Pub Date : 2017-12-31DOI: 10.4285/JKSTN.2017.31.4.177
Jaedo Yang, H. Yu
Living donor liver transplantation (LDLT) has become an inevitable procedure due a shortage of deceased donors under the influence of religious and native cultures. The most important concern in LDLT is donor safety. This study reviewed the safety of LDLT donors from reported studies of morbidity and mortality. Many studies have reported mortality and morbidity rates ranging from 0% to 33% for healthy liver donors. Use of laparoscopic surgery on LDLT donors has advantages of reduced blood loss, lower postoperative morbidity and shorter hospital stay relative to conventional open surgery. There is a consensus that remnant liver volume (RLV), degree of steatosis, and donor age are the most important factors influencing donor safety. In LDLT, donor hepatectomy can be performed successfully with minimal and easily controlled complications. However, a large-scale prospective cohort study is needed to better understand the risk factors and accurately determine the complication rates for LDLT.
{"title":"Donor Complication in Living Donor Liver Transplantation","authors":"Jaedo Yang, H. Yu","doi":"10.4285/JKSTN.2017.31.4.177","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.4.177","url":null,"abstract":"Living donor liver transplantation (LDLT) has become an inevitable procedure due a shortage of deceased donors under the influence of religious and native cultures. The most important concern in LDLT is donor safety. This study reviewed the safety of LDLT donors from reported studies of morbidity and mortality. Many studies have reported mortality and morbidity rates ranging from 0% to 33% for healthy liver donors. Use of laparoscopic surgery on LDLT donors has advantages of reduced blood loss, lower postoperative morbidity and shorter hospital stay relative to conventional open surgery. There is a consensus that remnant liver volume (RLV), degree of steatosis, and donor age are the most important factors influencing donor safety. In LDLT, donor hepatectomy can be performed successfully with minimal and easily controlled complications. However, a large-scale prospective cohort study is needed to better understand the risk factors and accurately determine the complication rates for LDLT.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125725083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01DOI: 10.4285/JKSTN.2017.31.4.157
K. Kang, Junho Chung, Jaeseok Yang, H. Kim
Current Perspectives on Emerging CAR-Treg Cell Therapy: Based on Treg Cell Therapy in Clinical Trials and the Recent Approval of CAR-T Cell Therapy Koeun Kang, Junho Chung, M.D., Jaeseok Yang, M.D. and Hyori Kim, Ph.D. Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Transplantation Center, Department of Surgery, Seoul National University Hospital, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
新兴CAR-Treg细胞疗法的当前观点:基于临床试验中的Treg细胞疗法和最近批准的CAR-T细胞疗法Koeun Kang, Junho Chung, M.D.， Jaeseok Yang, M.D.和Hyori Kim，博士，首尔国立大学医学院生物化学和分子生物学学系，移植中心，外科，首尔国立大学医院，生物医学研究中心，峨山生命科学研究所，峨山医学中心，首尔，韩国
{"title":"Current Perspectives on Emerging CAR-Treg Cell Therapy: Based on Treg Cell Therapy in Clinical Trials and the Recent Approval of CAR-T Cell Therapy","authors":"K. Kang, Junho Chung, Jaeseok Yang, H. Kim","doi":"10.4285/JKSTN.2017.31.4.157","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.4.157","url":null,"abstract":"Current Perspectives on Emerging CAR-Treg Cell Therapy: Based on Treg Cell Therapy in Clinical Trials and the Recent Approval of CAR-T Cell Therapy Koeun Kang, Junho Chung, M.D., Jaeseok Yang, M.D. and Hyori Kim, Ph.D. Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Transplantation Center, Department of Surgery, Seoul National University Hospital, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133529810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01DOI: 10.4285/JKSTN.2017.31.4.193
Doo-Ho Lee, Hae Won Lee, Y. Ahn, Hyeyoung Kim, N. Yi, Kwang-Wonng Lee, K. Suh
Background: Although there more than 1,000 liver transplantations (LTs) are performed in Korea annually, their immense cost remains a great hurdle. Hence, in an attempt to reduce the medical costs of LT, a program was initiated at a public hospital affiliated with the Seoul National University Hospital. Methods: A total of 11 LTs have been successfully executed since the first LT performed at Seoul Metropolitan Government Seoul National University Boramae Medical Center in July 2011 through December 2014. Results: Nine patients (81.8%) were male and two (18.2%) were female. The mean age of patients was 53.4±11.4 years. Hepatitis B virus-related liver disease (n=6, 54.5%) was the most common causative disease, followed by alcoholic liver disease (ALD) (n=4, 36.4%). The actuarial 3-year survival rate was 90.9%. The median total medical cost of LTs was US $41,583 (calculated from operation to discharge), but only $11,860 was actually charged for patients with health insurance coverage. One female patient who had undergone deceased donor LT for alcoholic liver cirrhosis died during follow-up. This patient was non-compliant with the medical instructions after discharge, and finally expired due to septic shock at 10 months post-LT. Conclusions: In the public hospital, LT was successfully performed at a much lower cost. However, LT guidelines and peritransplant management protocols for patients with ALD must be established before escalating LT at public hospitals since ALD with poor compliance is one of the most common causes of complications at public hospitals.
{"title":"Initiating Liver Transplantation at a Public Hospital in Korea","authors":"Doo-Ho Lee, Hae Won Lee, Y. Ahn, Hyeyoung Kim, N. Yi, Kwang-Wonng Lee, K. Suh","doi":"10.4285/JKSTN.2017.31.4.193","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.4.193","url":null,"abstract":"Background: Although there more than 1,000 liver transplantations (LTs) are performed in Korea annually, their immense cost remains a great hurdle. Hence, in an attempt to reduce the medical costs of LT, a program was initiated at a public hospital affiliated with the Seoul National University Hospital. Methods: A total of 11 LTs have been successfully executed since the first LT performed at Seoul Metropolitan Government Seoul National University Boramae Medical Center in July 2011 through December 2014. Results: Nine patients (81.8%) were male and two (18.2%) were female. The mean age of patients was 53.4±11.4 years. Hepatitis B virus-related liver disease (n=6, 54.5%) was the most common causative disease, followed by alcoholic liver disease (ALD) (n=4, 36.4%). The actuarial 3-year survival rate was 90.9%. The median total medical cost of LTs was US $41,583 (calculated from operation to discharge), but only $11,860 was actually charged for patients with health insurance coverage. One female patient who had undergone deceased donor LT for alcoholic liver cirrhosis died during follow-up. This patient was non-compliant with the medical instructions after discharge, and finally expired due to septic shock at 10 months post-LT. Conclusions: In the public hospital, LT was successfully performed at a much lower cost. However, LT guidelines and peritransplant management protocols for patients with ALD must be established before escalating LT at public hospitals since ALD with poor compliance is one of the most common causes of complications at public hospitals.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128465377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01DOI: 10.4285/JKSTN.2017.31.4.170
Uiju Cho, K. Suh, J. Kie, Yeong-jin Choi
Uiju Cho, M.D., Kwang Sun Suh, M.D., Jeong Hae Kie, M.D., Yeong Jin Choi, M.D. and Renal Pathology Study Group of Korean Society of Pathologists Department of Pathology, St. Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon, Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, National Health Insurance Service Ilsan Hospital, Goyang, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
{"title":"Investigation and Standardization on Current Practice of Renal Transplant Pathology in Korea","authors":"Uiju Cho, K. Suh, J. Kie, Yeong-jin Choi","doi":"10.4285/JKSTN.2017.31.4.170","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.4.170","url":null,"abstract":"Uiju Cho, M.D., Kwang Sun Suh, M.D., Jeong Hae Kie, M.D., Yeong Jin Choi, M.D. and Renal Pathology Study Group of Korean Society of Pathologists Department of Pathology, St. Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon, Cancer Research Institute, Chungnam National University School of Medicine, Daejeon, National Health Insurance Service Ilsan Hospital, Goyang, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116035352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-30DOI: 10.4285/JKSTN.2017.31.3.143
Mina Kim, Seirhan Kim, S. Lee, C. Oh, J. Bang
Background: This study was conducted to analyze the current system for allocation of deceased donor kidney transplantation in Korea, which includes an incentive regulation for candidates registered at the Hospital-based Organ Procurement Organization (HOPO). Methods: Between January 2011 and November 2016, there were 2,655 deceased donors in Korea. During the same period, there were 21,247 current candidates and recipients of kidney, pancreas and simultaneous pancreas-kidney transplants. We analyzed data from all of these donors, candidates, and recipients. Results: Mean waiting times for organ allocation of each priority differed significantly (2nd priority group, 1,701±974 days; 3rd priority group, 1,316±927 days; 4th priority group, 2,077±1,207 days). Additionally, HOPO candidates/deceased donor ratios were very different from each other (maximum, 49; minimum, 0.6). The number of deceased donors in region 1, 2, and 3 were 1,623, 429, and 603, respectively, while the number of transplantations in each region was 3,095, 597, and 1,165, respectively. The candidates registered at region 1 HOPO moved the longest distances on average for transplantation, and this value differed significantly different from that of other regions (56.18±91.9 km vs. 24.66±28.0 km vs. 26.20±37.3 km, P＜0.05). Conclusions: The incentive system of current allocation system for deceased donor kidney in Korea does not coincide with the purpose of the `Declaration of Istanbul` and unnecessary social costs have occurred. Therefore, we should make an effort to change our current allocation system to the geographic sequence of organ allocation system.
背景:本研究旨在分析韩国目前分配已故供体肾移植的制度，其中包括对在医院器官采购组织(HOPO)注册的候选人的激励规定。方法:2011年1月至2016年11月，韩国共有2655例死亡献血者。在同一时期，目前有21247名肾脏、胰腺和胰肾同时移植的候选人和接受者。我们分析了所有捐赠者、候选人和接受者的数据。结果:各优先组器官分配的平均等待时间差异有统计学意义(第二优先组，1701±974天;第三优先组，1316±927天;第四优先组，2077±1207天)。此外，HOPO候选者/已故供体比例彼此之间差异很大(最大值为49;至少,0.6)。1区、2区、3区死亡者分别为1623人、429人、603人，移植件数分别为3095人、597人、1165人。在HOPO 1区登记的候选者移植平均移动距离最长，与其他区域的差异有统计学意义(56.18±91.9 km vs. 24.66±28.0 km vs. 26.20±37.3 km, P<0.05)。结论:韩国现行的死者供肾分配激励制度与《伊斯坦布尔宣言》的宗旨不符，造成了不必要的社会成本。因此，我们应该努力改变我国现行的器官分配制度，以地理顺序分配器官。
{"title":"Current System for Allocation of Deceased Donor Kidney Transplantation","authors":"Mina Kim, Seirhan Kim, S. Lee, C. Oh, J. Bang","doi":"10.4285/JKSTN.2017.31.3.143","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.3.143","url":null,"abstract":"Background: This study was conducted to analyze the current system for allocation of deceased donor kidney transplantation in Korea, which includes an incentive regulation for candidates registered at the Hospital-based Organ Procurement Organization (HOPO). \u0000Methods: Between January 2011 and November 2016, there were 2,655 deceased donors in Korea. During the same period, there were 21,247 current candidates and recipients of kidney, pancreas and simultaneous pancreas-kidney transplants. We analyzed data from all of these donors, candidates, and recipients. \u0000Results: Mean waiting times for organ allocation of each priority differed significantly (2nd priority group, 1,701±974 days; 3rd priority group, 1,316±927 days; 4th priority group, 2,077±1,207 days). Additionally, HOPO candidates/deceased donor ratios were very different from each other (maximum, 49; minimum, 0.6). The number of deceased donors in region 1, 2, and 3 were 1,623, 429, and 603, respectively, while the number of transplantations in each region was 3,095, 597, and 1,165, respectively. The candidates registered at region 1 HOPO moved the longest distances on average for transplantation, and this value differed significantly different from that of other regions (56.18±91.9 km vs. 24.66±28.0 km vs. 26.20±37.3 km, P＜0.05). \u0000Conclusions: The incentive system of current allocation system for deceased donor kidney in Korea does not coincide with the purpose of the `Declaration of Istanbul` and unnecessary social costs have occurred. Therefore, we should make an effort to change our current allocation system to the geographic sequence of organ allocation system.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123237210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-30DOI: 10.4285/JKSTN.2017.31.3.99
J. S. Lee
Ischemia-reperfusion injury (IRI) is an inevitable consequence of organ transplantation that has major consequences for graft-and patient survival. During transplantation procedures, allografts are exposed to various periods of complete ischemia. Ischemic insult starts with brain death, and its associated hemodynamic disturbances continue during donor organ procurement, cold preservation, and implantation. Ischemia-reperfusion injury, which is a risk factor for acute graft injury, delayed graft function, and acute and chronic rejection, is triggered following reperfusion. Along the cascade of pathogenic events that accompany ischemic insults and cause IRI, there has been an appreciation for various immune mechanisms within the allograft itself. The pathophysiological events associated with IRI originate in signals derived from pattern recognition receptors (PRRs) expressed in the donor organ. Danger associated molecular patterns (DAMP) released from injured cells serve as ligands for PRRs expressed on many cells in the donor organ. Activation of PRR signaling in the donor organ leads to production of proinflammatory cytokines and activates the innate immune system, triggering adaptive immune responses as well as cell death signaling, ultimately worsening the initial ischemic injury. Accordingly, deciphering the inflammatory pathway of innate immunity in IRI may provide a good therapeutic target to block acute sterile inflammation caused by tissue damage.
{"title":"Immunologic Mechanism of Ischemia Reperfusion Injury in Transplantation","authors":"J. S. Lee","doi":"10.4285/JKSTN.2017.31.3.99","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.3.99","url":null,"abstract":"Ischemia-reperfusion injury (IRI) is an inevitable consequence of organ transplantation that has major consequences for graft-and patient survival. During transplantation procedures, allografts are exposed to various periods of complete ischemia. Ischemic insult starts with brain death, and its associated hemodynamic disturbances continue during donor organ procurement, cold preservation, and implantation. Ischemia-reperfusion injury, which is a risk factor for acute graft injury, delayed graft function, and acute and chronic rejection, is triggered following reperfusion. Along the cascade of pathogenic events that accompany ischemic insults and cause IRI, there has been an appreciation for various immune mechanisms within the allograft itself. The pathophysiological events associated with IRI originate in signals derived from pattern recognition receptors (PRRs) expressed in the donor organ. Danger associated molecular patterns (DAMP) released from injured cells serve as ligands for PRRs expressed on many cells in the donor organ. Activation of PRR signaling in the donor organ leads to production of proinflammatory cytokines and activates the innate immune system, triggering adaptive immune responses as well as cell death signaling, ultimately worsening the initial ischemic injury. Accordingly, deciphering the inflammatory pathway of innate immunity in IRI may provide a good therapeutic target to block acute sterile inflammation caused by tissue damage.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"263 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133310142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-01DOI: 10.4285/JKSTN.2017.31.3.133
Jaesook Oh, Minsun Kang, Kyung Sook Jang, Hyunjin Kang, W. Cho, J. Ha
Background: The main factor limiting the increase in brain dead organ donors is low consent rates for organ donation. Methods: This study is a retrospective analysis of donor records of Korea Organ Donation Agency from 2013 to 2015. Factors related before providing information about organ donation and process of explaining organ donation were analyzed. Results: Donor gender, marital status, religious affiliation, residence area, knowledge of patients’ wishes, understanding of brain death status, and the referring system, providing initial information about donation and initial medical staff providing information about donation had a significant influence on decision to donate. Organ donation greatly increased when the donor family knew the patient’s intent to donate. As the degree of family understanding of brain death status and the referring system increased, organ donation rate significantly increased. Conclusions: Providing sufficient information about brain death during the period of delivering medical services as well as activating campaign and public education are essential to improving the positive attitude toward organ donation.
{"title":"Factors Influencing Family’s Organ Donation Decision","authors":"Jaesook Oh, Minsun Kang, Kyung Sook Jang, Hyunjin Kang, W. Cho, J. Ha","doi":"10.4285/JKSTN.2017.31.3.133","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.3.133","url":null,"abstract":"Background: The main factor limiting the increase in brain dead organ donors is low consent rates for organ donation. Methods: This study is a retrospective analysis of donor records of Korea Organ Donation Agency from 2013 to 2015. Factors related before providing information about organ donation and process of explaining organ donation were analyzed. Results: Donor gender, marital status, religious affiliation, residence area, knowledge of patients’ wishes, understanding of brain death status, and the referring system, providing initial information about donation and initial medical staff providing information about donation had a significant influence on decision to donate. Organ donation greatly increased when the donor family knew the patient’s intent to donate. As the degree of family understanding of brain death status and the referring system increased, organ donation rate significantly increased. Conclusions: Providing sufficient information about brain death during the period of delivering medical services as well as activating campaign and public education are essential to improving the positive attitude toward organ donation.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115719182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-01DOI: 10.4285/JKSTN.2017.31.3.150
Hyejin Park, Byungho Lee, Y. Lim, B. Han, E. Song, M. Park
Background: Basic National Institute of Health (NIH) and sensitive antihuman globulin (AHG) methods are widely used for T-cell complement-dependent cytotoxicity crossmatch (XM) tests. Whereas NIH-negative, AHG-positive (NIH-/AHG＋) results are caused by weak antibodies, NIH＋/AHG- results are usually due to autoantibodies. We found that solid organ transplantation candidates with NIH＋/AHG- XM results are repeatedly excluded from allocation of deceased donor organs by the Korean Network for Organ Sharing (KONOS) allocation system. Here, we attempted to demonstrate that these patients do not have donor-specific HLA antibodies (DSAs). Methods: Sera showing NIH＋/AHG- results in the analysis of 1,668 KONOS T-cell XM tests were screened for panel reactive antibody (PRA) using a Luminex test. For screen-positive samples, antibody identification was conducted using a Luminex single antigen assay and the presence or absence of class I DSAs was determined. For positive controls, 42 KONOS XM tests showing probable true-positive (NIH-/AHG＋ or NIH＋/AHG＋) results were reviewed for PRA results based on electronic medical records and the presence or absence of DSAs was determined. Results: NIH＋/AHG- results were observed in 1.3% (21/1,668) of KONOS XM tests analyzed. Most of these (18/21, 85.7%) were negative for PRA or DSAs. All probable true-positive cases were either positive for DSAs (24/42, 57.1%) or had high PRA (mean, 92% [range; 42%∼100%]), complicating accurate identification of antibody specificities. Conclusions: NIH＋/AHG- results are not rare (1.3%) in KONOS XM tests. Most of these results are not due to DSAs, and these patients should not be excluded from organ allocation.
{"title":"False-Positive T-Cell Cytotoxicity Crossmatch Results Due to Autoantibodies in Korean Network for Organ Sharing Crossmatch Tests","authors":"Hyejin Park, Byungho Lee, Y. Lim, B. Han, E. Song, M. Park","doi":"10.4285/JKSTN.2017.31.3.150","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.3.150","url":null,"abstract":"Background: Basic National Institute of Health (NIH) and sensitive antihuman globulin (AHG) methods are widely used for T-cell complement-dependent cytotoxicity crossmatch (XM) tests. Whereas NIH-negative, AHG-positive (NIH-/AHG＋) results are caused by weak antibodies, NIH＋/AHG- results are usually due to autoantibodies. We found that solid organ transplantation candidates with NIH＋/AHG- XM results are repeatedly excluded from allocation of deceased donor organs by the Korean Network for Organ Sharing (KONOS) allocation system. Here, we attempted to demonstrate that these patients do not have donor-specific HLA antibodies (DSAs). \u0000Methods: Sera showing NIH＋/AHG- results in the analysis of 1,668 KONOS T-cell XM tests were screened for panel reactive antibody (PRA) using a Luminex test. For screen-positive samples, antibody identification was conducted using a Luminex single antigen assay and the presence or absence of class I DSAs was determined. For positive controls, 42 KONOS XM tests showing probable true-positive (NIH-/AHG＋ or NIH＋/AHG＋) results were reviewed for PRA results based on electronic medical records and the presence or absence of DSAs was determined. \u0000Results: NIH＋/AHG- results were observed in 1.3% (21/1,668) of KONOS XM tests analyzed. Most of these (18/21, 85.7%) were negative for PRA or DSAs. All probable true-positive cases were either positive for DSAs (24/42, 57.1%) or had high PRA (mean, 92% [range; 42%∼100%]), complicating accurate identification of antibody specificities. \u0000Conclusions: NIH＋/AHG- results are not rare (1.3%) in KONOS XM tests. Most of these results are not due to DSAs, and these patients should not be excluded from organ allocation.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122035954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-01DOI: 10.4285/JKSTN.2017.31.3.111
H. Jang
Acute kidney injury (AKI) is classified into three types according to its pathophysiology: prerenal, intrinsic renal, and post-renal AKI. Experimental models of AKI can be divided into two categories: in vivo and in vitro. Models can be further subdivided according to how AKI is simulated. The pathophysiology of intrinsic renal and post-renal AKI has been investigated using animal models. Most studies have been conducted in murine models using male mice or rats, while large mammals like sheep, pigs, and monkeys have been used in a limited number of studies. The intrinsic renal AKI model is divided into septic vs. aseptic AKI. Aseptic AKI is subdivided into ischemic vs. nephrotoxic AKI. Lipopolysaccharides (LPS) injection or cecal ligation and puncture (CLP) have been used to simulate the septic AKI model in rodents. Ischemic AKI is the most extensively investigated field to date because ischemic AKI is the most common and serious cause of AKI in both native kidneys and renal allografts. Ischemia-reperfusion injury (IRI) surgery has been used to induce ischemic AKI. There are two different methods of IRI surgery: laparotomy vs. flank approach. Warm temperature and male sex are critical to induction of sufficient grade of renal injury in this model. Many nephrotoxicants pertinent to human disease have been used to reproduce nephrotoxic AKI in rodent models. Cisplatin, a common chemotherapeutic agent, has many pathophysiologic features that overlap with IRI. Other nephrotoxicants such as gentamicin or glycerol were studied in the past, whereas much more attention has recently been devoted to environmental nephrotoxicants such as cadmium. However, variant susceptibility to different doses of nephrotoxicants is a big hurdle to set up a reproducible and consistent model of nephrotoxic AKI. Post-renal AKI is simulated with ureteral obstruction surgery, whereas the unilateral ureteral obstruction (UUO) model has frequently been used. Although some novel findings have been reported through numerous studies using murine AKI models, AKI still remains a challenging condition that lacks specific diagnostic or therapeutic tools because of species barriers or experimental settings. Animal AKI models using mammals genetically closer to human like monkeys would be valuable to simulate human AKI more appropriately.
{"title":"Animal Models for Acute Kidney Injury","authors":"H. Jang","doi":"10.4285/JKSTN.2017.31.3.111","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.3.111","url":null,"abstract":"Acute kidney injury (AKI) is classified into three types according to its pathophysiology: prerenal, intrinsic renal, and post-renal AKI. Experimental models of AKI can be divided into two categories: in vivo and in vitro. Models can be further subdivided according to how AKI is simulated. The pathophysiology of intrinsic renal and post-renal AKI has been investigated using animal models. Most studies have been conducted in murine models using male mice or rats, while large mammals like sheep, pigs, and monkeys have been used in a limited number of studies. The intrinsic renal AKI model is divided into septic vs. aseptic AKI. Aseptic AKI is subdivided into ischemic vs. nephrotoxic AKI. Lipopolysaccharides (LPS) injection or cecal ligation and puncture (CLP) have been used to simulate the septic AKI model in rodents. Ischemic AKI is the most extensively investigated field to date because ischemic AKI is the most common and serious cause of AKI in both native kidneys and renal allografts. Ischemia-reperfusion injury (IRI) surgery has been used to induce ischemic AKI. There are two different methods of IRI surgery: laparotomy vs. flank approach. Warm temperature and male sex are critical to induction of sufficient grade of renal injury in this model. Many nephrotoxicants pertinent to human disease have been used to reproduce nephrotoxic AKI in rodent models. Cisplatin, a common chemotherapeutic agent, has many pathophysiologic features that overlap with IRI. Other nephrotoxicants such as gentamicin or glycerol were studied in the past, whereas much more attention has recently been devoted to environmental nephrotoxicants such as cadmium. However, variant susceptibility to different doses of nephrotoxicants is a big hurdle to set up a reproducible and consistent model of nephrotoxic AKI. Post-renal AKI is simulated with ureteral obstruction surgery, whereas the unilateral ureteral obstruction (UUO) model has frequently been used. Although some novel findings have been reported through numerous studies using murine AKI models, AKI still remains a challenging condition that lacks specific diagnostic or therapeutic tools because of species barriers or experimental settings. Animal AKI models using mammals genetically closer to human like monkeys would be valuable to simulate human AKI more appropriately.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126060656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-01DOI: 10.4285/JKSTN.2017.31.3.117
J. Yun, Jeong Hye Kim, S. Im
Background: This study was conducted to investigate the knowledge, anxiety and compliance with preventive behavior of Middle East respiratory syndrome (MERS) in liver transplant patients. Methods: The participants in the study were 100 liver transplant patients at an outpatient clinic. The data were collected from May 20, 2016, to June 20, 2016. Results: The knowledge score was 6.37±1.73 (range; 1∼10) and the correct answer rate was 63.7%. The state anxiety score was 41.35±10.08 (range; 20∼68) and the trait anxiety score was 39.60±8.85 (range; 22∼59). The compliance with preventive behavior score was 35.70±5.23 (range; 21∼45). Anxiety differed significantly according to education level (P=0.040) and occupation status (P=0.047). Compliance with preventive behavior differed significantly according to period after surgery (P=0.035). Compliance with preventive behavior and state anxiety (P=0.007) and trait anxiety (P<0.001) were negatively related. The factor that had the greatest effect on compliance with preventive behavior was trait anxiety (P=0.003). Conclusions: The epidemic of the MERS has already been completed and none of the subjects of this study has been infected with the MERS; however, patients with liver transplantation always have a risk of various opportunistic infections. If new infectious diseases such as MERS occur in the future, increased anxiety may decrease the practice of prevention. Therefore, anxiety experienced by liver transplant patients should be managed.
背景:本研究旨在调查肝移植患者对中东呼吸综合征(Middle East respiratory syndrome, MERS)的认知、焦虑及预防行为依从性。方法:研究对象为100例门诊肝移植患者。数据采集时间为2016年5月20日至2016年6月20日。结果:知识得分为6.37±1.73(范围;1 ~ 10)，正确率为63.7%。状态焦虑评分为41.35±10.08(范围;20 ~ 68)，特质焦虑评分为39.60±8.85(范围;22日∼59)。预防行为依从性评分为35.70±5.23分(范围;21日∼45)。受教育程度(P=0.040)和职业状况(P=0.047)对焦虑程度有显著影响。术后不同时期预防行为依从性差异有统计学意义(P=0.035)。预防行为依从性与状态焦虑(P=0.007)、特质焦虑(P<0.001)呈负相关。对预防行为依从性影响最大的因素是特质焦虑(P=0.003)。结论:MERS疫情已经结束，本研究对象均未发生MERS感染;然而，肝移植患者总是有各种机会性感染的风险。如果未来出现新的传染病，如中东呼吸综合征，焦虑的增加可能会减少预防措施。因此，肝移植患者的焦虑应得到控制。
{"title":"Knowledge, Anxiety, and Compliance with Preventive Behavior of Middle East Respiratory Syndrome (MERS) in Liver Transplant Patients","authors":"J. Yun, Jeong Hye Kim, S. Im","doi":"10.4285/JKSTN.2017.31.3.117","DOIUrl":"https://doi.org/10.4285/JKSTN.2017.31.3.117","url":null,"abstract":"Background: This study was conducted to investigate the knowledge, anxiety and compliance with preventive behavior of Middle East respiratory syndrome (MERS) in liver transplant patients. Methods: The participants in the study were 100 liver transplant patients at an outpatient clinic. The data were collected from May 20, 2016, to June 20, 2016. Results: The knowledge score was 6.37±1.73 (range; 1∼10) and the correct answer rate was 63.7%. The state anxiety score was 41.35±10.08 (range; 20∼68) and the trait anxiety score was 39.60±8.85 (range; 22∼59). The compliance with preventive behavior score was 35.70±5.23 (range; 21∼45). Anxiety differed significantly according to education level (P=0.040) and occupation status (P=0.047). Compliance with preventive behavior differed significantly according to period after surgery (P=0.035). Compliance with preventive behavior and state anxiety (P=0.007) and trait anxiety (P<0.001) were negatively related. The factor that had the greatest effect on compliance with preventive behavior was trait anxiety (P=0.003). Conclusions: The epidemic of the MERS has already been completed and none of the subjects of this study has been infected with the MERS; however, patients with liver transplantation always have a risk of various opportunistic infections. If new infectious diseases such as MERS occur in the future, increased anxiety may decrease the practice of prevention. Therefore, anxiety experienced by liver transplant patients should be managed.","PeriodicalId":420886,"journal":{"name":"The Journal of The Korean Society for Transplantation","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131032281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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