Kyung Ock Jeon

Pretransplant soluble CD30 level has limited effect on acute rejection, but affects graft function in living donor kidney transplantation.

Background. Serum soluble CD30 (sCD30) levels might be a useful marker of immunologic status in pre transplant (Tx) recipients. We retrospectively correlated preTx sCD30 levels (high versus low) on postTx graft survival, incidence of acute rejection, and graft function using stored preTx serum. Methods. Of 254 recipients who underwent kidney Tx, 120 recipients were enrolled under the uniform criteria (living donor, age >25 years, viral hepatitis free, diabetes free). Results. The preTx sCD30 was not significantly associated with differences in graft survival rate during 47.5±11.4 months of follow-up (P=0.5901). High sCD30 (≥115 U/ml) was associated with a higher incidence of clinically or pathologically defined acute rejection than low sCD30, but the difference was not statistically significant (33.9% vs. 22.4%, P=0.164). The response rate to antirejection therapy in patients with high sCD30 was inferior to those with low sCD30, but also was not statistically significant (33.3% vs. 7.7%, P=0.087). However, mean serum creatinine levels in high sCD30 patients at one month, one year, and three years postTx were significantly different from those with low sCD30 (P<0.05). In multiple regression analysis, acute rejection episodes, donor age, kidney weight/recipient body weight ratio, and preTx sCD30 levels were independent variables affecting the serum creatinine level three years postTx. Conclusion. PreTx sCD30 level has a limited effect on the incidence of acute rejection and response to antirejection treatment, but inversely and independently affects serum creatinine level after living donor kidney transplantation.

Gender-related differences of renal mass supply and metabolic demand after living donor kidney transplantation

Abstract: Kidney donation from female donors to male recipients has been reported to be associated with decreased allograft survival. Whether there was a gender‐related inadequacy between donor nephron supply and recipient functional demand was investigated in this study. One hundred ninety‐five living donor kidney transplant recipients that had neither ischemic injury, episode of rejection, nor any complication were included. Weights and heights of both donors and recipients were recorded to calculate body surface area, lean body weight, and body mass index. The donated kidney was weighed just after cold flush, and the recipients serum creatinine (Scr) was measured on a daily basis post‐operatively. When the recipients Scr reached the baseline, a 24‐h urine was collected for the amount of proteinuria (Upr), creatinine excretion (Ucr) and creatinine clearance (Ccr) calculation. The effect of donor and recipient gender was analysed by independent sample t‐test. On average, male donors and recipients were heavier and taller than females. However, the mass of kidneys donated from men and women were not statistically different. The gender‐related differences in post‐transplant Scr and Ucr of recipients were associated with the differences in the parameters of metabolic demands of recipients rather than with the weight of implanted kidney (renal mass supply) or with pre‐operative renal functions of donors (functional supply). The early graft function is not determined by donor gender. The effect of recipient gender on the graft function depends on the metabolic demands, which are higher in male recipients.

Chronologically different incidences of post‐transplant malignancies in renal transplant recipients: single center experience

The incidence of malignancy in transplant recipients is known to be higher than the same in the general population. However, the types of malignancies vary geographically, and the relative risks (RR) for malignancy in transplant recipients, compared with that of the general population, also differ country‐by‐country. In this study, we investigated the incidence and characteristics of malignancies after renal transplantation in a single center. A total of 2630 renal recipients who underwent surgery between April 1979 and June 2007 were enrolled in this study. The cumulative and interval incidences of malignancies were calculated for every 3 years post‐transplantation. One‐hundred ninety cases of postrenal transplant malignancies among 177 recipients (6.73%) were reported until 2007. The post‐transplant malignancies were detected from 6 to 290 months after transplantation, with a mean duration of 112.6 ± 66.0 months. Skin cancer [35 (18.4%)] was the most common post‐transplant malignancy, followed by thyroid [25 (13.2%)], stomach [22 (11.6%)], colorectal [22 (11.6%)], and urologic cancers [19 (10.0%)]. As the post‐transplant period increased, the interval incidence of malignancy correspondingly increased. Virus‐related malignancies, such as Kaposi’s sarcoma and cervical cancer, developed earlier within the post‐transplant period, while urologic cancer, colorectal cancer developed late in the post‐transplant period. The recipient’s age at the time of transplantation was the sole independent risk factor for post‐transplant malignancy based on the multivariate analysis (RR = 2.723, P < 0.0001 in the >50‐year‐old age group). We should establish strategies for post‐transplant malignancy‐screening based on the recipient’s age at the time of transplantation, the post‐transplant interval, and the national trend of post‐transplant malignancy.

Metabolic Demand and Renal Mass Supply Affecting the Early Graft Function After Living Donor Kidney Transplantation

BACKGROUND Graft mass has been demonstrated to be a determinant of outcome after kidney transplantation. An insufficient nephron might fail to meet the metabolic demands of the recipient and lead to hyperfiltration. METHODS The study population was restricted to live donor transplants demonstrating immediate function that had neither ischemic injury, episodes of rejection, nor any complications that resulted in a functional decrease of the graft. The donated kidney was weighed just after cold flush, and the recipients serum creatinine (Scr) was measured on a daily basis postoperatively. When the recipients Scr reached the baseline, the recipients 24-hour urine was collected for the amount of proteinuria (Upr), creatinine excretion (Ucr), and creatinine clearance (Ccr) calculation. As the parameters of the metabolic demands of donor and recipient, body weight, height, body surface area, lean body weight, and body mass index were noted. Pearson correlation and linear regression were carried out. RESULTS The graft function, as measured by Scr, Ucr, and Upr, was not directly correlated with the graft weight but rather correlated with the ratios of graft weight to the parameters of recipients metabolic demands. As recipient size increased, the metabolic demand has increased. The parameters of recipients metabolic demands were directly correlated with Scr and Ucr, rather than with Upr. CONCLUSION During living donor and recipient matching, both the potential sizes of the donated kidney and the recipient should be considered in terms of the early graft function after transplantation.