significant differences in patient and graft survival rate were observed between the two groups.
Allografts ; Cyclosporine ; Follow-Up Studies ; Graft Survival ; Humans ; Hyperlipidemias ; Hypertension ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation* ; Renal Insufficiency, Chronic ; Research Report ; Survival Rate ; Tacrolimus

Despite a remarkable increase of deceased donors, organ shortage is the main hurdle of organ transplantation in Korea. Therefore, liver transplantation priority is a major issue of liver allocation. We confront a situation that needs to change in order to achieve more adequate and objective allocation of the system. We considered the MELD system as an alternative to the CTP score and Status system. For application of the MELD system, comparison between two systems is required; and a national-based retrospective review of liver transplantation candidates (waiting list) was conducted as a multi-center collaborative study. Eleven transplant centers participated in this national study. From 2009 to 2012, 2,702 waiting lists were enrolled. After mean 349+/-412 days follow-up, 967 patients (35.8%) of liver transplantation, 750 patients (27.8%) of drop-out/mortality, and 719 patients (26.6%) on waiting were identified. In analysis of patient mortality during waiting time, status system showed significant difference of waiting mortality by status at registration. However, differences of waiting mortality by MELD system were more prominent and discriminate. In comparisons by MELD score in exclusive Status 2A waiting patients, there was a significant difference of waiting mortality by MELD score. This means that the MELD system is a good predictor of short-term survival after listing compared with status system with CTP score. Korean national-based retrospective study showed the superiority of the MELD system in prediction of short-term mortality and usefulness as a determinant for allocation priority.
Cytidine Triphosphate ; Emergencies* ; End Stage Liver Disease ; Follow-Up Studies ; Humans ; Korea ; Liver Transplantation* ; Liver* ; Mortality ; Organ Transplantation ; Resource Allocation ; Retrospective Studies ; Survival Analysis* ; Tissue Donors* ; Transplants ; Waiting Lists

BACKGROUND: Two of the most sensitive methods for detecting donor-specific HLA antibodies (DSAs) are solid phase panel reactive antibody (PRA) assay using Luminex platform (Luminex-PRA), and a cell-based flow cytometric crossmatch (FCXM) test. We evaluated FCXM results in relation to DSAs detected by the Luminex-PRA method in solid organ transplantation candidates or post-transplant follow-up patients. METHODS: A total of 171 donor-recipient pairs were evaluated by Luminex-PRA (LIFECODES Class I and Class II ID kits; Gen-Probe, USA) and FCXM (T- and B-cells) tests. DSA levels were analyzed using a sum of median fluorescence intensity (MFI) values, and FCXM results were analyzed using MFI ratios. RESULTS: Class I and II DSAs were detected in 11.7% (20/171) and 11.1% (19/171) of tested sera, respectively. T-FCXM was negative in 97.4% (147/151) of Class I DSA negative sera, and B-FCXM was negative in 99.3% (137/138) of Class I and II DSA negative sera. T-FCXM was positive in 91.7% (11/12) of sera with moderate to strong Class I DSAs and B-FCXM was positive in 88.9% (16/18) of sera with moderate to strong Class II and/or Class I DSAs in the evaluation of sensitivities of FCXM in relation to DSA. There were significant correlations between FCXM ratios and DSA levels for both T-FCXM (P=0.008) and B-FCXM (P<0.001). CONCLUSIONS: The FCXM results correlated well with the DSAs detected by the Luminex-PRA method. The specificities of T- and B-FCXM in relation to DSAs were high (>97%) and the sensitivities of T- and B-FCXM were satisfactory (>88%) in detecting moderate to strong DSAs.
Antibodies ; Flow Cytometry ; Fluorescence ; Follow-Up Studies ; Histocompatibility Testing ; HLA Antigens ; Humans ; Organ Transplantation ; Transplants