PURPOSE: As transplantation depends greatly on organ donations, it is very important to gain better understanding of perceptions and attitudes on organ donation. In this paper, we want to evaluate the perceptions and attitudes of Koreans on the brain death and the organ donation. METHODS: The interview survey was carried out on a national scale. Questionnaires were collected from 1,002 adults and analyzed using descriptive statistics. RESULTS: 51.8% of respondents have positive perceptions on the brain death, and 74.3% of positive respondents on the brain death suppose to agree to the organ donation from the brain dead. 37.1% of respondents have positive perceptions on their own marrow donation, and 76.3% of respondents have positive perceptions on their own kidney or part of liver donation to family members. They consider urgency to be the most important criterion in deciding the order of transplantation, and then recoverability, age, and waiting order are considered to be important criteria in the order. 43.8% respondents think that buying or selling organs should not be allowed in any case, 46.7% think that it could be allowed in some special cases, and 6.1% think that it should be allowed in any case. CONCLUSION: The survey results show that Koreans have positive perceptions on the organ donation on the whole. However, the number of cases of organ donations from brain dead donors reduced in recent years after the enactment of the law of organ transplantation. To find a way out of this situation, relevant policies and effective champagnes need to be developed and put into effect.
Adult ; Bone Marrow ; Brain Death ; Humans ; Jurisprudence ; Kidney ; Liver ; Organ Transplantation ; Surveys and Questionnaires ; Surveys and Questionnaires ; Tissue and Organ Procurement* ; Tissue Donors ; Transplantation ; Transplants

A twenty-year-old man developed pruritic papules on his right forearm on the 25th day after an allogeneic bone marrow transplantation from an HLA-matched related donor. The skin lesion turned out to be lymphomatoid papulosis, both histologically and immunophenotypically, not a GVHD skin lesion. Lymphomatoid papulosis is a chronic lymphoproliferative disease of the skin, characterized by recurrent crusts of pruritic papules, which initially appearing on the upper trunk and both extremities. The lesions heal spontaneously within 2~8 weeks, usually leaving slightly depressed oval scars. Histologically, the lesions show wedge-shaped dense dermal infiltrates of lymphoid cells, with numerous eosinophils, neutrophils and atypical lymphocytes. As much as 50% of the infiltrates show atypical lymphocytes, and the dermal vessels may show endothelial swelling, fibrin deposition and red blood cell extravasation. We are reporting a case of spontaneously healing CD56+ lymphomatoid papulosis, in the patient who received bone marrow transplantation, is reported.
Bone Marrow Transplantation ; Bone Marrow* ; Cicatrix ; Eosinophils ; Erythrocytes ; Extremities ; Fibrin ; Forearm ; Humans ; Lymphocytes ; Lymphomatoid Papulosis* ; Neutrophils ; Skin ; Tissue Donors

Acute graft-versus-host-disease (GVHD) is characterized by selective damage to the liver, the skin, and the gastrointestinal tract. Following allogeneic hematopoietic stem cell transplantation, donor bone marrow (BM) cells repopulate the immune system of the recipient. We previously demonstrated that the acute intestinal GVHD (iGVHD) mortality rate was higher in MyD88-deficient BM recipients than that in the control BM recipients. In the present study, the role of MyD88 (expressed by donor BM) in the pathophysiology of hepatic GVHD (hGVHD) was examined. Unlike iGVHD, transplantation with MyD88-deficient T-cell depleted (TCD) BM attenuated hGVHD severity and was associated with low infiltration of T cells into the liver of the recipients. Moreover, GVHD hosts, transplanted with MyD88-deficient TCD BM, exhibited markedly reduced expansion of CD11b(+)Gr-1(+) myeloid-derived suppressor cells (MDSC) in the liver. Adoptive injection of the MDSC from wild type mice, but not MyD88-deficient mice, enhanced hepatic T cell infiltration in the MyD88-deficient TCD BM recipients. Pre-treatment of BM donors with LPS increased MDSC levels in the liver of allogeneic wild type BM recipients. In conclusion, hGVHD and iGVHD may occur through various mechanisms based on the presence of MyD88 in the non-T cell compartment of the allograft.
Allografts ; Animals ; Bone Marrow* ; Gastrointestinal Tract ; Graft vs Host Disease* ; Hematopoietic Stem Cell Transplantation ; Humans ; Immune System ; Liver ; Mice ; Mortality ; Skin ; T-Lymphocytes ; Tissue Donors*

Cyclosporine A, a fungal metabolite, has been known as a potent immunosuppressant in experimental animals and clinical settings of allotransplantation. It has been responsible for improvements on the success of human kidney, liver, heart, lung, and bone marrow allotransplantation. FK-506, a new antilymphocytic agent, has been reported to be a potent immunosuppressive agent discovered in recent years and now being actively investigated. But there are many questions remaining unanswered about the effective dose and possible side effects of FK-506. So we studied the full thickness skin allotransplantation from BALB/c mouse to C57BL mouse to investigate the survival of allografted skin in a mouse model using the different doses of cyclosporine A and FK-506 and to examine the histological findings at the different period. The results were as follows: 1. The mean survival time (MST) of skin allograft in nontreated control group was 8.6 days. 2. The MST of skin allograft in group 3 treated with cyclosprorine A in 10 mg/kg/day for two weeks was 17.7 days, and that of the group 4 treated with FK-506 in 0.5mg/kg/day for two weeks was 19.7 days. The MST of group 4 was longer than that of group 3 (p>0.05). 3. The MST was increased from 19.7 to 23.1 days as the dose of FK-506 increased from 0.5 mg/kg/day to 1 mg/kg/day (p>0.05). 4. There was no difference in MST between long-term(16 weeks) treatment groups of cyclosporine A and FK-506, and the expire rates of the experimental animals were similarly high in both groups (40%, 50%). 5. The combined treatment of low dose cyclosporine A and FK-506 was more effective method to lengthen the MST and to reduce the expire rate than individual high dose treatment of Cs A or FK-506. 6. The expire rates of experimental animal were higher in long-term treatment groups (36.6%) than in short-term treatment groups(7.5%), and the expire rate of combined treatment groups was lowest (20%) among those of long-term treatment groups. The cause of death was not exactly known, but it could be assumed that the toxicity of drugs may result in death. 7. The histologic findings showed necrosis and mononuclear cell infiltration in rejection period that was consistent with the gross findings, but treated groups maintained normal histological architecture a much longer period than the nontreated group. There was no difference in histologic findings between the cyclosporine A treated groups and FK-506 treated groups. With the above results, it can be concluded that FK-506 and Cs A prolonged the survival of skin allotransplantation in mouse. and the low-dose combined treatment of these two drugs is the most effective method for reducing the rejection. It can be expected that adequate use of these immunosuppressants may be useful for skin allografting in severed burn patients and composite tissue transplantation.
Allografts* ; Animals ; Bone Marrow ; Burns ; Cause of Death ; Cyclosporine* ; Heart ; Humans ; Immunosuppressive Agents ; Kidney ; Liver ; Lung ; Mice* ; Mice, Inbred C57BL ; Necrosis ; Skin* ; Survival Rate ; Tacrolimus* ; Tissue Transplantation ; Transplantation, Homologous ; Transplants

The infusion and persistence in a transplant recipient of donor-derived bone marrow cells (DBMC) of multi-lineage can lead to a state of permanent chimerism. In solid vascular organ transplantation, the donor bone marrow lineage cells can even be derived from the transplant organ, and these cells can be detected in very small numbers in the recipient. This has been called microchimerism. Much controversy has developed with respect to the function of chimeric cells in organ transplantation. One idea is that the occurrence of these donor cells found in microchimerism in the recipient are coincidental and have no long-term beneficial effect on engraftment. A second and opposing view, is that these donor cells have immunoregulatory function that affect both the acute and chronic phases of the recipient anti-donor responses. It follows that detecting quantitative changes in chimerism might serve as an indication of the donor-specific alloimmune or regulatory response that could occur in concert with or independent of other adaptive immune responses. The latter, including autoimmune native disease, need to be controlled in the transplant organ. The safety and immune tolerance potential of DBMC infusion with deceased and living donor renal transplants was evaluated in a non-randomized trial at this center and compared with non-infused controls given identical immunosuppression. Overall DBMC infusions were well tolerated by the recipients. There were no complications from the infusion (s), no episodes of graft-vs-host disease (GVHD) and no increase infections or other complications. In the deceased DBMC- kidney trial, actuarial graft survival at 5 years was superior especially when graft survival was censored for recipient death. Acute rejections were significant reduced in patients given two DBMC infusions, and chronic rejection was dramatically reduced in all DBMC treated patients. The most interesting finding was that the degree of microchimerism slowly increased over the years the DBMC group that had exhibited no rejection episodes. In the DBMC-living related trial, the incidence of acute rejection did not differ between groups. However, DBMC chimerism in recipient iliac crest marrow had increased more rapidly than might be predicted from results previously seen in the cadaver group, despite four times fewer DBMC infused, with the generation of T- regulartory cells in-vitro assays.
*Bone Marrow Transplantation ; Humans ; *Kidney Transplantation ; *Living Donors ; *Tissue Donors ; *Transplantation Chimera ; *Transplantation Tolerance

PURPOSE: Peripheral blood stem cells (PBSC) can be mobilized by use of G-CSF alone from normal bone marrow. In this study, feasibility of mobilization, collection, and hematologic recovery after transplantion were evaluated. METHPDS: From normal undamaged bone marrow of normal PBSC donors and patients with high risk brain tumor who had no experience of chemotherapy or radiotherapy, PBSC was mobilized by use of G-CSF alone. Ten ug/kg/day of G-CSF was injected subcutaneously and leukaphereses were done on the fourth and fifth day of G-CSF injection. Nucleated cells (NC), mononuclear cells (MNC), CD34+ cells and colony forming cells (CFC) were counted. Hematologic recovery was evaluated in 4 autologous transplantations and 6 allogeneic transplantations, 4 of which were done after T cell depletion. RESULTS: Twenty four leukaphereses were done in 6 normal donors and 6 patients with high risk brain tumor. Median 603.3 (342.6~834.5) mL/kg of blood was processed for median 447 (392~549) minutes. Collected cells were as follows; NC: 11.88 (3.11~25.89)x108/kg of donor, MNC: 8.66 (2.61~12.84)x10(8)/kg of donor, CD34+ cells: 7.05 (2.95~11.73)x10(6)/kg of donor, CFC: 25.38 (3.62~35.27)x10(5)/kg of donor, respectively. In allogeneic transplantation, time to reach absolute neutrophil count (ANC)> 500/uL, 1,000/ uL and platelet count> 20,000/uL, 50,000/uL were 10 (9~15) days, 11 (9~16) days, 11 (8~30) days, and 32 (19~156) days, respectively. In autologous transplantation, time to reach ANC> 500/uL, 1,000/uL and platelet count> 20,000/uL, 50,000/uL were 9.5 (9~11) days, 10.0 (9~11) days, 10.5 (9~13) days, and 14.5 (13~17) days, respectively. CONCLUSION: Sufficient number of undamaged PBSC was collected from normal bone marrow by use of G-CSF alone. Hematologic recovery after transplantaion was more rapid than allogeneic bone marrow transplantation or autologous PBSCT which was done with cells collected after chemotherapy and/or radiotherapy.
Autografts ; Blood Platelets ; Bone Marrow Transplantation ; Bone Marrow* ; Brain Neoplasms ; Drug Therapy ; Feasibility Studies ; Granulocyte Colony-Stimulating Factor* ; Humans ; Leukapheresis ; Neutrophils ; Peripheral Blood Stem Cell Transplantation ; Radiotherapy ; Stem Cells* ; Tissue Donors ; Transplantation, Autologous ; Transplantation, Homologous

PURPOSE: Whole liver transplantation has limitation including donor shortage and fatal surgical complications. Hepatocyte transplantation, which is simpler and less expensive than whole liver transplantation, allows the use of living related donors, permits the use of a single donor organ for multiple recipients, and makes possible the cryopreser-vation of hepatocytes for future use. However, hepatocytes have limitation of proliferation and lose their property during culture period. To over come this problems, here we performed differentiation of bone marrow derived mesenchymal stem cells into hepatocytes. METHODS: Human bone marrow cells were harvested from posterior iliac spine of male and then mononuclear cells were obtained by Ficoll-Paque density-gradient centrifuge and plated in tissue culture flasks. For hepatogenic differentiation, we used modified Kuan-Der Lee's method. After differentiation, hepatocytes were collected and RT-PCR and PAS stain analysis were performed. RESULTS: After 5 weeks of cultivation period, mesenchymal stem cells showed cuboidal morphology and contained abundant granules in the cytoplasm. RT-PCR analysis showed increased expression of hepatocyte-specific marker genes (albumin,CK18, PERCK, CPS). Undifferentiated MSCs were not stained with PAS and differentiated hepatocytes from human MSCs stained with PAS indicating that hepatocytes contained glycogen in the cytoplasm. CONCLUSION: Hepatocyte transplantation could be one of the most effective treatments for chronic liver disease. However, hepatocyte has several disadvantages and problems. For alternative cell therapy sources, human bone marrow derived MSCs are considered as transplantable cells. Human MSCs are able to differentiate into functional hepatocytes in vitro and can be a possible cell transplantation source for chronic liver disease patients. Further studies should be done for differentiating human MSCs to hepatocytes in vivo condition.
Bone Marrow ; Bone Marrow Cells ; Cell Transplantation ; Cell- and Tissue-Based Therapy ; Cytoplasm ; Glycogen ; Hepatocytes* ; Humans* ; Liver Diseases ; Liver Transplantation ; Male ; Mesenchymal Stromal Cells* ; Spine ; Tissue Donors ; Transplants

BACKGROUND: Transplantation of solid organs has been increasing explosively. However, numerous problems remain unsolved, including the requirement for chronic immunosuppressive therapy and the shortage of donor organs. Recently one way to overcome this is bone marrow transplantation after total body irradiation. Especially though the dose of radiation used for conditioning is decreased, allogeneic bone marrow cells are engrafted and it can induce donor specific tolerance for allografting. The aim of this study is to develop a nonlethal conditioning approach to achieve donor chimerism and to confirm donor specific tolerance in C57BL/6 mice. METHODS: We performed experiments on C57BL/6 mice divided into three groups according to preparatory radiation dosage. C57BL/6 mice received sublethal dose of radiation and transplanted with bone marrow cells from BALB/c. The percentage of donor derived cells was analyzed by flow cytometry (FACS) and the donor specific tolerance for allografts was assessed by BALB/c skin grafts and so did it by mixed lymphocyte reaction (MLR) and cytotoxicity (CML) using spleen cells from chimeras (BALB/c->C57BL/6). RESULTS: Induction of alllogeneic donor chimerism occurred in 50%, 100%, 100% of animals irradiated with 6Gy, 7Gy, and 9Gy TBI, respectively. One hundred percent of chimeras with evidence of donor chimerism accepted skin allografts. Moreover, mixed chimeras exhibited donor specific tolerance in vitro as assessed by MLR and CML. CONCLUSION: This strategy induced the donor chimerism and exhibited the donor specific tolerance effect for skin allografting.
Allografts ; Animals ; Bone Marrow Cells ; Bone Marrow Transplantation ; Chimera ; Chimerism* ; Flow Cytometry ; Humans ; Immune Tolerance* ; Lymphocyte Culture Test, Mixed ; Mice ; Organ Transplantation* ; Radiation Dosage ; Skin ; Spleen ; Tissue Donors* ; Transplantation, Homologous ; Transplants* ; Whole-Body Irradiation

OBJECTIVETo investigate the feasibility of using marrow stromal osteoblast (MSO) as bone derived cell and using cancellous bone matrix (CBM) as scaffold for bone tissue engineering, the subcutaneous osteogenesis of MSO-CBM compound artificial bone (MCCAB) was observed in the experiment.

METHODSThe marrow stromal cells of adult New Zealand rabbits cultivated and induced in vitro were used to form MCCAB by mixing, seeding and solidifying methods assisted by alginate. The MCCABs were auto-transplanted subcutaneously into the rabbits for 4 to 8 weeks. The alginate-cancellous bone matrix composites or the cancellous bone matrix alone were implanted as control. The effectiveness of bone formation was assessed by means of roentgenography, histology and computerized histomorphometry.

RESULTSThe osteogenesis of MCCABs was better than that of the alginate-cancellous bone matrix composites and of the cancellous bone matrixes. In the MCCABs, both intramembranous and cartilaginous osteogeneses were seen but the former was obvious. In the control, only slight cartilaginous osteogeneses were seen.

CONCLUSIONSThe osteogeneses of the MCCABs constructed by using tissue engineering method were obvious when transplanted subcutaneously. The MSO and CBM can be used as good bone-derived cell and scaffold material respectively for tissue-engineered bone construction.

Animals ; Bone Marrow Transplantation ; Bone Matrix ; transplantation ; Bone Transplantation ; methods ; Male ; Osteoblasts ; transplantation ; Osteogenesis ; Rabbits ; Tissue Engineering

BACKGROUND: Patients receiving bone marrow transplantation (BMT) are highly susceptible to infection. This study aims to analyze the frequencies, types and distributions of the organisms causing infectious complications following BMT. METHODS: We retrospectively analyzed infectious complications of 76 bone marrow transplant patients treated at Chonnam National University Hospital during the period 1992~1999. RESULTS: The patient group consisted of 52 allogeneic and 24 autologous recipients. In the allogeneic recipient group, the majority of the patients were diagnosed with acute myelogenous leukemia (37%) and in the autologous group, non-Hodgkin's lymphoma (58 %). Sixty-five of 76 recipients (85.5%) had a total of 118 infectious complications. Out of the 52 allogeneic and 24 autologous recipients, 87 and 31 infectious complications occurred, respectively. Clinically defined infections were reported in 88 cases, microbiologically defined infections in 20 cases, and unexplained fever in 10 cases. Seventy-two infections occurred within the first 30 days following transplant, 17 cases between days 30 and 100, and 29 cases after the 100th day. Infection of the oral cavity occurred in 25.9% of the subjects, pneumonia in 24.1% and skin and soft tissue infection in 19.4%. Oral mucositis was the most common type of infection within the first 30 days following transplant, pneumonia between days 30 and 100, and skin and soft tissue infection after the 100th day. The causative organisms for bacteremia were gram- positive organisms in four of the cases and gram-negative organisms in six of the cases. Similarly, the causative organisms for pneumonia were cytomegalovirus in 5 cases, Pneumocystis carinii in 1 case, methicillin- resistant Staphylococcus aureus in 1 case, and M. tuberculosis in 2 cases. The most common cause of death was acute respiratory distress syndrome due to pneumonia (11 cases). CONCLUSION: Infection is a major complication in patients undergoing BMT. Infection occurred most commonly within the first 30 days following transplant, with oral mucositis and pneumonia being the most common types of infection. Antimicrobial prophylaxis with improved strategies should be utilized in order to prevent infection during post-BMT immunohematopoietic recovery.
Bacteremia ; Bone Marrow Transplantation ; Bone Marrow* ; Cause of Death ; Cytomegalovirus ; Fever ; Humans ; Jeollanam-do ; Leukemia, Myeloid, Acute ; Lymphoma, Non-Hodgkin ; Mouth ; Pneumocystis carinii ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Staphylococcus aureus ; Stomatitis ; Transplantation* ; Tuberculosis