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대한이식학회> 대한이식학회지> 이식사구체병증의 정도에 따른 단백뇨 및 이식신 생존율과의 상관성

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이식사구체병증의 정도에 따른 단백뇨 및 이식신 생존율과의 상관성

Relationship of Proteinuria and Graft Survival According to the Degree of Transplant Glomerulopathy

정현주 ( Hyeon Joo Jeong ) , 문장일 ( Jang Il Moon ) , 김순일 ( Soon Il Kim ) , 홍순원 ( Soon Won Hong ) , 김유선 ( Yu Seun Kim ) , 박기일 ( Kiil Park )
  • : 대한이식학회
  • : 대한이식학회지 12권2호
  • : 연속간행물
  • : 1998년 12월
  • : 269-274(6pages)

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Transplant glomerulopathy (TG) is a special form of glomerular injury in renal allografts. It affects varying proportions of glomeruli, which may have an influence on the amount of proteinuria or graft survival. We reviewed 32 cases of TG to evaluate histologic changes and graft outcome. The severity of TG as well as acute and chronic changes of the glomerular, tubulointerstitial and vascular compartment were scored according to Banff classification. There were 17 cases of cg1, 3 cases of cg2 and 12 cases of cg3. There was no significant difference in age, duration of transplant at time of biopsy and duration of follow-up between groups. Serum creatinine level and the degree of proteinuria were higher in cg3 and statistically significant. However, there was no difference in the degree of glomerulosclerosis, inter-stitial inflammation, fibrosis, tubular atrophy or vascular wall thickening between groups. Graft failure was present in 13 cases, mostly due to chronic rejection including sepsis and CMV infection in one case each. Five-year graft survival was 84.1% and was not significantly different from cases without TG. In conclusion, the severity of TG indicates profuse proteinuria, but does not affect graft outcome, which indicates tubulointerstitial and vascular pathology as being a more important prognosticator.

UCI(KEPA)

I410-ECN-0102-2009-510-001332924

간행물정보

  • : 의약학분야  > 병리학
  • : KCI등재
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  • : 계간
  • : 1598-1711
  • :
  • : 학술지
  • : 연속간행물
  • : 1987-2020
  • : 1007


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1급성거부반응의 면역학

저자 : 박수길 (Su Kil Park)

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 135-144 (10 pages)

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2면역 내성의 유도

저자 : 권오정 (Oh Jung Kwon)

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 145-150 (6 pages)

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3한국에서의 장기이식 현황보고 - 1997 년 -

저자 : 대한이식학회 장기이식등록위원회 ()

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 151-160 (10 pages)

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During the year of 1997, total 1,061 solid organ transplantations were performed at 40 centers in Korea: 962 kidney transplantations at 40 centers, 64 liver transplantations at 7 centers, 29 heart transplantations at 5 centers, 3 pancreas transplantations at 1 center, and 3 heart-lung transplantations at 2 centers. (Kidney) There were 962 kidney transplantations including 56 retransplantations (5.8%). Living related donors were 459 (47.7%), living unrelated donors were 327 (34.0%), and cadaveric donors were 176 (18.3%). Nineteen centers of 40 performed kidney transplantation less than 10 cases. Donors and recipients were largest at 3rd and 4th decades. Cadaveric donor kidneys were procured at the same transplant center in 158 (89.8%). Multiorgan procurement technique was used in 81 cases (46.0%). The most common cause of donor death was traffic accident (56.8%). Chronic GN was the most frequent disease for ESRD (33.2%). Three or less HLA antigen mismatch was more than half the cases (57.2%). Cadaveric donor transplantation was performed within 12 hours of cold ischemia time in 93.8%. Triple regimen immunosuppression (AZA CSA PDS) was used in 54.0%. Acute rejection occurred in 252 patients (26.2%). Overall response rate with antirejection therapies was 75.7%. Among 962 patients, 19 patients was dead with 6 (0.6%) operative mortality. Graft losses were 39 (4.1%.). (Liver) There were 64 liver transplantations. Living related partial liver transplantation was performed in 33 (51.6%). Donors were most frequent in the third and fourth decade groups. Recipients were most frequent in the first decade group. Cadaveric donor liver was obtained from the same transplant center in 24 (77.40%). The most frequent cause of hepatic failure was chronic viral hepatitis (25) in adults and biliary atresia (13) in children. Status 3 was the most common medical status of recipients (62.5%). Cadaver donor liver transplantation was performed within 12 hours of cold ischemia time in 96.8%. Triple regimen immunosuppression was used in 31.3% and FK506 based regimen in 37.5%. Acute rejection occurred in 17 patients (26.6%). Overall response rate with antirejection therapies were 78.3%. Among 64 patients, 20 were dead with 13 (20.3%) operative mortality. (Heart) There were 29 heart transplantations. Donors were most frequent in the third decade group. Recipients were most frequent in the fourth decade group. Heart was obtained from the same transplant center in 21 (72.4%). The most frequent cause of heart failure was idiopathic cardiomyopathy (23). All heart transplantations were performed within 4 hoursof cold ischemia time. Triple regimen immunosuppression was used in 75.9%. Acute rejection occurred in 10 patients with 100% response rate. Among 29 patients, 2 were dead without operative mortality. (Pancreas) There were 3 pancreas transplantations. All were juvenile diabetes patients. All three were harvested by multiorgan procurement technique, two at the same transplant center. Cold ischemia time was less than 12 hours and quadruple immunosuppression was performed in all. All were surviving and only one patient needs insulin treatment with reduced dose. (Heart-Lung) First heart-lung transplantations was performed in 1997 and three transplantations were performed. All were double lung transplantations.
Causes of lung disease were idiopathic pulmonary fibrosis and of heart diseases were Eisenmenger` s diseases. Two of three heart-lungs were procured at the other transplant center with multiorgan harvest technique. Cold ischemia time was less than 8 hours and all were alive. (1-year follow up results of transplantations in 1996) In 941 kidney transplantations, there were 48 (5.1%) graft losses including 21 dead patients. 1-yr actual graft and patient survival rates were 94.9%, 97.8%, respectively. Cadaveric donor transplantations showed comparable results to those of living donor. Living unrelated donors had tendency to be lower graft survival rate than o

4성견의 연속 양측 폐이식 실험모델에서 24 시간 폐보존 연구

저자 : 박창권 ( Chang Kwon Park ) , 권건영 ( Kun Young Kwon ) , 전석길 ( Suk Kil Zeon ) , 김정식 ( Jung Sik Kim ) , 배제훈 ( Jae Hoon Bae )

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 161-171 (11 pages)

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Background: Numerous studies on safe, long term preservation for lung transplantation has been performed for the purpose of developing ideal preservation solution with extracellular type or intracellular type solutions and overcoming the shortage of donors. We prepared LPDG (low potassium dextran glucose)solution for lung preservation study. In this study we examined the efficacy of LPDG solution in 24-hour lung preservation by using of a sequential bilateral canine lung allotransplant model. Method: Seven bilateral lung transplant procedures were performed using weight-matched pairs (23 to 26 Kg) of adult mongrel dogs. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 10oC for a planned ischemic time of 24 hours for the lung implanted first. After sequential bilateral lung transplantation, dogs were maintained on a ventilator for 3 hours: arterial oxygen tension, pulmonary artery pressure, and pulmonary vascular resistance were determined in the recipients hourly after bilateral reperfusion and compared with pretransplant-recipient values, which used as controls. After 2 hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were performed for assessment of early graft lung function. And pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. Results: Five dogs of seven experiments had successfully finished the whole assessments after bilateral reperfusion for three hours. Arterial oxygen tension in the recipients was markedly decreased in immediate reperfusion period but gradually recovered after reperfusion for three hours. The pulmonary artery and pulmonary vascular resistance showed singificant elevation (p <0.05 versus control values) but also recovered after reperfusion for three hours (p <0.05 versus immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung preservation and reperfusion. Conclusions: The present study suggests that LPDG solution provide excellent preservation and transplanted lung function after 24 hours of preservation in a canine model in which the dog is completely dependent on the fuction of transplanted lung.

5새로운 면역억제제로서 변이 IL-15/IgG 융합단백질의 효과

저자 : 김연수 ( Yon Su Kim ) , 채동완 ( Dong Wan Chae ) , Terry B Strom

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 173-182 (10 pages)

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Owing to shared receptor components, the biological activities of IL-15 are similar to those of IL-2.However the patterns of tissue expression of IL-2/IL-2R αand IL-15/IL-15R αdiffer. The development of agents targeting the receptor and signaling elements of IL-15 may provide a new perspective for                            treatment of diseases associated with expression of IL-15/IL-15R. We designed, genetically constructed and expressed a receptor site specific IL-15 antagonist by mutating glutamine residue within the C-terminus of IL-15 to aspartic acid and linked this mutant IL-15 to murine IgG2a. These IL-15 mutant/IgG fusion proteins specifically bound to the IL-15R, and competitively inhibited IL-15 triggered cell proliferation. We examined the immunosuppressive activityof this agent because of prolonged half-life and the potential for destruction of IL-15R+ leukocytes. The
IL-15 mutant/IgG proteins markedly attenuated antigen specific DTH responses in Balb-c mice comparing
with the responses in the mice treated with control IgG. Intraperitoneal injection of this mutant protein
enhanced the acceptance of crude islet allograft from DBA/2J (H-2d) to B6AF1 (H-2b/d,k) rendered diabetic
by injection of streptozotocin (15 vs >65 days; control IgG vs IL-15 mutant/IgG treatment, mean
survival time, 8 mice in each group).
These findings suggest that i) IL-15/IL-15R+cells are crucial to these T-cell dependent immune responses,
and ii) treatment with IL-15 mutant/IgG protein may ameliorate T-cell dependent immune/inflammatory
diseases.

6면역억제제가 백서 대동맥 평활근 배양세포의 증식에 미치는 영향 ( I ) - Cyclosporine, Mycophenolic Acid 및 Rapamycin 의 단독 투여 효과 -

저자 : 문장일 ( Jang Il Moon ) , 김유선 ( Yu Seun Kim ) , 김은희 ( Eun Hee Kim ) , 권민수 ( Min Soo Kwon ) , 김순일 ( Soon Il Kim ) , 박기일 ( Kiil Park )

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 183-190 (8 pages)

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Proliferative and obliterative arteriopathy resulting ischemic end organ dysfunction is the main histologic feature of chronic rejection after organ transplantation. This vascular narrowing and intimal hyperplasia produced by chronic rejection is one of the major factor that limits long-term survival after solid organ transplantation. At present, effective prophylactic and therapeutic strategies for chronic rejection is still missing. The proliferation and migration of smooth muscle cells and finally deposition of extracellular matrix account for much of the arterial intimal thickening in organ allografts. In vivo animal models of hyperplastic vascular luminal narrowing induced by allogeneic or mechanical injury to the vasculature indicate that certain immunosuppressive drugs have inhibitory properties on smooth muscle cell  proliferation. This study summarizes the inhibitory effects of different immunosuppressive drugs in vitro on the growth factor-induced proliferation of vascular smooth muscle cells isolated from rat aorta. Rapamycin and mycophenolic acid potently inhibited the proliferation of vascular smooth muscle cells at clinically attainable concentration, individually. Cyclosporine showed limited inhibition of smooth muscle cell proliferation, but the inhibitory concentration50 (IC50) values were just below cytotoxic levels. Therefore these direct antiproliferative action on vascular smooth muscle cells by rapamycin or mycophenolic acid, in vitro, may prevent the development of arterial intimal thickening associated with chronic rejection.

7한림의료원 신장이식의 임상적 분석

저자 : 이삼열 , 이필립 , 조마해 , 김주섭 , 이영철 , 채동원 , 김형직 , 양대열 , 김성용 , 김하영 , 이경화 , 조현찬 , 남은숙 , 김미혜 , 김태수 , 윤대원 , 최창식 (Samuel Lee , Philip Lee , Ma Hae Cho , Joo Seop Kim , Young Cheol Lee , Dong Wan Chae , Hyung Jik Kim , Dae Yul Yang , Sung Yong Kim , Ha Young Kim , Kyung Wha Lee , Hyoun Chan Cho ,

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 191-198 (8 pages)

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Renal transplantation has been adopted as the treatment of choices for most patients with a end stage renal disease. This is the presentation of our experience of renal transplantation at Hallym University Hospital. From March 1984 to July 1998, 207 cases of renal transplantations were performed, 15 cases out
of which were lost during follow-up period and excluded from the study. The mean age of recipients
was 37.1 years. The male to female ratio was 1.5 :1. Eighty nine renal allografts (46.4%) were from living unrelated donors, 59 (30.7%) from living donors and 44 (22.9%) from cadaveric donors. As an  immunosuppression theray, a triple regimen was used in 104 cases (54.2), a double regimen in 86 (44.8%)
and a single regimen in one (0.5%). The overall rejection developed in 87 cases (45.3%). The rejection
rate was 59.3% in renal allografts from living related donors, 37.1% from living unrelated donors and
43.2% from cadavaric donors. The OKT3 and the antilymphocyte globulin (ALG) were used for steroid
resistent rejection in 8 and 2 cases, respectively. Post-transplant diabetes mellitus were noticed in 22
cases (11.5). The most common complication was infection (28.1%), and 11 recipeints (5.7%) died during
follw-up period. Infection was the leading cause of mortality. The overall graft survival was 92.2% at
1 year span and 83.1% at 3 year span. The overall patient survival was 95.6% at 1 year span and 92.5%
at 3 year span.

8신이식 250 예의 수술적 합병증 :임상경과 및 예후

저자 : 박귀호 ( Kwi Ho Park ) , 정준헌 ( Joon Heon Jeong ) , 공진민 ( Jin Min Kong )

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 199-207 (9 pages)

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The surgical technique of renal transplantation has been well established, but surgical complications are not uncommon and still be important factors in postoperative mortality and morbidity. From August 1990 to May 1998, we performed 250 consecutive renal transplantations at Maryknoll hospital. The authors analyzed the kinds and incidences of surgical complications in a single center by using information from hospital records. The results were as follows: 1. The overall surgical complication rate was 9.6% (24 episodes in 250 cases). 2. These were composed of 6 vascular, 8 urologic, 4 lymphatic, and 6 wound complications. 3. Vascular complication included renal artery stenosis in 1 case and bleeding and hematoma in 5 cases. 4. Urologic complication included urine leakage in 4 cases, ureter stenosis in 2 cases and bladder stone in 2 cases. 5. Lymphatic complication was all lymphoceles. 6. One case in which renal artery stenosis had occured progressed to graft loss after 4 years later. There was no complication related mortality. 7. 1 year, 3 year and 5 year graft survival rate was 97.2%, 94.8% and 90.0%, respectively. and patient survival rate was 98.0%, 95.6% and 94.7%, respectively.

9생체신이식 118 예에 대한 임상적 경험

저자 : 김찬영 ( Chan Young Kim ) , 유희철 ( Hee Chul Yu ) , 조백환 ( Baik Hwan Cho ) , 김재천 ( Jae Chun Kim ) , 강남부 ( Nam Poo Kang )

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 209-219 (11 pages)

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From Feburary 1989 to December 1997, 118 cases of primary livindonor renal transplantations were
performed in Chonbuk National University Hospital. We analyzed the outcome of grafts and the potential risk factors that could influence the graft survival. The results were as follows. Male versus female ratio
of recipients and donors were 3.2 :1 and 1.1 :1, and the mean age of them were 33.4 years and 44.8
years, respectively. Overall graft and patient survival rates were 95.7%, 97.4% at 1 year, 90.8%, 93.5%
at 3 year, and 87.7%, 93.5% at 5 year, respectively. In all, 16 cases (13.6%) were lost during the obser-vation
period, with the most common causes of graft loss being chronic renal failure (10 cases, 63%), death with a functioning graft (3 cases, 19%), acute renal failure, anastomotic infection, and spontaneous renal rupture in each other one case. The deaths of patients occured in 9 cases (7.6%). The most common
causes were pneumonia (5 cases, 56%), and the others were sepsis, breast cancer, retroperitoneal hema-toma, and multiple organ failure in each other one case, respectively. The analyzed variables that could affect the graft survival were HLA typing, relative relationship, ABO typing, pretransplant blood trans-fusion, prevalence of CRF, acute rejection, and frequency of rejection episodes, but the results were
not statistically significant. According to the relative relationship, acute rejection rate was 28.4% (25
of 88 cases) in relative, and 59.3% (16 of 27 cases) in non-relative. And so relative relationship influ-enced
the acute rejection rates (p=0.003).

10신이식에서 급성거부반응의 발생양상이 이식신에 미치는 영향

저자 : 오정택 ( Jung Taeck Oh ) , 이경근 ( Kyung Keun Lee ) , 채권묵 ( Kwon Mook Chae ) , 소병준 ( Byung Jun So )

발행기관 : 대한이식학회 간행물 : 대한이식학회지 12권 2호 발행 연도 : 1998 페이지 : pp. 221-227 (7 pages)

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The major reason for the chronic graft loss is chronic rejection. The only predictive factor for chronic rejection is a prior acute rejection episode resulting in a poorer long-term outcome. Also the number of acute rejection episodes is a strong predictor of long-term allograft failure. This study evaluated the impact of a first acute rejection episode and the severity of the rejection and the number of acute rejection episodes on allograft survival. Total of 136 renal transplant were performed between August 1987 to January 1996 at Wonkwang university hospital, and we studied 108 renal transplants that were followed for a minimum of 1.5 years. Acute allograft rejection was mainly diagnosed by clinical evaluation and laboratory data. Transplant patients were divided into three groups according to the time to the first acute rejection; no rejection (group I, n=44); acute rejection during the first 6 months (group II, n=42), acute rejection after 6 months (group III, n=22) and divided into four groups according to the number of acute rejection episodes; no rejection (Group A, n=44), one time (Group B, n=24), two times (Group C, n=23), and more than three times (Group D, n=17). Five-year allograft survival rate for group I-III was 96.4%, 82.7%, 58.5%, respectively (p <0.05 for each comparison to group I). Later acute rejection episodes were associated with worse response to rejection therapy and Group III had higher serum creatinine concentration after rejection therapy than Group II (2.46 1.13 mg/dl vs 1.19 0.7 mg/dl, p <0.05). Five-year allograft survival rate for group A-D was 93.4%, 73.2%, 57.4%, 74.5%, respectively, Group A shows higher graft survival rate, but there was not significant difference in long-term allograft survival among Group B-D. We conclude that late occurrence of a first acute rejection portends a worse prognosis for long-term allograft survival and decreases response to rejection therapy and results in poor graft function. Prevention of later rejection may require a broader focus, with additional efforts directed at improving patient com-pliance and renal allograft monitoring.

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