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Papular Mucinosis in a Renal Transplantation Recipient.

Jae Keun PARK ; Mi Yeon YU ; Gunwoo KOO ; Joo Hee KWAK ; Jung Hoon LEE ; In Sub JUNG ; Hyunwoo OH ; Joon Sung PARK

The Journal of the Korean Society for Transplantation.2014;28(4):236-240. doi:10.4285/jkstn.2014.28.4.236

Papular mucinosis (PM, scleromyxoedema) is a rare dermatologic disease. It is histologically characterized by a focal dermal deposit of mucin within the skin. Although PM is accepted as an idiopathic disease in most cases, some authors argued that it may be a cutaneous manifestation of a systemic disease. Here, we describe a 68-year-old male kidney transplantation recipient with a complaint of intractable itching sensation on the forehead. We diagnosed the skin lesions as PM, which were improved after cyclosporine dose reduction.
Aged ; Cyclosporine ; Forehead ; Humans ; Kidney Transplantation* ; Male ; Mucins ; Pruritus ; Scleromyxedema* ; Sensation ; Skin

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Pre-transplant Predictors for 3-Month Mortality after Living Donor Liver Transplantation.

Nuri LEE ; Jong Man KIM ; Choon Hyuck David KWON ; Jae Won JOH ; Dong Hyun SINN ; Joon Hyeok LEE ; Mi Sook GWAK ; Seung Woon PAIK ; Suk Koo LEE

The Journal of the Korean Society for Transplantation.2014;28(4):226-235. doi:10.4285/jkstn.2014.28.4.226

BACKGROUND: High model for end-stage liver disease (MELD) scores (> or =35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT. METHODS: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively. RESULTS: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores > or =35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores > or =35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively. CONCLUSIONS: Patients with both risk factors (ICU care before LDLT and MELD scores > or =35) should be cautiously considered for treatment with LDLT.
Adult ; End Stage Liver Disease ; Hepatic Encephalopathy ; Hepatorenal Syndrome ; Humans ; Intensive Care Units ; Liver Diseases ; Liver Transplantation* ; Living Donors* ; Medical Records ; Mortality* ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survival Rate ; Transplants ; Ventilators, Mechanical

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Attitude Favorability towards Organ Donation in Family Members of Brain Dead Organ Donors.

Jaeheon LEE ; Won Jung LEE ; Jae Myeong LEE

The Journal of the Korean Society for Transplantation.2014;28(4):219-225. doi:10.4285/jkstn.2014.28.4.219

BACKGROUND: Analyzing the attitudes toward organ donation and the factors that influence such attitudes is fundamental to improving the quality of management for the process of brain dead organ donation. METHODS: We interviewed 23 primary carers of donors after a minimum period of one year post organ donation from a single hospital, from 2008 to 2011. This telephone survey analyzed factors including relationship with the donor and the impact of such factors on making the decision for donation and attitude towards organ donation. RESULTS: With respect to the carers' relationship with the donor, seven carers who participated in the interview were spouses (30.4%), six were parents (26.0%), three were offspring (13.0%), and seven were siblings (30.4%). Ten of the decision makers (43.4%) were not legal priority holders. Twenty-two interviewees (95.6%) experienced no regret for their decision to go through with the donation. Fifteen participants (65.1%) were willing to donate their own organs in case of brain death, and the favorability towards organ donation was significantly related to the satisfaction with their experience of medical services during the process of organ donation. CONCLUSIONS: Organ donation after brain death is still viewed favorably by carers even after the bereavement period. Positive attitude and favorability toward organ donation were significantly related to the satisfaction with the medical service. We suggest interventions to improve the quality of medical services in order to promote organ donation.
Bereavement ; Brain Death* ; Caregivers ; Humans ; Parents ; Siblings ; Spouses ; Telephone ; Tissue and Organ Procurement* ; Tissue Donors*

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The Analysis of Prognostic Factors Affecting Survival in Liver Transplantation: A Single Institution Experience.

Sung Won PARK ; Gil Jae LEE ; Sang Tae CHOI ; Yeon Ho PARK ; Jung Nam LEE ; Keon Kuk KIM

The Journal of the Korean Society for Transplantation.2014;28(4):211-218. doi:10.4285/jkstn.2014.28.4.211

BACKGROUND: Liver transplantation is considered as the most powerful modality for patients with acute on chronic liver failure and fulminant hepatic failure. The aim of this study is to identify potential prognostic factors that may affect survival after emergent liver transplantation. METHODS: A total of 42 patients who underwent emergent liver transplantation at Gachon University Gil Medical Center from June 2005 to May 2013 were enrolled. The clinical scoring system analyzed for this study were as follows: Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), Model for end-stage liver disease with incorporation of serum sodium (MELD-Na), Acute physiology and chronic health evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA). RESULTS: Preoperative SOFA and APACHE scores were closely related with patient's survival after the operation. Also, the changed value of SOFA while patients waited for their transplantation showed to be significant. In a univariate analysis, serum bilirubin and Glasgow Coma Scale (GCS) showed statistical significance for patient's prognosis. Several factors, such as the use of mechanical ventilator and inotropic agent for treating multiple organ failure were also important. The central nervous system and cardiovascular scores showed an intimate relation with the survival group by a more detailed analysis in SOFA. In a multivariate analysis, SOFA and bilirubin levels affected patient's survival. CONCLUSIONS: In emergent liver transplantation with acute on chronic liver failure and fulminant liver failure, recipient's hepatic function is an important factor along with the donated liver condition l eading to successful operation. Also, it is important to pay attention to the progression of organ failure in predicting the prognosis.
APACHE ; Bilirubin ; Central Nervous System ; End Stage Liver Disease ; Glasgow Coma Scale ; Humans ; Liver ; Liver Diseases ; Liver Failure, Acute ; Liver Transplantation* ; Multiple Organ Failure ; Multivariate Analysis ; Prognosis ; Sodium ; Ventilators, Mechanical

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Incidence of Post-transplant Malignancy after Renal Transplantation: Single Center Analysis.

Seung Jo CHOI ; Dongho CHOI ; Oh Jung KWON

The Journal of the Korean Society for Transplantation.2014;28(4):204-210. doi:10.4285/jkstn.2014.28.4.204

BACKGROUND: Immunosuppression after kidney transplantation is associated with increased risk of malignancy, which has become the second most common cause of death among kidney transplant recipients. In this review, we report the incidence of malignancies after kidney transplantation in a single center and evaluate the incidence, characteristics, relationship to immunosuppressive drugs and discuss what clinicians must consider during a follow-up of patients after kidney transplantation. METHODS: Between May 1978 and September 2013, a total of 748 kidney transplant patients who were able to undergo a follow-up process through electronic medical records were enrolled in this retrospective cohort study to determine the potential incidence and types of malignancy that may occur after kidney transplantation and the associated impact on patients and graft survival. RESULTS: Among 748 patients, 63 cases of malignancy appeared in 54 patients (7.2%). Gastrointestinal cancer (12 cases, 19%) and post-transplant lymphoproliferative disorder (12 cases, 19%) were the two most common types of malignancy. The second most common type of malignancy was urinary tract malignancy in 10 patients. Two different types of malignancy were diagnosed in nine patients during our follow-up. The overall graft survival in malignancy patients was better, which may mean that malignancy did not affect the overall graft loss. CONCLUSIONS: Clinicians should be aware of the incidence of malignancy in transplant patients and perform routine examinations for early detection of malignancy.
Cause of Death ; Cohort Studies ; Electronic Health Records ; Follow-Up Studies ; Gastrointestinal Neoplasms ; Graft Survival ; Humans ; Immunosuppression ; Incidence* ; Kidney ; Kidney Transplantation* ; Lymphoproliferative Disorders ; Retrospective Studies ; Transplantation ; Transplants ; Urinary Tract

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Alteration of Ankle-Brachial Index after Kidney Transplantation.

Dae Jung KIM ; Oh Hyun PARK ; Jeong Seon JO ; Ho Kyun LEE ; Sang Young CHUNG ; Soo Jin Na CHOI

The Journal of the Korean Society for Transplantation.2014;28(4):200-203. doi:10.4285/jkstn.2014.28.4.200

BACKGROUND: A steno-occlusive disease of the iliac artery can mimic renal vascular hypertension, and is an important cause of renal dysfunction in renal transplant recipients. We assessed the alternation of postanastomotic arterial blood flow of lower extremities by ankle-brachila index (ABI). METHODS: We analyzed 50 patients who underwent kidney transplantation between March, 2010 and November, 2012 at Chonnam National University Hospital. This study was performed prospectively and case selection by renal transplantation patients who got first operation on right iliac fossa. All operational procedures were end to side anastomosis of the external iliac artery to the renal artery. We measured and compared the preoperative and postoperative (1 week, 6 months, 1 year) ABI. We analyzed the diameter of the recipient external iliac artery and renal artery of the transplanted kidney. RESULTS: Among 50 patients, 34 were male (68%) and 16 were female (32%). The mean age of recipients was 44.37+/-11.42 years. The mean preoperative ABI at the right lower extremity was 1.17+/-0.11, postoperative 1 week, 6 months, and 1 year was 1.14+/-0.10, 1.15+/-0.11, 1.17+/-0.15, respectively. Alternation of preoperative ABI and postoperative 1 week, 6 months, and 1 year was P=0.331, P=0.864, and P=0.992, respectively. CONCLUSIONS: Alternation of ABI on the ipsilateral lower extremity was not significant in renal transplanted recipients. We recommend a long-term study with more cases.
Ankle Brachial Index* ; Female ; Humans ; Hypertension ; Iliac Artery ; Jeollanam-do ; Kidney ; Kidney Transplantation* ; Lower Extremity ; Male ; Prospective Studies ; Renal Artery ; Transplantation

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Vaccination Strategy in Organ Transplantation.

Youn Jeong KIM ; Sang Il KIM

The Journal of the Korean Society for Transplantation.2014;28(4):195-199. doi:10.4285/jkstn.2014.28.4.195

Transplant candidates and recipients are at increased risk for infections, many of which are preventable by immunization. Patients who are waiting for transplant or post-transplant patients, as well as their household members and healthcare workers have completed the recommended vaccinations before transplantation. Live attenuated vaccines including varicella and MMR are generally not recommended after transplantation, thus protective level of antibodies should be detected before transplantation. Currently, pneumococcal vaccine and zoster vaccines are in clinical trial among post-transplant patients. In this article, we reviewed the guidelines for vaccination in solid organ transplant candidates and recipients and summarize the available literature on the efficacy and safety of vaccines for patients who are scheduled for or who have undergone organ transplantation.
Antibodies ; Chickenpox ; Delivery of Health Care ; Family Characteristics ; Herpes Zoster ; Humans ; Immunization ; Organ Transplantation* ; Transplants* ; Vaccination* ; Vaccines ; Vaccines, Attenuated

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Islet Encapsulation Using Chondrocyte.

Jeong Ik LEE ; Joon Ye KIM ; Jae Geun LEE ; Yu Seun KIM

The Journal of the Korean Society for Transplantation.2014;28(4):187-194. doi:10.4285/jkstn.2014.28.4.187

Diabetes mellitus is one of the leading metabolic diseases that cause an increasing rate of mortality and morbidity. Recently, rather than the current drug treatment, pancreatic islet transplantation has been regarded as a potentially promising strategy for insulin- dependent diabetes mellitus while preventing complications such as kidney damage, vascular damage, nerve damage, and blindness. Recently, a number of advanced islet encapsulation techniques have been designed to enhance the efficiency of islet transplantation, including cell sheet engineering and generation of 3D islet spheroids by high density suspension system (HDSS). Chondrocytes derived from cartilage sources have been used as an encapsulation biomaterial for islets not only for autograft but also for allograft and xenograft transplantation. Cartilage is an avascular, white connective tissue that is rich in extracellular matrix, and expandable in vitro. Hence, this tissue might have immunologically privileged properties that make it an intelligent cell source for manufacture of encapsulation biomaterials. However, cell sheet engineering and HDSS still have their respective limitations, which need to be elucidated. This review will describe the advantages and disadvantages of the current encapsulation techniques in order to provide a comprehensive foundation for further modifications and improvements of tissue engineering for islet transplantation.
Allografts ; Autografts ; Biocompatible Materials ; Blindness ; Cartilage ; Chondrocytes* ; Connective Tissue ; Diabetes Mellitus ; Extracellular Matrix ; Islets of Langerhans ; Islets of Langerhans Transplantation ; Kidney ; Metabolic Diseases ; Mortality ; Tissue Engineering ; Transplantation, Heterologous

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Successful Sirolimus Treatment of Kaposi's Sarcoma in Multiple Pulmonary Nodules after Kidney Transplantation.

Si Yeon KIM ; Hyo Jung LEE ; Yun Jung CHUNG ; Seungsoo SHEEN ; Jong Hoon LEE ; Chang Kwon OH

The Journal of the Korean Society for Transplantation.2012;26(4):299-304. doi:10.4285/jkstn.2012.26.4.299

Kaposi's sarcoma is one of the most serious complications associated with immune suppression treatment after kidney transplantation. Because it usually manifestations as skin lesions or lymphadenopathies, its clinical suspicion and tissue diagnosis is relatively easy. However, Kaposi's sarcoma presented as multiple pulmonary nodules without skin manifestations is not easily detected early and usually has a deadly prognosis. We present the case of a 36-year-old male who underwent kidney transplantation 13 months ago and has been on tacrolimus and mycophenolate mofetil (MMF)-based immune suppression presented dry cough, blood tinged sputum, and multiple pulmonary nodules without any skin lesions. Both bronchoscopic washing cytology and fine needle aspiration cytology of peripheral lung tissues were performed but failed due to low cellular yields. A video-assisted thoracoscopic biopsy subsequently revealed Kaposi's sarcoma. Following the diagnosis, we changed the immune suppression from a tacrolimus and MMF-based regimen to a sirolimus-based regimen. Respiratory symptoms gradually disappeared and we found complete remission on follow-up radiologic evaluations. Thus sirolimus may be the preferred method of treatment for patients with immune suppression after kidney transplantation.
Biopsy ; Biopsy, Fine-Needle ; Cough ; Follow-Up Studies ; Humans ; Kidney ; Kidney Transplantation ; Lung ; Male ; Multiple Pulmonary Nodules ; Mycophenolic Acid ; Prognosis ; Sarcoma, Kaposi ; Sirolimus ; Skin ; Skin Manifestations ; Sputum ; Tacrolimus ; Tolnaftate

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Successful Sirolimus Treatment of Multiple Visceral Kaposi's Sarcoma in a Renal Allograft Patient.

Min Hwan KIM ; Myoung Soo KIM ; Yoon Jin CHA ; Kyoung Sook PARK ; Beom Seok KIM ; Soohyeoun LEE

The Journal of the Korean Society for Transplantation.2012;26(4):293-298. doi:10.4285/jkstn.2012.26.4.293

The use of immunosuppressant's increases the risk of developing malignancies in renal allograft patients. One of the most important malignancies, Kaposi's sarcoma, can cause mortality and graft failure among renal allograft patients. We report the case of a 39-year-old male diagnosed with multiple visceral Kaposi's sarcoma 6 months after a second cadaveric renal allograft. The patient's renal function was markedly deteriorated at admission and required hemodialysis initially. Radiologic studies revealed Kaposi's sarcoma in multiple lymph nodes, liver, lung, and peritoneum. The excisional biopsy of an inguinal lymph node confirmed this diagnosis. After diagnosis, tacrolimus treatment was gradually decreased, and sirolimus treatment initiated. The patient did not receive any chemotherapy or radiotherapy. The Kaposi's sarcoma lesions decreased dramatically (both in size and number) 1 month after sirolimus treatment, and kidney graft function improved. This case thus shows successful sirolimus treatment of visceral Kaposi's sarcoma in a renal allograft patient.
Biopsy ; Cadaver ; Humans ; Kidney ; Kidney Transplantation ; Liver ; Lung ; Lymph Nodes ; Male ; Peritoneum ; Renal Dialysis ; Sarcoma, Kaposi ; Sirolimus ; Tacrolimus ; Transplantation, Homologous ; Transplants

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