• 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.

• Journal of Chest Surgery
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• 제33권4호
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• pp.338-341
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• 2000

Renal transplant recipients who received immunosuporessive agent are in high risk of development Kaposi's sarcoma. In Korea a few report of Kaposi's sarcoma has been pubilshed but any report of intrathoracic Kaposi's sarcoma provedn by open lung biopsy has not been pulbilshed until now. We report a case of intrathoracic Kaposi's sarcoma developed in a 25 year old Korean man, who had been operated renal transplantation due to end stage renal disease and received cyclosporine and prednisolone as immunosuppessive agent, without any other organ involvment and was proven by open lung biopsy. Although discontinuation of immunosuppressive agent, temporary symptomatic and radilolgic improvement were observed, he died 11 days later after open lung biopsy because of intractable resiratory failure.

• Archives of Plastic Surgery
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• 제41권5호
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• pp.505-512
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• 2014

Background Laryngeal allotransplantation (LA) is a technique involving transplantation of a deceased donor's larynx into a recipient, and it may be substituted for conventional laryngeal reconstruction. There are widely different views on LA, as the recipient is administered continuous, potentially life-threatening, immunosuppressive therapy for a functional or aesthetic result, which is not directly related to life extension. The purpose of this study was to analyze the difference in risk acceptance and expectations of LA between four population groups. Methods A survey was performed to examine patients' risk acceptance and expectations of LA. The survey included 287 subjects in total (general public, n=100; kidney transplant recipients, n=53; post-laryngectomy patients, n=34; doctors, n=100), using a Korean translated version of the louisville instrument for transplantation (LIFT) questionnaire. Results All four groups responded differently at various levels of their perception in risk acceptance and expectations. The kidney transplant recipients reported the highest risk acceptance and expectations, and the doctor group the lowest. Conclusions This study examined the disparate perception between specific population groups of the risks and benefits of using LA for the promotion of the quality of life. By addressing the information gaps about LA in the different populations that have been highlighted from this survey, we suggest that LA can become a more viable alternative to classical surgery with resultant improved quality of life for patients.

• 대한간호학회지
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• 제30권5호
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• pp.1181-1194
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• 2000

This study was attempted to evaluate how the self efficacy promotion and exercise training program effect on the postoperative general conditions of transplant recipients after kidney transplantations. The subjects were selected randomly among the patients who underwent renal trans- plantations at three major transplantation hospitals in Seoul, Korea. This study was carried out between November 1999 and March 2000. The observed subjects in this study consisted of 56 patients. The exercise training group(n=16) received the self efficacy promotion and exercise training program for 12 weeks which contained general knowledge for compliance instruction, exercise training and self efficacy promotion education. The self efficacy group(n=18) received general knowledge for compliance instruction and self efficacy promotion education but no exercise training was given. The control group(n=22) were not offered any education. The knowledge for compliance, self efficacy, physical conditions(weight, muscle strength, muscle endurance, flexibility), lab studies (hemoglobin, creatinine, cholesterol), activities of daily living and quality of life were evaluated 3 times, before the experiment, at 8 weeks and at 12 weeks. The data were analyzed with mean, standard deviation, Chi-square test, ANOVA and Scheff test. The results were as follows: 1. The knowledge and self efficacy score of the exercise training group and self efficacy group were significantly increased than those of the control group(p=.0001). 2. The weight of the exercise training group was significantly decreased compared to those of the self efficacy group and the control group(p=.0001). Muscle strength (grip strength, back lift strength), and flexibility of all 3 groups were significantly changed(p=.0001). However, muscle endurance in all 3 groups showed no significant differences. 3. The hemoglobin level of the exercise training group and the self efficacy group were significantly increased compared to that of the control group(p=.0001) and the cholesterol levels of the exercise training group and the self efficacy group were significantly decreased compared to that of the control group(p=,0001). However, the creatinine levels in all 3 groups showed no significant differences. 4. The activities of daily living scores of the exercise training group was significantly increased than that of the control group (p=.0003), and the quality of life scores of the exercise training group and the self efficacy group were significantly better than that of the control group(p=.0001). It would be expected that this self efficacy promotion and exercise training program could be applied widely as an effective nursing intervention for kidney transplant recipients.

• 임상간호연구
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• 제19권3호
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• pp.395-406
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• 2013

Purpose: This study was aimed to investigate the relationship between the level of stress and the quality of life among the adult recipients of living donor liver transplantation. Methods: Participants were 213 outpatients who received living donor liver transplantation at least 3 months prior to this study. Stress was measured using a modified version of the Kidney Transplant Recipient Stressor Scale (KTRSS), and the quality of life was measured using SF-36 version 2. Results: The mean of scaled stress level and quality of life of liver transplant recipients were $2.44{\pm}0.13$, $69.28{\pm}18.25$, respectively. There was an inverse correlation between those two parameters. Therefore lower stress could improve quality of life. Conclusion: For the liver transplantation recipients, improving the quality of life is to be the ultimate goal of health-related mediation. Liver transplantation recipients would need to cultivate self-care ability to manage stress, and improving their quality of life.

• Childhood Kidney Diseases
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• 제21권2호
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• pp.75-80
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• 2017

Purpose: To investigate the frequency, presentation, management, and outcome of cytomegalovirus (CMV) infection in pediatric patients who underwent renal transplantation. Methods: We performed a retrospective chart review of 70 patients under the age of 18, who underwent renal transplantation between January 1990 and November 2014. A diagnosis of CMV infection was based on serology, molecular assays, antigenemia assays, and culture. CMV infection was defined as detection of virus and CMV disease was diagnosed when clinical signs and symptoms were present. Results: The number of patients with CMV infection was 18 (25.7% of renal transplant recipients). Twelve were male (66.7%), and the $mean{\pm}standard$ deviation (SD) age at infection was $13.3{\pm}3.9$ years. Median time of infection after renal transplantation was 4 months (range 1.0-31.0 months). Pretransplantation CMV status in the infected group was as follows: donor (D)+/recipient (R)+, 11 (61.1%); D+/R-, 7 (38.9%); D-/R+, 0; and D-/R- 0. Nine patients had CMV disease with fever, leukopenia, thrombocytopenia, or organ involvement such as enteritis, hepatitis, and pneumonitis. The age of disease occurrence was $13.1{\pm}3.9$ years and the median time to disease onset after renal transplantation was 8 months (range 1.0-31.0). Immunosuppressive agents were reduced or discontinued in 14 patients (77.8%), antiviral agents were used in 11 patients (61.1%), and all patients with CMV infection were controlled. Conclusions: A quarter of the patients had CMV infection about 4 months after renal transplantation. CMV infection was successfully treated with reduction of immunosuppressants or with antiviral agents.

• 한국콘텐츠학회논문지
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• 제19권2호
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• pp.619-628
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• 2019

본 연구는 신장이식 환자를 대상으로 치료지시이행에 미치는 영향을 분석하기 위한 설명적 조사연구이다. 연구대상은 일 대학병원 외래를 방문하는 신장이식 환자 132명이었다. 자료수집은 2017년 7월 17일부터 2017년 8월 22일까지 이루어졌으며, 수집된 자료는 SPSS WIN 24.0을 이용하여 빈도와 백분율, 평균과 표준편차, 분산분석, 상관관계, 회귀분석을 통해 분석되었다. 연구결과, 대상자의 연령, 종교의 유무, 이식 후 경과기간에 따라 치료지시이행에 유의한 차이가 나타났다(p<.05). 또한 총 사회적 지지(r=.54, p<.001), 가족의 지지(r=.43, p<.001), 의료인의 지지(r=.57, p<.001) 및 자가 간호지식(r=.21, p=.015) 역시 치료지시이행과 통계적으로 유의한 양의 상관관계를 보였다. 회귀분석의 결과, 치료지시이행의 영향요인은 의료인의 지지, 신장이식 후 경과기간, 배우자 유무, 종교의 유무였고, 최종 설명력은 41.9%였다. 결론적으로, 신장이식 환자들의 치료지시이행을 높이기 위해 의료인의 지지를 증진시킬 수 있는 효율적인 중재방안이 도입되어야 할 것이다.

• 디지털융복합연구
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• 제15권3호
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• pp.259-266
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• 2017

본 연구는 신장이식 대상자의 자가간호이행에 영향을 주는 융복합 요인 및 경과기간에 따른 자가간호이행 정도를 파악하기 위해 시도된 연구이다. 연구대상은 신장이식을 받은 대상자 235명이며, 2014년 9월부터 10월까지 자료수집을 실시하였다. 자가간호이행도에 영향을 주는 융복합 요인으로는 나이가 많을수록(B=.007), 여자일수록(B=.157), 이식 후 경과기간이 짧을수록 (B=-.001) 자가간호이행도가 유의하게 높았다. 신장이식 후 1년 이상~5년 미만군부터 자가간호이행의 감소가 크게 나타났으며, 지속적으로 감소되었다. 신장이식 후 합병증 발생을 최소화 하고, 이식 신장을 건강하게 유지하기 위하여, 자가간호이행에 영향을 미치는 요인과 자가간호이행이 낮아지는 경과기간을 파악하여 자가간호를 강화시킬 수 있는 지속적이고 구체적인 자가간호 강화 프로그램을 개발하여 교육하는 것이 필요하다.

• 대한이식학회지
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• 제32권4호
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• pp.104-107
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• 2018

Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Gastrointestinal (GI) mucormycosis is very rare and occurs primarily in highly malnourished patients, especially in infants and children. A 55-year-old man with end-stage renal disease due to diabetic nephropathy, who had undergone deceased donor kidney transplantation 2 years prior, complained of abdominal pain and distension with a 3-day duration. Computed tomography revealed diffuse gastric wall thickening, and a huge amount of grey colored necrotic debris surrounded by erythematous erosive mucosa was observed at the antrum to upper body by GI endoscopy. The microscopic examination obtained from a GI endoscopic specimen demonstrated peptic detritus with numerous non-septate mucor hyphae in the mucosa and submucosa. Mucormycosis was diagnosed based on the clinical findings and morphological features. A total gastrectomy was performed and an antifungal agent was administered. A microscopic examination of the surgical specimen demonstrated invasive mucormycosis with numerous fungal hyphae with invasion into the mucosa to subserosa. The patient and graft were treated successfully by total gastrectomy and antifungal therapy.

• 대한이식학회지
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• 제28권3호
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• pp.165-168
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• 2014

The recipient candidate was a 51-year-old male with end-stage renal disease owing to diabetes mellitus. The initial immunosuppressive regimen included basiliximab for induction and tacrolimus, mycophenolate mofetil, and steroids. Urine output was 413 mL/day on the operative day and 100 mL/day on the postoperative day (POD) 1. There was no definite stenosis of the ureter or vessels. He had anuria on POD 2~4 and he had undergone hemodialysis. His serum creatinine level did not decrease. Therefore, a graft biopsy was performed on POD 4. The pathologic finding was consistent with acute calcineurin inhibitor (CNI) toxicity. There was no evidence of rejection or acute tubular necrosis. Anuria continued on POD 6; therefore, we started sirolimus instead of a CNI based regimen. Graft function was gradually recovered 1 day after reduction of CNI dose and hemodialysis was stopped. The serum creatinine level was normalized on POD 10. He was discharged on POD 21.