• Childhood Kidney Diseases
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• 제19권2호
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• pp.176-179
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• 2015

Rituximab (RTX), a monoclonal antibody against the B-cell marker CD20, is commonly used as a treatment for antibody-mediated diseases or B-lymphocyte-mediated diseases. Destruction of B cells may reverse the disease course in many conditions; however, patients who are treated with RTX cannot respond appropriately to de novo infection due to lack of B lymphocytes. Here, we report one such case. A 7-year-old renal allograft recipient presented with severe anemia due to parvovirus infection after RTX treatment. The patient had focal segmental glomerulosclerosis and had received cadaveric kidney transplantation 6 months previously. She was treated with high-dose steroid for acute rejection and RTX for Epstein Barr Virus infection 3 months previously. At presentation, her hemoglobin level was 5.4 g/dL and leukocyte and platelet counts were normal. She had microcytic normochromic anemia and high viral load of parvovirus B19(70,578 copies/mL). Intravenous immunoglobulin ($200mg/kg{\cdot}d$) treatment controlled the progression of anemia and parvovirus infection. De novo parvovirus infection during the B lymphocyte-depletion period may have precipitated the severe anemia in this case. Close monitoring of infection is required after RTX therapy.

• Yonsei Medical Journal
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• 제59권9호
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• pp.1015-1025
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• 2018

Kidney diseases including acute kidney injury and chronic kidney disease are among the largest health issues worldwide. Dialysis and kidney transplantation can replace a significant portion of renal function, however these treatments still have limitations. To overcome these shortcomings, a variety of innovative efforts have been introduced, including cell-based therapies. During the past decades, advances have been made in the stem cell and developmental biology, and tissue engineering. As part of such efforts, studies on renal cell therapy and artificial kidney developments have been conducted, and multiple therapeutic interventions have shown promise in the pre-clinical and clinical settings. More recently, therapeutic cell-secreting secretomes have emerged as a potential alternative to cell-based approaches. This approach involves the use of renotropic factors, such as growth factors and cytokines, that are produced by cells and these factors have shown effectiveness in facilitating kidney function recovery. This review focuses on the renotropic functions of bioactive compounds that provide protective and regenerative effects for kidney tissue repair, based on the available data in the literature.

• 대한간호학회지
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• 제54권1호
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• pp.93-105
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• 2024

Purpose: The study aimed to understand the semantic structure and nature of the disease experience of kidney transplant recipients with kidney graft failure by applying phenomenological research methods. Methods: Data were collected between February and September 2021 through individual in-depth interviews with 12 kidney transplant recipients with kidney graft failure. Colaizzi's phenomenological analysis was used to analyze the meaning of the participants' illness experiences. Results: 5 theme clusters and 15 themes were derived. The five theme clusters are as follows: (1) First transplant giving me a second life; (2) Body and mind becoming sick again; (3) Waiting for a re-transplant with hope and worry; (4) Life supported by gratefulness; (5) Having control over my own life. Conclusion: This study shows that kidney transplant recipients with kidney graft failure experience physical and psychological difficulties during the long disease period and require help from many people, including family members, friends, colleagues, and health care providers, to overcome their difficulties.

• 대한이식학회지
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• 제31권4호
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• pp.182-192
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• 2017

Background: In recent years, introduction of novel immunosuppressive agents and its proper implementation for clinical practice have contributed to improving clinical outcomes of kidney transplantation (KT). Here, we report clinical outcomes of KTs and related risk factors. Methods: From July 1998 to June 2016, 354 KTs (182 from living and 172 from deceased donors) have been performed at Ulsan University Hospital. We retrospectively reviewed the clinical characteristics and outcomes of KT recipients, then estimated graft and patient survival rate were estimated and analyzed risk factors using Cox-regression. Results: The median follow-up period was 53 months (range; 3 to 220 months). The mean ages of recipients and donors were 45.0 years (SD, 12.5) and 44.7 years (SD, 13.6) years, respectively. During follow-up, 18 grafts were lost and 5- and 10-year death-censored graft survival was 96.7% and 91.5%, respectively. Biopsy-proven acute rejection (BPAR) occurred in 71 patients (55 cases of acute cellular rejection and 16 of antibody-mediated rejection). Cox-regression analysis showed that BPAR was a risk factor related to graft loss (hazard ratio [HR], 14.38; 95% confidence interval [CI], 3.79 to 54.53; P<0.001). In addition, 15 patients died, and the 5- and 10-year patient survival was 97.2% and 91.9%, respectively. Age ≥60 years (HR, 6.03; 95% CI, 1.12 to 32.61; P=0.037) and diabetes (HR, 6.18; 95% CI, 1.35 to 28.22; P=0.019) were significantly related to patient survival. Conclusions: We experienced excellent clinical outcomes of KT in terms of graft failure and patient survival despite the relatively high proportion of deceased donors. Long-term and short-term clinical outcomes have improved in the last two decades.

• Childhood Kidney Diseases
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• 제7권2호
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• pp.245-252
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• 2003

Posttransplant lymphoproliferative disease(PTLD)는 이식 후 발생하는 림프증식성 질환으로 이식장기의 거부반응을 억제하기 위한 면역억제제의 사용 및 이에 따른 EBV 감염과 연관이 있다고 알려져 있다. 소아 PTLD의 경우 성인에 비해 EBV의 초감염 또는 재활성이 더 많은 것으로 보고되고 있으며 최근 더 강력한 면역억제제들의 개발 및 사용에 따라 발생이 증가하고 있다. 본 증례는 14세 여아로 신이식 44개월 후에 EBV 감염의 증거 없이 지발성 PTLD가 발생하였으며 골수 검사상 B-세포 급성 림프구성 백혈병으로 진단되어 항암화학요법 치료를 시작하였고, 치료 후 완전 관해는 이루어졌으나 심한 중성구 감소증에 따른 패혈성 쇼크로 입원 77일만에 사망하였다.

• Clinical and Experimental Pediatrics
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• 제52권10호
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• pp.1069-1074
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• 2009

Peritoneal dialysis is a preferred modality of replacement therapy in children and adolescents with end-stage renal disease waiting for kidney transplantation. Recent development of pediatric swan-neck catheters with cuffs, novel dialysis solutions, and cyclers for automated peritoneal dialysis enabled more flexible prescriptions of dialysis with less complication, and improved patients' activities as well as the dialysis adequacy. Principles and practical issues of chronic peritoneal dialysis in children and adolescents are reviewed and utility of a web-based Korean Pediatric CRF Registry is explained.

• IMMUNE NETWORK
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• 제4권1호
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• pp.53-59
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• 2004

Background: Minor histocompatibility HY antigen, as a transplantation antigen, has been known to cause graft rejection in MHC (major histocompatibility complex) matched donor-recipient. The aim of our study is to investigate the role of male antigen (HY) disparity on MHC matched pancreatic islet transplantation and to examine the mechanism of the immune reaction. Methods: Pancreatic islets were isolated and purified by collagen digestion followed by Ficoll gradient. The isolated islets of male C57BL6/J were transplanted underneath the kidney capsule of syngeneic female mice rendered diabetic with streptozotocine. Blood glucose was monitored for the rejection of engrafted islets. After certain period of time, tail to flank skin transplantation was performed either on mouse transplanted with HY mismatched islets or on sham treated mouse. The rejection was monitored by scoring gross pathology of the engrafted skin. Results: HY mismatched islets survived more than 300 days in 14 out of 15 mice. The acceptance of second party graft (male B6 islets) and the rejection of third party graft (male BALB/c islets) in these mice suggested the tolerance to islets with HY disparity. B6 Skin with HY disparity was rejected on day $25{\pm}7$. However, HY mismatched skin transplanted on the mice tolerated to HY mismatched islets survived more than 240 days. Tetramer staining in these mice indicated the CTL recognizing MHC Db/Uty was not deleted or anergized. Conclusion: The islet transplantation across HY disparity induced tolerance to HY antigen in C57BL6 mouse, which in turn induced tolerance to HY mismatched skin, which otherwise would be rejected within 25 days. The MHC tetramer staining suggested the underlying mechanisms would not be clonal deletion or anergy.

• Archives of Plastic Surgery
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• 제50권4호
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• pp.415-421
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• 2023

The revision of the Korea Organ Transplantation Act (KOTA) in 2018 included hand/arm among the organs that can be transplanted. The first hand transplantation since the revision of KOTA took place in January 2021. A 62-year-old male patient experienced hand amputation on July 13, 2018, by a catapult injury. The patient first visited our institute 3 months after the injury. After serial interviews and an overall evaluation, the patient was registered on the hand transplantation waiting list in January 2020. On January 9, 2021, the patient underwent hand transplantation at the right distal forearm level. The total operation time was 17 hours 15 minutes, and the cold ischemic time was 4 hours 9 minutes. Postoperative immunosuppression was administered based on the protocol used for kidney transplantation. Two acute rejection episodes occurred, on postoperative days 33 and 41. Both rejection episodes were reversible with rescue therapy of a higher tacrolimus trough level, steroid pulse therapy, and topical immunosuppressants. Controlled passive range of motion exercise was started on postoperative day 10. Dynamic splint was applied on postoperative day 18. At 1 year, graft maintenance and functional improvement were satisfactory, and the patient showed a Disabilities of Arm, Shoulder and Hand score of 25.8. We successfully performed the first hand transplantation surgery under the KOTA amendment. It came from the organic and effective cooperation of plastic, orthopaedic, and transplantation departments and we believe it will guarantee the future ongoing success.

• Archives of Plastic Surgery
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• 제46권5호
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• pp.462-469
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• 2019

Background Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. Methods This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. Results The mean age of patients was $61.0{\pm}8.3years\;old$, with a mean body mass index of $28.4{\pm}4.8kg/m^2$, 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of $28.7{\pm}22.8months$. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. Conclusions This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

• 셀메드
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• 제10권2호
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• pp.17.1-17.5
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• 2020

Background: Chronic kidney disease (CKD) is affective a large portion of the world population prompting the need for extensive healthcare resources such as lifelong dialysis or kidney transplantation. The beneficial effect of conventional therapy in controlling the CKD progression remains a challenge due to their relative efficacy, safety, and accessibility. On the other hand, Unani medicine provides a therapeutic regimen that consists of a combination of treatment from rehabilitation to herbal pharmacotherapy. Methods: Two cases of chronic kidney disease were treated with dietotherapy, regimenal therapy ('bukhoor aam') and oral herbal drugs for 2-3 weeks. Endpoints of evaluation were symptoms and signs of the CKD, kidney function test, urine albumin, urine RBC, hemoglobin and liver function test. Result: Notable improvement was observed in the endpoints. Conclusion: Unani treatment was observed preliminarily beneficial in the treatment of chronic kidney disease. Rigorous pharmacological and clinical studies should be performed to warrant their efficacy and safety in CKD individuals.