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Safety for Expanding Living-Donor Criteria in Renal Transplantation.

The Journal of the Korean Society for Transplantation.2010;24(2):80-86. doi:10.4285/jkstn.2010.24.2.80

The increasing waiting times for deceased donor kidneys have focused attention on living donors as a useful way to increase the organ supply. However, living donors with potential medical risks for renal transplantation raise medical and ethical questions for donor nephrectomy about conditions such as hypertension, hematuria, obesity, and old age. Data on the long-term risks of conditions are sparse and potential acceptance criteria are under development. Many older donors hope to donate to their offspring, despite the presence of elevated blood pressure. Transplant professionals have internal debates on these situations that require a well-defined scoring system for donating risk. This review summarizes the characteristics and risk of marginal living donors in renal transplantation and discusses strategies for overcoming the current limitation.
Blood Pressure ; Hematuria ; Humans ; Hypertension ; Kidney ; Kidney Transplantation ; Living Donors ; Nephrectomy ; Obesity ; Tissue Donors ; Transplants

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Prophylaxis for Hepatitis B Core Antibody-Positive Donors after Liver Transplantation.

Hee Yeon KIM ; Jong Young CHOI

The Journal of the Korean Society for Transplantation.2010;24(2):73-79. doi:10.4285/jkstn.2010.24.2.73

The growing shortage of organs for orthotopic liver transplantation (OLT) has led to an expanded donor pool with the use of marginal grafts. Recipients who receive liver grafts from HBsAg-negative, anti-HBc positive donors have an increased risk of developing de novo hepatitis B infection. This review covers several issues in liver transplantation using hepatitis B core antibody-positive donors: (1) the mechanism of de novo hepatitis B infection, (2) high risk groups, (3) prophylactic regimens and (4) clinical significance and a proposal for patients in Korea.
Hepatitis ; Hepatitis B ; Humans ; Korea ; Liver ; Liver Transplantation ; Tissue Donors ; Transplants

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Transplantation Options in Type 1 Diabetes with End Stage Renal Disease.

Jae Hyeon KIM

The Journal of the Korean Society for Transplantation.2010;24(2):69-72. doi:10.4285/jkstn.2010.24.2.69

For patients with type 1 diabetes complicated by end stage renal disease (ESRD), kidney transplantation prolongs life and frees the recipient from the substantial morbidities of dialysis. Transplantation of whole pancreas has emerged as an effective treatment modality for patients with diabetes mellitus, especially those with established end-stage renal disease. However, it is not clear that transplantation of the pancreas itself prolongs the life of the recipient. Living donor kidney transplant (LDKT) and simultaneous pancreas-kidney transplant (SPKT) provide distinct benefits over deceased donor kidney transplant (DDKT) alone. But, previous studies have not demonstrated that the SPKT approach prolongs life compared with LDKT. Patients who receive an LDKT can later opt for a pancreas after kidney transplant (PAKT) or an islet after kidney transplant (IAKT). Therefore, when a transplant doctor is counseling a patient with type 1 diabetes and ESRD and has a live donor, the decision about whether to proceed with an LDKT or to remain on the waiting list for an SPKT requires careful consideration. The aim of this review was to summarize the current status and outcomes of SPKT, LDKT, IAKT, and PAKT and their effects on survival of patients with type 1 diabetes and ESRD.
Counseling ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Dialysis ; Humans ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Living Donors ; Pancreas ; Pancreas Transplantation ; Tissue Donors ; Transplants ; Waiting Lists

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Use of Graft with Eosinophilic Abscess in Living Donor Liver Transplantation.

Choon Hyuck KWON ; Kyung Suk SUH ; Jai Young CHO ; Yong Beom CHO ; Nam Joon YI ; Kuhn Uk LEE

The Journal of the Korean Society for Transplantation.2004;18(1):87-88.

No abstract available.
Abscess* ; Eosinophils* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Transplants*

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Nurse's Knowledge and Attitudes on Organ Donation in Brain Death.

Kyung Ja KANG ; Sang Hee KIM

The Journal of the Korean Society for Transplantation.2004;18(1):81-86.

PURPOSE: This study attempted as investigations of nurse's knowledge and attitudes on organ donation in brain death, to find the method solving of the problems. METHODS: A survey questionnaire was used and received responses from nurses (n=180) of university hospital and general hospital in B city. The data were analyzed using SPSS/PC program on real numbers, percentage, frequency, mean, standard deviation and t-test. RESULTS: Organs invaded by cancer cell or infected by microorganism are not able to donate' obtained to highest score (94.9%) in knowledge measurement on organ donation in brain death. According to nurse's knowledge and positive attitudes, there were statistical differences in ''Knowing the Korean government permit the organ transplantation from brain death donors' (P=0.014), and ''Best organs to donate are aged 20 years of young people in brain dead state from head injury' (P=0.005). There was statistical difference between knowledge and negative attitude in 'Unknowing the Korean government permit the organ transplantation from brain death donors' (P=0.050). CONCLUSIONS: This study might help the nurses who are concerning organ sharing and make effective interventions and educations to facilitate the decision making process for organ donation in brain dead donors or families.
Brain Death* ; Brain* ; Decision Making ; Head ; Hospitals, General ; Humans ; Organ Transplantation ; Surveys and Questionnaires ; Tissue and Organ Procurement* ; Tissue Donors ; Transplants

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Donor Quality of Life in Living Donor Liver Transplantation.

Jin Young YOO ; Nam Joon YI ; Kyung Suk SUH ; Choon Hyuck KWON ; Seok Ho CHOI ; Kuhn Uk LEE

The Journal of the Korean Society for Transplantation.2004;18(1):73-80.

PURPOSE: The safety of donors and the impact on quality of life (QOL) was the most important thing in living donor liver transplantation (LDLT). METHODS: Questionnaires were sent to 50 donors who were followed up more than 4 months after LDLT from December 2001 to January 2003 (response rate 92.0%). The control group was selected the same number of the general public (n=42). The questionnaire consisted of donors characteristics, medical and psychosocial outcomes, and global QOL (KHP 1.0). Follow-up investigations were also performed at out patient clinic 1, 4, and 12 months after discharge. RESULTS: The donors were more prevalent in male patient (63.0%) and most common in twenties (23.8%). The relations to the recipients were 17 offsprings (37.0%), 12 parents (26.1%), 6 spouses (13.0%), and et cetera. There was no perioperative transfusion, reoperation, and none of the donors died or has suffered life-threatening complications. Average length of hospital stay is 11.4+/-4.5 days. The mean recovery time was 1~3 months in a half of them. All donors resumed their predonation occupation or regular activity and felt no limitation. Most donors were satisfied with their donation (95.6%) and their current life (87.0%) after operation. The score of QOL examined by KHP 1.0 showed that physica role of donors were more restricted but emotional health was better than that of the general public. CONCLUSIONS: Most donors in LDLT felt it to be good, but some limitation ofl their physical role despite of their physical recoveries. Donor follow-up needs to be emphasized and followed more systemically.
Follow-Up Studies ; Humans ; Length of Stay ; Liver Transplantation* ; Liver* ; Living Donors* ; Male ; Occupations ; Parents ; Quality of Life* ; Surveys and Questionnaires ; Reoperation ; Spouses ; Tissue Donors*

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Clinical Review of Post-transplantation Diabetes Mellitus after Liver Transplantation.

Deok Bog MOON ; Sung Gyu LEE ; Kwang Min PARK ; Shin HWANG ; Ki Hun KIM ; Chul Soo AHN ; Young Joo LEE ; Chong Woo CHU ; Tae Yong HA ; Sung Hun CHO ; Ki Bong OH ; Yeon Dae KIM ; Keon Kuk KIM

The Journal of the Korean Society for Transplantation.2004;18(1):65-72.

PURPOSE: Liver transplantation (LT) can cure abnormality of glucose metabolism, but cause altered glucose metabolism with immunosuppressive treatment. Up to now, almost all studies have been performed in cadaveric donor liver transplantation (CDLT). We underwent study in CDLT and also living donor liver transplantation (LDLT) recipients. METHODS: Among 397 adult-to-adult LT recipients between January 1994 and August 2001, we selected 81 patients who could be followed more than 12 months by using the table of random sampling numbers. We reviewed the change of blood glucose and risk factors, complications and survival retrospectively between post-transplantation diabetes mellitus (PTDM) and no PTDM patients. RESULTS: Clinical data showed 34 : 47 in frequency of PTDM to no PTDM. Age, family history of DM, preoperative DM history over 6 months had a significant risk of PTDM. There was no difference of PTDM frequency between CDLT and LDLT and its subgroup. The worse post-transplant graft function causes the more incidence of PTDM (P=0.051). FK506 had higher relation with PTDM than cyclosporine and mycophenolate mofetile (P=0.058). The incidence of DM after operation has been decreased by 6 months, but thereafter no further. There were 18 of De Novo DM among 34 PTDM patients, and only 1 preoperative DM patient improved after LT. Between PTDM and no PTDM group, there were no significant difference of complication rate and 5-year survival rate. CONCLUSIONS: The types of graft would not affect the incidence of PTDM if the graft function were preserved. Other clinical data showed similar results to previous reports.
Blood Glucose ; Cadaver ; Cyclosporine ; Diabetes Mellitus* ; Glucose ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Metabolism ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tacrolimus ; Tissue Donors ; Transplants

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Review of Patients who Underwent Renal Transplantation in China.

Young Chan LEE ; Kyu Ha HUH ; Hyun Jung KIM ; Kyung Ock JEON ; Soon Il KIM ; Yu Seun KIM ; Kiil PARK

The Journal of the Korean Society for Transplantation.2004;18(1):61-64.

BACKGROUND: The number of patients awaiting for renal allograft is continuously increasing as the kidney donors are limited worldwide. Undesirably, for this reason, more and more patients are currently visiting China for renal allograft worldwide, and Koreans are not an exception in this unhappy environment. METHODS: We analyzed 21 patients who are on follow-up in our hospital after receiving a renal allograft in China and return back to Korea. Surgical complications at the time of their arrival, prevalence of infection and kinds of immunosuppression, and finally their outcome were evaluated. RESULTS: Of 21 patients, 15 patients were male. The age ranges from 30 to 62 years old. At the time of their arrival, 14 were on tacrolimus-, and 7 were on cyclosporine-based triple immunosuppression including mycophenolate mofetil (MMF) and steroids. The doses of MMF were different (1~1.5 g/day in 5, 2 g/day in 15, and 2.5 g/day in 1 patient) center to center in China. Most of patients had received daclizmab for once or twice doses during their stay in China. They recommended further doses in Korea. Acute rejection episode was detected in 3 patients 17, 36, and 39 days after operation. All of them recovered completely after steroid pulse therapy. Three patients developed HCV-RNA-PCR positive C-viral hepatitis and 3 patients developed CMV-IgM positive viral infection. Two patients died during the follow-up. One patient died 15 months after operation due to rapid progression of liver failure after acquiring C-viral hepatitis immediately after renal transplantation. The other patient died 39 day after operation due to systemic sepsis caused by Aureobasidium Pullulans fungal infection. In 2 patients, significant urinary leakage were developed requiring surgical intervention. CONCLUSIONS: Patients who had received renal allograft in China and returned back seem to be exposed more likely and easily to infections and surgical complications. Therefore, at the arrival of patients, strict evaluation of viral, fungal infection should be carried out and net amount of immunosuppression should be tailored.
Allografts ; China* ; Follow-Up Studies ; Hepatitis ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation* ; Korea ; Liver Failure ; Male ; Middle Aged ; Prevalence ; Sepsis ; Steroids ; Tissue Donors

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Impacts of Metabolic Demand and Renal Mass Supply on the Early Graft Function Following Living Donor Renal Transplantation.

Sung Ho JIN ; Yong Geun PARK ; Chang Kwon OH ; Se Joong KIM ; Gyu Tae SHIN ; Heung Soo KIM

The Journal of the Korean Society for Transplantation.2004;18(1):55-60.

PURPOSE: Chronic rejection accounts for the majority of late renal graft losses and there is good evidence that both immunologic and non-immunologic factors are important in late graft loss. The hyperfiltration hypothesis postulates that kidneys with reduced renal mass will progress toward failure due to hypertrophy of the remaining nephron to meet the excess metabolic demand, eventually leading to nephron exhaustion. The impact of metabolic demand and renal mass supply on the early graft function, especially hyperfiltration phenomenon, remains uncertain. METHODS: In this study, we analyzed age, gender, body weight, height, body surface area (BSA), lean body weight (LBW), and serum creatinine (SCr) of both donors and recipients. We weighed the donated kidney and measured the recipient's SCr and LBW for six months postoperatively. Modified Cockcroft-Gault Equation standardized for BSA was used to calculate renal glomerular filtration rate (CrCl, mL/min/1.73 m2). The variables and the CrCl of the 3rd day and 6th month were analyzed with accordance to donor/recipient LBW ratio(D/R LBW) and graft weight/recipient LBW (GW/RLBW) by independent sample t-test and paired t-test using SPSS, and P<.05 was considered significant. RESULTS: The means of the 3rd day and 6th month CrCl were 76.90+/-24.35 and 73.41+/-10.80, respectively and there were no statistical differences (P=0.340). In D group (D/R LBW>1), the 3rd day and 6th month CrCl were 80.82+/-28.74 and 71.66+/-12.12, respectively. In R group (D/R LBW< or =1), the 3rd day and 6th month CrCl were 69.94+/-12.06 and 75.80+/-7.24, respectively. D group CrCl was decreased (P=0.093) and R group CrCl was increased slightly (P=0.169) during the study period, but there was no statistical significance. In H group (GW/RLBW>3), the 3rd day CrCl was 86.08+/-25.13, which was significantly decreased to 73.48+/-11.64 at the 6th month (P=0.023). In L group (GW/RLBW< or =3), the 3rd day and 6th month CrCl were 66.95+/-19.94 and 73.34+/-10.60 (P=0.158), respectively. the 3rd day CrCl of H group was higher than that of L group significantly (P=0.047), but 6th month CrCl showed no difference between the two groups (P=0.975). CONCLUSIONS: The 3rd day CrCl represents early graft function well. GW/RLBW has a strong correlation with early graft function. In L group with low early graft function, CrCl was tended to be increased to meet the metabolic demand for following the 6 months. Conversely, in H group with high early graft function, CrCl was decreased to reduce the excess graft function. So the 6th month CrCl represents adapted graft function. In this study, therefore, we postulate that the hyperfiltration or hypofiltration develops according to metabolic demand and renal mass supply.
Body Height ; Body Weight ; Creatinine ; Glomerular Filtration Rate ; Humans ; Hypertrophy ; Kidney ; Kidney Transplantation* ; Living Donors* ; Nephrons ; Tissue Donors ; Transplants*

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The Safety and Effectiveness of Microemulsion Cyclosporine in Renal Allograft Recipients: 1 Year Follow-Up Study.

Ki Il PARK ; Jang Il MOON ; Soon Il KIM ; Yu Seun KIM

The Journal of the Korean Society for Transplantation.1997;11(2):263-268.

A microemulsion cyclosporine(Me-CsA) was developed and became available with more predictable whole blood CsA concentration and minimal inter- and intra-personal variability in daily dosage of CsA. We prospectively performed this study to assess 1) the ability of Me-CsA maintaining the adequate predefined therapeutic level and 2)long-term safety and tolerability of Me-CsA in kidney transplant recipients. A total of 123 renal transplant patients were enrolled on the Me-CsA group, who have been on Me-CsA as an initial main immunosuppressant since their transplantation. This group of patients were compared to 200 renal transplant patients on conventional cyclosporine(Con-CsA) as a historical control group(Con-CsA group). There were no differences in the methods of operation, induction immunosuppression, the strategies of maintenance immunosuppression and anti-rejection therapy between these two groups. The clinical status and laboratory values were monitored at 1,3,6,9, and 12 months after the kidney transplantation. There were no statistical differences in acute rejection episodes, serum creatinine level, and graft failure and survival rate between Con-CsA and Me-CsA groups. In this study, we could demonstrate the significant fluctuation of the mean values of daily dosage and whole blood trough level and their standard deviations of cyclosporine in Con-CsA group compare to those of Me-CsA group. We also could demonstrate early stabilization of CsA blood trough level in patients using Me-CsA. These results mean that Me-CsA has less interpersonal variations than Con-CsA. In conclusion, Me-CsA has more predictable pharmacodynamic characteristics than Con-CsA and comparable tolerability and safety to Con-CsA with no additional side effects.
Allografts* ; Creatinine ; Cyclosporine* ; Follow-Up Studies* ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Prospective Studies ; Survival Rate ; Transplantation ; Transplants

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