S. I. Kim

The antihypertensive effect of ethyl acetate extract of radish leaves in spontaneously hypertensive rats.

Radish (Raphanus sativus L.) is a cruciferous vegetable, and its leaves have antioxidant and anticancer properties. This study was conducted to evaluate the effects of ethyl acetate extracts from radish leaves on hypertension in 11-week-old spontaneously hypertensive rats (SHRs). The SHRs were randomly divided into 3 groups of 6 rats each on the basis of initial systolic blood pressure (SBP) and were treated with oral administration of radish leaf extract (0, 30, or 90 mg/kg body weight [bw], respectively) for 5 weeks. Six Wistar rats were used as normotensive controls. The amount of the radish leaf extract had no effect on body weight. The SBP of the SHRs showed a decreasing trend with the consumption of the radish leaf extract. In the third week, the SBP of the group fed 90 mg extract/kg bw reduced from 214 mmHg to 166 mmHg and was significantly lower than that of the normotensive and hypertensive controls. The extract did not show a significant effect on the angiotensin-converting enzyme (ACE) activity in the serum, kidney, and lung. The extract increased the concentration of NO in serum and the activities of antioxidant enzymes such as glutathione peroxidase and catalase in red blood cells (RBCs). The serum concentrations of Na+ and K+ were not significantly different between all groups. However, the fecal concentrations of Na+ and K+ increased; the fecal concentrations of Na+ and K+ for the normotensive and hypertensive controls were not different. Urinary excretion of Na+ was higher in the normotensive Wistar rats than in the SHRs, while that of K+ was not significantly different. These findings indicate that consumption of radish leaves might have had antihypertensive effects in SHRs by increasing the serum concentration of NO and fecal concentration of Na+ and enhancing antioxidant activities.

Effects of Takju intake and moderate exercise training on brain acetylcholinesterase activity and learning ability in rats

Takju is a Korean alcoholic beverage made from rice, and is brewed with the yeast Saccharomyces cerevisiae. This study was conducted to evaluate the effects of exercise training and moderate Takju consumption on learning ability in 6-week old Sprague-Dawley male rats. The rats were treated with exercise and alcohol for 4 weeks in six separate groups as follows: non-exercised control (CC), exercised control (EC), non-exercised consuming ethanol (CA), exercised consuming ethanol (EA), non-exercised consuming Takju (CT), and exercised consuming Takju (ET). An AIN-93M diet was provided ad libitum. Exercise training was performed at a speed of 10 m/min for 15 minutes per day. Ethanol and Takju were administered daily for 6-7 hours to achieve an intake of about 10 ml after 12 hours of deprivation, and, thereafter, the animals were allowed free access to deionized water. A Y-shaped water maze was used from the third week to understand the effects of exercise and alcohol consumption on learning and memory. After sacrifice, brain acetylcholinesterase (AChE) activity was analyzed. Total caloric intake and body weight changes during the experiment were not significantly different among the groups. AChE activity was not significantly different among the groups. The number of errors for position reversal training in the maze was significantly smaller in the EA group than that in the CA and ET groups, and latency times were shorter in the EA group than those in the CC, EC, CT, and ET groups. The latency difference from the first to the fifth day was shortest in the ET group. The exercised groups showed more errors and latency than those of the non-exercised groups on the first day, but the data became equivalent from the second day. The results indicate that moderate exercise can increase memory and learning and that the combination of exercise and Takju ingestion may enhance learning ability.

Analysis of Reasons for Rejection and Discontinuance of Tissue Donation in Korea

Background Korea Organ Donation Agency (KODA) newly launched for organ and tissue donation program from April 1, 2017. However, unlike organ donation, tissue donation is still on the starting line because of unpleasant result after donation. We attempt to investigate the causes of reject in tissue donation and find out any improving points of activation in tissue donation. Method Total 1,201 brain death and cardiac death donors for potential tissue donation were reported to KODA call center between April 1 and September 30, 2017. Potential brain death patient are mandatory reported to KODA and cardiac death patients whose family want to donate his(her) body for tissue donation are also reported to KODA. When KODA received call, we sent coordinator to evaluate the reported patient eligible for tissue donation or not. If family of deceased patient consent tissue donation, we evaluate medical status and decide the suitability of tissue donation. Medical supervisor of tissue bank decide the first medical availability and if the result is eligible, tissue retrieval is performed in tissue bank. We have second medical evaluation including tissue culture and blood culture and final decision of tissue donation is decided. Result Among the 1,201 potential donors, 829 patients(69%) were eligible for tissue donation and among them, 364 patients(44%) were possible to interview for donation. In the 364 interviewed cases, 253(70%) were rejected to donate tissue and only 111(30%) were agree to donate. The cause of rejection were damaged body of their loved family (102 patients. 40.3%), rejected by their guardian without specific cause (74 patients, 29.2%), 38 cases (15%) were rejected because of transporting deceased patient to tissue bank and 37 cases (14.6%) were agreed only organ donation. Among 111 patients agreed on tissue donation, 55 were excluded because of withdrawal of consent (11 case, 20%), suspicious infection in 24 cases(9 for newly developed systemic infection, 8 for herpes simplex, 5 for pneumonia, 2 positive bacterial culture), plasma dilution in 3 cases, improved general condition in 4 cases and pressure ulcer, non-compliance with medical records or autopsy. Conclusion Most of the early rejected cases whom we tried to contact with can be converted to donation if we do enough campaign and education to change their attitude. Realization of shortage of tissue and its socioeconomic result will also support to change people’s mind to positive.

What We Learned from Changing Patterns of Deceased Organ Donors

Introduction There was continuous increment of organ donor since after legislation of transplantation law in year 2000 in Korea, and we have 573 deceased donor in 2016 last year, but still the number of donors were far behind of waiting list. Many patients waiting for kidney and liver were received organs from living related donor but we have more concern about donor safety. Methods In order to learn the trend of organ donation in Korea, and to establish future plan for organ donation activation from these results, we reviewed donor characteristics from the data registry of KONOS from 2008 through 2015. Results Male donor is predominant (68.4% vs 31.6%) and donor age is shifted from 35‐45 to 50‐60 years old. Old age donor more than 75 years old occupy 2.2% in 2015. Among ABO blood group, type A donor were most frequent and least in AB type. About cause of brain death, cerebrovascular disease, head trauma and anoxia, CNS tumors were in their order but interestingly, we have more anoxia recent years because of increasing the suicide. Average organ procurement per donor was 3.23 in 2008 but nearly the same in 2015(3.25). Most common organs procured were kidney (more than 55%). In case of renal transplantation, 10 year living donor graft survival was 91.1% and 85.7% in deceased donor. Conclusion Even though we have increasing organ donors every year, we are still experiencing organ shortage to cover the waiting list. Changing pattern of causes of deceased donor and increasing number of aged donor suggest us to prepare future donor activation plan.

THE EFFECT OF CHANGE OR MODULATION OF MAINTAIN IMMUNOSUPPRESSIVE REGIMEN ON LONG-TERM TRANSPLANT RESULT: 2263

Introduction: Type of maintenance immunosuppressive regimen (ISR) is a major prognostic factor that determines graft survival. Therefore, a change or modulation of the ISR may be a potential determinant that affect the transplant results. This study evaluates the effects of change or modulation of ISR on long-term transplant results. Methods: A total of 1,164 patients that underwent kidney transplantation from January, 1997 to December, 2008 in Yonsei University Health System were enrolled in this study. The change mode of immunosuppressant, the reason for change, and the transplant results were retrospectively collected. Results: Among 1,164 kidney transplant recipients, 201 recipients (17.3%) were started under the double regimen (DR) (calcineurin inhibitor (CNI) and steroid) and 963 recipients (82.7%) were under triple regimen (TR) (CNI+steroid+antimetabolite). Seventy-seven recipient (38.3%) with DR and 271 recipients (28.1%) with TR were changed ISR during post-transplant period. Among the recipient with DR, the most frequent reason for regimen change was acute rejection in early post-transplant period and chronic allograft dysfunction in late period. Conversion to TR (69/201, 34.3%) was predominant change mode of recipient with initial DR. Unlike recipient with DR, major causes of regimen change in recipients with TR were complications related with over-immunosuppression and drug toxicity regardless of posttransplant period. Conversion to DR and change of antimetabolite were performed in 127 recipients (127/ 963, 12.6%) and 98 recipient (98/963, 10.2%) respectively. The change group of initial DR showed statistically superior graft survival rate (GSR) (p=0.032) compared with maintain group of initial DR. On the other hand, the change group of initial TR showed inferior GSR (p<0.001). [Figure] Conclusion: The cause and mode of regimen change was clearly different by type of initial regimen. And effect of regimen change on transplant result was also different. The type of regimen after post-transplant change or modulation affects the long-term transplant result. The triple maintain regimen with antimetabolite showed a superior GSR.

CLINICAL CHARACTERISTICS OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS RECURRENCE IN ADULT RENAL TRANSPLANTATION: 2963

Introduction: Recurrence of focal segmental glomeulosclerosis (FSGS) after kidney transplantation is a frequent and still unpredictable complication, However, risk factors for recurrence have not yet been clearly indentified. Methods: We enrolled 2,882 adult kidney recipients who underwent transplantation from April 1979 to April 2009. And we retrospectively reviewed clinical manifestations of recurrence of FSGS. Results: Among forty four patient who underwent renal transplantation for primary FSGS from 2,882 adult renal recipients, 12 cases (27.3%) of recurrent FSGS were detected. Mean duration between transplantation and FSGS recurrence was 22.8 ± 37.4 months. There were no significant differences of patient’s characteristics in recurrence group and non-recurrence group. The cumulative incidence of FSGS recurrence was 13.8% within 1 year after kidney transplantation and 23.2% in 3 years. Overall graft survival of the recurrence group was significantly lower than that of non-recurrence group (P=0.0018) and non-FSGS group (P=0.0001; Fig. 1). Graft failure happened more in recurrence group (75%) than non-recurrence group (37.5%, P=0.042). Recurrence group showed tendency of older donor but there was no statistic significance (Nonrecurrence group: 33.5±11.6, Recurrence group: 40.3±10.4, P=0.067). Conclusions: Donor age and FSGS duration is a reliable risk factor for recurrence in adult recipients. We suggest that early detection of FSGS and early transplantation be helpful for the adult FSGS patients.

IMPACT OF GRAFT TYPE ON THE REGENERATION PATTERN OF REMNANT LIVER: RIGHT HEPATECTOMY VERSUS EXTENDED RIGHT HEPATECTOMY: 2294

Introduction: After right hepatectomy with the middle hepatic vein (MHV) trunk, venous outflow of segment IV is disturbed. The aim of this study is to compare the remnant liver volume change after donor hepatectomy by graft type. Method: Living donors who underwent right hepatectomy without MHV (Right hepatectomy; RH, n = 36) and those with MHV (Extended right hepatectomy; ERH, n = 19) were reviewed. When remnant left liver was estimated to be more than 30% was considered. Remained liver volume by segment was measured using computed tomography based volumetry program (Voxel Plus® 2.0; Medisys co., Seoul, Korea) at the 1st and 4th week after donor hepatectomy. Degree of regeneration of remained liver was expressed as a liver remnant volume increase rate [(LV at 1st or 4th post-operative weekLV at initial)/ LV at initial x 100%]. Results: Mean residual volume and residual volume ratio were not significantly different between two groups (462 ml vs. 433 ml, P = 0.203 and 35.8% vs. 35.0%, P = 0.474). Four of 19 (20.1%) ERH group patients showed venous congestion in segment 4 on CT at 1st post-operative week. However, no one showed congestion at 4th post-operative week. The regeneration rate of segment IV was significantly low in ERH group compared with that in RH group at the 1st and 4th postoperative week (160% vs. 141%, P = 0.018 and 189% vs. 154%. P = 0.007). In contrast, the regeneration rate of total remnant liver volume was not significantly different between two groups (173% vs. 175%, P = 0.758 and 199% vs. 198%, P = 0.880). Conclusion: When deprived of the middle hepatic vein, liver regeneration of segment IV was impaired but was compensated for by the regeneration of other segment. Therefore, total remnant liver regeneration was not impaired in extended right hepatectomy group. However, for the donor safety, careful preoperative consideration should be given on a case-by-case basis to the extent of right liver harvesting.