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Calcineurin Inhibitor Induced Multiple Infarctions.

Hae Bong JEONG ; Jeong Min KIM ; Il Han YU ; Jae Han BAE ; Oh Sang KWON ; Kwang Yeol PARK

The Journal of the Korean Society for Transplantation.2016;30(4):190-193. doi:10.4285/jkstn.2016.30.4.190

Tacrolimus is the most commonly used immunosuppressant after kidney transplantation. Here, we report a patient with multiple cerebral infarctions during tacrolimus treatment after kidney transplantation. A 54-year-old female was admitted due to sudden onset right leg weakness. Brain magnetic resonance imaging (MRI) showed multiple acute infarctions but normal vasculature. Evaluations of cardiac embolism were unremarkable. After 8 months, her weakness progressed and follow-up brain MRI showed additional multiple infarctions. We changed here medication from tacrolimus to mycophenolate mofetil, and her symptoms improved gradually.
Brain ; Calcineurin* ; Cerebral Infarction ; Embolism ; Female ; Follow-Up Studies ; Humans ; Infarction* ; Kidney Transplantation ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Tacrolimus

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A Successful Case of a High Anti A/B Antibody Titer ABO Incompatible Kidney Transplantation Patient Who Received a Kidney from a Hepatitis B Carrier.

Jin Ho LEE ; Han Sae KIM ; Dong Yeol LEE ; Joon Seok OH ; Yong Hun SIN ; Joong Kyung KIM ; Jong Hyun PARK ; Kill HUH ; Jong In PARK

The Journal of the Korean Society for Transplantation.2016;30(4):184-189. doi:10.4285/jkstn.2016.30.4.184

Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.
Adult ; Allografts ; Antibodies ; Antibody Formation ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoglobulins ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Mortality ; Plasmapheresis ; Rituximab ; Tissue Donors

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Hand-assisted Laparoscopic Donor Surgery for Living Donor Pancreas and Kidney Transplantation: A Single Center Experience.

Jeong Sub KIM ; Cheol Woong JUNG ; Heungman JUN ; Kwan Tae PARK

The Journal of the Korean Society for Transplantation.2016;30(4):178-183. doi:10.4285/jkstn.2016.30.4.178

BACKGROUND: In this era of donor shortage, use of organs from living donors has increased significantly. Nonetheless, less than 1% of pancreas transplantations involve living donors, despite the immunological benefits, reduced cold ischemic time, and decreased waiting time. One reason for the paucity of donors is the high morbidity after open surgery. Using hand-assisted laparoscopic donor surgery (HALDS) can be a favorable technique for living donors. METHODS: Using HALDS, we performed three Simultaneous pancreas-kidney transplantations (SPKs) involving living donors. Two donors were women; one was a man. RESULTS: Their mean age was 34.3±4.7 years, and their body mass index was 23.2±2.36 kg/m². The mean operation time was 241±19.0 minutes and the mean cold-ischemic time of the kidney was 42.7±9.8 minutes, while that of the pancreas was 64.3±5.2 minutes. One donor developed a pancreatic fistula, which was controlled using conservative management. The donors' pancreatic and renal functions were well preserved postoperatively. CONCLUSIONS: HALDS for SPKs can be performed without significant complications if the surgeon has sufficient skill.
Body Mass Index ; Cold Ischemia ; Female ; Hand-Assisted Laparoscopy ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Pancreas Transplantation ; Pancreas* ; Pancreatic Fistula ; Tissue Donors*

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The Role of Bile Duct Probe for Bile Duct Division during Donor Right Hemihepatectomy.

Soong June BAE ; Dai Hoon HAN ; Gi Hong CHOI ; Jin Sub CHOI

The Journal of the Korean Society for Transplantation.2016;30(4):172-177. doi:10.4285/jkstn.2016.30.4.172

BACKGROUND: To prevent bile duct related complications, exact division of donor bile duct is essential, not only for the recipient, but also for the donor during living donor liver transplantation. Cholangiography has been used for bile duct division during living donor right hemihepatectomy. This study was conducted to determine if bile duct probe could be used to replace cholangiography for bile duct division during living donor right hemihepatectomy. METHODS: Surgical outcomes of 234 donors with right hemihepatectomy and duct to duct biliary anastomosis in living donor liver transplantation between January 2009 and December 2014 were retrospectively analyzed. A total of 85 donors used the bile duct probe for bile duct division during the right hemihepatectomy, whereas 149 donors used cholangiography. All donors underwent preoperative magnetic resonance cholangiopancreatography (MRCP). RESULTS: The expected number of bile duct orifices based on MRCP did not differ significantly from the observed number of bile duct orifices after bile duct division (10 donors and five donors in each group were mismatched, P=0.238). The operation time was 384.7 minutes in the probe group, which was significantly shorter than that of the cholangiography group (400.4 minutes, P=0.041). CONCLUSIONS: Bile duct probing without intraoperative cholangiography might be a feasible procedure for bile duct division during living donor hemihepatectomy.
Bile Ducts* ; Bile* ; Cholangiography ; Cholangiopancreatography, Magnetic Resonance ; Humans ; Liver Transplantation ; Living Donors ; Postoperative Complications ; Retrospective Studies ; Tissue Donors*

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Sirolimus Combination with Tacrolimus in Kidney Transplant Recipients at High Immunological Risk: Observational Results 3 Years after Transplantation.

Juhan LEE ; Seung Hwan SONG ; Jae Geun LEE ; Beom Seok KIM ; Kyu Ha HUH ; Yu Seun KIM

The Journal of the Korean Society for Transplantation.2016;30(4):165-171. doi:10.4285/jkstn.2016.30.4.165

BACKGROUND: The optimal immunosuppressive strategy for renal transplant recipients at high immunological risk requires clarification. We compared the 3 year outcomes of a sirolimus group (tacrolimus plus sirolimus) to those of a control group (tacrolimus plus mycophenolate mofetil). METHODS: This observational study was an extension of a prospective pilot study. We assessed acute rejection, glomerular filtration rate, adverse events, graft, and patient survival. RESULTS: Overall, 43% of the sirolimus group versus 78% of the control group were still on the initial immunosuppressive regimen at 3 years (P=0.005), and most discontinuations in each group were due to adverse events. No differences were observed between two groups with respect to acute rejection. The mean glomerular filtration rate at 36 months was greater in the sirolimus group than in the control group, but this was not statistically significant (64.0±6.8 mL/min/1.73 m² vs. 61.8±17.1 mL/min/1.73 m², P=0.576). Graft and patient survival were similar in both groups. Importantly, mean tacrolimus through levels were significantly lower in the sirolimus group than in the control group at each time point. No neoplasm was reported in the sirolimus group. In the control group, three cases of neoplasms developed during the study period. CONCLUSIONS: The sirolimus group had a greater number of discontinuations, particularly related to adverse events. Nevertheless, optimal concentration of sirolimus allowed reduced calcineurin inhibitor exposure in high immunologic risk patients, without increasing the risk of acute rejection and graft failure.
Calcineurin ; Glomerular Filtration Rate ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Observational Study ; Pilot Projects ; Prospective Studies ; Sirolimus* ; Tacrolimus* ; Transplant Recipients* ; Transplants

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Outcomes for Patients with Hepatitis C Virus after Liver Transplantation in Korea.

Jong Man KIM

The Journal of the Korean Society for Transplantation.2016;30(4):155-164. doi:10.4285/jkstn.2016.30.4.155

Hepatitis C virus (HCV)-related liver disease is the most common indication for liver transplantation (LT) in Western countries, whereas HCV LT is rare in Korea. We conducted a survey of HCV RNA-positive patients who underwent LT and investigated the prognostic factors for patient survival and the effects of immunosuppression. To accomplish this, we retrospectively reviewed the multicenter records of 192 HCV RNA-positive patients who underwent LT. The 1-, 3-, and 5-year overall survival rates were 78.8%, 75.3%, and 73.1%, respectively. Excluding cases of hospital mortality (n=23), 169 patients were evaluated. Most patients were genotype 1 (n=111, 65.7%) or genotype 2 (n=42, 24.9%). The proportion of living donors for LT (n=135, 79.9%) was higher than that of deceased donors (DDLT; n=34, 20.1%). The median donor and recipient ages were 32 and 56 years, respectively. Twenty-eight patients (16.6%) died during the observation period, while 75 underwent universal prophylaxis and 15 received preemptive therapy. HCV recurrence was detected in 97 patients. Recipients who were older than 60, received DDLT, used cyclosporine, or suffered acute rejection had lower rates of survival. Acute rejection was closely associated with a lack of induction therapy, cyclosporine use, and universal prophylaxis after transplantation. The careful avoidance of acute rejection in the post-transplant period through adequate use of tacrolimus is a preferable strategy that increases patient survival following liver transplantation.
Antiviral Agents ; Cyclosporine ; Genotype ; Graft Rejection ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Hospital Mortality ; Humans ; Immunosuppression ; Korea* ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors ; Recurrence ; Retrospective Studies ; Survival Rate ; Tacrolimus ; Tissue Donors

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Strategy for Hepatitis C Treatment in Liver Transplant Settings.

Jun Yong PARK

The Journal of the Korean Society for Transplantation.2016;30(4):149-154. doi:10.4285/jkstn.2016.30.4.149

In patients with detectable virus at the time of liver transplantation, hepatitis C virus (HCV) infection always recurs on the graft, and 30% of patients have an aggressive clinical and histologic course with increased morbidity, mortality, and graft loss. Moreover, in some transplantation patients, recurrent HCV infection leads to an aggressive course of disease known as fibrosing cholestatic hepatitis, which is characterized by hepatic decompensation and death. Liver allograft and recipient survival can be substantially improved with successful eradication of HCV. Recent advances in direct-acting antiviral agents have revolutionized the management of HCV infection, and a number of these agents have shown high sustained virological responses, shorter durations of treatment, and much improved tolerability when compared with previous pegylated interferon based therapies in liver transplant settings.
Allografts ; Antiviral Agents ; Hepacivirus ; Hepatitis C* ; Hepatitis* ; Humans ; Interferons ; Liver Transplantation ; Liver* ; Mortality ; Transplants

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Cryptosporidiosis in a Small Bowel Transplant Recipient.

Youn Jeong KIM ; Sang Il KIM ; Yang Ree KIM ; Ik Jun CHOI ; Myung Duk LEE ; Yeon Joon PARK ; Ho Woo NAM ; Moon Won KANG

The Journal of the Korean Society for Transplantation.2008;22(1):138-141.

No abstract available.
Animals ; Cryptosporidiosis ; Transplants

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A Case of Invasive Aspergillosis in Transplanted Kidney and Perirenal Area.

Hyun Hee NA ; Seong Woo HONG ; Mun Cheol KIM ; Yun Kyung KANG ; Young Chul YOON ; Haeng Il KOH

The Journal of the Korean Society for Transplantation.2008;22(1):135-137.

Recently, the incidence of fungal infection increases because of immunosuppressive therapy and chemotherapy. In immunosuppressed transplant recipients, Aspergillus can be a dangerous pathogen, capable of inducing fulminant clinical disease. Invasive fungal infections are life-threatening complications in solid-organ transplantation. Although the rate of fungal infections in transplant recipients is lower than that of other infections, the mortality rate is higher. A 34 year-old male was admitted to our hospital with fever and gross hematuria. He had received renal transplantation 2 years ago and had been transferred the other hospital 1 month ago. Initial laboratory data evaluation showed a pancytopenia and azotemia. We thought that pancytopenia was caused by immunosuppressive agents and infection. The patient was treated with antibiotics but fever was not subsided. After 4 days, he complained of transplant site pain and tenderness to percussion. A percutaneous renal biopsy was performed. Microscopic examination showed invasive aspergillosis in transplanted kidney and perirenal area. We removed the transplanted kidney and perirenal tissue, and prescribed antifungal agents for 3 months.
Anti-Bacterial Agents ; Antifungal Agents ; Aspergillosis ; Aspergillus ; Azotemia ; Biopsy ; Fever ; Hematuria ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation ; Male ; Pancytopenia ; Percussion ; Transplants

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Two Successfully Treated Cases of Posttransplant Pneumonia Caused by Cytomegalovirus and Aspergillus Coinfection.

Youn Jeong KIM ; Sang Il KIM ; Yang Ree KIM ; Chul Woo YANG ; Moon Won KANG ; Byung Kee BANG

The Journal of the Korean Society for Transplantation.2008;22(1):130-134.

No abstract available.
Aspergillus ; Coinfection ; Cytomegalovirus ; Pneumonia

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