Joon Seok Oh

Treatment of acute antibody-mediated rejection using bortezomib: a case report.

Here we report the successful treatment of acute antibody‐mediated rejection (AMR) with bortezomib. Bortezomib rescue treatment was administered after a 42‐year‐old woman failed to respond to steroid pulse and plasmapheresis with intravenous immunoglobulin (IVIG). The patient underwent a second renal transplantation with a deceased donor kidney. She was treated pre‐operatively with rituximab (200 mg/body) and underwent plasmapheresis twice (day‐1 and operation day) because ELISA screening revealed that her pre‐operative peak panel reactive antibody (PRA) composition was 100% class I and 100% class II and 15 times of cross‐match positive history during the waiting period for transplantation. The patients received induction therapy with Simulect (an IL‐2‐blocking agent). A 1‐hour protocol biopsy revealed C4d‐positivity and mild peritubular capillary inflammation. This was suggestive of early AMR‐associated changes. After transplantation, the patient underwent plasmaphereses (nine times) with low‐dose IVIG (2 mg/kg). Despite this treatment regimen, serum creatinine levels increased to 3.4 mg/dL on post‐transplant day 15. A second graft biopsy was performed, which showed overt AMR with glomerulitis, peritubular capillary inflammation and no C4d deposition. On post‐operative day (POD) 22, treatment with four doses of bortezomib (1.3 mg/m2) was initiated with the patients consent. On POD 55, renal function had recovered and serum creatinine was 1.5 mg/dL. In summary, bortezomib was administered as a rescue treatment for a patient who developed AMR that was refractory to a combination of plasmaphereses with low‐dose IVIG and preemptive administration of rituximab.

Graft rupture after high‐dose intravenous immunoglobulin therapy in a renal transplant patient

Cases of life‐threatening thromboses in pulmonary, coronary, cerebral and peripheral vessels are associated with high‐dose intravenous immunoglobulin (IVIg) therapy that is generally considered safe. We experienced a patient with a renal graft rupture that developed after high‐dose IVIg was administered for desensitization. A needle biopsy performed 4 days prior to the rupture revealed the presence of glomerular thrombosis and mesangiolysis. The ruptured nephrectomy specimen contained renal infarction around the haemorrhagic segment and arterial wall thickening with intimal fibrosis. This might have contributed to rupturing associated with small arterial and glomerular arteriolar thrombi. This is the first case of a graft rupture as a complication of high‐dose IVIg we have encountered.

Placement of tunneled cuffed catheter for hemodialysis: Micropuncture kit versus Angiocath IV catheter:

Introduction: Tunneled cuffed catheters provide stable, instantaneous, long-term intravenous access for hemodialysis. Because catheterization is often performed in emergency situations, speed and accuracy are emphasized. Methods: We retrospectively compared the Micropuncture kit with the standard 18-gauge Angiocath IV catheter for tunneled cuffed catheter insertion in the right jugular vein. From June 2016 to May 2017, 31 tunneled cuffed catheters were successfully inserted via the Micropuncture kit and another 31 via the Angiocath IV catheter. All patients underwent the same ultrasound-guided procedure performed by a single experienced interventionalist. Procedure time was the time from draping of the patient to the completion of povidone dressing after the catheterization. In our center, the Angio Lab nurse maintains records, including procedure time and method for every procedure. All patient records were retrospectively tracked through electronic medical record review. The primary outcome was procedure time and the secondary outcomes were complications and cost-effectiveness. Results: There were no significant differences in the patients’ demographic data between the two groups. However, procedure time was significantly shorter in the Angiocath group than in the Micropuncture group (12.4 ± 3.5 vs 17.6 ± 6.9 min, p = 0.001); there were no serious complications, such as hemorrhage, pneumothorax, or hematoma, in both groups. Moreover, cost-effectiveness was better in the Angiocath group than in the Micropuncture group (0.34 vs 52 US

Reliability of Hemodialysis Adequacy Measured by Ionic Dialysance

, p < 0.01). Conclusions: Using the Angiocath IV catheter can reduce procedure time and cost with no severe complications. Moreover, experienced practitioners can reduce the risk of complications when using Angiocath. There are several limitations to this study. First, it was retrospective; second, it was not randomized; and finally, it was conducted by only one experienced interventionalist.