Korean Journal of Transplantation最新文献

To address a donor kidney shortage, marginal grafts have been applied in deceased donor kidney transplantation (DDKT). These grafts exhibit comparatively unfavorable outcomes, particularly when cold ischemia time (CIT) is prolonged. Hypothermic machine perfusion (HMP) has been investigated to mitigate the effects of prolonged CIT during graft transport. The present case involved successful management of the longest CIT recorded in Korea by employing HMP in DDKT. The donor was a 54-year-old man (Korean Kidney Donor Profile Index, 82%) with diabetes. The recipient, a 51-year-old man on peritoneal dialysis, had end-stage renal disease secondary to diabetic nephropathy. Following procurement, the left kidney was preserved using HMP. Inclement weather delayed graft transportation; consequently, the total CIT was 28 hours and 6 minutes, with the kidney preserved by HMP for 22 hours and 35 minutes. Postoperative graft function gradually recovered, and urine output was satisfactory. Delayed graft function was not observed, and the patient was discharged on postoperative day 13 without significant complications. Five months after surgery, his serum creatinine level was 1.7 mg/dL. Successful DDKT with a marginal donor graft via HMP, despite the longest CIT yet observed in Korea, underscores the usefulness of HMP in enhancing graft quality and preserving function.

Robotic surgery is emerging as a feasible minimally invasive approach for donor hepatectomy at specialized centers. The aim of this article is to systematically describe the surgical techniques for robotic hilar dissection and right lobe mobilization in right donor hepatectomy. The setup of the robotic arms, the dissection of inflow vessels and retrohepatic inferior vena cava, and the pearls and pitfalls of these two parts of the operation are detailed.

Despite the increasing demand for lung transplants, donor lungs remain in short supply. Although organ donations have been steadily increasing in Korea, with the utilization rate for donor lungs increasing to 40% in recent years, many potential donor organs remain unused. To match the increasing number of patients on the lung transplant waitlist, it is essential to increase the donor procurement rate through optimal management. Improvements in donor lung management programs can lead to expansion of the donor pool and optimal posttransplant outcomes. This review focuses on basic protocols for the optimal management of donor lungs and summarizes coronavirus disease 2019-related considerations for donor lung evaluation.

Renal transplant recipients are prone to urological complications, the most common of which is stricture of the transplant ureter. We present a rare case of complete ureteric stricture in a 37-year-old man who had undergone spousal living donor kidney transplantation with ABO incompatibility. Initially, treatment involved creating an anastomosis between the native right ureter and the renal pelvis of the transplanted kidney. However, the stricture recurred. Subsequently, the patient was successfully treated with inferior polar nephrectomy and vesicocalicostomy, which entailed anastomosing the lower calyx of the transplanted kidney to the bladder. After 7 months of follow-up, the patient continued to exhibit stable renal function without stricture recurrence.

Post-liver transplant (LT) hepatic artery vasospasm is a vascular complication that is not well recognized and its incidence is not known. As a possible sequela to vasospasm, hepatic artery thrombosis is the second major cause of allograft failure after primary nonfunction and its reported incidence is 2.9% in adults and 8.3% in pediatric LT. Lacuna in knowledge regarding early hepatic artery vasospasm post-LT makes it a difficult condition to diagnose and treat, as the initial ischemic insult on graft can have devastating consequences. We report a case of pediatric progressive familial intrahepatic cholestasis type 3-related chronic liver disease who underwent cadaveric orthotopic LT and postoperatively developed fever, worsening hypotension, and elevated liver enzymes with an absence of arterial flow in intrahepatic branches on Doppler ultrasound. Suspecting early hepatic artery thrombosis, the patient was re-explored and the graft hepatic artery was found to be in a state of vasospasm. Following the infusion of intra-arterial papaverine, urokinase, and intravenous nicorandil, there was an improvement in blood flow. The patient responded well and was discharged on postoperative day 23 with normal liver enzymes.

Robotic surgery is emerging as a feasible minimally invasive approach for donor hepatectomy at specialized centers. The aim of this article is to systematically describe the surgical techniques for robotic parenchymal transection and bile duct division in right donor hepatectomy. The setup of the robotic arms, methods of parenchymal transection using robotic instruments, and right hepatic duct division with the aid of indocyanine green dye are detailed, along with the pearls and pitfalls of these two parts of the operation.

Background: The utility of hepatitis B immunoglobulin (HBIg) in hepatitis D virus (HDV)-reactivation prophylaxis remains contentious. This study compared liver transplant (LT) patients based on whether they received perioperative HBIg to assess its protective effect against HDV reactivation.

Methods: Fifty-seven recipients with hepatitis B virus (HBV) and HBV/HDV, who were at least 1 year posttransplantation as of January 1, 2021, were enrolled in this single-center study. Tests for hepatitis B surface antigen (HBsAg), anti-HDV antibody, and quantitative reverse transcription polymerase chain reaction for HBV DNA and HDV RNA were performed. Interviews were conducted to assess compliance with the nucleos(t) ide analogue (NA) regimen and to document preoperative HBV/HDV status. Liver function tests were also carried out. The nonparametric Mann-Whitney U-test was utilized to determine statistical significance, with P<0.05 considered significant. Data analysis was conducted using GraphPad Prism software.

Results: The prevalence of HDV RNA, HBV DNA, HBsAg, and anti-HDV positivity in the HBIg group (n=23) was 4.3% (n=1), 17.4% (n=4), 8.7% (n=2), and 95.7% (n=22), respectively. In the non-HBIg group (n=34), these rates were 5.9% (n=2), 8.8% (n=3), 11.8% (n=4), and 97.1% (n=33), respectively. Interviews revealed that all reactivations occurred in patients who were noncompliant with their NA regimen. Eleven of the 13 patients initially reported to be monoinfected with HBV pretransplantation were anti-HDV-positive.

Conclusions: No HDV replication occurred in either group due to spontaneous reactivation. High-efficacy NAs appear to be effective in sustaining HDV suppression post-LT. Most recrudescent cases of chronic hepatitis D are mild and self-limiting, typically resolving after 1-2 years of replication, as evidenced by liver function tests.

Posttransplant lymphoproliferative disorder (PTLD) is a rare and serious complication of kidney transplantation (KT), with 85% of cases being of B cell lineage. We present a case of T cell PTLD (T-PTLD) that rapidly progressed to liver failure, septic shock, and death despite various therapeutic interventions. A 50-year-old woman underwent ABO- and human leukocyte antigen-compatible preemptive living donor KT for diabetic endstage kidney disease under basiliximab induction therapy. During routine monitoring, 2 months after KT, her Epstein-Barr (EB) viral load was found to be elevated to 318,443 copies/mL. Despite a reduction in maintenance immunosuppressants and preemptive rituximab treatment, the EB viremia continued to increase. Eight months after KT, abdominopelvic computed tomography revealed multifocal splenic lesions and nonspecific lymph node enlargement. Concurrently, the patient's liver function tests began to deteriorate without evidence of viral hepatitis infection. A liver biopsy confirmed the diagnosis of EB virus-associated T-PTLD with CD3 and CD56 expression. Only 2 months after the PTLD diagnosis, the patient developed acute and severe liver failure. She died 12 days after being hospitalized, despite the administration of rescue cytotoxic chemotherapy. This case exemplifies the challenges of managing refractory EB virus-associated T-PTLD after KT, for which no specific treatment options are currently available. Further research into preventative and therapeutic methods for T-PTLD is warranted.

Background: Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors.

Methods: In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals.

Results: A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals.

Conclusions: This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Over the past decade, the field of solid organ transplantation has undergone significant changes, with some of the most notable advancements occurring in liver transplantation. Recent years have seen substantial progress in preoperative patient optimization protocols, anesthesia monitoring, coagulation management, and fluid management, among other areas. These improvements have led to excellent perioperative outcomes for all surgical patients, including those undergoing liver transplantation. In the last few decades, there have been numerous publications in the field of liver transplantation, but controversies related to perioperative management of liver transplant recipients persist. In this review article, we address the unresolved issues surrounding the anesthetic management of patients scheduled for liver transplantation.