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Hepatic Artery Reconstruction Using the Right Gastroepiploic Artery for Hepatic Artery Inflow in a Living Donor Liver Transplantation.

Joo Dong KIM ; Dong Lak CHOI ; Young Seok HAN

The Journal of the Korean Society for Transplantation.2010;24(1):40-42. doi:10.4285/jkstn.2010.24.1.40

Securing the source of hepatic artery inflow is essential for living donor liver transplantation. However, sometimes, the hepatic arteries of the recipients are in poor condition for a good anastomosis in living donor liver transplantation; problems include severe arteriosclerosis, intimal dissection, and significant intimal injuries caused by previous transarterial procedures. In these conditions, the right gastroepiploic artery has generally been the preferred artery because of its anatomical location, size and length. Here, a case of successful hepatic artery reconstruction is reported using the right gastroepiploic artery in living donor liver transplantation. The recipient's hepatic arterial intima was severely injured by multiple transarterial chemoembolization and unsuitable for reconstruction. Instead, the right gastroepiploic artery was anastomosed to the hepatic artery of the graft. Arterial blood flow was satisfactory on Doppler ultrasonography during the operation, and complications related to the hepatic artery were not detected during the follow-up period. Therefore, the right gastroepiploic artery may be considered as a suitable alternative for hepatic artery reconstruction in living donor liver transplantation.
Arteries ; Arteriosclerosis ; Follow-Up Studies ; Gastroepiploic Artery ; Hepatic Artery ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Transplants ; Tunica Intima ; Ultrasonography, Doppler

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A Case of Successful Treatment of Cutaneous Aspergillosis with Voriconazole at the Low Cyclosporine Trough Level in a Renal Transplant.

Seok Ju PARK

The Journal of the Korean Society for Transplantation.2010;24(1):35-39. doi:10.4285/jkstn.2010.24.1.35

Aspergillosis is a serious infectious complication with high mortality in transplant recipients. Voriconazole is a broad spectrum triazole antifungal agent, but it has a drug-drug interaction with immunosuppressants. Herein we report a case of the use of a small dose of cyclosporine (CsA) with coadministration of voriconazole. A 23 year old woman received a kidney transplant from a deceased donor. The initial immunosuppressant was tacrolimus, mycophenolate mofetil, steroids, and basiliximab. Thirty-two days after kidney transplantation, because of hemolytic uremic syndrome, she received Rabbit anti-human thymocyte immunoglobulin and plasmapheresis. Cyclosporine was used instead of tacrolimus. Three months after transplantation, she was admitted to the hospital because of an erythematous nodule on her trunk and a dry cough. Skin biopsy revealed an Aspergillus species and tissue culture showed that it was A. fumigatus. We treated her with itraconazole and subsequently with amphotericin B. Afterwards, her condition got worse. So we changed amphotericin B to voriconazole and a minimum dose of CsA (25 mg bid) at the peril of graft failure. Eventually, she recovered and maintained good graft function. The trough level of CsA ranged from 3.2 to 27.9 ng/mL.
Amphotericin B ; Antibodies, Monoclonal ; Aspergillosis ; Aspergillus ; Biopsy ; Cough ; Cyclosporine ; Female ; Hemolytic-Uremic Syndrome ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Itraconazole ; Kidney ; Kidney Transplantation ; Mycophenolic Acid ; P-Glycoprotein ; Plasmapheresis ; Pyrimidines ; Recombinant Fusion Proteins ; Skin ; Steroids ; Tacrolimus ; Thymocytes ; Tissue Donors ; Transplants ; Triazoles

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Combination Treatment of Rituximab and Plasmapheresis in Acute Cellular Rejection with Focal Segmental Glomerular Sclerosis after Renal Transplantation.

Ji Min JEON ; Joon Suk OH ; Sung Min KIM ; Yoong Gi SON ; Yong Ki PARK ; Yong Hun SIN ; Joong Kyung KIM ; Yong Jin KIM

The Journal of the Korean Society for Transplantation.2010;24(1):30-34. doi:10.4285/jkstn.2010.24.1.30

Focal segmental glomerular sclerosis (FSGS) accounts for recurrence in 20% to 40% of the renal allografts after transplantation, and it causes graft loss in 13% to 20% of the cases. We report here on successfully treating acute cellular rejection (ACR) combined with FSGS after a kidney transplantation with a combination treatment of plasmapheresis, rituximab and steroid pulse therapy. A 53-year-old female patient whose primary kidney disease was unknown developed massive proteinuria after living donor kidney transplantation. A urine protein/creatinine ratio of 13.42 and an elevated serum creatinine level was detected on postoperative days (POD) 10 and a renal biopsy showed acute cellular rejection (Banff IIb) combined with FSGS. We started steroid pulse therapy on POD 11. She underwent 5 plasmapheresis sessions in the first 3 week after transplantation and she received one dose of rituximab (375 mg/m2) on POD 12. The proteinuria decreased below the nephrotic range at POD 20 and the serum creatinine level was normalized. Three months later, the proteinuria was at 35 mg/day with stable graft function. Rituximab and plasmapheresis is a possible option to treat FSGS combined with a relapse of proteinuria after renal transplantation.
Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Creatinine ; Female ; Humans ; Kidney Diseases ; Kidney Transplantation ; Living Donors ; Middle Aged ; Plasmapheresis ; Proteinuria ; Recurrence ; Rejection (Psychology) ; Rituximab ; Sclerosis ; Transplantation, Homologous ; Transplants

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A Case of Tuberculous Peritonitis Confirmed by Laparoscopic Biopsy in a Patient Receiving Maintenance Hemodialysis Patient after Renal Transplantation.

Chang Seok SONG ; Hyang KIM ; Choong Nam SHIM ; Min Yong YOON ; Mi Hye SEO ; Wan PARK ; Jae Eun LEE ; Sung Eun HUR ; Kyu Beck LEE

The Journal of the Korean Society for Transplantation.2010;24(1):26-29. doi:10.4285/jkstn.2010.24.1.26

Tuberculosis is an opportunistic infection that causes significant morbidity and mortality in recipients of renal transplants. Although tuberculous peritonitis is easily diagnosed by paracentesis, it is difficult to diagnosis in the absence of ascites. Laparotomy and laparoscopic biopsies are needed for the diagnosis of tuberculous peritonitis. According to recent reports, the latter has a better outcome because of fewer associated complications. A case of tuberculous peritonitis in a renal transplant patient is reported that was diagnosed by laparoscopic peritoneal biopsy
Ascites ; Biopsy ; Humans ; Kidney Transplantation ; Laparotomy ; Opportunistic Infections ; Paracentesis ; Peritonitis, Tuberculous ; Renal Dialysis ; Transplants ; Tuberculosis

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Symptomatic Lower Extremity Deep Vein Thrombosis after Kidney Transplantation: a 40-Year Single Center Experience in Korea.

Jeong Kye HWANG ; Sang Dong KIM ; Sun Cheol PARK ; Ji Il KIM ; In Sung MOON

The Journal of the Korean Society for Transplantation.2010;24(1):19-25. doi:10.4285/jkstn.2010.24.1.19

BACKGROUND: It is well known that kidney transplant recipients in Western countries are at high risk for development of lower extremity (LE) deep vein thrombosis (DVT). The aim of this study was to establish the frequency of symptomatic LE DVT, the time until their occurrence, and to define risk factors for them following kidney transplantation (KT) in Korea. METHODS: We performed a retrospective analysis of LE DVT among 1695 patients who were kidney transplant recipients between 1969 and 2009. All patients were symptomatic with objective diagnostic modalities. Results were compared with those for a cohort of kidney transplant recipients from the same center without DVT. RESULTS: During follow-up, 21 symptomatic LE DVTs (1.2%) occurred in 18 patients (1.1%). The mean interval between transplantation and a first episode of DVT was 77.1+/-76.6 months. No DVT episode developed within one month after KT. There were no significant differences in body mass index, graft function, donor age and sex, recipient sex, type of preoperative renal replacement therapy, immunosuppressive agents, and malignancy between the two groups. Patients who developed LE DVT had a significantly different recipient age, presence of diabetes mellitus, presence of acute rejection episodes, and type of donor (P<0.05). CONCLUSIONS: Our retrospective study showed that the incidence of LE symptomatic DVT after KT is lower than after other surgeries performed in Korean hospitals and after KT performed in Western countries. There were no cases of symptomatic DVT within 1 month after KT. Our findings suggest that aggressive DVT prevention is not necessary for KT recipients in Korea.
Body Mass Index ; Cohort Studies ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Lower Extremity ; Rejection (Psychology) ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplants ; Venous Thrombosis

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Routine Perioperative Antibiotic Prophylaxis in Renal Transplantation: It Makes No Difference for Bacterial Infections.

Seong Uk CHOI ; Chang Kwon OH ; Ji Hye KIM ; Gyu Tae SHIN ; Heungsoo KIM ; Se Jung KIM ; Sun Il KIM

The Journal of the Korean Society for Transplantation.2010;24(1):13-18. doi:10.4285/jkstn.2010.24.1.13

BACKGROUND: Although it has been a popular practice to use preventative antibiotics for the kidney recipients, it could increase the cost, encourage the growth of resistant micro-organism and have adverse effects. There has been no reported concrete evidence about the benefits and risks of using peri-operative prophylactic antibiotics for an immunosuppressed population. Therefore, we retrospectively evaluated the differences in the incidences of bacterial infection and adverse events after transplant surgery according to using peri-operative prophylactic antibiotics. METHODS: We reviewed retrospectively 106 cases of renal transplantations (cadaver donor: 42 cases, living donor: 64 cases) that were performed at Ajou University Hospital, Korea from January, 2006 to December, 2008. We divided the cases into two groups: Group A (n=41; 38.7%) included the patients who did not receive prophylactic antibiotics and Group B (n= 65; 61.3%) included the patients who did receive prophylactic antibiotics. We analyzed the infectious complications that occurred within 1 month after renal transplantation. RESULTS: In Group A, most patients (62 cases, 95.3%) used a 1st generation cephalosporin. The incidence of wound infection after kidney transplant for the 65 patients who received prophylactic antibiotics was 1.5%, compared to 2.5% for the 41 patients who did not receive prophylactic antibiotics. CONCLUSIONS: This retrospective study could not demonstrate a statistically significant difference in the rates of infectious complications between the two groups, although renal transplantation is considered to be a clean-contaminated surgery. But in order to obtain a definite conclusion, we need a bigger cohort in a prospective study.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Bacterial Infections ; Cohort Studies ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Retrospective Studies ; Risk Assessment ; Transplants ; Wound Infection

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Liver Transplantation for Advanced Hepatocellular Carcinoma.

Kwang Woong LEE ; Kyung Suk SUH

The Journal of the Korean Society for Transplantation.2010;24(1):4-12. doi:10.4285/jkstn.2010.24.1.4

Hepatocellular carcinoma (HCC) has become an important indication for liver transplantation in Korea. Even though the Milan criteria have been accepted as the gold standard in deceased donor liver transplantation, the acceptable indication for living donor liver transplantation is controversial. This review covers several key issues in liver transplantation for advanced HCC: (1) recent developments and published data on expanded criteria, (2) the role of down-staging, (3) an ethical issue in expanding the criteria in living donor liver transplantation, and (4) post-operative management, including the immunosuppressive regimen and post-transplant adjuvant chemotherapy to improve survival after transplantation for advanced HCC. Biological factors, such as AFP, PIVKA-II, and a PET scan, in addition to tumor size and number, may be helpful in selecting eligible patients for liver transplantation among patients with advanced HCC. Low-level immunosuppression with low exposure of calcineurin inhibitor may reduce HCC recurrence after transplantation.
Biological Factors ; Biomarkers ; Calcineurin ; Carcinoma, Hepatocellular ; Chemotherapy, Adjuvant ; Humans ; Immunosuppression ; Korea ; Liver ; Liver Transplantation ; Living Donors ; Positron-Emission Tomography ; Protein Precursors ; Prothrombin ; Recurrence ; Tissue Donors ; Transplants

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The Role of NGO in Deceased Organ Transplantation.

Soon Il KIM ; Sang Il MIN ; Kyu Ha HUH ; Ki Tae BANG ; Curie AHN ; Won Hyun CHO

The Journal of the Korean Society for Transplantation.2010;24(1):1-3. doi:10.4285/jkstn.2010.24.1.1

Solid organ transplantations give end stage organ failure patients new, healthy and normal lives and have them return to their families, friends and communities. But, there has been a donor organ shortage and it has been considered a major obstacle. A national report in 2009 showed a severe disparity between the annual numbers of organ donors (1,787) and the number of patients (12,235) on the deceased donor waiting list. In terms of donor action, and to meet the demands of organs for transplantation, we need to educate the public on the need for organs, eye and tissue donations, and we need to motivate the public to make an actionable donor designation. The unification of non-governmental organization (NGO) is necessary to educate the public about organ, eye and tissue donations and to avoid duplication of effort.
Eye ; Friends ; Humans ; Organ Transplantation ; Tissue and Organ Procurement ; Tissue Donors ; Transplants ; Waiting Lists

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Pure Red Cell Aplasia (PRCA) due to Parvovirus B19 Infection after Kidney Transplantation.

Kwang Yeon KIM ; Je Hoon PARK ; Chul Nam KIM ; Sang Youb HAN ; Kum Hyun HAN ; Hye Ran LEE ; Tae Hyun UM

The Journal of the Korean Society for Transplantation.2007;21(2):302-306.

The patient was a 39-year-old male with anemia persistent after a living-related renal transplantation. He was diagnosed to have pure red cell aplasia (PRCA) due to parvovirus B19 infection on the 6th week after the renal transplantation. Serum Parvovirus B19 DNA polymerase chain reaction (PCR) and anti-Parvovirus B19 IgM were positive and bone marrow aspiration biopsy showed giant pronormoblasts including prominent intranuclear inclusions. He has been receiving immunosuppressive therapy including oral cyclosporine A, prednisolone, mycophenolate mofetil (MMF). After diagnosis of pure red cell aplasia, we reduced the dose of cyclosporine A and maintained prednisolone, mycophenolate mofetil. We used intravenous immunoglobin(IVIG) 0.4 g/kg/ day for 5 days. Patient's serum reticulocyte count increased a week after the treatment from 0.1% to 3.8%, and patient's serum hemoglobin level normalized on the 4th week of the treatment. Presently, 20 weeks following the initiation of IVIG, his hemoglobin remains normal without recurrent symptom. We are planning to follow up the serum anti-parvovirus B19 IgM/IgG and parvovirus B19 DNA PCR examination.
Adult ; Anemia ; Biopsy, Needle ; Bone Marrow ; Cyclosporine ; Diagnosis ; DNA ; Erythroblasts ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Immunoglobulins, Intravenous ; Intranuclear Inclusion Bodies ; Kidney Transplantation* ; Kidney* ; Male ; Parvovirus* ; Polymerase Chain Reaction ; Prednisolone ; Red-Cell Aplasia, Pure* ; Reticulocyte Count

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A Case of Renal Infarction with Arterial Thromboembolism.

Young Chul LEE ; Kang Nyeong LEE ; Sang Bong AHN ; Jee Hyun KIM ; Joon Sung PARK ; Nak Won CHOI ; Chang Hwa LEE ; Gheun Ho KIM ; Chong Myung KANG

The Journal of the Korean Society for Transplantation.2007;21(2):298-301.

Renal infarction in transplant kidney is an very uncommon post-transplant complication, and usually occurs in the early postoperative period. Thromboemboli to the renal arteries usually originate from the heart, e.g. atrial fibrillation. This paper reports a 64-year-old man who had total occlusion of transplanted renal artery after 9 years from transplantation. His medicines included cyclosporine, prednisolone, aspirin, clopidogrel, and propranlol. Our patient presented with fever, oliguria, and left costovertebral angle tenderness, three days ago. Abdominal computed tomography (CT) revealed total occlusion of transplanted renal artery and right common iliac artery. Preservation of renal function is inversely proportional to the period of renal ischemia. Our patient was treated with heparinization. Remnant renal function was lost, he has been treated with hemodialysis.
Aspirin ; Atrial Fibrillation ; Cyclosporine ; Fever ; Heart ; Heparin ; Humans ; Iliac Artery ; Infarction* ; Ischemia ; Kidney ; Kidney Transplantation ; Middle Aged ; Oliguria ; Postoperative Period ; Prednisolone ; Renal Artery ; Renal Dialysis ; Thromboembolism*

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