BACKGROUND: Ischemic injury and the rejection process are the main reasons for graft failure in tracheal transplantation models. To enhance the acceptance, we investigated the influence of mesenchymal stem cells (MSCs) on tracheal allografts. METHODS: Extracted tracheal grafts from New Zealand white rabbits were cryopreserved for 4 weeks and orthotopically transplanted (control group A, n=8). In group B (n=8), cyclosporin A (CsA, 10 mg/kg) was injected daily into the peritoneal cavity. In group C (n=8), MSCs (1.0x10(7) cells/kg) from the same donor of the tracheal allograft, which had been pre-cultured for 4 weeks, were infused intravenously after transplantation. In group D (n=8), MSCs were infused and CsA was injected daily. Four weeks after transplantation, gross and histomorphological assessments were conducted for graft necrosis, measuring the cross-sectional area of the allograft, determining the degree of epithelization, lymphocytic infiltration, and vascular regeneration. RESULTS: The morphologic integrity of the trachea was retained completely in all cases. The cross-sectional areas were decreased significantly in group A (p=0.018) and B (p=0.045). The degree of epithelization was enhanced (p=0.012) and the lymphocytic infiltration was decreased (p=0.048) significantly in group D compared to group A. The degree of vascular regeneration did not differ significantly in any of the groups. There were no significant correlations among epithelization, lymphocytic infiltration, and vascular regeneration. CONCLUSION: The administration of MSCs with concurrent injections of CsA enhanced and promoted epithelization and prevented lymphocytic infiltration in tracheal allografts, allowing for better acceptance of the allograft.
Cryopreservation ; Cyclosporine ; Mesenchymal Stromal Cells ; Necrosis ; Peritoneal Cavity ; Rabbits ; Regeneration ; Rejection (Psychology) ; Tissue Donors ; Trachea ; Transplantation, Homologous ; Transplants

PURPOSE: To investigate the clinical outcomes of primary pediatric keratoplasty. METHODS: Records of patients who underwent penetrating keratoplasty at the age of 5 years or younger were retrospectively reviewed. The survival rates of corneal grafts, postoperative complications, and causes of graft failure were evaluated. RESULTS: A total of 31 penetrating keratoplasties were performed in 29 patients, two of which were bilateral. The mean follow-up period was 78.72 +/- 8.94 months. The overall graft survival rate was 51.61%. The graft survival rate was 77.4% at 6 months, 61.3% at 12 months, 57.5% at 2 years, and 49.5% at 5 years after the surgery (the median survival time, 39.2 months). The main surgical indications included sclerocornea (35.5%), followed by Peter's anomaly (25.8%) and congenital glaucoma (9.7%). There were significant differences in graft survival time among the surgical indications, of which sclerocornea was the worst (p = 0.003). The main cause of graft failure was rejection (46.7%), followed by infection (26.7%) and primary endothelial decompensation (20%). When patients were sub-grouped according to age (under 12 months, between 12 to 48 months, and over 48 months), there was significant difference in graft survival time (p = 0.037) but not in overall graft survival rate (p = 0.154). Graft rejection occurred more frequently in patients between 12 to 48 months of age compared to other age groups (p = 0.016). Three out of 13 graft infections occurred in patients under 12 months of age. CONCLUSIONS: The type of disease causing corneal opacity was a significant factor affecting the clinical outcomes of penetrating keratoplasty in children.
Child ; Cornea ; Corneal Diseases ; Corneal Opacity ; Follow-Up Studies ; Glaucoma ; Graft Rejection ; Graft Survival ; Humans ; Keratoplasty, Penetrating ; Postoperative Complications ; Rejection (Psychology) ; Retrospective Studies ; Survival Rate ; Transplants

Antibody-mediated rejection (AMR) by preformed and/or de novo human leukocyte antigen alloantibodies is a leading cause of early and late allograft loss. In this review, we describe strategic approaches to various forms of AMR in clinical settings that are not based on pathologic classification, which is controversial for atypical AMR (C4d-, DSA-, subclinical etc.). For acute AMR, a variety of modalities like plasmapheresis, intravenous immunoglobulin, and anti-CD20 antibodies have been utilized singly, or in combination, with variable results; however, no established treatment for chronic AMR is known. Significant research efforts are being made for developing new and novel therapies. Improvements in clinical outcomes can be expected from studies evaluating innovative therapeutic concepts, such as proteasome inhibition or complement-blocking agents.
Antibodies ; Humans ; Immunoglobulins ; Isoantibodies ; Leukocytes ; Plasmapheresis ; Proteasome Endopeptidase Complex ; Rejection (Psychology) ; Transplantation, Homologous

The limited donor organ supply is a main problem for transplant surgeons in Korea, and forces them to use organs from extended sources. In one such case, we reused a transplanted kidney allograft in August 2012. This was the first successful case involving the reuse of a transplanted kidney allograft in Korea. The kidney donor was a 44-year-old man brain-dead due to spontaneous subdural hemorrhage. He received a kidney transplant from his sister in 2006. The second recipient was a 59-year-old man who had been receiving hemodialysis for 11 years. There were full human leukocyte antigen (HLA) matches between the first donor and the first recipient, and two HLA mismatches between the first donor and the second recipient. Fortunately, we were able to perform a crossmatch test between the first donor and the second recipient as well as the first recipient and the second recipient (with the first donor's agreement). We used the left iliac artery for perfusion instead of the aorta during organ procurement. The cold ischemic time was 4 hours and the initial kidney function was excellent. The patient has been doing well, without any significant complications or rejections, for 3 weeks. His last serum creatinine level was 0.91 mg/dL. Our case shows that the reuse of kidney allografts could be a possible solution for the shortage of donor kidneys. However, this method requires careful consideration and an agreement among participants before its performance.
Aorta ; Brain Death ; Cold Ischemia ; Creatinine ; Hematoma, Subdural ; Humans ; Iliac Artery ; Kidney ; Kidney Transplantation ; Korea ; Leukocytes ; Perfusion ; Rejection (Psychology) ; Renal Dialysis ; Siblings ; Tissue and Organ Procurement ; Tissue Donors ; Transplantation, Homologous ; Transplants

Progress in the field of antibody mediated rejection (ABMR) in kidney transplantation has shown a rapid increase during the past two decades. New pathologic entities have emerged and replace old concepts and diagnostic terms. According to newly acknowledged facts discovered by clinicians, researchers, and pathologists all over the world, an updated classification, rather than Banff 07, is needed. In order to improve the diagnostic accuracy for ABMR in clinicians as well as pathologists, recognition and awareness of various conditions such as C4d-negative ABMR, subclinical ABMR, de novo donor specific antibody, microcirculation inflammation, isolated vascular lesion, antibody-mediated transplant arteriopathy, etc. are essentially important.
Antibodies ; Complement C4b ; Graft Rejection ; Humans ; Inflammation ; Kidney ; Kidney Transplantation ; Microcirculation ; Peptide Fragments ; Rejection (Psychology) ; Tissue Donors ; Transplants

Improved immunosuppressive therapies for solid organ transplantation (SOT) have reduced the incidence of allograft rejection while increasing susceptibility to opportunistic infections. Diagnosis and treatment for infectious disease after SOT are evolving with various preventive strategies, improved microbiologic diagnostic tools, and newer therapeutic regimens. Despite these improvements, various opportunistic infections can develop in SOT recipients. Early and specific diagnosis of infections is essential to guide treatment and minimize nonessential antibiotics. Invasive diagnostic procedures are often required for accurate and timely diagnosis. Here, I reviewed general aspects of common infections in SOT recipients.
Anti-Bacterial Agents ; Communicable Diseases ; Incidence ; Opportunistic Infections ; Organ Transplantation ; Rejection (Psychology) ; Transplantation, Homologous ; Transplants

BACKGROUND: We summarize our experience in the pathological diagnosis of late complications of liver transplantation (LT) to better understand the causes of late allograft dysfunction in a population mostly composed of patients with hepatitis B virus (HBV) infection. METHODS: We reviewed 361 post-transplant liver biopsies from 174 patients who underwent LT and first presented with liver function abnormalities 3 months post-procedure. The underlying diseases included HBV-associated liver disease (77%), toxic or alcoholic liver disease (10.3%), hepatitis C virus (HCV)-associated liver disease (8.6%), primary biliary cirrhosis (1.2%), primary sclerosing cholangitis (1.2%), and metabolic disease (1.7%). RESULTS: The three most common late complications were acute rejection (32.5%), recurrent disease (19.1%), and biliary complication (17.1%). Patients who underwent LT for HBV infection or for drug- or alcohol-related liver disease had a lower incidence of recurring disease than those who underwent transplantation for HCV infection. During post-transplantation months 3-12, acute rejection was the most common cause of allograft dysfunction and recurring disease was the leading cause for allograft dysfunction (p=0.039). The two primary causes of late allograft dysfunction have overlapping histological features, although acute rejection more frequently showed bile duct damage and vascular endothelialitis than recurring HBV infection, and recurring HBV infection had more frequent lobular activity and piecemeal necrosis. CONCLUSIONS: The causes of late liver allograft dysfunction are closely associated with the original liver diseases and the period after LT. Careful attention is required for differential diagnosis between acute rejection and recurrent HBV.
Bile Ducts ; Biopsy ; Cholangitis, Sclerosing ; Diagnosis, Differential ; Hepacivirus ; Hepatitis B virus ; Humans ; Incidence ; Liver ; Liver Cirrhosis, Biliary ; Liver Diseases ; Liver Diseases, Alcoholic ; Liver Transplantation ; Metabolic Diseases ; Rejection (Psychology) ; Transplantation, Homologous ; Transplants

PURPOSE: Despite the well-known public health benefits of vaccination, increasing public concern about the safety of childhood vaccinations has led some parents to refuse or hesitate having their children immunized. The purpose of this study was to identify the subjectivity of parents toward refusal of childhood vaccination. METHODS: Q-methodology, in which subjective viewpoints are explored and analyzed using a combination of quantitative and qualitative techniques, was used. Thirty-five participants were asked to rank 42 statements on diverse issues of childhood vaccination according to a continuous 9-point scale ranging from -4 for strongly disagree to +4 for strongly agree. Collected data was analyzed using the PC-QUANAL program. RESULTS: The results revealed three discrete groups of parents in the refusal of children's immunization: type I, distrust; type II, concern about side effects, and type III, belief that vaccinations are unnecessary. CONCLUSION: Special nurse counselors who can provide correct information about vaccination based on the three types should be part of the government policy. Customized education programs to shift viewpoints should be also redeveloped according to the results in this study.
Child ; Counseling ; Disulfiram ; Humans ; Parents ; Public Health ; Rejection (Psychology) ; Vaccination

PURPOSE: There is controversy concerning the effect of a positive T-lymphocytotoxic crossmatch (TLC) on clinical outcomes in adult living donor liver transplantation (LDLT). The aim of this study was to investigate the effect of TLC on clinical outcomes in LDLT and to determine how long a pretransplant positive TLC continues after liver transplantation (LT). METHODS: Between January 2005 and June 2010, 219 patients underwent adult LDLT at National Cancer Center. The TLC test was routinely performed before LDLT. TLC test results were positive in 8 patients (3.7%). Patients were divided into 2 groups according to the result of TLC: positive TLC (n = 8) and negative TLC (n = 211) groups. All patients with a pretransplant positive TLC (n = 6) underwent a TLC test every week until negative conversion of TLC, except 2 patients who refused to receive the TLC test. RESULTS: Acute cellular rejection, surgical complications and patient or graft survival were not significantly different between both groups. All patients with a positive TLC (n = 6) had a posttransplant negative TLC. The median time to negative conversion of TLC was 1.5 weeks (range, 1 to 3 weeks). CONCLUSION: A pretransplant positive TLC does not affect clinical outcomes in adult LDLT. Moreover, T-lymphocytotoxic cross-reactivity disappeared within 3 weeks (range, 1 to 3 weeks) after LT.
Adult ; Graft Survival ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Rejection (Psychology)

OBJECTIVES: The Patient rejection scale (PRS) has been reported as a valid tool for the assessment of rejecting feelings of family respondents toward schizophrenics who return to live with their families. The aim of this study was to assess the reliability and validity of the Korean-version of PRS (K-PRS). METHODS: A sample of 272 primary caregivers of schizophrenics completed the K-PRS and the data were analyzed for internal consistency and factor structure. Additionally 117 caregivers refilled K-PRS after two weeks for test-retest reliability. To test for validity, Family Questionnaire (FQ), Drug Attitude Inventory-10 (DAI-10) and the Scale to Assess Unawareness of Mental Disorder (SUMD) were administered. RESULTS: Internal consistency of K-PRS was good (Cronbach' alpha=0.787) and principal component factor analysis revealed the three-factor structure. The K-PRS also showed reasonable test-retest reliability (r=0.795). Convergent validity was examined through correlations between the K-PRS and the FQ-criticism subscale (r=0.78). Divergent validity was examined through correlations between the K-PRS and KDAI-10 (r=-0.02, p=0.001), and between the K-PRS and SUMD-K (r=-0.02, p=0.796). CONCLUSION: The Korean version of PRS proved to be a reliable and valid instrument measuring rejecting feelings in relatives of Korean patients with schizophrenia.
Caregivers ; Surveys and Questionnaires ; Humans ; Mental Disorders ; Rejection (Psychology) ; Reproducibility of Results ; Schizophrenia